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https://todaysveterinarypractice.com/table-of-contents-september-october-2021/
Finding Balance, Personal/Professional Development

Caring for Clients at the End

Giving as much attention to the client as to the pet about to be euthanized can greatly affect the grieving process and outcome for everyone involved.

Kate BoatrightVMD

Dr. Boatright is a 2013 graduate of the University of Pennsylvania. She currently works as a small animal general practitioner and emergency clinician in western Pennsylvania at NVA Butler Veterinary Associates and Emergency Center. Her clinical interests include feline medicine, surgery, internal medicine, and emergency. As a freelance writer and speaker, Dr. Boatright enjoys educating veterinary students and colleagues about communication, team building, and the unique challenges facing recent graduates. Outside of the clinic, she is active in her state and local VMAs and serves on the VBMA Alumni Committee. In her spare time, she enjoys running and spending time with her husband, son, and three cats.

Caring for Clients at the End
Bee Johnson
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I experienced the death of pets in my childhood and have guided many clients through end-of-life decision-making in both emergency and non-emergency situations. But it was only recently that I found myself as the pet owner making the difficult decisions about end-of-life care.

As a veterinarian, I imagined how I might navigate being on the pet owner side of the experience, but I never could have prepared fully for what I would feel as my husband and I made the decision to euthanize our youngest cat, Echo. The experience was a reminder about how important clear communication and client care are at the end of a pet’s life. 

I believe the veterinary profession’s ability to provide euthanasia is a blessing—a final gift that we can give to our clients and their beloved pets. But just because I believe it is a blessing doesn’t mean that performing euthanasia or discussing end-of-life care is easy—in fact, it is one of the biggest challenges we may face in veterinary practice.

When we move into end-of-life care and discussions surrounding euthanasia, the rules shift. The clinical outcome for the pet will be death, regardless of how it happens. So, how can we measure a successful outcome? We must provide compassionate communication and empathy to our clients while minimizing pain and distress for our patients. 

Client-Centered Communication

Most veterinarians in practice, regardless of species or specialty, will engage in end-of-life discussions with clients. These discussions are an essential part of our oath to serve patient welfare and support the human-animal bond between our clients and their pets, but they can be emotionally taxing. Many veterinarians find that the conversations leading up to euthanasia and end-of-life decision-making are more stressful than the act of performing euthanasia.1

There are many factors that must be considered for each pet owner and family, including: 

  • Can the pet owner afford to pursue further diagnostics and treatments financially? 
  • What is the emotional impact of caring for the pet on the family?
  • Is the pet owner physically able to provide the necessary nursing care for the pet? 
  • What level of attachment and bond do the family members and pet have? 
  • What are the pet owner’s beliefs around end-of-life care and euthanasia?
  • What are the pet owner’s goals for quality of life of their pet?

Embracing a client-centered communication style allows discussion of the above factors while inviting the client to express their concerns, questions, and feelings surrounding the process. Clients want this type of communication during end-of-life conversations, but many veterinarians overestimate the amount of time they spend in client-centered conversation.2 Focusing on this communication style, especially during end-of-life care, will help to improve client bonds with individual veterinarians and our practices.

The Grieving Process

As I have grieved, I am reminded how the emotions surrounding end-of-life care and decision-making don’t end for the pet owner when the pet has died. In many cases, especially with an unexpected death or euthanasia in an emergency situation, the grieving process is just beginning. The pet owner is left to return to an empty home or walk into a room with 2 food bowls where 3 used to be. There are constant reminders of a companion who is no longer there.

Grieving is a natural process, and at least 30% of pet owners will experience severe grief following the loss of a pet.3 Half of pet owners who elect euthanasia will question their decision or experience guilt surrounding this decision.3 Providing emotional support to clients as they navigate the decision-making process around euthanasia is an important responsibility of the veterinary team. We should strive to be more proactive about offering resources (BOX 1) to grieving clients and helping them prepare for the emotions they may experience following the death of their pet.

It is important that we remember that most veterinarians are not trained in grief counseling or social work. While we can provide compassionate communication and empathy, some clients’ needs will be larger than we can meet. In these situations, we can provide information about pet loss hotlines, support groups, and one-on-one grief counseling with a trained social worker. Sometimes, recommending a grief counselor before the pet has passed away can be helpful for owners who are struggling to make a decision about how to best care for their pet.

The Patient Experience

In addition to embracing the human side of the equation, it is essential that veterinarians help pet owners understand the disease process and the trajectory of the disease.4 The healthcare team must discuss both what we can do for a pet and what we should do for a pet. These are 2 different things that must be considered on a case-by-case basis. Just because we can perform an invasive surgery or give a blood transfusion doesn’t always mean that we should. How will this procedure—whether diagnostic or therapeutic—impact the patient’s quality of life?

While our patients cannot talk, they can communicate. I rely on my clients, who know their pet better than I do, to share what they are observing at home. Clients may not always know how to interpret their pet’s behavior, but our medical training can help us guide them in clinical signs to monitor for subtle behavior changes that may indicate pain or distress. The American Animal Hospital Association/International Association for Animal Hospice and Palliative Care (AAHA/IAAHPC) end-of-life care guidelines provide a detailed list of considerations for the patient’s physical, social, and emotional needs.4

As end-of-life care and euthanasia have become increasingly valued and nuanced in the veterinary profession, many wonderful veterinarians have chosen to specialize in caring for clients and patients during this final stage of life. The IAAHPC offers certification programs for veterinarians, veterinary nurses, and social workers.5 These individuals are trained to provide hospice and palliative care in addition to personalized home euthanasia. This offers owners who are reluctant to euthanize in a clinical setting, or at all, an alternative way to care for their pet at the end of their life.

Veterinarians should embrace the growing field of animal hospice and palliative care and offer referral to those who have chosen to specialize in this area of practice, just as we provide referrals to specialists when our patients’ disease process requires diagnostics or treatments that we are unable to provide.

The Lasting Impact of a Good Death

We only have to look at the wall in the doctor’s office or the table in the break room to see how important end-of-life care and euthanasia are to our clients. Far more cookie trays, cards, and other gifts arrive at the clinic following the euthanasia of a pet than do following a successful spay, vaccination appointment, or even successful treatment of a major injury or illness. Clients remember the last moments they share with their pet. They remember how the veterinary team treated their pet and how we made them feel during those moments. 

References

 

  1. Matte AR, Khosa DK, Coe JB, Meehan MP. Impacts of the process and decision-making around companion animal euthanasia on veterinary wellbeing. Vet Rec. 2019;185(15):480. doi.org/10.1136/vr.105540
  2. Nogueira Borden LJ, Adams CL, Bonnett BN, et al. Comparison of veterinarian and standardized client perceptions of communication during euthanasia discussions. JAVMA. 2019;254(9):1073-1085.
  3. Adams CL, Bonnett BN, Meek AH. Predictors of owner response to companion animal death in 177 clients from 14 practices in Ontario. JAVMA. 2000;217(9):1303-1309.
  4. Bishop G, Cooney K, Cox S, et al. 2016 AAHA/IAAHPC end-of-life care guidelines. JAAHA. 2016;52(6):341-356.
  5. International Association of Animal Hospice and Palliative Care.
    iaahpc.org. Accessed March 31, 2021.

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