Communication Challenges in Haematology

Question 1

4 Important Aspects of Disclosing Bad News

Answer 1

Gathering information from the patient. What do they already know?

Sharing the medical information(test results)

Providing support for the patient- acknowledge their reaction.

Explaining treatment options and facilitate the process of the patient making an informed choice about the treatment plan.

Question 2

SPIKES Model

Answer 2

Setting and listening skills
Patient’s Perception
Invitation or Indication
Knowledge (in small chunks, check understanding, avoid jargon)
Explore emotions and empathise
Strategy and summary - arrange the next step/follow-up

Question 3

Cause of Acute Promyelocytic Leukaemia

Answer 3

Caused by translocation between chromosomes 15 and 17

Creates PML-RARalpha fusion gene.

All trans-retinoic acid forces blasts to differentiate to normal cells and subsequently die

Question 4

Why do patients with acute promyelocytic leukaemia present with blood clots or catastrophic bleeding

Answer 4

Malignant promyelocytes contain pro-thrombotic granules. Granules trigger coagulation which uses up clotting factors/platelets

Question 5

Leukaemia in Pregnancy

Answer 5

Successful pregnancy outcome is unlikely
Spontaneous pregnancy loss carries considerable risk to mother
Therapeutic termination should be advised

When diagnosed after 32 weeks, aim for elective delivery to allow chemotherapy to be given

24-32 weeks – risk of fetal chemotherapy exposure should be balanced against risk of prematurity

Question 6

Leukaemia in Pregnancy risk to mother

Answer 6

Untreated AML is invariably fatal within months (and often days or hours)
Any deterioration in maternal health typically accompanied by fetal decline

Question 7

Leukaemia in Pregnancy risk to fetus

Answer 7

Pregnancy loss, growth retardation, congenital malformation all possible – increased risk with earlier exposure
No way of accurately quantifying risk – every mother/ baby is different