It is important to ascertain what the patient knows about the situation.  First, find out who is in the room with the patient or if they want someone else to be present.  Explore the patient’s understanding of the situation.  This will give you some insight into how the patient may react and give you a starting point to begin your explanation and offer of support later.  Bad news means different things to different people. Learning of a death or a terminal illness may be difficult, but it also may be the diagnosis of a long term condition (hypertension, diabetes) or for some, the need for surgery.  We can’t anticipate how our patients will react, but if we spend the time to get some understanding of what they already know, it will help us to respond better to their needs.