Counsel and plan with a family switching from IVIG to home SCIG — OSCE

Candidate brief

You have eight minutes to counsel the parents of a six-year-old boy with X-linked agammaglobulinaemia about switching from hospital intravenous to home subcutaneous immunoglobulin and about reassessing his regimen after breakthrough infection. Use a structured, honest, empathic approach. [1] [8]

Key teaching and communication objectives

Acknowledge and validate the parents' fear of self-infusion and their worry about losing expert oversight before delivering information. Explain that home subcutaneous therapy is not abandonment of care — the immunology team remains responsible for the regimen, the trough monitoring, and the training, and the family is supported at every step. [9] [8]

Explain in plain language why the trough that looked "normal" was not protecting their son: the number is a guide, but his repeated infection is the real signal, and dosing to the outcome means adjusting the regimen around his infection rate and lung function rather than around a single value. Address the pharmacokinetic rationale for the switch — subcutaneous therapy holds a steady, near-constant level instead of the peak-and-trough swing of intravenous dosing, which is why it tends to protect more evenly and is better tolerated. [2] [5]

Describe what home therapy involves: a weekly infusion into the subcutaneous tissue of the abdomen or thighs using a small pump, given at a time that fits the family's week; comprehensive training by the immunology nursing team before they ever infuse alone; a helpline and scheduled reviews; and the prospect of ending the two-hour hospital travel. Reassure them that local site reactions are usually mild and that the systemic reaction rate is low. [9] [8]

Close with a shared plan: a structured training schedule, a clear trough and infection-monitoring plan with named review points, an antibiotic-prophylaxis decision for the breakthrough infections, and a written summary plus contact details for the team. Offer written information and contact with a patient-support organisation. [1] [9]