Page 336 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

314 PART III Therapeutic Modalities for the Cancer Patient

Elicit the Client’s Perspective 415,442 understanding. This approach to giving information avoids lec-
Invite clients to share their thoughts, beliefs, opinions, ideas, turing to the client and aims to increase recall, understanding,
and commitment to plans. In this manner the process of giving
427,428
Again, a client’s perspectives are
feelings, and perceptions.
VetBooks.ir best obtained by asking open-ended questions. How the client information is responsive to the client’s needs and provides an
opportunity for the client to participate in the conversation, pro-
perceives the pet’s cancer can have a major effect on the decision-
making process and adherence to recommendations. Many cli- vide feedback, or ask for clarification. The check takes the form
ents have had previous experiences with cancer, and it is helpful of an open-ended question.
to hear these stories to address the client’s concerns, provide reas-
surance, and identify misconceptions or barriers to patient care. “What questions do you have at this point?”
Pick up on the client’s verbal cues (“I am not sure how she will “What needs more explanation?”
do with chemotherapy.” or “I am really concerned about her loss of “What part will be most difficult for you and Mandy?”
appetite.” or “My big fear is that we won’t get quality time.”) and
invite the client to share his or her worries. Knowing the client’s Building Relationships
expectations enables you to get on the same page and customize
the message to the client’s concerns and meet the individual’s Offer Partnership 442
needs. Partnership is inclusive language (e.g., let’s, we, together, our, or
us), which reflects that you and the client are working as a team
“I am wondering what experiences you have had with cancer in your toward mutual goals. Offering partnership informs clients that
life, because they may affect decisions we make for Mandy.” they are not alone and that they have a working partner in their
“How are you coping with all of this?” veterinarian, who will guide and advise them at each stage. Often
“What are your greatest hopes in caring for Mandy?” clients may arrive at the appointment on their own, and it may be
helpful to assess their support system and offer to include other
Explaining and Planning key decision makers in the conversations.

Assess the Client’s Starting Knowledge 415,442 “We’ll work together to determine the best treatment plan for Mandy.”
Assessing the client’s prior knowledge allows you to evaluate his “I’m here for you. Take your time. We have a few days to decide how
or her understanding and determine at what level to deliver the to proceed.”
information. Each client brings his or her own knowledge, back- “Who else will take part in making decisions in Mandy’s care?”
ground, experiences, and ideas to the table. Assessing the client’s Ask Permission 442
starting knowledge through open-ended questions allows you to
gauge the entry point to the conversation and enables the veteri- Asking permission is a gentle approach to assess the client’s readi-
nary team to meet the client where the person is. ness to take the next step. This act of respect allows the client to
ready his or her mind, be receptive to what you have to say, and
“What do you know about cancer in general?” pace the conversation with you. Asking permission is a method
“What have you heard or read about osteosarcoma?” of structuring the conversation by proposing a transition to the
“I am wondering what your veterinarian told you about Mandy’s can- client and to determine whether the client would like to move on.
cer.”
“Would it be alright if we sit down and I asked you some questions
about Mandy?”
Ascertain the Client’s Information Preferences 415,442 “I am wondering if we could talk more about pain manage-
An equally important goal is to ascertain the type and kind of ment.”
information the client desires, because not all clients may want the “Are you okay with talking about how we can reduce the tumor
same degree of information. Client preferences for information size?”
may change over time; initially, overwhelmed clients may want “Maybe you could write down your specific questions before our next
just the big picture; as they absorb and process the information, visit.”
they may produce a list of detailed questions for follow-up discus-
sions. Open-ended inquiry is a key technique for evaluating the Express Empathy 442
client’s information preferences. The stress of cancer can result in intense emotions: sadness, fear,
anxiety, uncertainty, and guilt, and acknowledging these emo-
“Some clients prefer the big picture and for others it is important to get tions reduces client distress. 421 Empathy is an affective response
into the details. What is your preference?” resulting from perceiving the situation of another, vicariously
“What additional information would be helpful to you?” experiencing what it might be like, and paying deep attention to
“Let me know if you would like me to go into greater detail.” another person’s emotions. As a result, three tasks are involved
in expressing empathy. 445 The first is to appreciate the client’s
Give Information in Manageable Chunks and Checks 442 situation, perspective, and feelings, and the attached meanings.
Chunk-and-check consists of giving information in small The second is to communicate that understanding to the cli-
pieces (i.e., chunks), followed by checking for understanding ent and check its accuracy. The third is to move forward in the
before proceeding further (i.e., check)—the Frisbee approach clinical interview and act on that understanding with the client
in action. 412 Sharing small pieces of information, one to three and patient in a helpful way. Simply, empathy is putting your-
sentences at a time, allows your client time to absorb the news, self in clients’ shoes and communicating that you understand
and checking-in encourages client participation in the discus- where they are coming from. Expressing empathy acknowledges,
sion and ensures that the client stays with you to achieve shared validates, and normalizes the client’s emotional response and