Sadly, the veterinary medical care team often is faced with patients that have been diagnosed with a life-ending disease. With pets having such a high rate of severe osteoarthritis, cancer, renal disease and heart failure, care teams frequently will be confronted with clients who must come to grips with the news that their beloved pet has limited time left.
How can we, as a team, best help these clients?
Cases can move from diagnosis to death in a period of years, months, days or hours. No matter the time frame, the news can be a shock to pet owners. Sometimes pet owners have seen symptoms coming on for some time, but the seriousness of what they witnessed is very easy to deny.
When you confirm an end-of-life diagnosis, the family will go through a variety of emotions, from denial to acceptance. These emotions are not necessarily linear as they can vacillate, recycle and regress.
We must always be honest in discussing the disease. Communications should always be done in a caring and unhurried manner using our experience with other cases and what the literature says, and offering options ranging from seeing a specialist to comfort care.
Because medicine is full of unknowns, giving the client hope tempered with facts and experience is the best approach.
Humans remember only 10 percent of what we hear. Imagine how hard it is to take in heartbreaking news and retain it. Be prepared to repeat yourself and never appear as though this is a burden. Further, the team must speak with one voice. This means good internal training about how to handle these sensitive cases.
Prepare the Client and Be Available
A client whose pet has a terminal diagnosis will have many questions. How accessible are you? Have you told them what to expect? Do they know the signs of dying?
It is extremely important for them to know they can always contact someone, but especially when that dreaded day or night comes and they think the pet may be dying. Without this reassurance, your client feels helpless, even abandoned.
Clients with a terminal patient should have confidence in knowing they have someone on your team who cares enough to be reached at all reasonable hours. If no one can be reached, make sure the client has instructions on what to do and where to go. Part of giving your clients hope is letting them know you will be there for them every step of the way.
Make sure clients have the tools needed for care, from medications to comfort aids. A client with a terminally ill pet should never find herself at home without the various resources needed to provide special care, such as physical aids, wound dressings and, especially, pain medications.
As a team, we should do whatever is needed to ensure a pet never suffers.
Mixing Science and Compassion
As a medical professional, you should offer a complete list of treatments, modalities and alternative care options that you can provide for both treating the disease and dealing with the symptoms as they become more serious. Be sure clients know there is depth in your ability to care. Communicate that you will help them with everything from medicine to comfort care and even a humane end to suffering when the time comes.
Should you run out of treatment options, clients want to know you will be there to ease the suffering and offer a compassionate and peaceful passing.
Very often when I answer the phone I am met with clients who are very frustrated amplified by fear. These clients feel their veterinarian is not listening or has given them only one option. They feel they have nowhere to turn, so they are calling about euthanasia when it may not be what they want or need. Many of these clients have other good options that never have been explained to them.
A frustrated client will not return to your clinic, and in today’s world, they can get very vocal and influential on social media.
One of the most important parts of treatment at all stages of this process is active and attentive listening. As veterinarians, we are full of information and eager to impart all the facts and knowledge to our clients. But at a time like this, one of the client’s most important needs is to be heard. For clients, simply knowing that they are being heard is more powerful than you can imagine.
Clients want to express their feelings, observations, concerns and fears. Even though you have heard all these concerns many times before, listen to them again, and with few interruptions. Your medical experience, your personal experience, your own emotions all can be added to this conversation, but as their pet is dying what most clients need is a doctor and staff who will take the time to listen and show compassion. This simple act can do more for a client’s loyalty than almost anything.
Should your client react in an opposite way and shut down—a normal reaction in some people facing such a scary event—then help kick-start a discussion with simple questions like:
- "What’s going on?”
- “You look like you have some questions.”
- “I know you are very worried; how can I help right now?”
Treating the End-of-Life Patient and Client
As you likely have seen with end-of-life cases, a full spectrum of client reactions is possible. Some clients, whether due to emotions, severity of disease or finances, will opt for euthanasia at the time of diagnosis. While their decision may not be what you would do, you must respect it. You can’t see all the factors that came into play to make this a very difficult decision for the family.
At this highly emotional time, real effort is necessary to make compassion be the central point that drives our decisions. When the client sees that you can combine both compassion and medical experience, you gain a tremendous level of client loyalty and trust. This often is rewarded with better decisions for the patient, positive online reviews and clients returning with new pets.
When a client wants to treat the pet, a wide variety of options is always available, such as multimodal pain relief, nutraceuticals and alternative medicine. Seeing a specialist or sending the client to a teaching hospital may be a good option for a family that wants to do everything it can.
The key point here is that many of your clients want to know that you and your team are doing everything possible. Remember, very often clients will do exhaustive searches online and may surprise you with their understanding of the disease and treatments.
This is a good time for you to jump online and search for any recent findings. When you do, why not send the client new information with your input on how it might apply to their case?
All this effort gives your client satisfaction in knowing that you are doing everything you can. It is amazing the power this has in building confidence and trust and stopping fear and frustration.
Moving to Palliative Care
Always keep in mind that end-of-life care is a continuation of doing everything we reasonably can. How you communicate the shift from curative treatment to palliative care is very important.
Veterinary palliative care focuses on providing relief from the symptoms and stress of a disease, while no longer treating the actual cause. Be sure your clients know that moving to palliative care is not about giving up but is about increasing the quality of life for the pet. Making end-of-life care part of a seamless continuum of care makes a very positive difference.
Carefully discuss this change in focus and explain that targeting the symptoms of the disease is now the best way to provide acceptable quality of life. This will be seen as a major shift in care and may take some time to explain and implement, but always reinforce the goal: to increase the pet’s quality of life.
Dr. Jim Humphries founded the American Society of Veterinary Journalists and the Veterinary News Network. He owns Home With Dignity, an end-of-life practice in Colorado Springs, Colo.
Originally published in the February 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!