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Home / Station 24: Breaking a new colorectal cancer diagnosis

NAC OSCE preparation

Station 24: Breaking a new colorectal cancer diagnosis

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Breaking a new colorectal cancer diagnosis

11 minutes

Discipline: Communication, Ethics & Professionalism
Station type: Bad-news communication
Setting: Outpatient endoscopy follow-up

Your task

Explain the biopsy result to the patient and respond to questions. No physical examination is required.

Information available at entry

Clinically stableBiopsy: invasive adenocarcinoma of sigmoid colonCT staging has not yet been completed

Coach prompt: Deliver serious news clearly, respond to emotion and establish a next-step plan.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 24 of 30

Standardized-patient profile

NameMs. Nadia Hassan

Age54

Pronounsshe/her

RolePatient

Demeanour: Anxious; becomes tearful after hearing the result.

Opening statement: “Please tell me straight. Was the colonoscopy normal?”

History and standardized-patient responses

Patient perspective

Candidate explores	Standardized-patient response
Understanding	Knows a mass was biopsied but was told results were pending.
Preference	Wants direct information and her sister present by phone.
Concern	Her mother died of cancer; fears imminent death.
Supports	Partner and adult daughter available.

Symptoms/context

Candidate explores	Standardized-patient response
Presentation	Iron-deficiency anemia and change in bowel habit.
Current red flags	No obstruction, severe pain or active bleeding.
Values	Wants enough information today but not every statistic.

Physical findings

No physical examination required.
Private seated setting; tissues and uninterrupted time available.

Examiner prompts

How do you state the result?

Use a warning shot and plain language: the biopsy shows colon cancer.

Prognosis?

Acknowledge uncertainty until staging; avoid false reassurance or unsupported numbers.

Next steps?

Staging, colorectal surgery/oncology referral, symptom safety advice and written follow-up.

Differential diagnosis

Confirmed sigmoid adenocarcinoma
Staging not yet known

Investigations

CT chest/abdomen/pelvis or local staging pathway
Baseline CBC, renal/liver profile and CEA where appropriate
Pathology review and multidisciplinary assessment

Management

Urgent referral to colorectal surgery
Oncology involvement based on stage
Manage anemia and symptoms
Provide contact and scheduled follow-up
Offer psychosocial and practical support

Communication behaviours

Name and validate emotion
Use short chunks and teach-back
Do not overload with statistics

Critical safety actions

Use unambiguous diagnostic language
Do not imply terminal disease before staging
Give a reliable next-step timeline

Model closing summary

I am sorry; the biopsy shows a cancer in the sigmoid colon. I can see this is frightening, especially given what happened to your mother. We do not yet know the stage, so I cannot responsibly tell you the prognosis today. The next steps are staging scans and prompt review by colorectal surgery, with oncology input depending on the results. We will arrange these, treat your anemia and make sure you know whom to contact for worsening pain, vomiting, inability to pass stool, heavy bleeding or other urgent symptoms.

Common pitfalls

Euphemisms such as bad cells
Talking continuously after disclosure
False reassurance
Ending without a plan

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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