Where are you?
FY2 in GP surgeryWho the patient is:
David Smith is a 19-year-old male who has come for follow-up after having some blood tests and an x-ray done 2 weeks ago after experiencing bone pain and swelling in the lower limb for over 1 month.Other information you have about the patient:
Blood tests and x-ray of the bones have been done.
Radiologist’s report: “Lytic lesions with sunburst appearance suggestive of osteosarcoma.”What you must do:
Talk to him, explain the results and discuss management.
PATIENT INFORMATION:
- Saw the doctor 2 weeks back for bone pain and swelling in leg.
- Bone pain and swelling has progressively got worse since it first started, exertion makes it worse, Ibuprofen doesn’t help. No associated symptoms.
- Symptoms making it difficult to walk.
- No weight loss, no changes in appetite, no fever or night sweats, no lethargy or lumps or bumps.
- Normally fit and well and not on any regular medications.
QUESTIONS:
- When will I be seen?
- Is it curable?
APPROACH
Setting / GRIPS
- I understand that you’re here for follow-up after having an x-ray and blood tests done.
- I’ve been asked to give you an update about your results.
Perception
- Before we go into the results, I’d like to ask a few questions to get a better understanding of
your situation. So that we are on the same page can you tell me what you have been told so far? - Was it explained to you the different possibilities of what this could be?
- Can you talk me through the symptoms that led you to first see the doctor?
- How are you feeling now?
- Any weight loss, fever/night sweats, lethargy or lumps & bumps?
Invitation- Is there anyone else you would like to be here while we discuss the results / OK to discuss
the results now?
Knowledge
- As you know: you came to us with bone pains and swelling in the leg. We then did some blood tests and an x-ray of the leg.
- Last step: The x-ray has been reviewed by an x-ray specialist.
- Warning shot + break news layer by layer:
– And unfortunately, I don’t have good news for you today.
– The specialist has written in his report that the x-ray is suggestive of a bone condition called osteosarcoma.
– I’m sorry to say that this is a type of cancer of the bone.
Emotions
-
Ask: How are you feeling? / Take me through what’s going through your mind.
-
EVE:
– I can see that you are upset / this is not what you were expecting.
– I know it’s a lot to take in at the moment.
– I am sorry I couldn’t give you the news we were hoping for.
– We’re here to support you through this. -
If crying:
– Take your time I know it’s distressing news + offer tissue.
– Are you okay to continue?
Strategy & Summary
-
You will be receiving the best possible treatment and care.
-
I will put in an Urgent Suspected Cancer Referral for you to be seen by the bone specialist (orthopaedics). You should be seen within 2 weeks.
– They will assess you
– Do further specialist tests and investigations (MRI, Biopsy)
– If the diagnosis is confirmed, there are different options for treatment. The treatment would depend on the stage of the cancer but options include surgery, chemotherapy and radiotherapy. -
Support
– Family / friends: Is there anyone else you want us to speak to / call for you?
– Groups: If confirmed, we can get you in touch with Macmillan Cancer Support who
can provide you with psychological and emotional support. There are lots of people living
with cancer. Macmillan are there to make sure that nobody goes through cancer on their own. -
Offer to answer questions: I know it’s a lot to take in but do you have any questions at this stage?
-
Offer to answer questions in follow-up telephone consultation: Because it is a lot to take in, I appreciate that you may later have questions or concerns that you can’t think of right now. I’d like to give you a call in 2 days’ time to see if there’s anything else you want to discuss before you see the specialist.
-
Safety netting for delayed or missed appointment
– If you don’t receive an appointment letter in the post / via the online Patient Portal Service to see the specialist within 1 week then let us know and we will chase up the appointment for you.
– If for whatever reason you miss your appointment, let us know as soon as possible so we can arrange another appointment for you (as the hospital policy is to discharge people who do not attend (DNA) appointments).