Videoscript

Audience

The target audience for this 5-segment video was physicians and allied health professionals involved in breast cancer screening, diagnosis, and treatment.

Breast Cancer Diagnosis–A Patient-Centered Approach

Script context/content

The 5-segment video Breast Cancer Diagnosis–A Patient-Centered Approach is a key component of a half-day CME workshop promoting a multidisciplinary “patient-centered” approach to breast cancer diagnostic methods and interventions. The 7-minute segment scripted here—Discussing the Biopsy-Proven Diagnosis—is the final portion of the video.

Woman_at_mirror_circa_1930s

To provide some context for the scripted segment, a basic outline of the entire video follows:

  • Segment 1: Building partnerships–Breast cancer patients and the healthcare team (primary care physicians, radiologists, oncologists, surgeons, nurses, technicians, counselors, health educators, and support groups)
  • Segment 2: Breast cancer screening— Promoting positive interactions during the clinical breast exam, the complete medical history, mammography and adjunctive imaging tests (chest x-rays, ultrasonography, MRI)
  • Segment 3: Diagnostic surgical procedures— What patients need to know about needle aspiration, needle biopsy, and excision biopsy
  • Segment 4: Breast cancer basics— What patients need to know about the types of breast cancer and breast cancer staging and grading
  • Segment 5: Discussing the biopsy-proven diagnosis

Goals and objectives

The overall goals and objectives of the entire 5-segment video are to:

  • Model a multidisciplinary, patient-centered approach to breast cancer screening and diagnosis
  • Provide structure and content for an interactive workshop

The goals and objectives of Segment 5 (i.e., this script sample) are to:

  • Present effective techniques for discussing the diagnosis of breast cancer with patients
  • Promote empathic and effective communication between healthcare professionals and recently diagnosed breast cancer patients

Video Segment 5 highlights specific steps providers can take when dealing with newly diagnosed breast cancer patients.
These include:

  • Give a specific diagnosis
  • Provide written reinforcement
  • Look at the “whole person”
  • Tailor language and behavior to meet individual patients’ needs
  • Target relevant information
  • Confirm understanding of the diagnosis
  • Explain the limits of treatment and align expectations
  • Clarify the roles of members of the healthcare team
  • Articulate what happens next

Segment 5 – Production style and treatment

Discussing the Biopsy-Proven Diagnosis. Through on-camera interviews,
voiceover (VO) vignettes, and expert commentary, this 7-minute video documentary heightens medical professionals’ awareness of what a biopsy-proven breast cancer diagnosis means to patients, while also highlighting effective communication techniques.

Cast

Video segment 5 includes the following individuals* :

  • William Dooley, MD, director of the Johns Hopkins Breast Center
  • Lillie Shockney, RN, BS, MAS, director of Education and Outreach at the Johns Hopkins Breast Center
  • Alice Holmes, a divorced college professor, age 57
  • Susan Powell, 42-year-old woman stunned that she’s stunned by her diagnosis
  • Gina Ferrar, 33-year-old  mother of two preschool kids
  • Rick Ferrar, age 35, is Gina’s concerned and supportive husband

* William Dooley, MD and Lillie Shockney, RN, BS, MAS were actual clinicians Liz interviewed for a handbook on physician-patient partnerships. Transcripts from these interviews helped Liz script some of this video. The other characters are fictional creations and their dialogue is invented.

Notes

  • Some formatting was lost when cut and pasting this 2-column document into WordPress.
  • What was the right column is the audio portion of the script. What was the left column indicates the visual portion of the script.
  • “B-roll” refers to images that appear while an individual is speaking.
  • “INTERVIEWS on camera” take place on a limbo set.
  • Other sets include a medical office and a medical examination room.

 

SCRIPT

FADE UP ON COLOR LOGO: XYZ Communications, Inc.

presents
DISSOLVE TO COLOR TITLE CARD:

Segment 5—Discussing the Biopsy-Proven Diagnosis

FADE TO BLACK
FADE UP ON B&W TITLE CARD:

Pain–has an Element of Blank–

INTERVIEW on camera

(music full)

(fade music) ___________________________________ (no music)

(music resumes, way under, and continues through the three patient vignettes, below)

ALICE
In times of crisis, I turn to poetry.
“Pain–has an Element of Blank–” wrote Emily Dickinson, and blank is how I feel.

