Breaking Bad News Practice vignettes

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.

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

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

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

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

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

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

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 mothers progress and has requested to speak to you. Inform the patients daughter of the diagnosis.

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 CT scan bowel cancer Tell her daughter

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

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

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

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

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