Breaking Bad News

Scenario

Your role: You are the senior house officer in an outpatient clinic

Problem: Breaking the news of lung cancer diagnosis

Patient: Mr. Peter Morris, a 45-year-old man

Scenario:

You have been asked to consult with this patient by his pulmonologist. Mr. Morris, a 45-year-old gentleman, presented initially with persistent cough and mild shortness of breath for the last two months. The patient underwent a series of diagnostic tests including chest X-ray, CT scan, and finally a bronchoscopy which revealed a mass in the left lung. A biopsy was performed, and the pathology report confirmed the presence of non-small cell lung cancer. Mr. Morris is a non-smoker and has no significant family history of cancer. His overall health status is good, with only essential hypertension being treated with antihypertensives.

Your task is to gently and compassionately inform Mr. Morris about his diagnosis, discuss the next steps in terms of treatment options, and answer any questions he may have.

DO NOT EXAMINE THE PATIENT DO NOT TAKE A HISTORY

Any notes you make must be handed to the examiners at the end of the station.

Conducting the Station: A Step-by-Step Guide

Introduction:

Start by introducing yourself to Mr. Morris and verifying his identity. Make sure he is comfortable and that the environment is suitable for the discussion ahead.

Establish rapport:

Establish rapport with Mr. Morris by expressing empathy for his situation and acknowledging any anxieties he may have.

Assess understanding and expectations:

Ask Mr. Morris about his understanding of his condition and his expectations from this meeting to help gauge his level of anxiety and knowledge needs.

Warning shot:

Prepare Mr. Morris for the serious news using a 'warning shot' such as, "I'm afraid I don't have good news for you."

Deliver the news:

Clearly and compassionately inform Mr. Morris of his lung cancer diagnosis, avoiding medical jargon as much as possible. Provide a pause for him to process the information.

Emotional Support:

Offer emotional support and validate his feelings. If he reacts strongly, provide tissues, a comforting gesture, and reassure him of your support.

Check the understanding and provide more information:

Make sure Mr. Morris has understood the diagnosis. Explain the specific type of lung cancer (non-small cell lung cancer) he has.

Discuss staging and further tests:

Explain the need for staging and describe the types of tests required, including imaging tests and possibly further analysis of his biopsy sample for genomic or molecular testing. Prepare him for the potential outcomes of these tests, and emphasise the collaborative nature of the team working on his case.

Discuss potential treatment options:

Give a brief overview of the potential treatment options for non-small cell lung cancer, explaining that the final decision will depend on the results of the staging tests.

Answer questions:

Encourage Mr. Morris to ask any questions and answer them in a clear and understandable way.

Summarise and arrange follow-up:

Recap the main points discussed, assure Mr. Morris of your continued support throughout his treatment journey, and arrange a follow-up appointment to discuss the results of the staging tests and to formulate a treatment plan.