PUID: 62 || PLAB 2 Mock 3 :: BBN1: Dementia Mother

Practice a case with the AI patient 🤖

Summary

A relative attends to discuss an elderly patient with advanced dementia who has had significant weight loss and is refusing to eat or drink. The core task is to break the news sensitively that the condition is progressive, irreversible, and now terminal, then pivot to a comfort-focused (palliative) plan and support for the carer.

Key Points

Link the symptoms to dementia (close the “explanatory gap”)

• Establish the relative’s perception of dementia first, then join the dots: the weight loss and refusal to eat are manifestations of late-stage dementia, not a separate disease. Use clear, jargon-free language and check understanding.

• Summarise investigations already done (e.g., “bloods and imaging”) and explain that no alternative reversible cause was found, supporting the conclusion that the current decline is due to dementia. Pause to let this land.

Use a robust BBN structure (SPIKES)

• S — Setting: private, calm, uninterrupted space.

• P — Perception: explore what the relative already knows about dementia, the admission trigger (weight loss), baseline function, and what’s been done in hospital.

• I — Invitation: “I need to discuss some important results—are you okay to talk about them now?” (warning shot).

• K — Knowledge (layered):

  1. “We’ve run several tests. Unfortunately, they do not show another cause for the weight loss…” pause.

  2. “…which means her dementia has progressed to a terminal stage; we do not expect her to get better.” pause again. Then check understanding.

• E — Empathy/Emotion (E-V-E): Identify the emotion, Validate (“anyone would feel this way”), Empathise (“I’m so sorry…we’re here to help”). Allow silence.

• S — Strategy: signpost a palliative focus on comfort, dignity and symptom relief; agree next steps and supports.

Treatments with more risk than benefit at this stage

• Be clear that aggressive feeding interventions (e.g., NG/PEG) can be painful, distressing in a conscious patient, and risk complications (infection, aspiration/misplacement), so are not recommended when harm outweighs benefit. Explain that doctors recommend options based on effectiveness and risk, and patients/relatives can accept or refuse—but cannot dictate a harmful intervention.

Carer-centred support is part of the task

• Explore home setup, available carers, the carer’s wellbeing, and offer hospice/community team input, written information, and 24-hour contact pathways.

Examination hall “safety”

• Don’t invent prior tests or outcomes; use the notes provided in the stem and keep your content aligned to the station brief.

• Avoid stock phrases and over-rehearsed language; show real interaction and clear, efficient communication.

Important Considerations

• Kind, honest, clear communication—especially about prognosis and limits of treatment—is a professional duty; avoid euphemism or giving false hope.

• Share information in a way the relative understands, check understanding, and support decision-making.

• Document key discussions (prognosis, ceilings of care, carer support, safety-netting) contemporaneously.

• Consider capacity/Best Interests if decisions about treatment limitation are required; follow local policies and GMC end-of-life guidance.

Diagnostic Approach (for this station’s context)

• Identify the presenting problem: weight loss and refusal of oral intake; clarify onset, course, and current risks (dehydration, aspiration).

• Perception & baseline: cognition, mobility, ADLs, feeding routine/preferences, carer supports.

• Review results in notes (don’t invent): bloods, imaging, nursing observations (e.g., “tolerated sips”). Use these to justify the link to dementia progression.

• Rule out red flags if suggested in the stem, but avoid unnecessary tests when the diagnosis and trajectory are clear.

Management

• Immediate priorities (comfort-focused):

  • Oral care; sips/comfort feeding as tolerated; manage secretions, pain, agitation, breathlessness; repositioning and skin care.

  • Avoid burdensome interventions where benefits do not outweigh harms; explain your clinical reasoning.

• Palliative & community supports:

  • Refer to palliative care team/hospice; discuss options for care at home vs inpatient hospice; coordinate community nursing and social services; provide written leaflets.

• Carer support & safety-netting:

  • Signs of deterioration (e.g., increasing breathlessness, fever, distress); how/when to seek help; 24-hour contact; arrange follow-up to address delayed questions.

• Documentation: record findings, discussions, decisions, and agreed plans clearly and contemporaneously.

Communication Skills

• SPIKES with two deliberate pauses in the Knowledge step (after “tests don’t show another cause” and after “the condition is terminal”).

• E-V-E for emotion: Identify → Validate → Empathise; allow silence; offer tissues/water appropriately—not performatively.

• Plain English, no jargon; avoid scripted stock phrases; check back (“Are you with me so far?”).

• Signposting and structured flow to keep to time.

Ethical Considerations

• Honesty about prognosis and limits of treatment; do not minimise risk or present opinion as fact.

• Support shared decisions; patients/relatives can decline treatments, but clinicians must not provide harmful or ineffective care.

• Respect, dignity, and compassion for patient and those close to them; be sensitive when sharing distressing information.

• Capacity/consent & end-of-life: follow GMC decision-making and end-of-life guidance.

Additional Resources

• GMC – Good medical practice (communication, end-of-life, decision-making & consent, documentation).

• GMC – Examiner top tips & OSCE pitfalls (don’t invent information; avoid stock phrases; keep the station’s task in focus; communicate naturally).

• Understanding your PLAB 2 results (domains, qualitative feedback statements that commonly apply to BBN: structure, time, rapport, language).