Medical Ethics 8 Minutes Margaret Taylor, 63 yo (Outpatient Clinic)

Breaking Bad News: Pancreatic Lesion (SPIKES)

Candidate Instructions: Mrs. Margaret Taylor attends the outpatient clinic following an urgent CT abdomen for painless jaundice and unintentional weight loss. The CT report confirms a mass in the head of the pancreas suspicious for adenocarcinoma. Break the news to the patient.

Examiner Marking Checklist

Setting & Perception (S & P)

✓ Ensure privacy, offer presence of a companion or support person
✓ Ask what the patient understands so far ("What did the GP tell you about the scan?")

Invitation & Warning Shot (I & K)

✓ Establish how much detail the patient wants to hear today
✓ Give a gentle warning shot ("I am afraid the results were not as reassuring as we hoped")

Empathy & Strategy (E & S)

✓ Pause and allow silence for emotional processing
✓ Name and validate emotions ("I can see this is very shocking news")
✓ Outline concrete next steps (MDT discussion, biopsy, specialist nurse contact)

Critical Red Flags

⚠ Giving medical jargon ("adenocarcinoma of the uncinate process") without explanation
⚠ Rushing through the patient’s tears or emotional pause
⚠ Falsely promising a cure before oncology MDT review

Post-Station Examiner Questions

Examiner: "What are the 6 stages of the SPIKES protocol?"

Model Answer: Setting up, Perception, Invitation, Knowledge (information sharing), Empathy/Emotions, Strategy and Summary.

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