Breaking Bad News, Post-Surgical Stroke Case: PLAB 2 Mock Scenario

Practice a case with the AI patient 🤖

Summary:

This scenario involves delivering difficult news to a family member after a patient developed complications following brain surgery. The patient, who initially underwent surgery for a space-occupying lesion, experienced a stroke in the recovery room and is now in intensive care. The task is to convey this information compassionately, using appropriate communication protocols.

Key Points:

Neurology / Post-Surgical Complication

• Patient had brain surgery for a lesion.

• Post-operative complication: stroke leading to hemiparesis.

• Stroke occurred in the recovery room; confirmed by CT scan.

Communication and Information Accuracy

• Do not assume prior communication or consent was given or understood.

• Avoid definitive statements unless confirmed (e.g., "the surgery was successful").

• Clarify your role and the purpose of the discussion at the start.

Important Considerations:

• Ensure understanding of what the patient/relative already knows.

• Never assume consent was valid or that explanations were understood.

• Validate and address the emotional impact using the EVE protocol (Emotion, Validation, Empathy).

• Avoid medical jargon or explain it in simple terms if used (e.g., "ischemia").

• Clearly outline the current clinical condition and avoid giving false hope.

• Safety netting includes addressing relative's emotional wellbeing and offering support resources.

Diagnostic Approach:

1. History Taking:

   • Ask what the relative knows.

   • Explore past medical and medication history.

   • Confirm any prior explanation of surgical risks and complications.

2. Clinical Information Sharing:

   • Outline the surgery and post-op findings.

   • Explain what a stroke is and its implications using non-technical terms.

Management:

• Communication of the diagnosis:

  • Follow SPIKES protocol:

    • Setting, Perception, Invitation, Knowledge, Empathy, Strategy & Summary.

• Supportive Measures:

  • ICU admission for close monitoring.

  • Stroke team involvement for further assessment and management.

  • Emotional support for the family.

• Further Steps:

  • Discuss ongoing care and prognosis cautiously.

  • Offer written information and arrange follow-up discussions.

  • Provide psychological support resources.

Communication Skills:

• Always introduce yourself and explain your role.

• Use appropriate signposting before transitioning to sensitive topics.

• Deliver news stepwise with pauses for emotional processing.

• Maintain empathetic, non-defensive tone.

• Validate emotions openly and provide reassurance without over-promising.

Ethical Considerations:

• Do not give information beyond your clinical remit.

• Ensure patient confidentiality and informed consent.

• Address patient/relative autonomy and emotional needs respectfully.

Additional Resources:

• GMC Good Medical Practice: Domains on Communication and Ethical Practice.

• Examiner Top Tips for PLAB 2.

• PLAB 2 marking domains and feedback statements.