A 52-year-old woman comes to the clinic to discuss the results of a recent abdominal CT scan. The patient says, "I hope the scan can tell me why I've been losing so much weight. What does it show?" The physician shares that the imaging is suggestive of pancreatic cancer. Upon hearing this, the patient begins to cry while holding her head in her hands. Which of the following is the most appropriate response by the physician?

Question

A 52-year-old woman comes to the clinic to discuss the results of a recent abdominal CT scan.  The patient says, "I hope the scan can tell me why I've been losing so much weight.  What does it show?"  The physician shares that the imaging is suggestive of pancreatic cancer.  Upon hearing this, the patient begins to cry while holding her head in her hands.  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

11ec160b_367e_709f_9249_df92a02ea1e4_MD0001_00 In this case, the physician has just delivered serious news and must respond sensitively to a crying patient. The most appropriate response is to acknowledge the patient's distress, express empathy, and allow the patient time to process the news. The patient should be allowed to cry without redirection of the conversation or assumption about how much information she wants to know at this point. Once the patient is able to converse, the physician can gently explore her feelings and respond to any questions, allowing the patient to take the lead in the discussion (eg, ask the patient how much information she would like to know at this point). Models have been developed to guide clinicians in delivering serious news. The SPIKES protocol, originally developed for cancer patients, can be adapted to conversations with patients in many situations (eg, medical futility discussion, STI results). (Choice A) This response immediately redirects the focus of the visit to discussion of results and does not allow the patient time to process the news and express her emotions. Instead, the physician should follow the patient's lead and answer any questions that arise. (Choice C) This response prematurely redirects the visit to discussing the patient's support system rather than allowing the patient to express her emotions and immediate needs. (Choice D) This statement uses optimism and reassurance by changing the focus to recent advances in treatment. This may have the unintended consequence of discouraging the patient from expressing her emotions and fears about the illness. After acknowledging the patient's emotions, it is preferable to gently explore how much she wants to know about the diagnosis and treatment options at this point. (Choice E) This response makes the inappropriate assumption that the patient is not ready or does not want to receive additional information during this visit. Instead, the patient should be allowed to express the full range of her emotions and invited to ask any questions. Depending on her response, the physician can educate her about the condition and her options. Educational objective: Delivering serious news requires allowing the patient time to process the information and express emotions. Empathic, supportive communication should include acknowledging the patient's distress and being open to answering any questions. __________ References: Assessing patient perspectives on receiving bad news: a survey of 1337 patients with life-changing diagnoses. (http://www.ncbi.nlm.nih.gov/pubmed/30596341) Delivering bad or life-altering news. (http://www.ncbi.nlm.nih.gov/pubmed/30215989)

A 52-Year-Old Woman Comes to the Clinic to Discuss the Results