Jennifer Hawkins (Breast Cancer)
Communicating Bad News Resident Evaluation
Adapted from: University of Rochester Medical Center, ACGME Competency Project, 2006
Standardized Patient Information
Name/Age/Sex: / Jennifer Hawkins, 65-75 year old womanEthnicity/Race / Any
Presenting Situation / You are coming in to your doctor’s office to follow-up on a breast biopsy done yesterday for a palpable lump. You had found the lump while doing a routine self-exam, and came in to be seen right away (last week).
Opening Statement / Good morning/afternoon Doctor.
If resident asks open-ended questions or allows silence, you will volunteer the following / “These have been the longest couple of days in my life.”
Onset of symptoms / Last week she found the lump while doing a routine self-exam, and came in to be seen right away. Dr. sent her for a biopsy that was performed yesterday. Today she is here for the results. She has been told that it is possible that it could be cancer.
Medications / Ibuprofen 400 mg three time a day as needed post-biopsy pain
HCTZ 25 mg once a day
Alendronate 70 mg PO once a week
Vitamin D 800 IU once a day
Multivitamin once a day
Past Medical History / Hypertension
Osteoporosis
Had a normal mammogram 11 months ago
Family History / Mother had breast cancer at age 60 and was treated with surgery alone. She died a few years ago of congestive heart failure.
Sister was diagnosed six years ago with left sided breast cancer and had a left total mastectomy. Positive lymph nodes were noted at surgery. Her sister received chemotherapy and radiation. Despite these treatments, 4 ½ years ago metastases were diagnosed and she was then treated with hormones. Two years ago she developed brain metastases and died six weeks later despite radiation therapy to the brain.
Since this sister died of cancer a few years ago, the patient was quite frightened regarding this possibility – she has been aware of her risk and has had regular mammograms though no genetic testing. The patient feels that she knows a fair bit about the side effects of treatment given her sister’s history.
Children / Two male children, age 40 and 42
Social history / Social supports include several close women friends none of whom have had breast cancer.
Functional status / Independent in all activities of daily living, continues to play tennis at least once a week, walks approximately two miles a day, enjoys travel
Education / College degree
Employment / Retired, former worked as a bookkeeper
Marital status / Divorced, and currently engaged to a different man
Habits / Drinks a glass of wine 2-3 times/week. Quit cigarette smoking five years ago.
Flow of conversation / At the visit last week she and the doctor had discussed the various possibilities of what this was, including both benign disease and cancer. However, he mentioned that there was a swollen lymph node in her armpit, which worried her further. The plan at the last visit was to obtain a biopsy then to return today to go over the results and decide what, if any, further steps needed to occur.
At today’s visit the patient learns that the biopsy does in fact show cancer. She is scared and her first thought is “I’m going to die, aren’t I?” Her other immediate concern is how she is going to tell her partner and children about the diagnosis.
Statements that the patient may make include:
“I knew it was possible, but I can’t believe I’m the third woman in my family to have breast cancer.”
“Aren’t I unlucky?”
“How will I tell my fiancée and kids?”
“I don’t want to miss watching my grandchildren grow up.”
“What should I do now?”
“Am I too old to get treatment?”
Demeanor / Frightened, Anxious
Appearance / Somewhat restless
Clothing / Comfortable clothes