Page 335 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

CHAPTER 16 Supportive Care for the Cancer Patient 313

results, and starting treatment. Providing 24-hour information to seek advice and guidance. Likewise, survey respondents of the
support in case of an unexpected event or complication, allow- Pet Cancer Support group stated that problem-focused tangible
support (i.e., veterinarian investment in animal care and being
ing clients to seek advice and guidance, manages uncertainty by
VetBooks.ir addressing the client’s questions and concerns and unexpected available and accessible to clients) was the other customary source
443
outcomes in a timely manner. In addition, peer support, wait-
It was supportive
of support provided by their veterinarians.
ing room interactions, social communities (i.e., family, friends, to clients when information was conveyed in a positive, compas-
or neighbors), and formal Internet groups offer opportunities to sionate, empathetic, and nonjudgmental manner, which provided
share and normalize the client’s experiences. much needed emotional support. In contrast, emotional-focused
support was not expected of their veterinarians. 443 Meeting infor-
Veterinarian Expressions of Uncertainty mational needs and creating a humanistic environment helped
clients cope with their pet’s cancer. 400
As much as is known today about cancer, much is still unknown,
and veterinarians need to express uncertainty to their clients.
Studies in human medicine contradict each other on whether Core Communication Skills for Cancer
a clinician’s expressions of uncertainty enhance or undermine a Communication
patient’s confidence and satisfaction. A qualitative survey study in
veterinary medicine explored veterinarian and client expressions The Calgary-Cambridge Guide 412 is an evidence-based commu-
of clinical uncertainty. 441 All clients wanted to know about clinical nication model that provides structure to the clinical interview,
uncertainties related to diagnostic accuracy and treatment appro- describing the tasks and identifying key communication skills to
priateness, and expressions of uncertainty did not erode clients’ help veterinarians achieve clinical outcomes. Defining and dem-
confidence. Behavioral expressions of uncertainty (e.g., consult- onstrating specific skills and behaviors are instrumental first steps
ing with or referring to a specialist) were less damaging to client to enhancing communication approaches. 409–412 The communi-
confidence than verbal expressions (e.g., “I need to find our more” cation tools described in the following discussions were identified
or “This might be…”). as core communication skills in human cancer communication
literature 402,409,414,416 and are highly applicable to veterinarian-
Client Expectations client-patient interactions. 442,446

In a survey study of members of the online Pet Cancer Support Gathering Information
group 77% of respondents were satisfied with their veterinar-
ian, 71% with the information the veterinarian provided about Identify the Client’s Full Agenda 442
treatment options, and 70% with the support they received from Eliciting the client’s full agenda through open-ended inquiry pro-
their veterinarian. 442 In a study of in-depth interviews of oncol- motes early detection of problem(s) and sets a plan for the rest
ogy clients at tertiary referral center, clients identified important of the visit. 437 This includes exploring the client’s reasons for the
aspects of veterinarian-client communication. 400,415 These client visit, concerns, goals, expectations, and priorities. An open-ended
comments can be divided into those related to communication question is designed to draw out a full response from the client
content (i.e., what is said 415 ) and process (i.e., how it is said 400 ). rather than a brief one; it usually begins with “how,” “what,” “tell
Interweaving communication content and process ensures effec- me,” “describe for me,” or “explain to me.” In a quantitative study
tive sharing of information. of soliciting client concerns, the use of open-ended solicitations
Regarding the content of information delivery, 415 the central resulted in significantly more client concerns being revealed than
theme was that clients wanted the truth about all aspects of their with closed-ended solications. 437
animal’s cancer and treatment. In particular they expected the
veterinarian to share information in relation to the client’s back- “Your referring veterinarian diagnosed Mandy with [disease]. What
ground, previous experiences, and information preferences (i.e., specific questions would you like me to address today?” [reasons
presenting the big picture or a highly-detailed discussion), in other for visit]
words, tailored to each client. This information was empowering “I see that your veterinarian referred you for [disease]. What else
for clients and enabled them to make treatment decisions, granted would you like to discuss?” [reasons]
a sense of control, and fostered hope and overall ability to cope “What are your greatest concerns about Mandy’s cancer?” [concerns]
with their pet’s cancer diagnosis and treatment process. “What other worries do you have about Mandy?” [concerns]
From a process perspective, 400 clients wanted information to “What are your goals for our time together?” [goals]
be delivered upfront in a forthright manner, in lay language, and “How can I best help you today?” [expectations]
using multiple formats, such as oral, written, and visual client “What is the most important thing for us to address today?” [priorities]
education tools (e.g., discharge instructions, brochures, handouts,
diagrams, drawings, models, images, and websites). It was impor-
tant to clients that the oncologists take time to listen, address This process of questioning may seem redundant, but clients
their questions, and repeat information as needed, facilitating often bring a laundry list (i.e., three to four 444 ) of concerns,
understanding of their pet’s disease. Survey respondents of the Pet questions, or topics that they would like to discuss with their
Cancer Support group identified problem-focused support (i.e., veterinarian. Given the overwhelming nature of cancer conversa-
sharing information, engaging in open discussion, and consider- tions, these steps help identify the key questions and informa-
ing options) as a common source of support provided by their vet- tion sought by the client. Helping generate the client’s list of
erinarians. 443 Clients appreciated an established relationship with concerns and melding it with your agenda sets the structure for
the oncologist or nurse, and having 24-hour information support the remainder of the appointment and optimizes efficient use of
in case of an unexpected event or complication, allowing them the visit time.