The New England Journal of Medicine [N Engl J Med 2012, 367(17):1616], October 25, 2012, published the results of a survey by the American scholar Weeks et al. showing that among 1193 patients with metastatic (stage IV) cancer who received chemotherapy, 69% of lung cancer patients and 81% of colorectal cancer patients did not understand that chemotherapy was non-curative and generally had chemotherapy with high expectations, and the false expectations were not related to factors such as the patient’s education level and social status. The investigators believe that this may undermine patients’ right to know and therefore make treatment decisions that are not consistent with their true wishes. This is not entirely consistent with the situation in the U.S. In China, where the traditional concept of “talking about cancer” and the current health care environment make the knowledge of a cancer patient’s condition perhaps not only a matter of the doctor and the patient, but sometimes the patient himself is the last to know. Why do patients with advanced cancer have high expectations of chemotherapy? According to Professors Smith and Longo of Johns Hopkins University, people have a habit of underestimating the difficulty of completing a laborious task and acting overconfidently before starting it, which Kahneman (Nobel Laureate in Economics) calls the “Planning Fallacy”. . Of course, optimism alleviates the fear of death to some extent, but when a patient near death is asked “what will be the outcome of the treatment you are receiving”, it is inevitable that expectations will be too high. This may be because the patient being surveyed was not informed at all or was not effectively communicated by the physician, because the patient chose not to believe, or because the patient fully understood but acted overconfidently in response to the question posed by the stranger. Although these were not mentioned in the Weeks et al. study, many observational studies have shown that most physicians in the United States will inform patients of an incurable condition at the initial consultation, and even when patients know the true situation, some are reluctant to admit it, knowing that the way people think may change after a diagnosis of cancer. The reality of the problem: chemotherapy (excluding radiation) is the primary treatment for most metastatic tumors, and although its efficacy has improved over the decades, in patients with advanced cancer, its role in various studies has been limited to extending survival by months, often only as palliative treatment rather than a cure. Almost all patients want to know the prognosis for their disease, and only after repeatedly getting real information and knowing exactly what is going to happen will they be able to make more informed choices in the final stages of their lives. There are many ways for doctors to help patients make these difficult decisions, and honest conversations between doctors and patients about death help patients understand the condition and do not create overwhelming emotions. A necessary skill for physicians to master is how to ask and inform. It is recommended to ensure that the prognosis is explained to the patient after a full discussion of the condition at the initial consultation and to provide information about end-of-life care during the first three consultations; to focus on the patient’s stress at every transition in the conversation; and to encourage the patient to receive hospice and palliative care. Physicians can more effectively share more information with their patients, enabling them to better organize their remaining lives. After all, people want to live longer with a good quality of life and then pass away peacefully outside the hospital.