Breaking Bad News: Suspected Lung Cancer
Your Role — Doctor
Respiratory Clinic
Your 66-year-old patient, an ex-smoker, was investigated for a persistent cough and weight loss. A CT scan shows a lung mass highly suspicious of cancer, and a biopsy is being arranged. The patient has come alone expecting routine results. You need to break this news sensitively, respond to their distress, and explain the immediate next steps without giving false reassurance or premature detail.
- •Establish what the patient already understands and expects, and check they are ready to discuss the results.
- •Give a warning shot, then deliver the news clearly and honestly in plain language, at the patient's pace.
- •Allow silence, acknowledge and respond to the emotional reaction with empathy before giving further information.
- •Explain the immediate next steps (biopsy to confirm the type, staging scans, specialist multidisciplinary team, urgent referral) without overwhelming or giving premature prognosis.
- •Offer support (someone to accompany them, written information, a clinical nurse specialist, a follow-up contact) and check understanding.
The Interlocutor
Played by the actor / assessor
You are 66 and came alone expecting to be told your cough is nothing serious. You quit smoking ten years ago. You are not prepared for bad news. When you hear the word cancer you feel shocked and frightened, and your first thoughts are of your grandchildren and whether you are going to die.
- •At first be relaxed and chatty, expecting good news.
- •React with shock and go quiet when the word cancer is used; then say 'Am I going to die?'
- •Say you came on your own and wish your daughter were here with you.
- •Ask whether it's definitely cancer and whether it's because you used to smoke.
- •If the doctor is compassionate and explains the next steps clearly, calm a little and agree to bring your daughter to the next appointment.
Sample Role-play
Hello Mr Fisher, come in and take a seat. I'm Dr Okafor. Before we start, can I ask what you've been told so far about why we did the scan?
Just that my cough was hanging around and you wanted to be thorough. I'm sure it's nothing — probably need some stronger cough syrup, eh?
I can see you were hoping for reassuring news today. I'm afraid the scan has shown something more serious than we'd hoped, and I need to talk it through with you. Is it alright to do that now?
Oh. Yes… go on.
The scan has shown a mass — a growth — in your lung. It looks very likely to be cancer, though we need a biopsy, a small sample, to be certain and to know exactly what type it is. I'm very sorry to have to tell you this.
Cancer… I… I don't know what to say. Am I going to die?
Take your time — this is a huge shock. I can't answer that fully yet, and I don't want to give you either false reassurance or fear that isn't warranted. What I can promise is that we'll find out exactly what we're dealing with quickly, and there are treatments we'll explore together. Right now, I'm here with you.
I came on my own. I wish my daughter was here. Is it because I used to smoke?
It would have been good to have her with you, and I'd really encourage you to bring her next time. As for the cause — smoking can raise the risk, but this is not your fault, and blaming yourself won't help you now. What matters is what we do next.
So what does happen next?
The next step is that biopsy to confirm the type, along with another scan to see the full picture. Your case will then be discussed by a team of specialists who plan the best treatment together. I'll arrange this urgently, and a specialist nurse will be your point of contact for any questions. I'll write the key points down for you to take home.
Alright. I think I'd like my daughter with me for all of this.
That's a very good idea, and completely understandable. Let's arrange the next appointment so she can come, and please phone the nurse before then if anything worries you. I'm so sorry to give you this news today, and we'll go through every step of this together.
Useful Phrases
Clinical Background
Use a structured framework such as SPIKES for breaking bad news: Setting, Perception, Invitation, Knowledge (warning shot then clear information), Emotions (empathic response), Strategy/Summary. Avoid euphemism and premature prognostication. A suspected lung cancer pathway includes tissue biopsy, staging (CT/PET), and multidisciplinary team discussion. A clinical nurse specialist provides continuity. Encourage the patient to have a companion. Give information in small chunks and check understanding.
Common Mistakes to Avoid
- ✕Delivering the diagnosis bluntly with no warning shot, or hiding it in jargon and euphemism.
- ✕Rushing to fill silence or offering false reassurance instead of sitting with the patient's emotion.
- ✕Overloading the shocked patient with staging and treatment detail they cannot absorb at this moment.