Breaking bad news is one of the most difficult tasks in the health system. While it is never easy, it can be done in a way that minimizes the emotional trauma on both sides. An unusual interdisciplinary study carried out recently at Assaf Harofe Medical Center in Tzrifin focused on 51 cancer patients, 51 nurses and 50 doctors who filled out questionnaires on the subject. The researchers, who presented their findings at a nursing conference in Taiwan, made several recommendations: It is preferable to tell patients about a serious condition as soon as possible after diagnosis. Information provided in the session should include possible treatments and side effects, and it's preferable to provide information in writing. The patient and his family should be given an opportunity to express their feelings, and they should be supported by quiet empathy, and a hand on the shoulder. The researchers also found that positive words of encouragement and avoiding the use of negative expressions also provided relief. Giving bad news is a process, not a one-time action, as the patient needs time to become aware of his situation and internalize it. Thus doctors and nurses must prepare for a broad variety of reactions and show patience and understanding. Staff should be trained in breaking bad news, said lead researcher and hospital nurse Dina Silver. "This is work that demands skill and planning." FINGERING SMOKE DAMAGE Here's one more reason not to smoke during pregnancy: A mother's cigarette smoking increases the risk that her newborn may have extra, webbed or missing fingers or toes, according to a study in the January issue of Plastic and Reconstructive Surgery. Although the overall risk of these abnormalities is relatively low, just half a pack of cigarettes a day increases the risk by 29%, compared to non-smokers. Because limbs develop early in pregnancy, the effect may occur even before a woman knows she is pregnant. "We found that the more a woman smoked, the higher the risk became that the baby would have these defects," said Dr. Benjamin Chang, pediatric plastic and reconstructive surgeon at the Children's Hospital of Philadelphia, who headed a review of 6.8 million live births in the US in 2001 and 2002. The researchers divided the study population into four groups: non-smokers, those who smoked one to 10 cigarettes, 11 to 20 and 21 or more. Women who smoked up to half a pack a day were 29% more likely to have babies with digital anomalies, while smoking more than a pack a day during pregnancy was linked to 78% more babies with digital anomalies. Of the total 6.8 million births, the researchers found 5,171 children born with digital anomalies whose mother smoked during pregnancy.