Learning outcome: Give difficult results clearly, allow the patient time to respond and adapt the amount of information that follows. This OET Speaking for Doctors lesson uses a lung-cancer biopsy consultation to practise honest language, attentive pauses and a usable next-step plan. Work through original paired five-task cards, a condition lesson, task coaching, an extended doctor model and a changed-answer exercise.
A pause after difficult news is not an empty space to fill with every treatment you know. The patient may be trying to understand the word cancer, thinking about a family member's experience or deciding what they can hear next. Speak clearly enough for the news to be understood, then give the response room to shape the conversation.
1. Original paired cards: confirmed news and unanswered questions
These original Jobins Training cards are independent OET preparation material, not official exam cards. They deliberately state what is confirmed and what is unknown so that reassurance stays accurate.
Doctor card
Setting: A private respiratory clinic consultation.
Situation: Mr Adams, 61, has attended to discuss a lung-biopsy result after investigations for a persistent cough. In this original case, pathology has confirmed lung cancer. The subtype, stage, molecular-test results and individual prognosis are not supplied; further assessment and specialist discussion are needed. He is clinically stable today and has come alone. No scan appointment or treatment decision has already been arranged in the card. Explain the confirmed finding sensitively without inventing missing details or avoiding the word cancer.
Tasks:
- Establish what Mr Adams understands about the investigations and whether he wants anyone with him for the discussion.
- Give a brief warning that the result is difficult, state the confirmed finding clearly and pause.
- Respond to his reaction and explore the concern behind his questions about the future.
- Distinguish what the biopsy confirms from what further assessment must establish, and discuss next steps at the level of detail he wants.
- Agree immediate support and follow-up arrangements to be confirmed, check the essential understanding and invite remaining questions.
Patient card
Setting: The clinic where you are receiving your biopsy result.
Situation: You are Mr Adams, 61. You knew cancer was one possibility but hoped the cough had another cause. You chose to come alone and initially want to hear the result now. When told it is cancer, you become quiet. Your father died shortly after a cancer diagnosis, and you fear the same timetable applies to you. You also worry about telling your adult son, who lives abroad. You want a clear next step but cannot take in a long treatment lecture.
Tasks:
- Explain what you were told about the biopsy and say you want to hear the result.
- React with a quiet pause, then ask the doctor to confirm what has been found.
- Explain your father's experience and ask whether the doctor can say how long you have.
- Ask what further tests are for and whether chemotherapy has already been decided.
- Discuss whom you want involved, say how much information you can manage today and explain what you understand about the next step.
Preparation prompt: Separate three messages: the biopsy confirms cancer; the stage and suitable treatment are not yet supplied; the patient needs support and a clear route to further discussion. Do not merge them into either “everything is uncertain” or “we already know what will happen.”
2. Understand the result before explaining the future
What lung cancer means
Lung cancer involves abnormal cells growing in the lung. Some cancers begin in the lungs; other cancers can spread there from another part of the body. The fictional card supplies a confirmed lung-cancer diagnosis, so the learner should not turn it into an unexplained “shadow” or merely a possibility. At the same time, the card does not supply the full pathology or staging information.
A biopsy examines a tissue sample. Its findings can establish the diagnosis and may help identify the cancer type. Explain that purpose in ordinary language: “The sample contained cancer cells.” The patient does not need a lecture about the laboratory process before hearing the result they came to discuss.
Diagnosis, type and stage answer different questions
The diagnosis names the condition. The type describes the kind of cancer cells, while the stage describes its extent, including whether it has spread. Lung cancers include small-cell and non-small-cell groups. These distinctions help guide treatment, but the learner must not select a type or stage simply to make the conversation sound more complete.
The need for further scans does not make the confirmed biopsy finding uncertain. Nor does ordering a scan prove that spread has occurred. A useful explanation is, “We know what the sample has shown; the further assessment helps us understand the extent and plan treatment.” This separates knowledge from the next question.
Why further assessment may be needed
The specialist team may use imaging and other tests to clarify the extent of the cancer and information relevant to treatment. Some tumours undergo tests for changes that can help guide medicine choices. Which tests are appropriate depends on the findings and the person's situation. Avoid listing every available scan as though all have already been requested.
