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PUID: 63 || PLAB 2 Mock 1 :: BBN12: Breast Cancer


📌 Summary:

This station focuses on effectively delivering a diagnosis of early-stage breast cancer using the SPIKES protocol, while demonstrating empathy, structured communication, and patient-centred care.



Key Points:


Communication Framework (SPIKES Protocol)

  • S – Setting

    • Ensure a private, calm environment

    • Start by clarifying purpose of consultation (e.g., discussing results)

    • Demonstrate preparedness using candidate instructions

  • P – Perception (Perspective)

    • Assess patient’s understanding of:

      • Mammography

      • Biopsy

      • Events so far

    • Identify gaps in knowledge and fill them appropriately

    • Use patient’s language (e.g., “injection” instead of biopsy)

  • I – Invitation

    • Ask permission to share results:

      • “Would you like to discuss the results now?”

      • “Would you like someone with you?”

  • K – Knowledge

    • Deliver information in a layered manner:

      • Start with known facts → abnormal findings → biopsy → diagnosis

    • Avoid excessive technical detail

    • Use clear, non-jargon language

    • Final statement should clearly state diagnosis:

      • “This shows early cancer cells in the breast”

  • E – Emotion

    • Pause after delivering bad news

    • Observe reaction (shock, denial, silence)

    • Acknowledge and label emotion:

      • “I can see this is a shock”

    • Show empathy and support

  • S – Strategy

    • Address patient questions first

    • Management discussion should be patient-led

    • Provide follow-up, leaflet, and safety-netting


Clinical Knowledge – Breast Cancer

  • Screening:

    • Age 50–70 years, every 3 years

  • Triple assessment:

    • History + Imaging (mammography/USG) + Biopsy

  • Diagnosis:

    • Example: Ductal carcinoma in situ (DCIS) = early-stage cancer

  • Early-stage cancer:

    • May be asymptomatic

    • Good prognosis if detected early


Red Flags (Must Ask Even if Patient Says “I’m Fine”)

  • Weight loss

  • Loss of appetite

  • Fatigue

  • Bone/back pain (metastasis)

  • New lumps or changes

👉 Important: Asking red flags shows examiner you are ruling out serious complications.


History Taking Focus

  • Reason for initial test (routine vs symptom)

  • Experience during biopsy (build rapport)

  • Family history of cancer

  • Risk factors (e.g., smoking)

  • Any prior discussion of results


Important Considerations:

  • Do NOT skip red flags even if patient reassures

  • Avoid overloading with medical jargon

  • Do not dominate conversation

  • Use pauses effectively

  • Tailor responses to patient emotions

  • Do not rush into management unless prompted

  • Use candidate instructions to structure opening


Diagnostic Approach:

  1. Confirm patient identity

  2. Clarify purpose of consultation (results discussion)

  3. Assess patient’s understanding (perception)

  4. Take focused history:

    • Red flags

    • Risk factors

    • Prior knowledge

  5. Deliver diagnosis using SPIKES:

    • Layered explanation

    • Clear final diagnosis

  6. Observe and respond to emotional reaction

  7. Allow patient to ask questions


Management:

  • In this station, breaking the news itself = primary management

  • Further steps:

    • Answer patient questions

    • Briefly outline:

      • Early stage → good prognosis

      • Referral to specialist team

    • Lifestyle advice:

      • Smoking cessation (if relevant)

  • End with:

    • Safety-netting

    • Provide leaflet

    • Arrange follow-up appointment

👉 Time tip: Ideally ~4 minutes for management, but flexible in BBN stations


Communication Skills:

  • Use structured flow (signposting)

  • Avoid stock/rehearsed phrases (examiner penalises this)

  • Maintain two-way conversation

  • Let patient speak more than you

  • Use empathy appropriately (not overdone)

  • Use simple language (avoid jargon)

  • Check understanding regularly

👉 Effective communication and empathy are core PLAB2 scoring domains


Ethical Considerations:

  • Respect patient autonomy (right to know/not know)

  • Provide honest, clear information

  • Maintain dignity and compassion

  • Support shared decision-making

  • Follow GMC principles of:

    • Patient-centred care

    • Clear communication

    • Compassionate approach


📚 Additional Resources:

  • GMC Good Medical Practice Guidelines

  • SPIKES Protocol (Breaking Bad News framework)

  • Breast Cancer Screening NHS Guidelines

  • PLAB 2 Examiner Top Tips

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