Page 340 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

318 PART III Therapeutic Modalities for the Cancer Patient

Euthanasia Decision Making Providing Support for Grief and Loss

VetBooks.ir Clients may be waiting for the veterinarian to raise the option of Research indicates that 70% of clients are affected emotionally by the
death of their pet, and as many as 30% of clients experience severe
euthanasia to give permission to consider euthanasia as a valid and
grief in anticipation of or after the death of their pet. In addition,
supported option (“One of the options that is important to discuss
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is euthanasia.” ). Clients may be worried that the oncologist may approximately 50% of clients studied reported feeling guilty about
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perceive them as “giving up” if they bring up the option of eutha- their decision to euthanize their pet. One of the factors contrib-
nasia, therefore clients may need your validation (“It is a valid and uting to client grief was the perception of the professional support
caring decision to consider euthanasia at this time.” or “Euthanasia provided by the veterinarian. A qualitative interview study described
is a humane option for Mandy given how the cancer has spread.”). the emotional, informational, and instrumental social support veteri-
Client anxiety results from the uncertainty that lies ahead, and a narians provide to grieving clients; the study revealed that these skills
large part of these conversations is helping clients cope with the were often learned on the job, and little or no training was provided
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unknown. 440 Previously clients had a clear plan for how to treat in veterinary school. A qualitative ethnographic study documented
the cancer, and it may be helpful to have a designated path for the emotional work of veterinarians in attending to the death of their
how to care for their animal at the end of life. Discussing end- patients and managing the guilt and grief of their clients as a gratifying
of-life wishes for the patient is crucial to preparing the client for experience for clients and a fulfilling part of being a veterinarian. 462
euthanasia decision making, and creating a euthanasia plan often The manner in which the veterinarian provides care for a client
eases the client’s discomfort and anxiety. 447 Once completed, it whose pet has died has the potential to alleviate or aggravate grief.
can be put on the shelf until it is needed, and the client can focus Use your communication toolbox to acknowledge, validate, and
his or her energies on being present with the pet during these final normalize client grief responses and provide emotional support. 460
precious days, weeks, or months. Being prepared ensures that the Offer written materials and verbal grief education to help clients
client’s needs are met, minimizes regrets, and reduces uncertainty understand their grief experiences (“Grief is hard. You may find it
during this difficult time of grief. 440 difficult to sleep; you may feel disoriented, restless, or exhausted, and
Use the communication skills to walk a client through euthana- unable to focus or concentrate; you may gain or lose your appetite. It
sia decision making; discuss the procedure and present options for can be crazy making.”). Send condolences in a timely manner after
location, body care, memorializing, and family presence. 447,460,479 euthanasia (e.g., a card, memorial gift, or flowers) or place a phone
Begin by asking the client about previous experiences with eutha- call to check in with the client to see how she or he is doing (“I
nasia (“Could you share with me your previous experiences with wanted to call to see how you are doing. I know that you miss Mandy
euthanasia?” or “I am wondering whether you have been present at a terribly.”). Assess the client’s support system and identify at-risk cli-
euthanasia procedure in the past. Tell me about that situation.”). If ents who may need more active grief support (“Who will you speak
appropriate, explore the client’s religious or spiritual beliefs, which with about losing Mandy?” or “Who do you turn to during difficult
may affect a decision about euthanasia. (“Some clients have religious times?”). Provide information on support services (e.g., grief coun-
or spiritual beliefs that guide the euthanasia decision. I am interested seling, pet loss support hotlines and groups, and websites) (“We
in how these beliefs might guide your decision-making process.”) have a grief counselor who works with our practice and hosts regular
Provide a warning shot (“This is one of the most difficult decisions pet loss support groups. Our clients share that it is helpful to them.” or
in caring for your pet.” or “There is a lot to consider, and the decision- “I have a list of pet loss support hotlines, if it would be helpful to speak
making process can feel overwhelming.”) with someone who understands how difficult it is to lose a pet.”).
Give information in small, easily understandable pieces, pause,
and check for the client’s understanding before proceeding (“Max is Caring for Yourself
probably feeling like you do when you have a bad flu. It probably hurts
just to move, and it is difficult for him to get comfortable. What ques- The health and wellness of veterinary professionals is a current and
tions do you have about his condition?”). Ask permission throughout poignant issue in the veterinary profession. Veterinarians’ risk of
to move from one topic to the next (e.g., timing, location, body suicide is four times that of the general population and twice that
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care, being present, and memorializing [e.g., paw prints, hair clip- of other health professionals, and attitudes toward and involve-
pings, pictures, videos, readings, or songs]) (“I am wondering if it ment in death and euthanasia are possible influences. 463,464 One
would be alright with you if I were to walk you through the euthanasia in 11 veterinarians have reported serious psychological distress,
procedure we use at our clinic.” or “There are a few options and deci- and 1 in 6 veterinarians have experienced suicidal ideation since
sions in relation to the euthanasia procedure and body care, and I am graduating from veterinary school. 465
wondering if you would like to discuss them now.”) During the con- Compassion fatigue is deep physical, emotional, and spiritual
versation, avoid use of technical jargon and define medical terms. exhaustion that can result from working day to day in an intense
Empathize throughout the conversation; acknowledge, vali- caregiving environment. 466,467 The natural response to this down-
date, and normalize the client’s emotions (“You have taken such ward spiral is to work harder until there is nothing left to give, which
good care of Mandy throughout his illness. I can tell how much you is counter to the adaptive response of taking a break. The symptoms
love her.”; “These are difficult decisions. It feels like an enormous are the same as those of chronic stress and are a consequence of car-
responsibility.”; or “It is normal to feel sad. Mandy means so much ing for the needs of others before caring for your own needs. 466,467
to you.”). Use silence and display compassionate and caring non- Compassion fatigue results from a lack of daily self-care practices
verbal cues. Offer partnership so the client feels you by his or her that create opportunities to reflect, refuel, and rejuvenate.
side (“We will talk through each step together.” or “I want you to The good news is that compassion fatigue results from being a
know that I fully support your decision, and will do my best to honor deeply caring person. When veterinarians care for themselves, they
your wishes for Mandy”). At the end, summarize what has been can care for others from a place of abundance, not scarcity. By devel-
discussed and the decisions made, and outline the next steps for oping healthy self-care routines, practitioners can continue to suc-
the client. cessfully provide compassionate care to others. This includes asking