In your specific example, the main focus should have been reassurance, outlining the next step, and reassuring the patient THIS IS NOT CANCER. Abnormal paps have a lot of emotions surrounding them and usually education significantly decreases the emotional burden and fear.
My standard outline for bad news bears:
1) Before we have bad news, we have an OV. That OV leads often to looking for causes of bad news. I let patients know most likely the chance of something bad going on is related to X, Y or Z in their history and exam but I don't know until I work them up if there is something bad going on. I then order the workup.
2) I await the results to come back and depending on what it shows, they will need to schedule an OV. I don't schedule a return OV with 1) because I don't know how quickly they are going to be able to complete workup.
3) At the follow up office visit I do much like BD outlines above. Tell them the findings, what it could be and reassure them I am there for them. I then outline the next plan whether it be further work up (such as a FNA) or referral. If I need an urgent referral, I contact the specialist's office. If the patient is already established, I ask to speak with the attending physician while the patient is still at my office and update them.
4) I assess needs. If they have uncontrolled pain, I start to control that. If they have stable anxiety/depression but are now having panic, I will offer them appropriate treatment.
5) I offer to call family members if need be.
6) If the prognosis is very grim just based on my workup, I will consider introducing palliation. Until they meet with a specialist for definitive diagnosis or if they defer all treatment, then I will discuss hospice.
