Before significant efforts relative to patient education and subsequent informed decision making can occur, it is essential to assess the patient's perceptions and emotional responses to the diagnosis. The direction and depth of this exploration are likely to be determined by such factors as quality of the previous relationship with the patient, the patient's belief and support system, and the patient's previous experience with trauma. Other determining factors are the sense of urgency with which medical decisions need to be made and the interpersonal skills of the physician. It is important at the time of diagnosis to understand and respond to the patient's cognitive and emotional responses to the diagnosis. The sensitive physician allows time to acknowledge and legitimate those responses. It is often important to allow the ventilation of those reactions before further education and decision making can occur. By accepting and acknowledging the patient's reactions, the physician can reduce the patient's feelings of isolation and helplessness. The quality of such a relationship then becomes the foundation on which the patient and family and physician can begin to attend to the issues before them.