High-quality palliative care also requires special expertise in honest, compassionate communication. In addition to enhancing the patient's and family's experience, these skills help to establish trust and overcome barriers to adequate care and relief of symptoms. Several communication tasks are especially important: conveying accurate prognostic information while maintaining hope, eliciting information about symptoms, decision making about curative and palliative treatments, handling emotions, and dealing with requests from patients and families who have unrealistic goals [34, 35, 36] . The challenges of communicating effectively are discussed later in this course.
Users on an oral steroid cycle may experience a sudden increase in body weight and muscular development, insomnia, irritability, aggressive combative behavior, puffy face, severe acne, bad breath, a yellowing of the eyes and skin, premature hair loss, hyperactivity, and exaggerated mood swings that include uncontrollable outbursts of anger. Males may also experience testicular shrinkage and can develop female breast tissue on the pectoral muscles. Females may also experience a deeper voice and decreased breast size. Continued use can result in life-threatening situations involving the liver, cardiovascular system, and brain.