Communicating bad news.

Ms Roberts, a 54-year-old African American woman with cirrhosis due to hepatitis B, presented with a new right upper quadrant abdominal pain. A computed tomographic scan showed a poorly defined mass with indistinct borders located near the portal vein. The likely diagnosis was hepatocellular carcinoma, probably unresectable due to proximity to the portal vein. A gastroenterologist tells her that the mass may represent cancer but that a liver biopsy is needed to establish the diagnosis. She agrees to the biopsy. Her physician reads the biopsy report while Ms Roberts is sitting in a clinic examining room.