GINA
It was the doctor’s tone of voice that tipped me off to the bad news, even before he put it into words: “The biopsy isn’t what we had hoped,” he said. “We’d like you to come in so we can discuss how we can treat this and hopefully get you well.”
(beat)
“. . .hopefully get you well.”
I didn’t hear anything, after he said that.

1

INTERVIEW on camera

SUSAN
Given my family history and all the biopsies I’ve been through, I thought I was prepared for this moment.
I mean, I’ve been bracing myself for a breast cancer diagnosis since my mother’s mastectomy when I was fourteen.
(beat)
But I was floored.
I still am.
I’ve had the weekend to cry with my family and friends, but I just can’t wrap my head around this. I feel all panicky inside.

LILLIE SHOCKNEY, RN
A breast cancer diagnosis is a shock to the system. Patients are numb. Their brains shut down. Initially, patients aren’t able to absorb a whole lot of information, so it’s a good idea to provide some written reinforcement. Don’t just state the diagnosis and hand out patient-education literature, but write down key facts and figures the patient needs to know about her particular case.
(beat)
Also, keep in mind that how you discuss the diagnosis can be as important as what you discuss.

(silence for a beat) __________________________________ (silence)

LILLIE (continues in VO)
Try to look at the “whole person” and assess her particular needs at that particular moment.
(beat)
Sometimes, you need to put on a very professional affect and use more clinical language.

LILLIE
Do you have any questions about the pre-operative instructions, Mrs. Powell?

INTERVIEW on camera

LILLIE speaks directly at camera.

LILLIE flips over a printed page of patient education and jots down a couple of notes.

LILLIE speaks directly at camera.

FADE TO BLACK

FADE UP ON B&W TITLE CARD:

How you say it

B ROLL – medical office

LILLIE SHOCKNEY, RN sits opposite a very tense-looking SUSAN POWELL

2

LILLIE AND SUSAN sit side by side as they review some paperwork.
LILLIE looks inquisitively at SUSAN. SUSAN winces.
LILLIE kindly squeezes SUSAN’s hand.

INTERVIEW on camera

LILLIE SHOCKNEY, RN sits opposite GINA and RICK FERRAR. GINA reads from her notes.

FADE TO BLACK

LILLIE (VO)
Other times, it’s better to be warm and personal. . .

LILLIE (TO SUSAN)
This won’t be easy, but if you feel ready. . .
. . .I’d like to take you through some pictures and show you how people look after a partial mastectomy.
(long beat)
I’m here for you, Susan. And–when we’re ready–Dr. Dooley will join us to answer any and all questions you might have.

LILLIE
Never let vocabulary become a barrier to communication. There are many types of patients, so you must be prepared to “translate” the same diagnosis many different ways.

RICK
The “second-opinion doctor” said something about hep-at-o–

GINA
“No sign of he-pat-o-meg-a-ly?”

LILLIE
That’s good news. “No sign of hepatomegaly” is a fancy way of saying your liver isn’t enlarged.

(silence for a beat) ___________________________________

3

FADE UP ON B&W TITLE CARD:

What you say

INTERVIEW on camera

WILLIAM DOOLEY, MD
Of course, what you say is also critical, and newly diagnosed patients need to know some basic things:

  • What does this disease mean to me?
  •  How will it impact my life?
  • What does it mean for my future?

They need a diagnosis and a prognosis and relevant and easy-to-grasp information that puts the illness in perspective and gives them a greater sense of control.
(beat)
And–when you’ve dealing with a potentially life-threatening condition– remember that this diagnosis doesn’t only affect the patient, this is now a family concern.
And family members can even be more upset than patients. . . .

GINA
The doctor said he wanted me to come in so we could discuss the diagnosis and weigh my various options.
RICK
And he told her to bring along a family member or a friend–someone to act as an “objective” set of ears.
(laughs nervously and jingles change)
I don’t know how objective I am!
GINA
To distract us from endlessly spinning out “worst-case scenarios,” he immediately gave us a homework assignment. Told us to read the first three chapters of this book before we came in.
RICK
The homework helped. It gave us something to do.
GINA
It was also educational.

INTERVIEW on camera

(Relatively calm GINA and her change- jingling, foot-kicking husband RICK sit side by side.)

GINA holds up dog-eared paperback book.

