Dig deep to help pets with cancer at your veterinary practice

Few words weigh heavier than this six-letter word: cancer. Though the word is small in size its meaning can release an avalanche of feelings for pet owners that may spring from their own experiences with cancer, especially if they've witnessed a loved one fight a cancer battle.

An important part of our job is comforting clients and aiding in the grieving process. Clients rely on us to create the perfect balance of lending a kind ear and offering supportive words when desired, but not being over-talkative at the wrong times. They also want team members to help them make treatment decisions without becoming overbearing or judgmental as they make their ultimate decision.

Unfortunately, we don't all possess a natural ability when we face these difficult situations. But we can learn critical skills that ease the way as we help pet owners navigate their pet's serious illness.

As team members, we may also struggle with loss and terminal illness and may at times feel that we're unable to give. When we relay a diagnosis of cancer to clients, it's important to remember most pet owners don't know that cancer therapies are much different in animals. Many clients associate chemotherapy with painful experiences involving relatives who were nauseated and felt miserable every day. It's important to dispel these notions during conversations regarding a cancer diagnosis. Remember, cancer is one of the most treatable conditions of all chronic diseases. The realm of cancer treatment is constantly growing, now including a xenogenic DNA vaccine for canine oral melanoma and tyrosine kinase inhibitors used for treatment of mast cell tumors. The past five years has also brought more effective ways to manage nausea, including maropitant.1

Consider these seven steps to delve into a pet's cancer diagnosis and help ease the burden pet owners feel:

1 Get the lay of the land

It's important to ease into this conversation. Consider the client's perspective. There's nothing worse than having someone spring depressing and unexpected news on you. It's true that some clients prefer a direct approach, and they seek forthright veterinarians. However, many people need to emotionally prepare themselves for this discussion and slowly absorb the information. By the same token, most owners aren't terribly fond of team members who beat around the bush to a fault. In these cases, clients may find it hard to realize the gravity of the situation and determine how to respond.

To introduce the conversation, explain that you've found something concerning. While the doctor will take the lead in this conversation, it's important to support the setting your veterinarian wants to create by matching the doctor's tone and demeanor. This helps prepare clients for tough news. Consider these steps:

> Stay seated at clients' level. Don't tower over them across an exam table. It may help to position yourself where you can easily move yourself closer to clients to hold a hand or offer a hug.

> Eliminate barriers between clients and yourself and make eye contact.

> Stay focused on the conversation. You don't want to be thinking about the next appointment, your evening plans, or reading off a chart. Focus completely on clients and their needs.

For additional assistance, look to Colorado State University's Argus Institute, which provides support for pet owners making quality-of-life assessments and euthanasia decisions and those in need of grief counseling. The institute is comprised of veterinarians and mental health professionals who work toward the goal of standardizing the emotional care provided by veterinary hospitals so that clients' experiences will be more predictable. Be mindful at the same time that this conversation doesn't necessarily need to be a negative, gloomy one. There are many options now to treat cancer patients.

2 Scratch the surface

Focus on listening and let clients absorb your message. This is an invaluable skill in a veterinary practice. Clients need to vent their emotions and concerns and tell stories. They don't need to feel like a burden. So it's a good idea to arrange appointments to discuss a cancer diagnosis, prognosis, and treatment in between other appointments, if possible. Try to provide ample time for clients to ask questions, express concerns, and absorb the news. If you're in charge of scheduling, bear in mind a referral to an oncologist and discussion of treatment can be a lengthy discussion.

During the discussion, it's important to demonstrate active listening. Try paraphrasing the pet owner's thoughts and add some of your input. Try to not talk clients out of their feelings or throw clichés their way. It can be useful to provide a personal story, if appropriate. Just remember that acknowledging clients' feelings is much more effective to lessen their heartache than many well-meaning clichés.

3 Find common ground

For more effective conversations, it helps to use education and bust common cancer myths. Many clients have preconceived notions regarding cancer. They don't see cancer as a controllable, even curable, disease. A significant amount of patients can be either cured or in remission for substantial periods of time—especially with early detection. Animals that undergo cancer treatment often will experience minimal to no toxicity from the drugs employed, unlike humans. Finally, it's important to remind pet owners that, when necessary, many options exist to improve an animal's quality of life, including palliative and hospice care.

