Question 57

Question 1

57. Alcohol, epithelial dysplasia and oral cancer – biopsy results given showing dysplasia. Told to break the news to patient and talk about risk factors

Answer 1

• SPIKES:
  o Setting – privacy (private room, may need chaperone?), sitting down at same level as patient, look attentive and calm, listen, allow time. How has pt been?
  o Perception – ask what the patient knows and understands before you tell, “are you aware of what we’re here to discuss today? Do you know the reasoning for the biopsy? Explain to me your understanding of things up until now”
  o Invitation – obtain permission, “I’ve got the results of your tests here, is it okay with you if we discuss them now?”
  o Knowledge – give a warning, present news in patient’s language, avoid jargon, tailor rate of delivery/break it down, clarify patients understanding, allow time and periods of silence
   “The biopsy that we took from the lesion in our mouth has came back, with a diagnosis of epithelial dysplasia. This term is used to describe harmful changes to the cells that make up the lining of the mouth. These changes occur due to damage to the cells DNA by cancer causing chemicals (carcinogens)” pause
   This can be categorised as low grade, high grade or carcinoma in situ
   Emphasis – “this condition is not cancer, however it is known as a potentially malignant condition, meaning the cells in your mouth are at increased risk of developing into cancer”
  o Empathy – emotional appreciation, put yourself in patients shoes, “im sorry, it must be very hard for you to hear this, I can see that you are upset by this news”
  o Summary and Strategy – summarise the information, allow time for Qs, ensure patient has a clear plan of what will happen next, give written information, reassure with support
   “Thankfully, we have caught this at this stage and we will continue to monitor the lesion regularly for any changes”
   There are ways in which we can reduce the risk of this progressing to cancer. Risk factors that we can change include smoking, alcohol, chewing tobacco and betel/araca nut. Other risk factors are HPV and genetic make up.”
   Low grade dysplasia is monitored, however high grade dysplasia is often removed
   In the mean time:
• Make sure that you attend all appointments for monitoring
• Look for any unsual changes or symptoms from within your mouth
• Avoid smoking and alcohol
• Try to eat 5 Portions of fruit and veg a day as this helps reduce risk

Question 2

what to help with alcohol reudction

Answer 2

o Feedback given to patient about behaviour
 Advised not to drink more than 14 units of alcohol per week on a regular basis
 If you do regularly drink as much as 14 units, it is best to spread it evenly over 3 or more days
 Risk of developing a range of health problems, including oral cancer
o Responsibility placed on patient
o Advice to change given
 Recommend cutting alcohol completely given even more increased risk of oral cancer due to diagnosis
 It also has lots of general health and dental health benefits
o Menu of options offered
 Number of local groups available such as alcoholics anonymous
o Empathic style
o Self-efficacy encouraged