As a staff nurse in the medical unit, I often care for patients who have cancer histories, become symptomatic with suspected metastases, and are admitted for workup. How should I approach a patient who's just learned her cancer has spread?-C.W., WASH.

If possible, be present when her health care provider gives the bad news. After she hears the word "spread," she may not hear much else. Afterward, you can help clarify the information and answer questions.

If you can't be present, follow up with her as soon as possible. Ask a coworker to cover for you so you can give her your full attention for at least 15 minutes.

Be gently honest-she knows you know. Pull up a chair and say, "I understand you just received some bad news. Do you feel like talking?"

If she says, "No, I think I prefer to be alone," respect her request but reiterate your availability if she changes her mind.

If she chooses to speak about the news, be still and listen without interrupting. She may have questions that she was too upset to think of when she got the news. Don't be afraid to say, "I don't know" if you don't. Then say, "But if it's important to you, I'll find out."

I met Mrs. Wilson for the first time after she learned that her colon cancer had spread to her liver and lung. Her physician had just talked with her about her prognosis, which was poor. I found her lying quietly on her side, staring at the wall. I knocked on the door, told her my name, and said that I worked exclusively with patients who are seriously ill.

"That's me, I guess," she said, sadly.

"Dr. Reston wanted me to visit in case you needed to talk about the cancer," I said, sitting down beside her bed.

"Yeah, what the heck. Sounds like it's about over for me now."

"What do you want to do?"

"I just want to go home."

"Do you know about hospice care?"

"Yeah, we had it in for my mother-in-law. That'd be okay, you know, to have help for my husband."

We sat quietly.

She began, "I guess you know how sick I am. Cancer all over the place. I'm done fighting. I just want to go home."

I explained that the social worker would be helping her with things she'd need at home, such as a hospital bed.

"She'll also set up a time for the hospice people to meet you at home. Do you have any concerns we need to address?"

"Nah, thanks," she said. Then she added, "I appreciate you kindness."