The original role-play does not provide dates. Say that arrangements must be confirmed and explain how the patient will be informed. “The scan will definitely be tomorrow” is not compassionate precision if the speaker has no evidence for it. A clear account of responsibility and contact is more dependable than an invented date.
Treatment is not one automatic pathway
Possible treatments include surgery, radiotherapy and medicines such as chemotherapy, targeted therapy or immunotherapy. Their suitability depends on factors including cancer type, extent, relevant tumour features, general health and the person's preferences. The specialist team explains the options, likely benefits and possible adverse effects before an individual plan is agreed.
For a newly informed patient, naming all these treatments may be too much. Ask how much detail would help now. If the immediate question is “Does this mean chemotherapy?”, the useful answer is that a treatment decision has not yet been supplied and requires the relevant assessment. It is not a promise that chemotherapy will be unnecessary or a declaration that it must happen.
Prognosis needs individual information
Prognosis concerns the likely course of a condition. It cannot be responsibly reduced to a survival estimate from the word lung cancer alone. A relative's experience may explain the patient's fear, but it does not establish this patient's outlook. Do not invent a stage, a chance of cure or a recovery timetable to make reassurance sound stronger.
Honesty can still be supportive. Explain what is not known, why it matters and how the next assessment helps. “I cannot give you a reliable answer from the information we have today” should be followed by a plan for continuing the discussion, not an abrupt change of subject.
Emotional responses and information needs vary
Silence, tears, anger, repeated questions or a practical question about getting home can all occur after difficult news. Do not decide that silence means acceptance, that an apparently calm patient is unaffected or that everyone wants detailed information immediately. Ask what the person needs and allow their preference to change during the consultation.
Support can include a clinical nurse specialist, further discussion with the team, written information and emotional or practical help. Ask before involving relatives or friends. A support person can help the patient remember and discuss information, but the patient remains the person whose wishes guide the conversation.
Keep immediate wellbeing in view
This is a stable results consultation. New severe physical symptoms require their own assessment rather than being attributed automatically to distress or cancer. Before closing, check how the patient is managing, whether they want someone contacted and whether they can leave with a usable plan. Do not give every person the same collection of leaflets as a substitute for asking what help they want.
Clinical reading: The lesson was checked against NHS lung-cancer tests and next steps, NHS treatment information, Cancer Research UK's explanation of types and stages, and Macmillan guidance on questions for the healthcare team and talking and support.
3. Complete the tasks at the patient's pace
Task 1: establish the starting point
Ask what the patient understands about why the biopsy was taken and what they were expecting today. This helps you avoid either assuming complete awareness or repeating information they already know. Check whether they want someone present without suggesting they cannot hear the result alone.
Use a private, attentive manner. In spoken practice, a brief setting statement is enough; the skill should then be demonstrated through the conversation. Narrating a long list of ideal behaviours is not a substitute for speaking to the patient.
Task 2: give the message clearly and stop
A short warning such as “I'm afraid the result is serious” prepares the listener. Follow it with the actual finding. Do not surround the diagnosis with euphemisms that leave the patient unsure whether cancer has been found.
After the clear sentence, pause. Avoid immediately adding the stage uncertainty, five treatment categories and the follow-up plan. The patient first needs a chance to hear and respond to the central news.
Task 3: respond to the meaning of the reaction
If the patient is silent, allow time and offer a gentle invitation. If they ask for repetition, repeat plainly. If they mention their father's death, recognise why that memory shapes the question about time. “What happened to your father is making this news feel even more frightening” is more specific than an unrelated reassurance.
Do not force the patient to express emotion in a preferred way. A practical question may be how they begin to manage the situation. Answer it with the same respect as a question accompanied by tears.
Task 4: distinguish facts, unknowns and options
Use short sections: what the result shows, what further assessment is for and what will be discussed afterwards. Check whether the patient wants more detail before expanding. Answer direct questions honestly rather than evading them behind a generic promise that the team will help.
When asked about prognosis, acknowledge the question and explain the information gap. Do not quote population statistics as a personal prediction or assume the patient's family experience will be repeated. Give a credible next step for revisiting the question.
Task 5: leave a small, usable plan
Agree who the patient wants involved and what information they would like to take away. Confirm how the next assessment and results discussion will be arranged, and the appropriate contact route. Distinguish an action you propose from one that has already been completed.
Check understanding gently: “What would be helpful for me to go over again before you leave?” A brief recap can follow. Avoid demanding a detailed teach-back immediately after distressing news as though the consultation were a memory test.
