INFORMATION SHEET FOR CANDIDATE:

You are working as a locum GP. The next patient is a 60 year old
Mr. Johnson who had a right sided hemicolectomy because of an
obstructing carcinoma two years ago.
About 1 month ago he developed a bowel obstruction and
underwent an emergency laparotomy. The intraoperative finding
was a local recurrence of the tumour as well as multiple
secondaries in his pelvis. The obstructing tumour was removed
with an entero-enterostomy. The secondaries were not removed,
the liver was described as being free of metastases. A discharge
letter informed you that Mr. Johnson had been made aware of
the findings and that he was scheduled for a review at
outpatients later this month regarding a discussion of further
management.
Mr. Johnson sees you today because of increasing dull pain in
his right lower abdomen and on physical examination you find a
firm, fixed mass in the RIF which you can also feel on p.r.
examination which gives you the impression of the recurrence
of a now incurable colon cancer.
Your tasks are to:
1. explain todays findings and the sinister outlook to the
patient
2. advise the patient regarding further management

TASKS:

you are expected to demonstrate an understanding, empathetic approach to

the patient, your communication skills need to include sensitivity to the
impact this has on the patient, aiming for establishing trust and support.

Assess the patients understanding of his conditions following the surgeries,

dont assume any knowledge!

Give your point of view in an unhurried and frank manner but balanced with
encouragement and hope and the reassurance of ongoing support.
Explain the most likely relationship between todays findings and the
previous operations and gently outline the possible future outlook even
though it might look bleak. However, avoid firm predictions! We will deal
with possible problems when they happen!

Offer to invite a relative or friend, discuss religious aspects if applicable.

Allow for time to react to the news (disbelief, stunned, silence, anger,
distress, guilt etc.).

Encourage patient to organise personal things like a will and financial affairs,
only if pat. seems to be up to this!

Advise other points like diet and general life style changes / adaptations.

Discuss possible complications like pains, bowel dysfunction, bleeding etc.

and assure patient that especially with the palliative care team these problems
can be managed quite well and that you will be available to co-ordinate
necessary services.