A patient in our oncology unit, who's been admitted three times in the last several months, has metastatic cancer with many hard-to-manage signs and symptoms. Her family supports her and wants her to return home, but she insists on going to rehab. She said the cancer will "go away" if she gets stronger. How can I respond compassionately, but realistically?-M.W., N.J.

I appreciate your caring kindness. Patients can sometimes lure their families and even nurses into their fragile world of false hope. Determined not to be cruel, some nurses find it easier to say something encouraging like, "My uncle had cancer, and rehab helped him get back to driving again."

Your patient's disease is causing serious problems that require hospitalization, a fact that provides a good springboard for discussion. You might gently say, "Yes, any strength you can regain will help you cope with your breathing problems. But it won't change the cancer."

Wait silently. Stay fully present. Take your cue from her response. She might say, "I know, dear, nothing's going to stop the spread. I just want to be able to do more for myself so it takes some of the load off my family."

Of course, she might say instead, "Well, you just wait and see. After rehab, I won't need to be coming back here."

"Mrs. Ford, I would love that for you." Then simply acknowledge her bravery and tell her how blessed her loved ones are to have her, for however long that might be.