Breaking Bad News with Compassion: Cancer Diagnosis

Mock examiner feedback from the mock conducted on 21/06/2024

General Feedback

• Overall Performance

• The flow of the conversation was commendable.

• Data gathering was thorough and complete.

• The patient interaction was empathetic and supportive.

Specific Areas of Improvement

Ending the Consultation

• When to End

• Recognize when the conversation has reached a natural end.

• Provide the patient with reading material for further understanding.

• Arrange for follow-up reading material and consultations before seeing a specialist.

Safety Netting

• Importance

• Critical in urgent referral cases, particularly for cancer diagnoses.

• Emphasize the urgency and importance of attending specialist appointments.

• Reassure the patient about the importance of follow-ups and provide clear instructions if appointments are missed or delayed.

• Incorporation

• Mention the availability of urgent referrals and the need to return if an appointment isn’t set up promptly.

• Ensure the patient understands the significance of attending specialist appointments and the steps to take if complications arise.

Management and Follow-Up

• Communication

• Clearly communicate the next steps and treatment options without overwhelming the patient with unnecessary details.

• Reassure the patient about the presence of specialists and support systems.

• Follow-Up Appointments

• Schedule follow-up appointments to monitor the patient’s progress.

• Maintain communication to understand the patient’s experience and provide continuous support.

Information and Support

• Patient Education

• Use specific medical terms like "osteosarcoma" to avoid confusion and ensure clarity.

• Offer pamphlets and leaflets to help the patient understand the diagnosis and next steps.

• Support Groups

• Mention support groups like Macmillan Cancer Support for emotional and psychological support.

• Ensure the patient is aware of the resources available for their holistic care.

Interaction and Empathy

• Patient Engagement

• Always ask about the patient’s current state and feelings.

• Give the patient time to express their concerns and respond empathetically.

• Avoiding Repetition

• Avoid dwelling too long on certain parts of the conversation, such as the invitation to have someone present.

• Move on smoothly once the patient’s preference is known.

Breaking the News

• Timing and Delivery

• Follow the SPIKES protocol: Set up, Perception, Invitation, Knowledge, Empathy, and Summary.

• Ensure the patient is prepared before delivering bad news.

Additional Points

• Always provide complete information regarding the diagnosis, including specific medical terms.

• Encourage patients to inform their family using the exact diagnosis for clarity.

• Maintain a balance between providing necessary information and not overwhelming the patient with excessive details.

Conclusion

• Continue to practice delivering bad news with empathy and clarity.

• Focus on ending consultations appropriately, safety netting, and ensuring the patient feels supported throughout the process.

• Use feedback to improve specific areas and maintain the high standards demonstrated in data gathering and patient interaction.