4 Let clients weigh their options

Once the veterinarian has offered a diagnosis and treatment recommendations, it's important to allow clients time to make a decision. Try to place these clients in a room they can occupy for a longer period of time without holding up the flow of the rest of the appointments for the day. Having a more comfortable room with pillows, comfortable chairs, and a pet bed with a table that can be lifted out of the way can be comforting and helpful. It's more difficult for clients to feel comfortable and be able to think clearly in a cold, clinical setting like many exam rooms. Try not to rush clients; allow them to go home, spend time with their pet, and contemplate their decision. It may be helpful to provide details and options for treatment in writing, so once clients acknowledge their shock, they can refresh their memory and absorb the information more easily.

5 Provide reinforcement

Regardless of an owner's decision, as veterinary team members, we always must show support and empathy. Try to remember that there are many factors that help influence treatment decisions—medical facts presented by the veterinarian and the clinical team, the pet's age and current quality of life, previous experiences, and even finances. It may be hard to understand owners who don't push enough—or push further than we would—but we must be supportive in most cases.

An exception is a suffering patient forced through treatments that aren't improving its quality of life. Although it's a difficult subject to broach, it's part of our ethical pledge as veterinary team members to do what's best for the patient and not prolong suffering. Some clients need an outside onlooker's view to ground them and help reassess the situation. It's critical to use careful wording in these situations. For example, "I know you love Fluffy dearly, and it's very difficult to see her like this. Just know it's OK to let her go if you're ready." An approach in this spirit can be comforting and nonjudgmental.

6 Discuss potential paths

When appropriate, your conversation may lead into a talk about palliative care. Make sure clients understand that palliative care can help improve a patient's quality of life, but it doesn't necessarily lengthen a patient's life or slow the disease's progression. Palliative care can sometimes be seen in a negative light, as allowing the owner to prolong suffering of a cancer patient. Instead, the purpose should be to make the patient more comfortable and allow more quality time with the owner, assuming the pet hasn't reached a poor quality of life already.

Some patients won't benefit from palliative care, and euthanasia is the most humane option. The veterinarian will attempt to guide owners using his or her best judgment in these situations. For example, the doctor may skip a discussion of palliative care with a patient already suffering in late-stage cancer. Make sure to thoroughly explain what palliative care means. It's not treating the cancer itself but the symptoms of cancer, with the goal of improving the patient's comfort.

7 Be a foundation for grieving clients

As you guide clients through their pet's illness, it's important to understand the stages of grief. Grieving applies to many situations with owners, whether or not a physical loss occurs. Even with owners of cancer patients who pursue treatment, they may be grieving the loss of the way their pet used to act and feel. A lot of times a powerful diagnosis such as cancer can be an unfriendly reminder of our pet's age, and it may make owners long for the kitten or puppy they once had not so long ago.

The veterinary hospital should be the place clients feel they can go to talk about their feelings and not fear disenfranchised grief—in other words, grief that isn't acknowledged as legitimate by others. You are likely familiar with the Kübler-Ross model of stages of grief: Denial, Anger, Bargaining, Depression, and finally, Acceptance. Each client will go through these stages differently, and in varying increments of time. Try to keep these in mind when relaying a diagnosis to owners, as any initial denial or anger clients display may be part of the shock and grief they feel.

Final thoughts

When you relay a devastating diagnosis to clients, whether it's cancer or another debilitating or terminal disease, patience, the right environment, and a listening ear may be the most helpful components for a smooth conversation. These conversations are our chance to make a huge difference in the lives of owners and their pets. Not only can we better educate on treatments available and their side effects on animals, but we can also comfort owners who've made the decision to gracefully let go of their pet. Each of us will have our own approach cancer discussions. But having a predetermined approach and understanding of grief may help us shore up the foundation of our practice as we plumb the depths of the care we can offer to clients and their pets.

Oriana D. Scislowicz, BS, LVT, VDT, is a technician in Richmond, Va. Share how your veterinary team members support clients during a difficult diagnosis at dvm360.com/community.

Reference

1. Ogilvie GK. Ethics and compassionate cancer care: Where do we draw the line? Compend Contin Educ Vet. 2008:30(12):616-618.