Section 2: Client Conversations Before a Referral

Top 3 Takeaways

1. The PCT communicates what to expect during the referral process, including, if known, the estimated costs, timelines, additional testing, and procedures.
2. The PCT discusses the client’s goals for caring for their pet, including quality-of-life measures and other points for reassessment and decision-making.
3. The PCT’s ongoing involvement with the client and pet during the referral is a top predictor of a client’s positive feelings toward the referral process and maintains the connection with the PCT.

A disorganized referral can add to a client’s uncertainty and worry about their pet’s illness, particularly when they lack understanding of their pet’s condition, the role of the specialist, or what will happen next.^1,2 However, many clients appreciate being offered a referral as an option for their pet and welcome an opportunity to make an informed decision on their pet’s medical care. A well-defined referral process that clearly outlines each team’s roles and responsibilities can ease client concerns and facilitate smooth and productive collaborations (Figure 2.1).

Before making a referral, have a detailed conversation with the client to ensure success. Discuss the pet’s needs, how the referral addresses those needs, and outline potential treatment goals. It is crucial to explain the likely care costs to avoid financial surprises and ensure clients are prepared for the commitment. This conversation can prevent clients from discontinuing care because of financial constraints, a common referral issue. To avoid guesswork, SCTs should provide PCTs with estimated costs for common conditions and treatments. A qualified team member, such as a veterinary technician, can effectively handle these discussions.

FIGURE 2.1: Timeline and steps for a hands-on referral

Download PDF of Figure 2.1

Key points for client communication

Discuss the client’s goals of care for their pet.

• Quality of life measures
• Points for reassessment
• Decision-making processes
• At-home factors, e.g., medical conditions or transportation and mobility limitations that may pose challenges with patient care

Mitigate client concerns and trust issues.

• Acknowledge illness uncertainty (see below).

Explore client information needs and questions.

Ask clients to share any previous experience at a specialty hospital.

• Address any concerns the client might have about veterinary specialists.
• Ensure they feel comfortable with the referral.

Personalize education on specialty care to the client and their family situation.

Manage client expectations.

• Warn clients there may be wait times.
• Work with them to mitigate the effects of the wait time.
• If indicated, consult with the specialist before the appointment to ensure client and patient needs are being met.

Designate a team member to serve as a referral coordinator. This team member will:

• Provide clear communication on what to expect when going through the referral process, including estimated costs, additional testing, and procedures.
• Describe alternative options including the potential benefits and risks.
• Explain the process for making a referral appointment, including whether client is to contact the SCT, or if the SCT will contact the client.

Reassure the client.

• Stay up to date with the diagnostics and treatment plan performed by the SCT.
• Keep connected and engaged in the process to show clients the PCT cares about them and their pet.
• This can be a top predictor of a client’s positive feelings during a referral.

What is illness uncertainty, and how can it be addressed?

Illness uncertainty can occur when a client receives a diagnosis or suspected diagnosis of serious illness in their pet. It is an emotional and mental state in which the client may feel unable to make sense of the illness or be able to anticipate what the outcome of the illness will be.³ This uncertainty can come with a sense of loss of control, cognitive stress, and an ongoing state of doubt.⁴

How does the veterinary team know if someone is experiencing illness uncertainty?

In human medicine, illness uncertainty has been recognized as a central feature in the experience of illness for decades. It is, therefore, not surprising individuals would experience this state when receiving an illness diagnosis for a pet. Four factors feed into uncertainty:

1. ambiguity about the state of the illness
2. unpredictability about prognosis and progression
3. lack of information
4. lack of clarity about what information exists.

Clients experiencing illness uncertainty may exhibit coping strategies such as information seeking (e.g., internet searches, online discussion groups, etc.), increased monitoring of the pet, social support, focusing on the positive, and living in the moment. Clients may also express “denial, avoidance, selective ignoring, minimizing, selective misinterpretation, and wishful thinking.”⁵ Understanding how and why these behaviors occur because of illness uncertainty can help veterinary teams better communicate with and support clients during the referral process.

How can the veterinary team support clients experiencing illness uncertainty?

Supporting clients through illness uncertainty can improve client and pet well-being and facilitate their ability to manage uncertainty. While investigations into illness uncertainty in veterinary clients are lacking, a 2019 study of veterinary oncology referrals proposed strategies to support clients experiencing illness uncertainty.⁶

1. Provide quality and structure to the information given.
   • Too much and overly complex information can increase uncertainty and cause information overload.
   • Give logically ordered information in digestible increments according to the client’s preferred communication methods.
   • Adopt a staged approach (“chunking and checking”) by giving small amounts of information and then asking questions/assessing client understanding.
2. Support informed decision-making.
   • Provide information so clients can weigh the risks/benefits of choices for care.
   • Clients may need time to think about the initial session, so provide opportunities for follow-up conversations.
3. Prepare clients for what to expect at the referral service.
4. Support clients who are seeking information.
   • Some pet caregivers may use the internet to find more information. Acknowledge their desire to be proactive in their pet’s care and direct them to websites and resources that offer accurate and high-quality information
   • Provide resources such as social and peer support groups.
   • Validate and encourage information seeking and sharing.
5. Provide ongoing support.
   • If possible, provide a consistent care team.
   • Reassure the client that the PCT will continue to assist them with any questions or concerns that arise.
   • Understand that uncertainty may change over time and encourage positive coping strategies, such as focusing on what can be controlled, remaining in the moment, and connecting with support systems.

The 2025 AAHA Referral Guidelines are generously supported by CareCredit.