Client support and communication
Good communication skills are a key component of a successful practice. Oncology cases raise the bar by placing a premium on the clinician’s ability to engage and empathize with the owner of a cancer patient. Cancer is an upsetting diagnosis associated with emotionally charged situations. The goal of the initial discussion is to present detailed information about the diagnosis, testing and treatment options, and prognosis while at the same time assessing the client’s goals and limitations, all done in an empathetic and supportive manner. Understanding costs, risks, benefits, and potential outcomes is crucial for owners of pets with cancer, as is feeling like part of a caring team battling the disease. Multiple studies in human oncology confirm that effective communication skills are a critical source of satisfactory case outcome for both the patient and clinician.
Empathy is the ability to imagine what a client is experiencing and to reflect that understanding. Stated another way, empathy can be thought of as having a client know that he or she is being seen, heard, and accepted. “You seem worried” or “you look like you have some questions” are statements that show clients that they are recognized as individuals with feelings and emotions, and not just as customers. While statements like these might seem awkward or unnatural at first, the ability to express empathy improves with practice. A common concern is that acknowledging a client’s concerns or state of mind will escalate that person’s emotions. Experts agree that the opposite usually occurs. Acknowledging their distress, discomfort, or doubts helps clients know that their feelings are seen and accepted. This usually helps the client focus on the medical discussion and treatment issues. Examples of nonverbal displays of empathy include varying your speaking tone and rate, adopting a sympathetic posture, or simply handing a box of tissues to a crying client.
To clients, knowing that they are being heard is as powerful as knowing they are seen and recognized. Telling clients that you recognize their concerns uses a core communication skill: reflective listening (discussed in more detail in the full guidelines). This type of acceptance will help the owner of a cancer patient to be open and express difficult or even embarrassing issues and questions. Statements like “I can see that this is difficult to discuss” or “it is common for these masses to be overlooked until they become large” can be reassuring to the client and open lines of discussion.
Breaking the news
Clients need time to adjust to the idea that their pet may have cancer, particularly if the prognosis is poor. Being empathetic and candid in discussing a suspected or confirmed cancer diagnosis often helps the pet owner accept the situation and make treatment decisions in a coherent, proactive manner. It is a good idea to announce a cancer diagnosis with a “warning shot” phrase, such as, “I’m afraid the news is not good.” Using short phrases and waiting for the client’s response is a good approach to discussing a cancer case. An example would be, “I’m so sorry about this upsetting diagnosis. Lymphoma is a common cancer in dogs. Unfortunately, it’s not curable but the good news is that it is treatable.” Then pause and ask, “Would you like to discuss further testing and treatment now, or would you prefer to talk later?”
Most clients will have a negative response to the words cancer and chemotherapy. Their initial reaction to a cancer diagnosis often changes as they process and accept the difficult news and listen to the options on how to proceed. It is not uncommon for an initial refusal to consider more testing or treatment to change with further discussion about how well most pets do with their therapy.
When discussing a cancer diagnosis or treatment plan with a pet owner, it is important to use lay terminology or medical vocabulary accompanied by a clear explanation. Using clinical terminology that clients are unfamiliar with will only create confusion or embarrassment and add to the owner’s sense of being overwhelmed. When presenting treatment options, it is important to avoid overwhelming the owner with choices and unnecessary detail. First assessing the client’s goals and limitations is an integral part of presenting options. When suggesting that the patient’s prognosis is poor, keep in mind that only the pet owner can determine the value of the additional time treatment may provide. Clients should be advised that median survival time does not predict what the outcome will be for an individual patient. Balancing realism with optimism is critical for veterinarians treating cancer.
One of the options that veterinary medicine has to offer in order to alleviate pain and suffering is euthanasia. Many cancer cases will conclude with a discussion and an end-of-life decision involving the owner and a member of the healthcare team. Understandably, these discussions can be difficult. Practitioners should be prepared to help the pet owner realize that euthanasia is a humane alternative and a viable option to end a pet’s suffering or an unacceptably poor quality of life. Veterinarians should advise clients to consider euthanasia when the clinician can no longer prevent suffering, preserve the pet’s quality of life, or otherwise ensure the quality of its death.