Breaking Bad News 1

Setting:

You are a Foundation Year doctor working in the Upper GI Oncology Clinic. You have been asked to explain a diagnosis of oesophageal cancer to a patient. You will be provided with results after a brief history.

Jerry Roberts

Tasks:

1. Take a brief history from the patient.

2. Explain the diagnosis to the patient.

3. Answer any questions they may have.

Diagnosis

Oesophageal cancer presenting with increasing difficulty swallowing and weight loss.

Briefing

You are Jerry Roberts a 73 year old male.

You have presented to the Upper GI oncology clinic awaiting results of your recent investigations.

The doctor has been asked to explain the results of your recent camera test (OGD) and biopsies to you.

Appearance and Behaviour

Nervous, leg shaking.

Opening Statement

“Well doctor I’ve had all these tests done recently and they’ve told me I needed to come in for you to tell me what’s going on. I’m really worried, it all sounds quite serious but nobody’s told me anything.”

Further Information

This all started when my wife forced me to go to my GP after I was having difficulty swallowing. It started 4 months ago. There's no pain, it just felt like things were getting stuck in my throat.

Other symptoms - you've noticed weight loss over the past 4 months, you've had to buy a new belt as your old ones are too loose now.

Other symptoms - you feel exhausted all the time

Other symptoms - you've been having night sweats and soaking the sheets nightly

Progression - when it started it was just difficulty swallowing solids, now you can only swallow liquids.

Exacerbating Factors - you're avoiding solids as you can no longer swallow them without choking.

PMH

GORD

DH

Omeprazole

SH

Smoking history - smoked 20 a day for 50 years. You are trying to give up as you know it’s bad for you. You are now down to 10 a day

Alcohol - a whisky each night before bed

Illicit substances - nil

Home - Lives with wife and dog. Walks with stick. Lives in bungalow. Struggles with activities of daily living due to lethargy recently, otherwise independent.

ICE

Ideas - ou googled what this clinic was about and when it said the word oncology you know that it is associated with cancer.

Concerns - you’re trying to stay calm and not panic too much for your wife, but you’re worried it might be something serious.

Expectations - the doctor to tell you the results of your investigations.

Discussion / Questions

The doctor will explain the results of the investigation and break the news that you have cancer.

They may ask if you want someone in the room with you- if so say “don’t worry I’m happy to get the results myself and I can tell Betty”.

You are very upset by the diagnosis. The doctor should allow you time to process this, if not become disconnected/shut down from the conversation and explain you are struggling so can the doctor give you some time.

Once the doctor has explained the diagnosis they may start explaining the next steps in management, if not, ask them “what happens now?”

The doctor may offer to help tell your wife- if so agree and thank them as you know she will be upset. If not, ask the student if they can help you tell your wife.