The information found on this site is the personal opinion of the authors, and is intended to educate and interest, rather than to direct clinical management for specific patients. Copyright is shared between the author/s and this site. You may reproduce this content as long as the original source is credited. No information on this site may be reproduced for profit.

Communication 8: Breaking bad news

Theme: Breaking bad news/Explaining a diagnosis
Suitable for: Paediatric trainee (ST1-3)
Clinical scenario: Jack was born at term 4 hours ago.  Midwife has asked you to review as the baby has abnormal facial features.

On assessment you feel Jack has T21.

Information for candidate: Please discuss your suspected diagnosis with Jack’s parents
Information for actor: You have just had your second child – a boy called Jack.

You have no idea at all that there might be something wrong with him – you think he looks like your first child did at birth.

On antenatal testing there was a low risk of trisomies on quadruple testing.   Care was otherwise routine and there were no abnormalities.

You don’t know much about trisomy 21 but know of children with the condition who are ‘a bit slow but very sweet’.

You have lots of questions about what happens now and what problems it may cause Jack.

–       What tests will be done?

–       Will Jack be able to stay with you or have to go to the neonatal unit?

–       When will you know for sure about the diagnosis?

–       What help will Jack need?

–       What problems could Jack have (short and long term)?

–       When can you go home?

You want to know whether Jack having trisomy 21 has an impact on the likelihood of any further children having it.

Information for scenario lead: Stop the scenario once the parents’ questions have been answered.  The candidate should ideally summarise the information given.
Possible points for discussion in debrief: Breaking bad news

How much information should you give before confirming the diagnosis?

Problems associated with trisomy 21.

Actions to take in cases of suspected T21

Supporting parents following an unexpected diagnosis

Scenario contributed by Claire Strauss

The clinical details of this simulation scenario are not based on any one particular case. Similarity to any real life clinical scenario or child is purely coincidental.

The information found on this site is the personal opinion of the authors, and is intended to educate and interest, rather than to direct clinical management for specific patients. Copyright is shared between the author/s and this site. You may reproduce this content as long as the original source is credited. No information on this site may be reproduced for profit. 2018, paediatricfoam.com