PLAB 2 Clinical Communication & Breaking Bad News

Question 1

Which framework is commonly used for breaking bad news in UK clinical practice?

Accepted Answer

SPIKES: Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary

Answer

ABCDE (Airway, Breathing, Circulation, Disability, Exposure)

Answer

SBAR: Situation, Background, Assessment, Recommendation

Answer

ISBAR: Introduction, Situation, Background, Assessment, Recommendation

Question 2

When breaking bad news, what does 'warning shot' mean?

Accepted Answer

Giving a preparatory phrase before delivering bad news to allow the patient to mentally prepare ('I'm afraid the results are more serious than we hoped...')

Answer

Informing security staff before a difficult consultation

Answer

Asking a colleague to be present in case of adverse reactions

Answer

Checking that emergency equipment is available

Question 3

After breaking bad news of a cancer diagnosis, the patient becomes angry and says 'You must have made a mistake — how could you have missed this earlier?' How should you respond?

Accepted Answer

Acknowledge the patient's anger with empathy ('I understand you're very angry and this must be a terrible shock'), allow them to express feelings, and avoid becoming defensive

Answer

Defend yourself and explain the diagnostic timeline in detail immediately

Answer

Ask the patient to calm down before continuing

Answer

Immediately arrange a formal complaint process

Question 4

A patient has been told they have terminal cancer. They ask 'How long have I got?' How should you respond?

Accepted Answer

Explore what the patient is really asking; give a range if asked for specifics; avoid false certainty while not removing all hope; check what they want to plan for

Answer

Give a specific number of weeks or months based on statistics

Answer

Tell them it is impossible to say and change the subject

Answer

Refer them to oncology without answering

Question 5

During a consultation about a patient's terminal illness, what is the purpose of checking understanding (the 'chunk and check' technique)?

Accepted Answer

To deliver information in small pieces and regularly check comprehension, so the patient can absorb what they have been told and ask questions

Answer

To test the patient's intelligence

Answer

To speed up the consultation by skipping already-known information

Answer

To document that information was given for medico-legal purposes

Question 6

A patient requires a lifestyle change (stopping smoking, starting exercise). Which communication approach is most likely to be effective according to evidence?

Accepted Answer

Motivational interviewing — exploring the patient's own motivation, identifying ambivalence, and supporting self-efficacy, rather than directing or lecturing

Answer

Telling the patient repeatedly about the health risks until they comply

Answer

Prescribing nicotine replacement without further discussion

Answer

Referring all lifestyle issues to the specialist nurse