The team-based approach to veterinary cancer care

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There is a fine line between a group and a team, according to Erika Krick, VMD, DACVIM (Oncology), and Lindsay Hallman, CVT, colleagues in the oncology unit at Mount Laurel Animal Hospital in Mount Laurel, New Jersey. And when you’re working in veterinary medicine, the difference matters. During a lecture at the Fetch dvm360® virtual conference this morning, the duo explained the differences between teams and groups, and shared their process of applying a team-based approach to the care of oncology patients.

What is a team?

“When we think about a group, it’s a number of individuals who are working together, but not necessarily collaborating,” Krick said. Groups typically work on a series of tasks assigned by a leader. Working independently, group members aren’t aware of the bigger picture, so they don’t have the luxury of seeing how their tasks contribute to the whole. “As a result, there is very little coordination between members,” she said.

By contrast, team members work together with a unified purpose, vision, and values to achieve a shared goal. In a team setting, all members understand how their individual tasks fit together toward making that common goal a success. “The success of a team, therefore, really depends on the ability of all members to collaborate,” she said.

Effective communication

“Communication is a prime and essential factor for a successful team,” Krick said, adding that communicating effectively with each other improves efficiency and flow and reduces errors and stress.

“We are here to provide the best possible care and compassion to not only our patients and our clients, but also our fellow colleagues and each other,” Hallman said. “We really focus on effective communication.” Following are the hallmarks of effective communication:

• Be clear, honest, and sincere.
• Communicate in an appropriate setting, without distractions.
• Always encourage questions, and clarify understanding where needed.
• Understand the perspectives of all involved.
• Acknowledge emotional responses, but communicate with rational responses and interactions.

Day-to-day duties of a cohesive oncology team

Hallman provided an overview of the daily workflow for the oncology team at Mount Laurel Animal Hospital. The team meets in the morning at the whiteboard, where they round to ensure that everyone knows the plans for each patient for the day. Throughout the day, the team does initial consults, diagnostic workups, chemotherapy visits, and recheck visits. They also do their best to communicate well and plan ahead with the other hospital team members to schedule diagnostic imaging, for example. Recheck visits are scheduled by technicians at checkout to reduce the burden on the receptionist staff. Other daily tasks include unexpected internal consults, answering phone calls and emails, and teaching veterinary students.

“As you probably can imagine,” Hallman said, “communication is integral to each of these tasks, and so doing our best to communicate effectively within our team really helps to improve the efficiency and flow of our service.”

The pair also outlined their specific roles for technicians and veterinarians:

Nursing roles

• Client communication
• Initial patient assessment
• Patient handling
• Diagnostic sample collection and processing
• Diagnostic imaging
• Chemotherapy dose-checking and preparation
• Medical record completion
• Phone and email triage
• Maintaining order and flow

Clinician roles

• Calculate chemotherapy doses
• Determine whether it's appropriate for a patient to receive chemotherapy on a given day
• Discuss chemotherapy side effects with clients
• Complete medical records
• Reach out to referring veterinarians
• Implement a double-checking system to reduce error

COVID-19 challenges

In light of the many pandemic-related challenges this year has brought, the two shared obstacles for treating their cancer patients. With the sensitivity of the diagnosis, Hallman expressed the need for compassion, patience, and perspective when dealing with clients whose pet has cancer. One of the obstacles Hallman identified is managing the patient without the owner present. “This is particularly challenging for patients that are new to practice. Breaking bad news over the phone is awful, especially when [the client hasn’t] had any prior contact with the team who is diagnosing and treating their animal.”

When the situation becomes challenging, Hallman said, it’s important to recognize and expect emotions to run high sometimes. As nurses, [we] have the ability to either escalate or de-escalate the situation rather quickly. “If we are feeling attacked and taking it personally and displaying the same discontent to the client that they are giving us, then it’s going to be like a mirror,” she said. “We will just continue mirroring each other back and forth and then nobody benefits at the end of the day.” Compassion is a huge strength in rectifying these challenging and uncharted situations.