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19) If they ask things like prognosis or life expectancy, don’t make up numbers or promises. Be honest and say that you’re not sure and you’ll have to speak to a consultant. This is beyond the role of an FY1 doctor to explain these things, so know your competencies

13) If you feel that it’s taking too long, you can use phrases like “I can’t begin to imagine what this feels like, but could you what’s going on in your mind” 🥺

12) Emotions Using a pause, acknowledge and validate the patient’s emotions. Give them time to express their feelings and cope with the shock. Don’t interrupt or rush them.

11) I’m sorry to tell you, but this means you have lung cancer. PAUSE.” This is the most crucial part of the OSCE station and your delivery here is what makes or breaks the station💔

10) For example, you could say: “We did a chest x-ray to check your lungs. The results have come back, would you like to hear them? PAUSE. Unfortunately, I have some bad news. PAUSE. The x-ray showed that there was a large mass on your right lung. PAUSE.

9) Warn them before you say it, such as “I’m afraid I have some bad news” or “Unfortunately, the results are not what we hoped for”. Pause after each sentence to let them process it. Check their understanding and emotions.

8) Knowledge This is where you deliver the bad news. Use clear and simple language, avoid jargon or euphemisms

7) Invitation Ask the patient how much they want to know and how they want to receive the information. In the OSCE, they’ll want to know to know their result today, but it’s always important to ask🙋‍♂️🙋‍♀️

6) Ask open-ended questions, such as “What have you been told so far?” or “What are you hoping for?” Use ICE (ideas, concerns, expectations) to tailor your conversation accordingly. Tailoring your conversation to your patient is what gets you that 1st decile score❄️

5) Perceptions THIS IS THE MOST IMPORTANT STEP ! Find out what the patient knows and expects about their condition and prognosis. Although it doesn’t specifically say to take a history, I always like to ask the patient to tell me everything that’s been going on.

Congratulations to everyone starting their new year. We're back with our weekly threads🧵 Breaking bad news is the one of the most challenging skills to master as a medical student. Here’s a thread on how to tell patients they have cancer without breaking down yourself ! 👇👇👇

4) I always like to say I’m putting away my phone to show to the patient that I’m fully attentive📵,Ask if they want anyone else to be present, such as a relative or a friend. In most OSCE stations, they’ll just say no👥

3) Setting Let the patient know that you can talk in a quite and private place.

2) Use the SPIKES protocol. It’s a 6-step guide to structure your conversation and ensures that you cover all the important points🗣️

1) Confirm the patient details and the bad news you’re breaking. Read any notes carefully and make sure you understand the situation and the diagnosis📝