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Psych CASC / OSCEProfessional practice

Psych CASC / OSCE · Professional practice

Breaking the news of a dementia diagnosis — CASC communication station

MRCPsych/FRANZCP-style station: break the news of a dementia diagnosis using SPIKES, manage emotion and the spouse dynamic, address driving honestly, and close with a checkable plan.

communication3 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Study tools

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar in a memory clinic. A 68-year-old retired headmaster has completed assessment for progressive memory failure over 18 months; investigations support Alzheimer dementia. He attends with his wife. He has told the nurse he suspects 'it's just stress'. His wife has asked the team not to upset him. In the waiting room is a driving licence renewal form he wants to post tomorrow.

Station brief

Format. Communication station, approximately 7 minutes after reading time. You are the psychiatry registrar. Both the patient and his wife are in the room.[1]

Candidate instructions. Break the news of the diagnosis clearly and kindly, in a structured way; respond to emotion without blocking it; address the driving question honestly; agree next steps; check understanding before the bell. Do not lecture; do not collude with "just stress"; do not recite foreign legal section numbers — state that driving notification duties exist and you will check the local requirements with him.[1][2]

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References5ShowHide
  1. [1]Baile WF, Buckman R, Lenzi R, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer Oncologist, 2000.PMID 10964998
  2. [2]Kurtz S, Silverman J, Benson J, et al. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides Acad Med, 2003.PMID 12915371
  3. [3]Maguire P, Faulkner A, Booth K, et al. Helping cancer patients disclose their concerns Eur J Cancer, 1996.PMID 8695247
  4. [4]Jorm AF, Jacomb PA The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms Psychol Med, 1989.PMID 2594878
  5. [5]Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice J Gen Intern Med, 2012.PMID 22618581
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