Counsel an adolescent and her parent on a new scoliosis diagnosis and the bracing plan — OSCE

Communication framework

Establish what the girl and the mother already understand and fear. Ask them to tell you, in their own words, what they know so far and what they are most worried about. The mother's fear of an operation and the restriction from sport, and the girl's worry about the appearance of the brace and being different from her friends, are the concerns you will spend the most time addressing, and you address them with plain language and with the evidence of why the brace now gives her the best chance of avoiding the surgery. Hear them before you explain anything. ^[2]

Explain the diagnosis in plain language, without jargon. Tell them that the girl has a curve in her spine — a scoliosis — and that it is the common, painless type that appears in the adolescent growth spurt, with no underlying cause (which is reassuring). Translate the radiograph: the curve measures 32 degrees, and because she still has a lot of growing to do (the Risser 0 maturity), the curve is at risk of progressing during the growth spurt. Check their understanding by asking them to repeat back the key idea — the curve is real, it is the common type, and the goal is to stop it getting bigger while she grows. ^[2]

Address the surgery fear directly and honestly. An operation is not needed now. Surgery is reserved for the larger curve of 45 to 50 degrees or more, and the whole point of the brace is to keep her curve below that threshold while she finishes growing. The BrAIST trial — the study that established the benefit of the brace — showed that bracing raised the chance of the curve staying below 50 degrees to 72 percent, against 48 percent with observation alone, with a number needed to treat of 3. Frame the brace as the treatment that gives her the best chance of avoiding the surgery, and acknowledge that the surgery remains an option only if the brace does not hold the curve. ^{[1] [9]}