Lesson 3.2: Delivering Unwanted Results and Chronic Diagnoses
Not all difficult news is cancer. A new diagnosis of diabetes, a positive HIV result, or an abnormal smear can be devastating for the patient in front of you. These conversations require the same structural care as SPIKES, but the tone shifts toward information, support, and realistic hope.
How Chronic Diagnosis Delivery Differs
With a chronic or manageable diagnosis, there is an opportunity for genuine hope and action — 'We caught this early', 'This is very treatable with the right support.' The emotional work is still significant, but the structure shifts slightly toward education, reassurance, and shared planning.
Still apply the same opening sequence: check what the patient already knows, check how much detail they want, deliver clearly, respond to emotion first, then move to explanation and plan.
Common PLAB 2 Scenarios
| Scenario | Key Approach |
|---|---|
| Newly diagnosed Type 2 diabetes | Many patients have feared this for years. Others are completely unprepared. Assess ICE first: 'Had you suspected this might be the result?' Acknowledge the emotional impact before explaining. Avoid blame or lifestyle lectures in the first conversation. Offer hope: 'Many people with Type 2 diabetes live full, healthy lives with the right support.' |
| Abnormal cervical smear (CIN) | Common patient fear: 'Does this mean I have cancer?' Be precise: 'This does not mean you have cancer. These are pre-cancerous changes — they have the potential to develop into cancer if left untreated, but they are not cancer now. The good news is that we have caught this early. We refer everyone with this type of result to a colposcopy clinic, which allows us to treat it before it becomes anything more serious.' |
| New HIV diagnosis | HIV carries a specific stigma burden. Normalise first: 'HIV is a medical condition like any other — it is very well controlled with medication today.' With antiretroviral therapy, life expectancy is equivalent to the general population. Acknowledge the emotional response fully before managing. Explore partner notification sensitively — offer to support that conversation. Signpost: Terrence Higgins Trust, specialist HIV clinic. |
| Incidental finding | Do not rush to explain a finding you cannot fully interpret. If you must tell the patient now, use SPIKES. Be honest about what you know and do not know: 'We've found something on your scan that we need to look at further. I don't have enough information yet to tell you exactly what it means, but I don't want to leave you without knowing, and I'm going to arrange the right review as soon as possible.' |