| Course | NURS 6910 Introduction to Palliative Care: Principles of Hospice and Palliative Care |
|---|---|
| Week | Week 6 |
| Paper type | Communication case (scripted conversation) |
| Length | About 1,050 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6910 Week 6
"Is There Anything Else?" A Scripted Conversation Telling a 66-Year-Old Woman That Her Pancreatic Cancer Has Grown Through Second-Line Treatment, Annotated With SPIKES and NURSE
Student Name
College of Nursing, Walden University
NURS 6910: Introduction to Palliative Care: Principles of Hospice and Palliative Care
Instructor Name
Month Day, Year
"Is There Anything Else?" A Scripted Conversation Telling a 66-Year-Old Woman That Her Pancreatic Cancer Has Grown Through Second-Line Treatment, Annotated With SPIKES and NURSE
Setup
The composite patient is a 66-year-old former church organist whose pancreatic cancer has spread to her liver. Her disease has progressed on first-line chemotherapy and again on a second regimen, and her oncologist, after reviewing the latest scan, does not recommend further chemotherapy because it is not expected to help and would likely make her feel worse. The palliative care advanced practice registered nurse, who has met her twice for pain and appetite, has agreed with the oncologist to lead this conversation. A quiet consultation room is booked for forty minutes, phones are silenced and tissues are on the table. Her daughter is present at the patient's request.
The conversation below is organized by the SPIKES protocol: setting, perception, invitation, knowledge, emotions and empathy, and strategy and summary (Baile et al., 2000). Responses to emotion are labeled with the NURSE mnemonic, naming, understanding, respecting, supporting and exploring (Back et al., 2005). A study of recorded oncology visits found that clinicians often missed or redirected patients' expressions of emotion, which is why this script slows down wherever emotion appears (Pollak et al., 2007).
The Conversation
The script is shown in three columns: who speaks, what is said and why.
Table 1
Script With Commentary
| Speaker | Line | Commentary |
|---|---|---|
| Nurse | Thank you both for coming in. Before we talk about the scan, can you tell me what you have noticed in your body over the last few weeks? | Perception. Starting with her experience lets the nurse hear what she already suspects. |
| Patient | I'm more tired. I don't want to eat. My back is worse at night. I think it's growing. | She has named her own fear. The news will confirm rather than surprise. |
| Nurse | That sounds hard. What do you understand about why we did this scan? | Perception continued. Her understanding of purpose shows how much context she needs. |
| Patient | To see if the new chemo was working. | |
| Nurse | Some people want all the details of a scan, and some prefer the big picture. What would you like today? | Invitation. She chooses the depth; the nurse does not assume. |
| Patient | Just tell me straight. No numbers. | Her preference now governs the whole conversation. |
| Nurse | I'm afraid I have some difficult news. | Warning shot. One short sentence gives her a moment to prepare. |
| Nurse | The scan shows the cancer has grown, even with the new chemotherapy. Your oncologist and I both believe more chemotherapy is not going to help, and it would likely make you feel worse. | Knowledge. The key sentence is short, plain and unhedged. No jargon, no numbers, as she asked. |
| [Silence for about ten seconds.] | The silence is deliberate. Speaking now would interrupt her taking in the news. | |
| Patient | So that's it. There's nothing else. | |
| Nurse | It sounds like you were hoping there would be another option. | Naming the emotion rather than rushing to correct her words. |
| Daughter | [Crying.] How long does she have? | The prognosis question often comes from the family first. |
| Nurse | I can see how frightening this is for you both. | Understanding. The emotion is acknowledged before the question is answered. |
| Nurse | No one can know exactly. I worry that the time may be short, more likely weeks to months than many months. It could be shorter, and some people do have more time. We will keep telling you what we see. | The answer uses ranges and says plainly that it is uncertain. It honors the patient's wish for no numbers. |
| Patient | I don't want to spend it in the hospital. | A goal, offered unprompted. This is where strategy begins. |
| Nurse | You have been through a great deal of treatment, and you have faced every scan head on. I admire that. | Respecting. Acknowledging what she has already done. |
| Nurse | Tell me more about what matters most to you now. | Exploring. The plan will be built on her answer, not on a menu. |
| Patient | Being at home. My back not hurting. Seeing my grandson's recital next month. | |
| Nurse | We will not stop caring for you. We can work hard on the pain, help you stay at home and talk about extra support there, including hospice when you are ready to hear about it. | Supporting, then strategy. Non-abandonment is stated before any service is named. |
| Nurse | When you get home and your son asks how today went, what will you say to him? | Summary through teach-back. Her words show what she took in. |
The patient's answer, "that the chemo stopped working and now we work on keeping me comfortable at home," shows that she has heard the central message.
Analysis
Three choices carry most of the conversation. First, the knowledge statement is a single sentence without hedges. Clinicians often soften bad news until it is unclear, which leaves patients uncertain about what they have been told. Baile et al. (2000) recommend giving information in small pieces and in plain language, and this script uses one plain sentence followed by silence.
Second, emotion is answered before information. When the daughter asks how long, the nurse names the fear first. Back et al. (2005) argue that information given to someone in strong emotion is rarely absorbed, and that empathic statements help the person return to the conversation. The prognosis answer follows, and it is framed in ranges with honest uncertainty, which respects the patient's request for no numbers while not avoiding her daughter's question.
