A patient with terminal cancer says death may come soon. Which response is most appropriate?

• A. What are your feelings about being so sick and thinking you may die soon?
• B. None of us knows when we are going to die. Is this a particularly difficult day?
• C. Would you like for me to call your spiritual advisor so you can talk about your feelings?
• D. Perhaps you are depressed about your illness; I will speak to the doctor about getting some medications for you.

Answer: (A)

In palliative care conversations, inviting the patient to express their emotions directly is key. Asking, “What are your feelings about being so sick and thinking you may die soon?” opens a safe space for the patient to share fears, sadness, anger, or spiritual concerns, validating that their emotional experience is real and important. This approach communicates presence, avoids rushing to reassurance or solutions, and helps you assess distress and needs without imposing judgments or diagnoses.

Other responses shift the focus away from the patient’s current experience. Suggesting that death timing is uncertain can feel detached or minimizing, and it doesn’t invite the patient to reveal what they’re feeling right now. Involving a spiritual advisor may be valuable later, but should be patient-led and done with consent after you’ve explored the patient’s immediate emotional needs. Jumping to medication for possible depression presumes a diagnosis and solutions before a proper psychosocial assessment, which can overlook the patient’s current emotional state and autonomy.