Breaking Bad News

1. Breaking Bad News Practice vignettes

2. Case 1 You are an Emergency Medicine trainee. You have been asked to speak to Mr Gould, a 78 year old man who has been brought in by ambulance after being knocked over by a vehicle whilst crossing the road. Following a series of X-Rays and CT scans, he is found to have a crush injury of his right leg and now requires a below knee amputation. Mr Gould is otherwise very fit and well and is quite active for his age. Break the news to him that he will require an amputation.

3. Right leg crush injury • Below knee amputation Setting • Mr Gould, active 78yo • Hit by car • Close curtains / door • Hand over or turn off pager and phone

4. Right leg crush injury • Below knee amputation Perception (and intro) • Mr Gould, active 78yo • Hit by car

5. Right leg crush injury • Below knee amputation Invitation • Mr Gould, active 78yo • Hit by car

6. Right leg crush injury • Below knee amputation Knowledge • Mr Gould, active 78yo • Hit by car

7. Right leg crush injury • Below knee amputation Explore emotions • Mr Gould, active 78yo • Hit by car

8. Right leg crush injury • Below knee amputation Strategy and Summary • Mr Gould, active 78yo • Hit by car

9. Case 2 You are an Internal Medicine registrar. Mrs Dawson is an 82 year old woman with dementia who was recently admitted onto your ward with chronic constipation and a recent episode of PR bleed. On routine examination, a hard abdominal mass was found and a CT scan confirmed for metastatic malignancy. Her daughter, who is her main carer, has come in to find out about her mother’s progress and has requested to speak to you. Inform the patient’s daughter of the diagnosis.

10. CT scan → bowel cancer • Tell her daughter Setting • Mrs Dawson, 82yo, dementia • PC: Constipation, PR bleed • You invite the patient into a consulting room • Hand over or turn off pager and phone

11. CT scan → bowel cancer • Tell her daughter Perceptions • Mrs Dawson, 82yo, dementia • PC: Constipation, PR bleed

12. CT scan → bowel cancer • Tell her daughter Invitation • Mrs Dawson, 82yo, dementia • PC: Constipation, PR bleed

13. CT scan → bowel cancer • Tell her daughter Knowledge • Mrs Dawson, 82yo, dementia • PC: Constipation, PR bleed

14. CT scan → bowel cancer • Tell her daughter Explore emotions • Mrs Dawson, 82yo, dementia • PC: Constipation, PR bleed

15. CT scan → bowel cancer • Tell her daughter Strategy and Summary • Mrs Dawson, 82yo, dementia • PC: Constipation, PR bleed