To the Editor Tanco et al1 report that physicians delivering a more optimistic message are perceived by patients with advanced cancer as being more compassionate and trustworthy. Patients may perceive a more optimistic message as a sign of their physician’s compassion and trustworthiness because they need to protect themselves from devastating news in order to carry on. “Who am I to disrupt this potentially fragile cognitive strategy?” wrote an oncologist.2(p4372) Yet we must acknowledge that the 2 messages in the study by Tanco et al1 do not convey the same degree of truth. The “more optimistic” message is not as truthful as the “less optimistic” one because patients in palliative care stages are unlikely to resume active treatment or benefit from it.