Third, strategy starts from the patient's own goal. Her statement that she does not want to spend her remaining time in the hospital shifts the conversation from what has been lost to what can still be done. The nurse's commitment not to abandon her comes before hospice is named, and hospice is introduced as an option for when she is ready, not as the next step on a list.
What the Script Leaves Out
The script does not decide her pain treatment or complete any documents. Those follow in later visits. It also does not resolve the daughter's distress; a follow-up call to the daughter is planned for the next day. A single conversation cannot do everything, and trying to make it do so is one of the ways clinicians overwhelm patients at the hardest moment.
References
Back, A. L., Arnold, R. M., Baile, W. F., Tulsky, J. A., & Fryer-Edwards, K. (2005). Approaching difficult communication tasks in oncology. CA: A Cancer Journal for Clinicians, 55(3), 164-177. https://doi.org/10.3322/canjclin.55.3.164
Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES: A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist, 5(4), 302-311. https://doi.org/10.1634/theoncologist.5-4-302
Pollak, K. I., Arnold, R. M., Jeffreys, A. S., Alexander, S. C., Olsen, M. K., Abernethy, A. P., Sugg Skinner, C., Rodriguez, K. L., & Tulsky, J. A. (2007). Oncologist communication about emotion during visits with patients with advanced cancer. Journal of Clinical Oncology, 25(36), 5748-5752. https://doi.org/10.1200/JCO.2007.12.4180
The Walden NURS 6910 Week 6 instructions
For this sixth week, instructors generally want you to demonstrate how you would deliver serious news or respond to emotion in a palliative care scenario, often by writing a dialogue or case and analyzing it with a framework such as SPIKES. Papers of three to five pages are typical. Set the scene briefly, including who is present and why. Write the conversation as the people would actually speak. Label the framework's steps where they occur and explain each choice in commentary. Keep the key sentence of bad news short and plain. Respond to emotion before giving more information. Close with an analysis of the conversation's most important choices and an honest note about what one conversation cannot do.
Inside the NURS 6910 Week 6 example
A setup section introduces the patient, the oncologist's recommendation and the room, and cites Baile and colleagues for SPIKES, Back and colleagues for the NURSE responses and Pollak and colleagues on missed emotional cues. Table 1 holds the script in three columns, from the opening question about what she has noticed through the warning, the key sentence, the silence, the daughter's question about time, the patient's goal and a teach-back. The analysis section explains the unhedged knowledge statement, answering emotion before information and building strategy from her goal. A short section names what the script leaves for later, including pain treatment and a call to the daughter.
NURS 6910 Week 6 rubric: what earns full marks
Communication cases are commonly scored on demonstrated skill, correct use of the framework, responsiveness to emotion and reflection. Skill is shown in the lines themselves, so graders look for open questions, a plain statement of the news and space for silence. Framework credit goes to steps applied in context and labeled where they occur. Emotional responsiveness is often weighted heavily, and naming or exploring emotion before offering facts earns it. Honesty about prognosis, without false precision or evasion, is valued. The analysis section earns credit when it explains why the choices work, with sources. Professional format, realistic dialogue and APA references complete the criteria for most instructors.
Common NURS 6910 Week 6 mistakes, and how to avoid them
Communication scripts lose points when the news is wrapped in so many qualifiers that the patient could not tell what was said. Another loss is answering a question about time with a figure the scenario does not support, or dodging it entirely. Some scripts move straight to hospice before responding to the patient's grief. Others list SPIKES steps in a paragraph without showing them. Write realistic dialogue, label the framework in the moment, state the news plainly, meet emotion first, answer prognosis with honest ranges and build the plan from the patient's goal. The desk can draft a script for the scenario your prompt supplies. Keep the patient's words plausible rather than textbook perfect.
Get a NURS 6910 Week 6 example written to your instructions
Send the scenario your Week 6 prompt sets, who is in the room and what news is being shared, along with the rubric. The conversation is scripted to it with framework commentary beside each turn, free the first time you ask and ready inside 24-48 hours. A different framework named in your course replaces SPIKES throughout.
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NURS 6910 Week 6 questions, answered
Why write the conversation as a script?
Because your rubric is asking whether the communication skills appear, and a script is the only form in which they can be seen. A description of an empathic conversation asserts the skill; dialogue demonstrates it. The example pairs each line with commentary so the reasoning is visible too, and keeps the patient's and daughter's words as plausible speech rather than textbook phrasing.
What are NURSE statements?
A VitalTalk set of responses to emotion: naming the feeling, showing understanding, expressing respect, offering support and exploring further. The example labels each where it occurs in the dialogue, most densely after the news and after the daughter's question. Listing all five in a paragraph at the end would describe the tool without showing that the conversation used it.
Does the script give a prognosis?
It answers the daughter's question in ranges, framed with honest uncertainty, and states no figure. Prognosis in this case belongs to the composite scenario and the oncologist's assessment, not to the page. Should your course want a specific prognostic discussion, the sample follows the information your materials supply rather than inventing a number.
Where can I find a free NURS 6910 Week 6 sample paper?
The full script with commentary, the setup and the analysis are posted on this page free. A scripted case for the scenario your course gives can be requested.
How does the NURS 6910 Week 6 script answer the daughter's question about time?
It names her fear first, then says the time may be short, more likely weeks to months, that no one can know exactly and that the team will keep telling them what it sees.