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Materials

Mr./Mrs. Mendoza

 


 
 
Case Focus: Discussing a Cancer Diagnosis with a Latino Patient who does not want to know the diagnosis.

Presenting Complaint: Patient is coming in for follow-up visit to Family Medicine Clinic for results of colonoscopy.


CASE SUMMARY:

Mr/s. Mendoza is a middle-aged (can be older if available standardized patients are older) man or woman who is of Mexican origin. S/he speaks English adequately for communication, but prefers to speak Spanish at home and with friends.

Mr/s. Mendoza recently saw you for complaints of fatigue and mild RLQ abdominal pain. S/he also complained of occasional dark stools. At that time, physical examination was remarkable only for positive guaiac stool on rectal exam. The remainder of his/her exam had been negative except for a 5 pound weight loss from a prior visit 5 months earlier. You had ordered some labs and found that his/her CBC showed a microcytic anemia. His/her comprehensive metabolic panel was all within normal limits.

You requested a colonoscopy and the patient is returning to discuss the results of this. Unfortunately, a mass in the cecum was identified on colonoscopy, which pathology revealed to be adenocarcinoma.

At the patient’s last visit, he/she was accompanied by his/her son, Luis. Luis had pulled you aside for a moment while his father/mother went to check out to tell you that his father/mother should not be told any bad news, especially if there is something serious like cancer. He explained that the family wants to protect his father/mother from the shock of any bad news and not make him/her sicker by making him/her afraid.

Mr/s. Mendoza lives with his/her son, daughter-in-law and grandchildren. His wife/her husband died 3 years ago


LEARNER OBJECTIVES:

  1. Discuss with a patient his/her wishes regarding disclosure of a cancer diagnosis (a potentially terminal illness)
  2. Use the patient’s and family’s wishes to guide the physician’s approach to disclosure of diagnosis, recommendations for additional testing and treatment possibilities.

Your challenge as the Simulated Patient is threefold:

  1. Describe Mr/s. Mendoza’s wishes regarding learning his/her diagnosis and how much s/he wishes to know
  2. Observe the physician’s approach to asking the patient about his/her wishes and to future testing and treatment options while performing the role; and
  3. Accurately recall the physician’s behavior and complete the performance checklist


PRESENTATION/EMOTIONAL TONE:

A little reserved and anxious about learning the results

Throughout the Encounter

You are mainly going to be answering the questions posed by the doctor. You are respectful of authority and are also not used to asking too many questions yourself. You trust the doctor to do the right thing for you and are optimistic that everything will be fine.

Basically, you do not want to hear bad news, namely that you have cancer. You are willing to do what the doctor recommends regarding additional testing and treatment. You want your son involved in decision making too.


PAST MEDICAL HISTORY:

No allergies, No medications. You are in good health except for the above problems. Your only surgery was an appendectomy as a child in Mexico.


SOCIAL HISTORY:

You were born in Mexico and came to the U.S. at 19 years of age with your husband/wife. You lived in Florida. You worked in construction/housekeeping all your life and moved to Charlottesville 3 years ago to be closer to your son, Luis, after your husband/wife died. You retired when you came to Charlottesville. You have two children, ages 35 (Luis) and 32 (Anna). Anna lives in Washington, DC. You have an 8th grade education and can read and write in Spanish. You speak English conversationally and can read and write a little. You are an observant Catholic and go to church regularly. You have started to make some friends through the church.


SUBSTANCE USE:
You do not smoke, drink or take illicit drugs.