How to Have a Difficult Conversation About Brain Illnesses

When you and your family enter the world of brain illness, whether you are dealing with a brain tumor or a diagnosis of dementia, you will have a lot to talk about. Unfortunately, much of the information you are receiving might fall into the category of "bad news" - anything that significantly alters your view of your life and plans in a negative way, whether that's learning of a diagnosis of Alzheimer's disease or finding out that a malignant brain tumor is not going away after months of treatment.

Talking about bad news can be difficult, whether you are delivering the news or simply trying to cope with it.


Here are some tips for those difficult conversations:


A person receiving a terminal diagnosis might not want to know all the details. Whether you are the physician or a family member, try to find out how much information the person wants. Likewise, if you are the person receiving the diagnosis, know that it is OK to set limits about how much detail you want at any given time. You can always ask more questions later.

It also helps to know a bit about a person's support network and religious or spiritual beliefs so you can help them identify resources to draw on for assistance.

Finally, know the facts you will be discussing - or at least, prepare a list of questions to ask.

How and When to Talk about Your Illness

Choose the Right Place and Time

Find a place and time where you will be uninterrupted. Try to choose a private and comfortable location, such as an office or bedroom where you can close the door as needed.


Turn off your cell phone, Blackberry, land line and the television. When discussing difficult topics such as a terminal diagnosis or a diagnosis of Alzheimer's or dementia, it is important to be fully focused on the conversation.

Choose a time when you and the person or people you need to speak with are more or less relaxed and not focused on another activity, such as preparing dinner or picking up kids from school.

Be Honest and Realistic

Most people who are receiving bad news, especially a medical diagnosis related to their brain health, already have some idea that there is a problem. They might even intuit that the problem is serious. Bearing in mind the constraints set by how much detail they want to know, be as honest as possible about the topic at hand and the likely outcome.

However, miracles do happen, and people who have some optimism and hope - however unlikely - have a higher quality of life and are more motivated to do what they need to do. Always allow room for hope.

Show Empathy

A gentle touch, the offer of a tissue to wipe away tears, even a moment alone while people absorb what you have talked about are all ways to let the people in the conversation know you understand their feelings about these difficult matters.

Expect some anger at times, and try not to react. Anger is a normal reaction to bad news.

Things You Should NOT Say or Do:

  1. Don't use the phrase "I know how you feel"
  2. Don't use euphemisms for the diagnosis or the prognosis
  3. Don't fill silence with more words
  4. Don't ignore cultural or language barriers

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American College of Physicians


Written by Madeline Roberts Vann, MPH

Reviewed by George T. Grossberg, MD

St. Louis University School of Medicine

Department of Psychiatry