By KRISTA CONGER

What's the best way to deliver bad medical news to adolescents and their parents? For openers, don't shirk the truth but allow room for the power of hope. Don't underestimate the capacity of adolescents to grasp complex medical information and to assess their options. Finally, cultivate empathy and compassion for the patient and family as a way to support them and reduce the risk of your own burnout.

These are some of the answers offered by Edwin Forman, MD, in the ninth annual Rudene Marie Di Carlo Lectureship during a recent pediatric grand rounds talk.

"Thinking through tears is a very important ability of caretakers," said Forman, professor of pediatrics at Brown University Medical School and associate physician-in-chief and director of pediatric hematology/oncology at the Hasbro Children's Hospital in Providence, RI. "Empathy can prevent burnout caused by the psychological energy used in trying to believe that there are those to whom bad things happen. And then there's us -- who try to help but don't experience bad things," said Forman, who received the 2003 Rhode Island Hospital Outstanding Physician of the Year Award. "I gain support from the families that I treat, which is why I am still in this field."

Through it all, Forman emphasized the importance of maintaining honesty while cultivating hope. "We must balance that hope with our knowledge of the course of the disease," said Forman. "The loss of hope can be survivable if diversified, that is, it may be possible to replace one hope with another. Rather than focusing only on one marker of success -- whether or not the patient survives -- another goal can be maintaining dignity while alive. The most important thing is that we use all our powers to achieve the best end for the patient."

Rudene Di Carlo, MD, would likely have agreed. Di Carlo was a pediatric resident at Lucile Packard Children's Hospital from 1991 until her death from chronic myelogenous leukemia in 1995. She recorded a video a few weeks before her death describing the lessons she learned as a patient. They included simple ways for physicians to connect with patients by touching them and spending time with them. Reliability when making promises and involving the patient in the decision-making process is also important, as is consideration for the family at all times.

Forman recommended the following articles and books on the subject:

• Four models of the physician-patient relationship" E. J. Emanuel; L. L. Emanuel Journal of the American Medical Association 1992; 267:2221-2226.

• "The Healer's Power" Howard Brody, MD, Yale University Press

• 'Dying words' Jerome Groopman, MD, Annals of Medicine New Yorker Magazine Oct. 28, 2002 (http://www.newyorker.com/fact/content/?021028fa_fact)

• "The Anatomy of Hope: How People Prevail in the Face of Illness" Jerome Groopman, MD, Random House

• "Are there good ways to give bad news?" G. L. Krahn; A. Hallum; and C. Kime. Pediatrics 1993; 91(3): 578-582