Breaking bad news — confirmed lung cancer
PLAB 2 & PRES 3 · communication · hard · 8 minutes
Candidate brief
You are an FY2 doctor/SHO in a respiratory clinic. Mr Alan Murphy, 64, recently underwent a biopsy of a right lung mass. The biopsy has confirmed non-small-cell lung cancer. Full staging and molecular results are not yet available. Explain the result, respond to his concerns and discuss the immediate next steps. A consultant and lung cancer clinical nurse specialist are available nearby.
What examiners look for
Prepare before delivering serious news. Confirm the result, identify what remains uncertain and arrange privacy, sufficient time and appropriate support. Check what the patient already understands and how much information they want before giving the result. Use a brief warning, followed by clear language such as: “The biopsy has confirmed lung cancer.” Avoid vague expressions that leave the patient unsure of the diagnosis. Pause after giving the news. Allow silence, observe the patient’s reaction and acknowledge emotion before providing more information. Give information in small sections and check understanding. Do not overwhelm the patient with every possible treatment or complication during the first conversation. Be honest about uncertainty. A confirmed diagnosis does not necessarily establish the cancer stage, treatment options, curability or prognosis. Do not guess how long a patient has to live. Explain what further information is needed and when a more informed discussion can occur. Do not blame the patient for smoking. Acknowledge guilt sensitively and focus on current care and support. Involve family or supporters only with the patient’s permission. Provide a named contact, written information and a definite follow-up plan before ending the consultation.
Guideline references
- https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/domain-2-patients-partnership-and-communication
- https://healthservice.hse.ie/staff/training-and-development/training/
- https://www.medicalcouncil.ie/news-and-publications/publications/guide-to-professional-conduct-and-ethics-for-registered-medical-practitioners-2024.pdf
- https://www.nhs.uk/conditions/lung-cancer/diagnosis/
- https://www.nhs.uk/conditions/lung-cancer/treatment/
- https://www.england.nhs.uk/long-read/implementing-a-timed-lung-cancer-diagnostic-pathway/
- https://www2.hse.ie/conditions/cancer/living-with-cancer/
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