Delivering Difficult News

This week, we are asked to execute ways on delivering difficult news to the patient using three different cases. One of the three cases I chose is a 33-year-old female who is 11 weeks pregnant who has been having pelvic cramping and vaginal bleeding since three days ago. Her quantitative hCG today has decreased since it was checked a couple of days ago. Based on the signs and symptoms, she is having a spontaneous abortion. The second case that I chose is a 52-year-old female patient who had a mammography and found some abnormalities in the test. She was then sent for a biopsy and was diagnosed to have stage II breast cancer. Lastly, the third patient that I chose is a 17-year-old female who is in the clinic for painful vaginal sores. She was diagnosed with genital herpes.

The questions for these cases are: What do I tell them? What are the next steps in their treatment? To answer the first question, I will tell them their diagnoses. However, I will inform them their diagnoses in a sequential and more therapeutic way by the use of SPIKES protocol (Setting, Patient perspectives, Invitation for information, Knowledge, Explore emotion, Summarize) (Clinical Advisor, 2015). I will first make sure that the setting of where I am going to talk to the patient is in a quiet environment in which there are no detractions. When I talk to the patient, I will make sure that there is proper eye level and that he/she is comfortable. Second, I will make sure to ask patient’s perspectives. By doing this, I am aware of the reason the patient is in the clinic and what he/she is thinking about the symptoms that were presented in the clinic. Thirdly, I will ask if he/she is ready to hear more about the diagnosis. This is the stage in which patient is starting to get a hint of what the diagnosis is about. The more therapeutic way to handle the situation is to at least ask the patient if he/she is prepared to hear further details of the problems. From there, the fourth important aspect is to talk to them at their level of knowledge. I would refrain from using medical terms that they cannot understand. Rather, I will use layman’s term for them to easily understand the message I am trying to convey. By now, they have the information that they want to know. This is the perfect time to explore their emotion and empathize. I can do that by directly asking the patient about what they feel about the news while being empathetic to the situation. Finally, after relaying the news, I will summarize everything that the patient and I have talked about. This will facilitate confirmation that the patient gets the right information.

The next step in the treatment of the 33-year-old female patient who is having a spontaneous abortion is to do a transvaginal ultrasound, to prepare her for a dilation and curettage (D&C) and to monitor the decreasing number HCG. Our goal for her HCG is to completely decrease down to pre-pregnancy level. She should be advised not to try to get pregnant until after three menstrual periods after the D&C.

As for the second patient, a 52-year-old woman who was diagnosed with breast cancer, she will be referred to an oncologist to manage the breast cancer.

Lastly, the 17-year-old female will be counseled about the mode of transmission of genital herpes, prevention, and treatment about the problem. She will be started on an antiviral medication. Her partner should also be treated.


Clinical Advisor (2015). The spikes protocol for telling patients bad news. Retrieved from




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