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PUID: 51 || PLAB 2 Mock 1 :: BBN1: Dementia Mother

Summary:

Delivering terminal dementia diagnosis and explaining shift to palliative care for Susan Bones, focusing on communication, emotional support, and management planning.



Key Points:


1. SPICES Protocol & Breaking Bad News Framework

  • Setting: Quiet, private environment; confirm identities (full names, relationship, age)—e.g., Carol Bones (daughter), Susan Bones (patient).

  • Perception: Gauge what the relative knows—ask about presenting complaint (weight loss), prior investigations, medical conditions, medications, allergies; inquire about dementia awareness.

  • Invitation: Offer a “warning shot” before sharing serious news; ask permission to proceed and about support persons who might join.

  • Knowledge: Explain investigations, test results (all mostly normal), connect weight loss to progressive terminal dementia in simple lay terms without jargon.

  • Emotion: Use the E‑VE model—identify, validate, empathize with emotional reactions after delivering worst news.

  • Strategy & Summary: Introduce palliative care (hospital- or home-based hospice) as the plan, emphasizing comfort, dignity, symptom control; ask for consent, offer follow-up and leaflet information; safety-netting to know when help is needed.


Important Considerations:

  • Always confirm full identifiers even if only first name provided.

  • Use non‑medical language or explain clearly when using medical terms.

  • True consent: treatment decided by clinicians but requires patient/relative agreement.

  • Explore carer’s wellbeing, impact on finances and daily life; offer referrals (e.g. Citizens Advice Bureau).

  • Clarify support options including hospice at home, community nursing.


Diagnostic Approach:

  1. Confirm identity and gather full names and relationship.

  2. Explore perception: presenting complaints, timeline, investigations, knowledge of dementia.

  3. Clarify expectations and understanding.

  4. Offer invitation before disclosing.

  5. Provide knowledge: test results, progressive irreversible nature of dementia.

  6. Deliver worst news sensitively.

  7. Respond to emotion using E‑VE.

  8. Outline strategy: palliative care plan, symptom control, consent.

  9. Discuss social support, finances, home-based care options.

  10. Provide follow-up, leaflets, referrals, safety‑netting instructions.


Management:

  • Explain palliative vs curative approaches.

  • Symptom control: pain, breathlessness, secretions.

  • Address specific questions (e.g., NG tube insertion)—explain potential distress and harm.

  • Arrange hospice or community nursing if home-based care is preferred.

  • Provide contact information, leaflets, community support resources.

  • Safety-net: signs to monitor, when to seek urgent help.

  • Follow-up: regular contact; reassure support is available.


Communication Skills:

  • Introduce yourself and state purpose before revealing sensitive information.

  • Use invitation phase to prepare listener for heavy news.

  • Use clear language, avoid jargon or explain it well.

  • Watch verbal and nonverbal cues; respond to silence (pausing mentally) and emotional reaction.

  • Check understanding periodically and invite questions.

  • Show empathy, validate feelings, and normalize emotional response.


Ethical Considerations:

  • Seek consent before implementing palliative care.

  • Respect patient dignity and comfort over life‑prolonging interventions with little benefit.

  • Avoid causing unnecessary distress (e.g., NG tube insertion without benefit).

  • Transparency and honesty balanced with sensitivity.


Additional Resources:

  • NHS guidelines on end‑of‑life and palliative care pathways.

  • SPICES and E‑VE communication frameworks.

  • GMC guidance on consent and breaking bad news.

  • Patient/carer support leaflets, hospice care eligibility.

  • Links to past YouTube case simulations for practice.

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