Courageous conversations: Grief
Taking the time to have difficult or “courageous” conversations with clients who are anticipating or have already experienced the loss of their pet can have significant benefits to the practice. A companion animal practice that gains a reputation for providing EOL care in a skillful, compassionate way will retain clients and gain referrals as a result. How clients view the healthcare team’s response following the loss of a pet is a critical factor in their continued advocacy for and loyalty to the practice. Studies in human medicine have demonstrated a correlation between empathetic physician-patient communication and an improvement in patient emotional health, compliance with physician recommendations, and satisfaction with their healthcare.7
Grief after the loss of a pet1,2
30% of pet owners experience significant grief
50% will question their decision following euthanasia
Given the intense and sometimes conflicting emotions that accompany client bereavement, responding to anticipated and actual pet loss with sensitivity and compassion is vital to the mission of animal hospice.
How can the healthcare team help pet owners deal with this predictable grief?
Take time to listen to their feelings
“How are you managing?”
“What are your fears?”
“What are your concerns?”
“How is this making you feel?”
“Are you overwhelmed by the care you are providing?”
Regular, empathetic communication is the hallmark of effective client support during EOL treatment and after a patient’s death. The healthcare team has a responsibility to see the EOL case experience through the client’s eyes and to provide non-judgmental support.
Tools for conversations with bereaved clients
To normalize the behavior a practitioner is seeing and the client is feeling, it is useful for practitioners to view the normal grief response that their clients experience in terms of the five stages:8
Denial → Bargaining → Anger → Depression → Acceptance
Genuine and empathetic interaction with a bereaved client is a skill that can be learned and improved. Asking open-ended questions is an excellent technique for assessing how a client is handling EOL caregiving responsibilities or bereavement over the loss of a pet. Examples include queries such as “How are you managing?” or “What concerns do you have?” The hospice team members can then validate the extent of the difficulty or grief the individual is experiencing. Reflective listening techniques, such as acknowledging that you heard what the client said and then summarizing their comments, are helpful for facilitating what is always a difficult topic of discussion.
The clichés of grief
Healthcare team members may offer any of an assortment of phrases intended to be consoling that may come across to the client as insincere or out of bounds. Team members should be careful to avoid these expressions termed the clichés of grief.10
Conversations about EOL, death, and grief with a bereaved client are never easy. Descriptions of various verbal and nonverbal communication techniques appropriate for veterinarians involved in EOL discussions with clients are available from a variety of sources.9, 11, 12
- Colorado State University College of Veterinary Medicine FRANK™ clinical communication workshops
- Institute for Healthcare Communication in New Haven, Connecticut
- International Veterinary Communication Institute in Ontario, Canada
- Other training opportunities are available at many veterinary conferences
Client support roles
Educator: Observe; ask questions; offer grief counseling information when appropriate.
Supporter: Listen to client's nonmedical concerns; favor listening over dispensing advice; allow expression of thoughts and emotions; acknowledge client's loss; express support in nonverbal and verbal ways.
Facilitator: Ask questions; make suggestions; provide relevant client education; assume partnership role in decision-making; remain neutral, nonjudgmental, and respectful of client's wishes.
Resource and referral guide: Inform client about available resources; encourage client to self-educate and find own solutions to establish control over the situation.
Client support principles
Observe boundaries: Offer support by mutual agreement; do not overstep boundaries or offer unwanted assistance; do not exceed teh confines of a client-support role.
Have realistic expectations: Understand that client's response to loss is beyone your control; you control only your own response.
Respect the client's feelings: Never express denial of client's feelings; do not assume you completely know how the client is feeling.
Practice open and honest communication: Convey information honestly; avoid withholding or censoring information to spare the client's feelings.
Maintain confidentiality: Respect client's privacy; do not discuss the case outside the practice without the pet owner's permission.
Offer professional support: Seek outside resources when needed.
Phrases to avoid
"If there is anything I can do, just call me."
"I know just how you feel."
"Time will heal your loss."
"(Your pet) had a long life; think of all the good memories."
"There will be other pets"
"You need to be strong for the rest of the family."
"Children will bounce back."
"Count your blessings."
"God never gives more than we can handle."
Client support roles9 | Client support principles9 | Phrases to avoid10