4. Extended doctor-viewpoint model with listening pauses
This model contains the doctor's spoken contributions and teaching notes for the pauses. A partner supplies the patient's reactions. It demonstrates several possible branches, so select what fits the response rather than attempting to recite every paragraph during one role-play.
“Hello, Mr Adams. I'm Dr Shah. We are meeting to discuss your biopsy result. Before we begin, could you tell me what you understood about why the sample was taken?”
Listen to the patient's starting point. Do not assume he already knows the result merely because cancer was mentioned as a possibility.
“You knew that cancer was one of the possibilities, but you were hoping the tests would show another cause. Would you like anyone with you while we discuss the result, or would you prefer to talk now?”
In the first attempt he chooses to continue alone. Respect the answer and remain open to a change of preference later.
“I'm afraid the result is serious. The biopsy has confirmed cancer in your lung.”
Stop speaking. Allow the news to register. Stay attentive without demanding eye contact, touching the patient without regard to their wishes or filling the silence with treatment information.
“Take the time you need.”
If he asks whether he heard correctly, repeat the central finding clearly rather than changing to a euphemism.
“Yes. The tissue sample contained cancer cells. I'm sorry to be giving you this news.”
“Would you like a moment, or would it help to talk about what is going through your mind?”
Let the patient choose. If he begins to discuss his father's experience, listen before responding to the prognosis question.
“Your father died soon after he was diagnosed, and you are frightened that the same thing will happen to you. That experience makes this news especially difficult to hear.”
“You are asking how much time you have. I cannot give you a reliable estimate from the information we have today. We need to understand more about the cancer and your overall situation. Your father's experience does not tell us what will happen in your case.”
“I know that not having an answer is hard. I do not want to give you a number that would be a guess. We can return to that question with the specialist team when the relevant information is available.”
Pause. If the patient wants no more information, move to essential support and arrangements. If he asks about the tests, explain their purpose briefly.
“Would it help to hear the main next step, without going into all the treatment details today?”
“The biopsy has told us that cancer is present. Further assessment helps establish its extent and the information needed to choose treatment. You may hear the word stage; that describes how far the cancer has developed or spread. We do not have that complete information here.”
“Needing further scans does not mean we already know it has spread. The scans help answer that question.”
“Which part would you like me to explain again?”
If he asks whether chemotherapy is decided, answer that specific question before adding alternatives.
“No individual treatment plan has been agreed from the information we are discussing today. There are different options for lung cancer, and what is suitable depends on the type, extent and other findings, as well as your health and preferences. The specialist team would explain the options and their benefits and risks with you.”
“Would a brief outline help now, or would you prefer to leave that discussion until we have more information?”
Do not give the outline if the patient declines. A choice is meaningful only when the response changes the conversation.
“You also mentioned your son. What is worrying you most about telling him?”
“You want to tell him yourself, but you are not sure what to say while there are still unanswered questions. We can help you separate what is confirmed from what is still being assessed. Would a short written summary be helpful?”
“If you later want someone to join a discussion with the team, we can explore how to arrange that. Who, if anyone, would you like us to involve? We will check your wishes about what is shared.”
Use only the support preferences the patient expresses. Do not call or promise to call a family member without agreement.
“You do not have to remember every detail today. The two main points are that the biopsy confirms lung cancer and that further assessment is needed to plan the next steps. We should make sure you know how those arrangements will be communicated and whom you can contact with questions.”
“I can discuss support from the clinical nurse specialist and check the contact details with the team. Would you like help with that before you leave?”
“How are you feeling about leaving the clinic today? Is there someone you would like to contact or have with you?”
Respond to the answer before ending. If new physical symptoms or another immediate concern emerges, assess it rather than assuming it is simply an emotional reaction.
“What is the most useful thing for us to clarify now? We can keep the written plan brief and continue the discussion when you are ready for more detail.”
5. Speaking tips: allow space without losing clarity
Use the diagnosis word when it is confirmed. “An abnormality” may describe many things. If the result confirms cancer, unclear wording can leave the patient trying to decode the message rather than process it.
Let the pause be responsive. There is no single correct number of silent seconds. Attend to the patient, allow time and offer a gentle invitation when appropriate. Counting a fixed pause and then restarting a lecture misses the purpose.