INTERVIEW on camera (continues)

4

FADE TO BLACK

FADE UP ON B&W TITLE CARD:

Empower patients with information

INTERVIEW on camera

(silence for a beat) ___________________________________

(silence)

LILLIE SHOCKNEY
We’ve learned that the more information we give patients about their disease and their treatment options, the more control they feel over their situation, and the higher level of confidence they have in us, their healthcare team.
(beat)
But–when educating patients about their diagnosis–targeting relevant information is key. I mean: A woman with stage 1 breast cancer does not need to read the chapter on advanced metastatic disease!

DR. DOOLEY
A breast cancer diagnosis compels patients to make a host of emotionally and medically difficult decisions, so–in addition to targeting relevant information–you need to gauge how well patients understand what you’ve said and what they’ve read.
(beat)
Open-ended questions–questions that require more than a “yes” or “no” reply –can be valuable tools.

(silence for a beat) ___________________________________

INTERVIEW on camera

FADE TO BLACK

FADE UP ON B&W TITLE CARD:

Confirm understanding

5

B-ROLL – examining room

DR. DOOLEY stands eye-level with tense- looking ALICE, who sits on the examining table.

DR. DOOLEY smiles kindly as he shakes his head “no.”

INTERVIEW on camera

DR. DOOLEY
Why do you think we prescribed the tamoxifen?

ALICE
Because the cancer has spread?

DR. DOOLEY (VO)
Discussing the diagnosis naturally leads to discussions about treatment, and–although we’re not going to tackle that huge topic here–it’s important to note that early in your discussions, you need to align patient expectations with your own.

In many cases, it helps to lay out the odds.

DR. DOOLEY:
If we perform this type of surgery you have roughly a 70% chance of survival, but if we follow up with chemotherapy, your odds improve to better than. . .

FADE OUT

DR. DOOLEY:
Of course a lot of times we’re going on a hunch. And our expectations for a positive outcome are uncertain.
(beat)
I think a lot of physicians aren’t as upfront about this as they might be, but most patients understand there are gray areas in medicine. . . .

DR. DOOLEY (VO)
Let’s give this a try. This should work reasonably well. It might not be the solution we’re looking for, but I just have a feeling that it will be better than where we are now.

___________________________________

B ROLL – medical office

DR. DOOLEY sits beside his desk as he talks to ALICE , who sits opposite.

INTERVIEW on camera

DR. DOOLEY AND ALICE sit face to face; again, no desk divides them.

FADE TO BLACK
FADE UP ON B&W TITLE CARD:

6

“Rehearsing the play”

INTERVIEW on camera

LILLIE SHOCKNEY, RN and WILLIAM DOOLEY, MD sit side by side.

DR. DOOLEY
Finally, you want to introduce patients to other members of the healthcare team and be absolutely clear about follow up–let patients know who on the team is best equipped to deal with what sorts of problems, and walk patients through what happens next.

LILLIE SHOCKNEY
We call this “rehearsing the play.”

DR. DOOLEY
Before the curtain falls on our brief presentation, let’s recap key points:
(beat)
When dealing with newly diagnosed patients it’s important to discuss the diagnosis and prognosis and provide written reinforcement.

LILLIE SHOCKNEY
You also want to look at the “whole person” and tailor your language and behavior to meet each individual patient’s particular needs.

DR. DOOLEY: Target relevant information and confirm understanding–

LILLIE SHOCKNEY
–And align expectations.

DR. DOOLEY
Last but not least, introduce patients to members of the healthcare team and explain what happens next.

SUPERGRAPHICS APPEAR BEHIND DR. DOOLEY AND LILLIE,
IN SYNC WITH THEIR WORDS

  • Give a specify diagnosis
  • Provide written reinforcement
  • Look at the “whole person”
  • Tailor language and behavior
  • Target relevant information
  • Confirm understanding
  • Align expectations
  • Clarify roles
  • Be clear about follow up

7

INTERVIEW on camera

LILLIE
All this is a tall-order. But, if you’re able to do even some of these things, you go a long way toward promoting empathic and effective communication with newly diagnosed breast cancer patients.
(beat)
Not only does good communication help promote positive interactions and positive outcomes–

DR. DOOLEY (interrupting)
–it helps you make the best possible use of limited time.

(silence for a beat)
(music up and out)

FADE TO BLACK
RUN CLOSING CREDITS

 

Image Credit:
Woman at Mirror, circa 1930s, Wikimedia Commons