Page 334 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

312 PART III Therapeutic Modalities for the Cancer Patient

These principles translate readily to the veterinary con- that enhanced adherence was associated with clear recommenda-
text. 419,427,428 Expanding data gathering to explore the broader tions, relationship-centered care, client satisfaction, an empathetic
and unhurried atmosphere, longer appointment time, and use of
lifestyle of the client and pet enhances the veterinarian’s under-
VetBooks.ir standing of the animal’s cancer. Discussing unique details, such positive rapport-building statements. 437 Moreover, evaluation of
the association between veterinarian-client communication and
as financial resources, the role of the primary caregiver, feasibility
of implementing a plan, and recent life events (e.g., new birth, veterinarian satisfaction with the visit revealed that veterinarian
death, new job, or moving) promotes adherence to recommenda- positive talk (e.g., compliments, laughter, statements of approval
tions. With increased recognition of the human-animal bond, it and agreement) was correlated with veterinarian satisfaction with
is important to assess the level of attachment and the effect of the wellness visits (i.e., pets brought to the veterinarian for routine
animal’s cancer on the family. Eliciting information on the client’s examination), and client rapport building and veterinarian-to-pet
expectations, thoughts, feelings, and fears about the pet’s cancer talk were associated with veterinarian satisfaction with problem
fosters client participation and satisfaction and promotes shared visits (i.e., pets brought to the veterinarian because of a health
decision making. problem). 438 In a detailed analysis of the use of communication
Studies found potential missed opportunities for eliciting cli- skills by companion animal veterinarians, the veterinarian’s expres-
ent perspectives during euthanasia discussions. In a quantitative sions of empathy resulted in higher levels of client satisfaction. 439
study investigating the use of client-centered communication
in euthanasia discussions with undisclosed standardized clients Client Uncertainty
(USC) (i.e., “secret shopper” in the marketing setting), veterinar-
ians did not fully explore clients’ feelings, ideas, and expectations, Uncertainty is at the core of the illness experience and the practice
or the effect of the illness on the animal’s function. 428 Veterinarian of medicine. During in-depth interviews of oncology clients at
and client perceptions of the client-centeredness of the euthana- a tertiary referral center, client uncertainty arose as a dominant
sia discussions differed—veterinarians perceived that client-cen- client psychological experience during oncology appointments. 440
teredness components were addressed more thoroughly than was Traditionally veterinarians focus on treating the animal’s disease,
perceived by the USC. 427 For both euthanasia scenarios, the vet- and the results of this study highlighted the importance of the
erinarian and client agreed that discussion of personal and family veterinarian’s role in managing the client’s experience of the ani-
issues was lacking. 428 Identifying clients’ background, experiences, mal’s illness. The diagnosis of cancer and its association with death
perspectives, and preferences is critical to shared decision making, shifted clients’ worldviews from orderly, predictable, and reliable
and working toward consensus is important to achieve significant to one of chaos, unpredictability, and ambiguity. Client experi-
clinical outcomes for the veterinarian, client, and patient. ences of uncertainty were greatest in the early stages and again in
Relationship-centered communication can be learned and the late stages of cancer treatment. For many clients uncertainty
taught. Communication interventions conducted in the practice was seen as danger, although some saw opportunity expressed
setting focused on relationship-centered care, and effective com- through optimism, hope, and living in the present. Veterinarians
munication resulted in a more client-centered approach. 410,411 can facilitate adaptive uncertainty management by supporting cli-
After a 1-year training, veterinarians gathered more lifestyle-social ents’ efforts to reduce uncertainty; this can be done by meeting the
data and used more partnership-building and positive rapport- client’s informational and relational needs.
building communication; clients provide more lifestyle-social Client informational needs 440 include orientation to the oncol-
information and emotional statements. 410 After a 6-month com- ogy appointment provided by the primary care veterinarian and
munication program veterinarians used more facilitative and emo- the oncology service, such as new client information packages,
tional rapport communication; clients felt more involved in the service websites, conversations with a client liaison, walking cli-
appointment and veterinarians expressed greater interest in their ents through the hospital processes and protocols, hospital tours,
opinions. 411 and meeting members of the oncology team, all of which prepare
clients for the initial visit. For some clients, providing information
Clinical Outcomes can be empowering, but for others this can be incapacitating; for
a few clients avoidance, denial, or minimizing may be vital coping
Based on medical communication studies, relationship-centered mechanisms. Therefore it is critical to tailor the approach to giving
care is associated with significant improvements in clinical out- information and identifying clients’ background and experiences,
comes. Broadening the explanatory perspective of disease beyond need for information, and information preferences (e.g., present-
the biomedical to include lifestyle and social factors is related to ing the big picture or a highly-detailed discussion). It is equally
expanding the field of inquiry and improved diagnostic reasoning important to discuss with clients the efficacy and success of treat-
and accuracy. 420 Building a strong relationship is associated with ment approaches, in addition to potential adverse effects, so cli-
increased accuracy of data gathering, 420 patient satisfaction, 429–431 ents are prepared for all treatment outcomes. Provide warnings
and physician satisfaction. 432,433 Encouraging participation, when necessary when delivering test results or progress reports to
negotiation, and shared decision making promotes patient satis- reduce unnecessary client distress. Set the course of cancer ahead
faction, 429–431 adherence to recommendations, 434 and improved of time, if required, so clients anticipate transitions from focusing
health. 435 on treatment to conversations addressing QOL, palliative, hos-
Veterinarian-client communication also is correlated with pice, or end-of-life care.
clinical outcomes. In a study in which closed- and open-ended Client relational support plays an equally critical role in reduc-
solicitation of client concerns were compared, open-ended inquiry ing client uncertainty. 440 The foremost relationship is that with
elicited more concerns and client dialog, with decreased odds of a the veterinarian or nurse, and continued, established, and trusting
new concern arising at the close of the interview. 436 Investigation relationships are paramount. Another source of relational support
of the relationship between veterinarian-client communication is timeliness of service, including booking appointments, return-
and adherence to dentistry and surgical recommendations revealed ing client’s phone calls, conducting diagnostic tests, providing test