以下の英文を読み、設問（1～5）に対する最も自然で適切なものを選択肢の中から一つだけ選び、それぞれ解答用紙の記号（(a),(b),(c),(d)または(e)）を鉛筆で塗りつぶしなさい。

There is no easy way to break bad news, nor is there any fixed way of way doing so. A starting point is, perhaps, to find out how other people deal with the situation and take the best from their experiences to suit yourself.

One very useful approach is Kaye's ten steps to breaking bad news (Kaye P, 1996, Breaking Bad News、A 10-step approach, Northampton EPL Publications). The first phase in the process is preparation for the interview with the patient, reading all the notes, making sure you know who should be present, making sure that the setting for breaking the news is suitable and private. The second stage in the interview is finding out what the patient or family knows about the situation. Following this comes a 'warning shot' like ( X ) to help prepare the patient for what is coming. The fourth step is denial with the patient controlling the situation by the amount of information he/she wants to be given. Next comes any further explanation, checking the patient understands using simple diagrams and simple ( Y ) .

The patient may be afraid of asking for more information so ask gently if you think they would like you to give more. And then, the ( Z ) step is to listen to the patient's concerns (physical or emotional health or to social or spiritual issues).

The next step is to allow the patient to express their feelings. This may be the key phase in the interview from the patient's point of view. The final two steps in the process are summarizing concerns and making a treatment plan, and then making sure you offer yourself for further explanation and possibly a family meeting.

Oxford English for Caeers: Medicine 1
Unit 10 Terminal illness and dying

• l Which of the following is closest in meaning to “There is no easy way to break bad news, nor is there any fixed way of doing so” ?
  • (a) Bad news can be easily broken and fixed with the right way of doing so.
  • (b) Breaking bad news is such that there is a fixed way of doing it easily.
  • (c) Even if there is a fixed way to do it, breaking bad news is never easy.
  • (d) It is not easy to break bad news, but it can be easy if it is fixed.
  • (e) You can break bad news if there is a fixed way of doing so.
• 2 Which of the following best fits ( X ) in the text?
  • (a) 'Do you have any questions?'
  • (b) 'I am afraid the news is not good'
  • (c) 'I am prepared for the bad news'
  • (d) 'This flu shot warning is true'
  • (e) 'Would you like to give it a shot?'
• 3 Which of the following best fits ( Y ) in the text?
  • (a) denials
  • (b) issues
  • (c) language
  • (d) shots
  • (e) treatment
• 4 Which of the following best fits ( Z ) in the text?
  • (a) fifth
  • (b) sixth
  • (c) seventh
  • (d) eighth
  • (e) ninth
• 5 Which of the following is true about Kaye's ten steps to breaking bad news?
  • (a) You should ask about patient's religion before finding out who the patient wants to be present.
  • (b) You should deny any requests from the patient so that the amount of information the patient receives can be controlled.
  • (c) You should encourage expression of the patient's feelings because it is the vital phase of the interview.
  • (d) You should invite several observers to the meeting to make the informed consent as transparent as possible.
  • (e) You should listen to the patient's concerns after allowing the patient's family members to hear the bad news.