Oncological History

Question 1

Additional considerations in the presenting complaint

Answer 1

Assess impact of cancer

• symptoms experienced
• explore knowledge of diagnosis, info given so far

Question 2

Additional considerations in the past medical history and drug history

Answer 2

Comorbidities may affect how they tolerate treatments
-try to assess which symptoms are treatment related

Explore potential interactions between medications and treatments
-do medications need adjusting?

Question 3

Additional considerations in family history

Answer 3

May indicate genetic cause of cancer => may impact on recommendations and genetic testing
Gives you an opportunity to explore past experiences with cancer
-can ICE

Question 4

Additional considerations in social history

Answer 4

Risk factors associated with cancer and complications of treatment

Possible loss of fertility
Financial, social support
-time off work?
-caring responsibilities
Cultural and religious beliefs

Question 5

What should you do when communicating a diagnosis of cancer?

Answer 5

Use the word cancer so there is no ambiguity
Be clear with the intentions of treatment

SPIKES
Setting - environment and people present
-ask if the patient would like anyone else around
-quiet room where possible

Perception - sequence of events leading up to this conversation

• talk about the symptoms they had and subsequent investigations
• current patient ICE
• Warning shot: Symptoms like the ones you’ve been describing can sometimes be as a result of an infection, but sometimes they can be as a result of more serious underlying conditions

Invitations - would the patient like you to explain the results now or later?

Knowledge

• Warning shot: As you know we took a biopsy/did a scan, and unfortunately the results were not as we hoped”
• simple language, chunk info
• give time and space for the patient to understand
• If an emotional response: I’m so sorry I had to break this news to you today

Emotions - respond to their reaction
-be honest, no false hope

Strategy

• will be referred to a team of specialists
• summarise important points slowly and gently
• ICE
• offer assistance for answers to questions
• ask about religious preferences, do they need a chaplain?
• highlight where the patient can go for more info