Breaking the news in amyotrophic lateral sclerosis

Telling the diagnosis to patients with amyotrophic lateral sclerosis (ALS) is a daunting task for any neurologist. Obviously, breaking the news in ALS is not a standardizable procedure. However, proven techniques exist to red uce the trauma to the patient and ease the burden on the doctor, thus reduc ing the risk of burnout and the tendency to 'pull away' from the patient. S uch communication skills are of fundamental importance to clinical practice and should be more prominent in medical teaching. The way the patient is t old the diagnosis is now recognized to be the first and one of the most del icate steps in palliative care. Information is best offered in a stepwise f ashion at the patient's pace with an emphasis on positive aspects, and in t he presence of the patient's family. Reviewing available therapeutic option s and current research efforts may foster hope for the future, while pointi ng out that almost all symptoms of ALS can be alleviated by palliative ther apy may help to reduce fears. Encouraging patients to ask questions and dis close anxieties is important for their psychological wellbeing. Available o ptions for mechanical ventilation should be reviewed early enough to allow for unhurried decision-making. We believe that the terminal phase of the di sease should be discussed at the latest when dyspneic symptoms appear, in o rder to prevent unwarranted fears of 'choking to death'. (C) 1998 Elsevier Science B.V. All rights reserved.