Answer the question that was asked. “Will I die soon?” deserves acknowledgement and an honest explanation of the limits of current knowledge. Responding only with a list of services can feel evasive.
Recognise a specific fear. The patient's father's experience is relevant because it explains the anticipated timetable. Acknowledge that link without treating the two illnesses as medically identical.
Ask before adding detail. An initial request for the result is not a request for every possible treatment. Information preferences can change after the central news has been heard.
Offer support concretely. Check the actual contact route, ask about a chosen support person and explain what will happen next. Avoid broad promises that the same doctor will always be available or that every requested service can be arranged immediately.
Keep hope honest. Hope can concern receiving clear information, discussing suitable options and getting support. It does not require a guarantee of cure or a prediction that treatment will be easy.
6. Useful sentences and when to use them
| Purpose | Adaptable wording | Why it helps |
|---|---|---|
| Find the starting point | “What were you told the biopsy was checking for?” | Establishes what the patient already understands. |
| State the result | “The biopsy has confirmed cancer in your lung.” | Gives the supplied finding without euphemism. |
| Allow a pause | “Would you like a moment before we continue?” | Offers space without assuming how the patient must react. |
| Separate the unknown | “We still need information about its extent.” | Clarifies the unanswered question without weakening the diagnosis. |
| Answer prognosis honestly | “I cannot give you a reliable estimate from what we know today.” | Acknowledges the question and avoids an invented prediction. |
| Check information preference | “Would the main next step be enough for now?” | Allows the patient to limit the amount of detail. |
| Explore support | “Who would you like involved in the next discussion?” | Keeps the patient's choice central. |
Say the result sentence aloud at a steady pace, then practise stopping. Ask a partner to vary the response: silence, a request for repetition, a prognosis question or a practical concern. Your next sentence should change with the reply.
7. Common mistakes and practical repairs
“There is a little problem on the result.” This hides the seriousness and may mislead. Use the confirmed diagnosis plainly and compassionately.
“It might be cancer” when the card confirms it. Sensitivity does not require false uncertainty. Separate the confirmed finding from the unknown stage and treatment.
“You will beat this if you stay positive.” This promises an outcome and burdens the patient with responsibility for it. Offer support without making emotional attitude a condition of recovery.
“Your scan is tomorrow; I have spoken to oncology.” These arrangements are not supplied. Explain what needs arranging and confirm the actual process.
“Your family needs to know, so I will call them.” Ask whom the patient wants involved and what they agree to share. Do not replace their preferences with yours.
“Let me finish explaining all the treatments first.” A request to stop should change the discussion. Agree the essential immediate plan and return to detail later.
8. Second attempt: the patient wants someone present
Keep the confirmed biopsy result and the unanswered staging questions. After hearing the diagnosis, Mr Adams now says, “I can't take in treatment details today. Could we talk about those with my sister here?” He wants the essential next step and contact information now, but asks to defer the longer discussion.
Your task: Recognise the information preference, ask about involving his sister and agree how a further discussion can be arranged. Keep the essential immediate plan clear. Do not treat the request as refusal of all care, assume permission to share everything or proceed with the full treatment lecture.
Reveal the teaching response and reasoning
“Yes, we can keep this to the main next step for now. Would you like your sister involved in the next discussion, and what would you like us to share with her? Let's confirm how that can be arranged and make sure you have the right contact details before you leave.”
This response changes the amount and timing of information while maintaining a plan. It respects the patient's request without pretending that an appointment or a relative's attendance is already confirmed.
A weaker answer says, “It is important, so you need to hear it all now.” Another ends with “Come back when you are ready” and gives no route to care. The stronger response combines a manageable immediate step with an agreed way to continue.
Recording review
Find the sentence that delivered the result. Did it accurately state the card's finding? Then listen to the next contribution. Did the doctor allow a response, acknowledge what the patient said and adapt the amount of detail?
Finally, identify which arrangements were confirmed and which still required checking. A convincing performance should make that distinction easy to hear. Repeat the role-play with the patient choosing a different support preference so that you practise listening rather than predicting the same emotional response.
Continue with OET Speaking for Doctors — Course 12 for the matching course lessons and further communication practice.
Your next step
OET Speaking for Doctors — Course 12
Explore the complete course outline and related practice topics.
Source: OET SP DOCTORS @@@.epub, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.