At graduation, the student should be able to:
- a) illustrate an ability to communicate the bad news of a diagnosis of cancer to a patient, their family and “significant others” in a sensitive manner, addressing concerns, fears and expectations, while making sure a realistic prognosis is explained and ensuring that appropriate confidentiality is observed
- b) be aware that the impact of receiving bad news interferes with patients’ ability to comprehend fully the important information being presented to them. Illustrate the ability to assess a patient’s realistic understanding of their situation and to individually tailor verbal and written information provided according to patient preferences and understanding
- c) provide supportive counselling for the patient and carers, both personally and by referral to expert help
- d) demonstrate an understanding of how to explain the risks and benefits of options for management to the patient and their significant others, so that active participation in the management process is encouraged
- e) facilitate informed consent for participation in clinical trials.
- Basic counselling and communication skills, including eliciting the patient’s agenda in relation to the doctor’s agenda; being able to listen
- Patient-centred counselling skills, including the importance of appropriate location and the amount of time devoted to the task
- Knowledge of the process of grief and loss
- Knowledge of support groups (physical and internet)
Representative questions that suggest the required depth of knowledge
1. At the consultation in which you must tell a patient a diagnosis of cancer (select the best answer/s):
(a) The most important thing is to cover all important aspects of management and prognosis in the initial interview, to give a comprehensive statement about the patient’s condition.
(b) Due to the need for confidentiality, the information is best given to the patient on his/her own.
(c) Patient autonomy dictates that all management options should be presented immediately to achieve informed consent.
(d) Most details of the discussion will be lost once the patient hears the diagnosis and will need repetition at a later date.
2. In patients who require an interpreter to fully understand and contribute to discussions about cancer management (select the most appropriate answer/s):
(a) A family member is always best at interpreting medical language and transmitting information.
(b) An external interpreter is usually more impartial and transmits information more consistently.
(c) Written material (in the patient’s native language) is often very helpful to aid understanding.
(d) Family members and friends interpreting for the patient may filter (remove parts of) medical information told to them by the treating doctor.
Answer: (b), (c) and (d)