Serious news: first update after stroke deterioration

Scenario setup

Conversation partner: Susan, John’s wife and listed family contact
Learner level: Resident
Your role: Resident physician on the ICU team
Your scope: Deliver the supervising team’s clinical update and arrange supported follow-up. Do not independently determine brain death, promise an outcome, or make treatment-limitation decisions in this call.
Setting: Calling from a private hospital workspace; Susan is receiving the call at home
Situation: John’s large ischemic stroke has worsened with swelling. He is now unresponsive in the ICU. Susan previously heard he was responsive and has not received the new update.
Your task: Use a compassionate SPIKES-informed structure to explain the serious update, respond to Susan’s understanding and emotions, and agree on a supported next step. Flexible wording and sequencing are appropriate; forced disclosure is not.
Time limit: 2 min
Who begins: You speak first. Your conversation partner waits for you.

Available information

Patient and spouse: John is 55. Susan, his wife, is 52.
Presenting event: John suddenly collapsed at home while having dinner with Susan.
Earlier assessment: John had a large ischemic stroke and was responsive to voice and touch when he arrived at the hospital.
What Susan was told: An earlier staff member told Susan that John was responsive. She understood that as a reason to hope he would be okay.
Current assessment: The stroke has expanded with substantial brain swelling. John is now unresponsive in the ICU.
Team assessment and uncertainty: The ICU and stroke teams are very worried about his survival and recovery. He is critically ill and his outlook is extremely poor, but he is alive. No death or brain-death determination has been made, and no exact outcome or time to death is established in this case.
Care continues: The ICU and stroke teams continue caring for John. The attending will discuss the current assessment, treatment questions and uncertainty with Susan; this phone call does not make independent treatment-limitation or procedural decisions.
Contact and role: The supervising team has reviewed the update and asked you, a resident physician on the ICU team, to call Susan at her listed family contact number. She is the appropriate family contact for this update. Confirm who answered and that she can talk privately and safely before sharing details.
Proposed in-person next step: In this fictional hospital, Susan can enter through the main entrance, ask the front desk for the adult ICU on the fourth floor, and ask the ICU desk for Dr. Rivera, the supervising attending. The team can arrange a meeting; do not promise an exact waiting time.
If she cannot come now: If Susan cannot come safely or wants someone with her before more discussion, arrange for the ICU team to call her back at the same verified contact number and agree on the immediate next step. The resident will relay her request promptly.

What you’re assessed on

Set up a safe, private call: Introduce yourself, confirm Susan’s identity and relationship, and check she can talk privately and is not driving. Ask about immediate support and adapt to what she needs.
Understand what Susan knows: Ask what Susan has heard and what she understands before adding the update. Respond to the hope she drew from the earlier report.
Check readiness and information preferences: Check whether Susan wants the update now and how to pace it. Respect a request to pause, have someone join, or arrange a prompt follow-up.
Explain the clinical update accurately: When she is ready, prepare Susan for serious news and explain the deterioration, current unresponsiveness and poor outlook in plain language. Check understanding and acknowledge uncertainty; do not say John has died or promise recovery.
Respond to emotion: Acknowledge Susan’s reaction and concerns with specific support. Allow her to respond without rushing into logistics or offering false reassurance.
Agree on a concrete next step: Summarize the update or what remains to be discussed, invite questions and agree on safe travel or phone follow-up using the supplied contact plan. Confirm what Susan will do and what the team will do.