Case Summary:
You are Elaine Stuart, a 55-year-old high school math teacher. You were in this doctor’s office two weeks ago for a physical exam after experiencing some rectal bleeding. Following this exam, you were sent to a gastroenterologist (GI specialist) and had more tests. You now are back to get the results of the colonoscopy and biopsy performed 10 days ago (1/14/98).

Why You Are Seeing The Doctor Today:
You are seeing the doctor today to obtain the results of the colonoscopy and biopsy.

Opening Statement:
In order to start all of the encounters in a similar manner, your opening statement should be about obtaining the results of your biopsy. It’s hard to predict what the resident will say when he/she comes in the room; your response should be appropriate to the resident’s statement or question. For example:

The resident may ask you, "How are you doing, Ms. Stuart?"

• You would respond: "OK, but I’ve been having some bleeding that has me concerned."

• Well-groomed, dressed neatly in a professional manner, as if you were going to return to work.

• You appear to be fairly calm.
• You look the resident in the eye.
• You may become a bit anxious as the interview proceeds, once you’ve been told you have cancer. The test results show that there is a large malignant (cancerous) mass found at the hepatic flexure of the colon. A mass in this area of the bowel does NOT indicate the need for a colostomy (wearing a bag for waste.)
• As the resident explains the treatment that you will need, he/she should acknowledge or ask about your feelings or concerns.
• If the resident does not, you will become quiet, as if you are thinking about something or are worried. Hopefully, this will prompt the resident to ask about your concerns, which are:
  • the possibility of a colostomy (wearing a bag for waste).
  • you wonder how you "got this."
  • you wonder if you will die.

• You have been generally in good health.
• Last seen by the doctor in January 1997, for an initial history and physical. At that visit, you were given a "clean bill of health."
• No allergies.
• Only hospitalization for a tonsillectomy at age 9.
• Surgery-tonsillectomy as a child.
• No serious illnesses except for pneumonia in 1980.
• Immunizations up to date.
• GYN/OB: Normal history; menopause 2 years ago at age 53; you see your gynecologist for routine care; had a Pap smear, rectal exam, and stool analysis 6 months ago which were normal. A mammogram 2 months ago was normal.

You have been feeling fine, except for minor fatigue, but are very concerned about the tumor that was found when they did the colonoscopy and whether or not it is cancer.

• Your current symptoms began about six weeks ago when you began noticing blood in your stool.
• The amount of blood increased and you became quite concerned; this is when you first saw this resident (2 weeks ago).
• The resident referred you to a GI specialist, who tested your stool for blood; the results were positive, so he did a colonoscopy.
• During the colonoscopy, a mass was found which was immediately biopsied. You do not know the results of the colonoscopy or biopsy.
• You have not lost any weight.
• You do not have any pain.
• You have been feeling fatigued for the last few weeks.
• You have spoken to your neighbor who has agreed to serve as your agent for health care proxy. You have spoken to her in detail about your wishes regarding your end of life preferences. (If pressed for a response you may offer this or something else that’s appropriate.)

• Prescription Medication: None. This is what you will answer when asked, "Are you on any medication?"
• Over-the-Counter Medication: Over the counter vitamins. Aspirin for occasional joint pain. This is what you will answer when asked, "Do you take any over-the-counter medicine?"

Personal Habits:
Alcohol Use: A glass or two of wine on weekends.
Tobacco Use: None.
Caffeine Use: 2 cups of coffee a day.
Drugs (Illicit): No history of illicit drug use.
Vitamins: Take "One a Day," one tablet per day; occasional aspirin for joint aches.
Exercise: You don’t have time.
Health Insurance: You are covered under your school’s Independent Health Association Plan.

• You will respond the same to all interviewing styles.

"What are you most concerned about?" "I am concerned about the need for a colostomy. I am also concerned about whether this has spread anywhere, how I got this and if I will die from it.

• "How did I get this?"
• "Do you think it has spread?"
• "Will I need a colostomy?"
• "How long will I live?"

• "What do you mean?"

• "Isn’t there anything else you can do?"
• "Is this the only course of treatment we can take?"