Page 337 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

CHAPTER 16 Supportive Care for the Cancer Patient 315

is essential to establishing a trusting veterinarian-client-patient Summarize 442
relationship. Summarizing is an explicit review of the information that has
been discovered and discussed with the client. Multiple opportu-
VetBooks.ir “I’m so sorry to tell you this. I know it was not what you were expect- nities arise to present a summary: reflect back what you heard and
ing.”
learned at several stages during information gathering, take time
“I can only imagine how hard this is to hear. Mandy has been your
companion for so long.” to repeat the key aspects of the diagnostic and treatment plan,
and finally provide a full and complete summary at the end of the
“I can see that you are agonizing over the right decision for Mandy.” clinical interview. Summarizing helps structure the conversation
by reviewing what has been discussed, identifying data that needs
Demonstrate Appropriate Nonverbal Behavior 442 further clarification, providing an opportunity for reflection on
Expression of all of the verbal core communication skills is where the interview could go next, and managing effective use of
strengthened when accompanied by complementary nonverbal time during the visit. The skill of summarizing creates a window
communication. As much as 80% of communication is non- to inform clients that they have been heard and time for clinicians
verbal in nature, whereas 20% is based on verbal content. 446 to gather their thoughts, synthesize and integrate the data, and
When verbal and nonverbal communication are incongruent, work through the diagnostic reasoning process.
the nonverbal behaviors reveal the truth. There are two areas
of focus for nonverbal communication: the first is to increase “So, if I understand it correctly, your referring veterinarian felt the large
your sensitivity to picking up on client cues, and the second is lymph nodes, took a sample, and diagnosed lymphoma. You were sent
enhanced awareness of the nonverbal messages you are sending here for further testing to determine if the lymphoma has spread to oth-
out. Tune in closely to the client’s nonverbal behaviors, such er organs. What other tests did your referring veterinarian perform?”
as breaking eye contact, nervous body movements, or tone of “What we talked about doing today is requesting a second opinion
voice, because nonverbal behaviors often reflect the client’s true from our pathologist on the tumor sample, and taking chest x-
underlying feelings and responses. Out of respect for their rela- rays and conducting an ultrasound exam to look at the abdominal
tionship with their veterinarian, clients often express hesitation lymph nodes, liver, and spleen for spread of the tumor. What fur-
indirectly through their nonverbal behaviors and may not feel ther questions do you have about those diagnostic tests?”
comfortable with directly verbalizing their concerns, doubts or
criticisms. It is important to pick up on these client clues and “I Don’t Have Time for This…”
follow-up on them with the client to explore the concerns (“I The concern about how veterinarians find the time to elicit the
sensed some hesitation when I mentioned chemotherapy as a treat- client’s agenda, perspectives, starting knowledge, and informa-
ment option.” or “You seem worried about taking Mandy to sur- tion preferences, and managing client emotions, may still remain.
gery; what are you most scared about?”) But contrary to popular belief the skills just discussed enhance
Veterinarian nonverbal cues include attentive body posture, appointment efficiency. More time with the client may be needed
appropriate distance from the client, turning your body toward upfront, but this will pay dividends in time savings by streamlin-
the client, sitting at the same level, maintaining good eye contact, ing decision making during diagnostic and treatment planning.
and complementary gestures. Display your compassion through 1. Eliciting clients’ full agenda, goals, and expectations early in the
nonverbal cues, such as sitting at a comfortable distance with your appointment is critical to optimizing appointment time. 436
client; using a gentle, calm tone and soft volume; slowing your Clients often bring a laundry list of issues, topics, or questions
pace of speech; and leaning forward and reaching out through they would like to discuss with their veterinarian. 444 Explor-
touch when appropriate. Use silence to create time for clients to ing this list and melding it with your agenda determines the
examine their thoughts and feelings. It can be difficult at times structure and tasks for the remainder of the appointment. If
to find the right words to say, and simply being a caring pres- you are unable to fully meet the client’s agenda, it allows you
ence can provide just as much comfort to the client as any spoken to reset client expectations and consider alternatives, such as a
words. Being mindful of the non-verbal messages sent is impor- drop-off, recheck visit, follow-up phone call, further discussion
tant because when veterinarians are triggered or feeling judgmen- with a veterinary nurse, or counseling support or referral.
tal, these sentiments can be leaked to the client through nonverbal 2. Identifying clients’ perspectives is important, because these can act as
behaviors. either promoters or inhibitors of clients’ decision-making process
in considering diagnostic and treatment options. Identifying con-
Providing Structure cerns a client brings to the visit enables the veterinarian to tailor a
care plan that aligns with the client’s needs, enabling the client to
Provide a Warning Shot 442,446,447 move forward more quickly. 415
A warning shot forewarns of difficult discussions or decisions 3. Assessing what clients already know helps veterinary profession-
ahead. It warns clients of bad news and allows them to prepare als deliver information that is appropriate to the individual’s
themselves for what they are about to hear. This approach reduces level, enhancing understanding and recall. 415 This step also
the chances of blind-siding and enhances the client’s ability to helps identify gaps, misunderstandings, or misinformation that
process versus react to the information. can be addressed in the moment before confusion arises. Also,
appointment efficiency can be enhanced by identifying clients
“This may be difficult for you to hear.” who are already well informed and need less education.
“Unfortunately, we do not have effective treatments for this kind of 4. Assessing clients’ information preferences enables you to gauge
cancer.” what information the client desires and how much detail is
“I am sorry to tell you that Mandy’s cancer is growing and no longer preferred. 415 This promotes explanations that are on target on
responding to the chemotherapy.” initial delivery, reducing the need to revisit material or to start
“I have disappointing news. Mandy’s cancer has spread to her lungs.” over again and provide the big picture or more in-depth details.