discussing serious news MCQs

Question 8 1 / 1 pts You have the fertility results for a young couple who is assessing their ability to conceive a child without the use of treatments. The results suggest that the young woman has PCOS. Which of the following is the best way to communicate this diagnosis to the couple? "You are very lucky, PCOS is one of the most common reasons women have trouble getting pregnant and we can easily address it." "You have PCOS, but don't worry there are many treatments that can still help you have a health pregnancy." "Polycystic ovary syndrome, or PCOS, can cause a hormonal imbalance that makes getting pregnant more difficult." "This must be devasting for you to hear, I'm very sorry but you have PCOS." "I wish the news were different, but you have polycystic ovary syndrome."

"Polycystic ovary syndrome, or PCOS, can cause a hormonal imbalance that makes getting pregnant more difficult." Correct. When delivering the diagnosis (Knowledge stage), it's best to use straightforward information and explain in plain language. You should also not make assumptions about how the couple feel about this news and address emotion as it comes up. ""This must be devasting for you to hear, I'm very sorry but you have PCOS" assumes the news is "devastating" to the couple. "Don't worry" and "You are very lucky" options both minimize the couple's feelings and don't allow them to respond. It also moves into treatment before they have fully understood the diagnosis. "I wish the news were different" is not the best answer. The qualifier assumes you know how the couple feel about this news and does not explain the situation in simple language.

Question 6 1 / 1 pts A 55-year-old man was diagnosed with Stage 4 pancreatic cancer and has limited treatment options. After you provide the diagnosis, the patient responds with silence and then begins crying and saying, "This is not real. You're lying." What is your next best response? "I can see how upsetting this is to you." "Why do you think I'm lying?" "Do you have any questions?" "What do you know about Stage 4 pancreatic cancer?" "I'm not lying, and I have told you the facts."

Correct answer is "I can see how upsetting this is to you." The patient is clearly upset and showing intense emotion. It is important to address this emotion with an empathic response. First and third answer options do not show empathy and can be interpreted as confrontational/defensive and a "patriarchal" response by the patient. Fourth and fifth options would be more appropriately made after providing an empathic response and addressing the patient's emotional reaction.

Question 2 1 / 1 pts A 65-year old man with longstanding hepatitis C has screened positive for hepatocellular carcinoma. Which of the following statements would be the most appropriate way of addressing this with the patient? "Unfortunately, we see this a lot, chronic hepatitis C is one of the leading causes of hepatocellular carcinoma." "I'm running late for another appointment but wanted to make sure you know that we found cancer in your liver." "No matter how long you live, you have had a very productive life to be proud of." "I'm afraid I've got some bad news - the test results showed you have cancer in the liver."

Correct answer is "I'm afraid I've got some bad news - the test results showed you have cancer in the liver.". When giving knowledge and information to the patient, provide the medical facts without excessive bluntness or technical terms. You also may use a cautionary statement if it seems appropriate. It is also important to make time for delivering this news without being rushed.

A 9-year-old girl diagnosed with an advanced stage, malignant brain tumor asks the physician, "Am I going to die?" The child's parents have previously told the physician that they do not want the child to know her diagnosis or a specific prognosis. What is the best response to the child's question? "I'm really sorry but I cannot answer that question." "Don't worry about a thing, you will be fine." "It's sad, but people can die from many different things." "What have your parents told you about your illness?"

Correct answer is "what have your parents told you about your illness?" Because of the child's age it would be best to address her desire to know (and not ignore it) but personalize communication by using the family's style and honoring the parent's preferences.

Question 5 1 / 1 pts A 35-year-old female patient comes to her specialist's office for the results of a core needle breast biopsy. The physician must communicate that the biopsy confirmed the presence of cancerous cells. After the patient is sitting down in the physician's private office, what is the best thing for the physician to say to open the conversation? "Have you ever known anyone with breast cancer?" "I'm sorry to say, you have breast cancer." "What is your understanding of why we did a biopsy of your breast?" "Tell me what you know about breast cancer." "I'm afraid the news is not what we had hoped."

Correct answer is "what is your understanding of why we did a biopsy of your breast?". Remember this is the best answer, and not just a plausible answer. E elicits the patient's perceptions and helps ensure the physician understands where the patient is coming from. First and second options might be fine when you enter the knowledge phase of addressing the bad news. C could be helpful after the patient knows she has breast cancer. Option D might also elicit the patient's understanding, but by beginning with this question, you are inadvertently communicating to the patient that she has breast cancer, when you haven't yet discussed the results with her.

Question 3 1 / 1 pts Which of the following techniques is an important part of setting up a discussion that will lead to delivering bad news? Naming the feeling Finding a private room Assessing for denial Asking questions about the patient's desires

Correct answer is finding a private room. Arranging for privacy, sitting down, making a connection with the patient, and managing time constraints are all an important part of Step 1: Setting up the interview. Assessing whether a patient is engaging in defense mechanisms (such as denial or wishful thinking) (B) is part of Step 2: Assessing the patient's perception. Asking questions about the patient's desires (C) is part of Step 3: Obtaining the Patient's invitation. Naming the feeling (D) is a technique that could be used in Step 5: Addressing the patient's emotions with empathy.

Question 4 1 / 1 pts A 45-year-old woman came for a follow-up appointment to get the results of a recent mammogram that showed evidence of early breast cancer. What stage of the SPIKES protocol would include asking the patient what she knows about breast cancer? Invitation Emotions Strategy Setting-up Perception Knowledge

Correct answer is perception. Assessing the patient's perception would include asking open-ended questions to find out what the patient knows, listening, correcting misinformation, and evaluating for possible defense mechanisms.

Question 7 1 / 1 pts A 34-year-old married woman and new patient has recently tested positive for HIV. How would you set up a discussion that will lead to delivering bad news? Schedule a meeting with the patient and tell her to bring her partner. Tell the patient you know she is worried and process her feelings. Call the patient and ask about her desires for how to receive information. Schedule a time for the patient to come in for a meeting in a private room. Call the patient on the phone and tell her you have some bad news.

The correct answer is schedule a time for the patient to come in for a meeting in a private room. In order to make sure the patient has your undivided attention and you can give her the news in person, it is important to schedule a time to meet and discuss the diagnosis and steps moving forward. First answer assumes that she would want her partner there, when she may not. This does not give the patient agency. Second answer option is incorrect because physicians should make attempts to meet in person when giving bad news, not share bad news over the phone. Giving bad news over the phone may be done in extenuating circumstances or when the physician has already built significant rapport and a trusting relationship with the patient. In those instances, an in-person follow-up meeting is strongly recommended to provide further support. Fourth answer is part of obtaining the patient's invitation, which is done after understanding the patient's perception about the test results. Fifth option is incorrect because you have not provided the patient with any information to react to. Processing her feelings is more appropriately done once you have provided bad news and the patient indicates an emotional reaction.