Informing about diagnosis, relapse and progression of disease--communication with the terminally III cancer patient.

This chapter focuses on four crucial situations representing important challenges for physician-patient communication: diagnosis, relapse, progression of disease and terminal illness. The psychological aspects of each situation are discussed and a framework for communication is provided. The aim of the chapter is to invite the oncology clinician to think about these different stages of disease and to support him or her in the communication with the patient. Communication with cancer patients is a difficult task in clinical practice and it is especially challenging when informing about diagnosis and prognosis, when relapse occurs or when the disease is progressing. Physician-patient communication has undergone considerable changes and has become-compared to decades before, when medicine was based on a more paternalistic model of care--a central duty and challenge of the oncology clinician. The following chapter aims to discuss key elements of communication in the above-mentioned specific situations; it is based on our clinical experience as psycho-oncologists and teachers of communication skills training (Razavi and Stiefel 1994; Stiefel and Razavi 1994; Razavi et al. 2003; Berney and Stiefel 2004; Delvaux et al. 2005; Voelter et al. 2005; Bragard et al. 2006).