CVC highlight: How to break bad news to veterinary clients

Studies in human medicine show that patients repeatedly mention the importance of the way conversations regarding bad news are handled. Key factors that influence the way veterinary clients adapt to a pet's illness and treatments include the setting for the talk, the choice in word use, and the emotional connection between you and the clients.

Laura D. Garrett, DVM, DACVIM (oncology)

The setting

It's best to have clients come into the office for bad news rather than to hear it by phone. Make sure you have adequate time for the discussion, and use a private space with seating. The primary clinician should be the one to break the bad news. It can be helpful to have family or friends in the room to help support the client and help the client recall information later.

Four core communication skills

While hearing bad news can be distressful for clients, delivering the news can also be distressing to clinicians. It is important to have specific skills to rely on for this critical and difficult task. Be sure to use these four core communication skills to improve the experience for all.

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1. Keep your nonverbal communication signals in line. Think about how you feel before you go into the room. Once you are in the room, maintain a calm tone of voice, have your body position on the same level as the client, and maintain good eye contact. You can give a pat on the back, a touch on the arm, or even a hug, as appropriate. Watch the client's nonverbal signals as well instead of charging ahead—gauge whether the client is focusing, and pause if the client looks upset or ill. You can check in by saying something such as, "Would you like a few minutes?"

2. Be empathetic. Let the client know he or she is seen, heard, and accepted. Verbally acknowledging a client's distress helps the client know that his or her feelings are seen and, thus, helps to validate those feelings. A statement as simple as, "I can see this is difficult for you. It can be very hard to hear that someone so close to you has cancer," can be grounding for clients and may help them to refocus on the medical discussion at hand.

3. Ask open-ended questions. Don't assume you understand what the client is thinking. Ask open-ended questions such as, "What are your thoughts about options from here?" instead of "Are you thinking about euthanasia?" Ask rather than tell is a great rule of thumb. Also, asking a client what they already know about a condition or disease can save time and avoid unnecessary client education. You will not only begin the discussion at an appropriate level, but you can also show the client that his or her knowledge is valued.

4. Use reflective listening. This core skill involves restating what a client has said in your words—or even stating how a client appears—to show the client he or she is heard and seen. Saying, "You look very worried," can help the client to acknowledge the fear and then move beyond it toward a productive discussion. And your interpretation of what a client is saying allows him or her to correct any misunderstandings: "So you were concerned about the cost of the treatment?" may elicit a "Yes, it seems very expensive," or possibly, "No, the cost isn't the problem. It's the time involved."

How do you start?

Begin with a warning shot such as, "I have some difficult news to share with you about the results of Misty's blood test." But do not make this warning long, since anticipation of bad news builds up in a negative way. Always use the pet's name and correct sex.

Give the information in small sound bites, intermittently checking in for the client's understanding or thoughts. You can say things such as, "We've covered a lot of information so far. Can you tell me what your understanding of Misty's problem is?" or "Let me pause here and ask for questions you have for me at this point."

After the news has been delivered

After sharing the news, be prepared to respond to clients' emotions. They may be shocked or speechless—or very matter-of-fact and unconcerned. Don't be afraid to ask if a response seems different than you would expect. Saying something such as, "You seem very distraught about the pancreatitis—what experiences have you had with it in the past?" may bring to light the fact that another one of their pets died of pancreatitis. Try not to use "why" (e.g. "Why are you so upset?") because it can sound judgmental.

And don't feel the need to fill the silence. Clients need time to adjust and think; a respectful silence provides nonverbal support. You can also show empathy by normalizing reactions with statements such as, "Many people have difficulty making these decisions," or "It is so hard to hear information like this. Getting upset is OK." Giving a client time to adjust and asking for permission to provide more information will help the pet owner transfer from grieving over the diagnosis to taking an active role in making treatment choices and moving forward with medical care, which is your ultimate goal.

Laura D. Garrett, DVM, DACVIM (oncology), Cancer Care Clinic, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois.

Listen in

To hear Dr. Garrett explain how understanding the stages of grief can prevent you from taking clients' reactions personally, scan the QR code above, or go to dvm360.com/CVC13Garrett.