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CHAPTER 16 Supportive Care for the Cancer Patient 311

care, the inclusive term “veterinarian” is used in this section to Throwing a shot-put is unidirectional, the intent is on the delivery,
encompass the roles of the referring veterinarian and specialists in the information to be presented is large in mass and scale, and it
is challenging to receive the message. Intuitively, it seems as if this
conducting cancer conversations.
VetBooks.ir cer communication. Only limited empiric studies are available in “take charge” approach enhances efficiency and promotes time
The purpose of this section is to present best practices for can-
management. The challenge is that the agenda and subsequent
the veterinary literature concerning cancer communication, 400,415 diagnostic or treatment plan may not be shared by the veterinar-
and information is based largely on clinical experience. 447,479,460 ian and client, compromising the ability to reach agreement and
In contrast, the literature on human medical communication achieve adherence to recommendations or, moving forward too
contains a large number of empiric studies; however, in relation quickly may lead to client regrets. This could result in a roadblock
to cancer communication, what is available is based on expert and the need to take steps backward to recover and regain client
opinion, case studies, reviews, and predominantly descriptive understanding, commitment, and trust.
studies. 414,416 The objectives of this section are to describe rela- In contrast, partnership or relationship-centered care repre-
tionship-centered care, define core cancer communication skills, sents a balance of power between veterinarian and client and is
and highlight communication approaches to difficult discussions. based on mutuality. 419,423–425 In the relationship-centered model
The medical cancer communication literature 402,404,416–420 and the relationship between veterinarian and client is characterized
clinical experience provide the foundation for communication by negotiation between partners, resulting in creation of a joint
techniques presented here. venture, with the veterinarian taking on the role of advisor for
Before moving on we should address one of the most com- the client and advocate for the patient. Respect for the client’s
mon concerns expressed in communication training: there is not perspective and values and recognition of the role the animal plays
enough time in the clinical interview. It seems as if the conver- in the client’s life are incorporated into all aspects of care. In com-
sational approach of relationship-centered care takes more time; panion animal practice, 69% of wellness visits and 15% of prob-
however, it was found in veterinary general practice visits that lem visits were characterized as relationship-centred. 419
relationship-centered care appointments were shorter because the The conversation content of relationship-centered visits is
veterinarian and the client achieved common ground early in the broad; it includes biomedical topics, lifestyle discussion of the
appointment. 419 In human medicine, when patients are left to pet’s daily activities (e.g., exercise regimen, environment, travel,
tell their story uninterrupted, their average talking time was 92 diet, and sleeping habits), and social interactions (e.g., person-
seconds, and they provided key clues to the diagnosis. 444 Empa- ality or temperament, behavior, human-animal interaction, and
thy also can be expressed without prolonging the appointment animal-animal interactions) that are key indicators of the patient’s
time; in one study as little as 40 seconds of empathy reduced QOL. 419 In addition, a relationship-centered approach encom-
the patient’s anxiety level. 421 Although it seems counterintui- passes building rapport, establishing a partnership, and encourag-
tive, evidence suggests that using the core communication skills ing client participation in the animal’s care, all of which have the
actually saves time and allows for a more efficient veterinarian- potential to enhance clinical outcomes.
client-patient interaction. In addition, spending time to build a This collaborative relationship is a dialog and is symbolized by
relationship at the beginning of the appointment creates trust, a Frisbee. 412 In playing Frisbee, the interaction is reciprocal; the
and this will pay off when diagnostic and treatment recommen- intent is on the exchange of information, small pieces of informa-
dations are made. tion are delivered, the client responds, and the message is adjusted
to target the individual. The emphasis of the Frisbee analogy 412
Paradigm Shift: Paternalism to Partnership is on eliciting client feedback to assess how the client perceives,
processes, and understands the information presented.
Recent societal changes caused a paradigm shift in the veterinar-
ian-client-patient relationship. Growing client expectations, the Relationship-Centered Care
strong attachment between people and their pets, and increasing
consumer knowledge demand a swing in communication style Combining several frameworks Mead and Bower 426 identified five
from the traditional paternalistic approach to a collaborative part- distinct dimensions of relationship or patient-centered care in the
nership. 399,400,419,281 Many clients are no longer content with tak- human medical setting.
ing a passive role in the healthcare of their animal, preferring to 1. The biopsychosocial perspective—A perspective on illness that
take an active role in the decision-making process. 399,400,419,422 includes social, psychological, lifestyle, and biomedical factors.
Paternalism is characterized as a relationship in which the vet- 2. The “patient/client as a person”—Understanding the personal
erinarian sets the agenda for the appointment, assumes that the meaning of the illness for each individual patient or the per-
client’s values are the same as the veterinarian’s, and takes on the sonal meaning of the animal’s illness for the client.
role of a guardian for the patient. 419,423–425 Traditionally, paternal- 3. Sharing power and responsibility—Sensitivity to preferences of
ism is the most common approach to medical and veterinary vis- the patient and/or client for information and shared decision
its. In a quantitative study published in 2006, companion animal making.
practitioners used a paternalistic approach in 31% of wellness vis- 4. The therapeutic alliance—Developing common therapeutic
its and 85% of problem visits. 419 In a qualitative study published goals and enhancing the physician-patient or veterinarian-cli-
in 2017, livestock practitioners used a directive communication ent-patient relationship.
style reflective of a paternalistic approach. 422 The topic of conver- 5. The “doctor as person”—Awareness of the influence of the sub-
sation was primarily biomedical in nature, focusing on the medi- jectivity of the doctor on the practice of medicine.
cal condition, diagnosis, treatment, and prognosis. 419 Incorporating these dimensions, cancer communication strives
In a paternalistic relationship the veterinarian does most of the to balance exchanging information, making decisions, fostering
talking and the client plays a passive role. This approach often healing relationships, enabling clients to provide patient care,
is referred to as the data dump and symbolized by a shot-put. 412 managing uncertainty, and responding to emotions. 414