Cancer communication: Learn how to shake your instincts
Sarah J. Wooten, DVM
Dr. Sarah Wooten graduated from UC Davis School of Veterinary Medicine in 2002. A member of the American Society of Veterinary Journalists, Dr. Wooten divides her professional time between small animal practice in Greeley, Colorado, public speaking on associate issues, leadership, and client communication, and writing. She enjoys camping with her family, skiing, SCUBA, and participating in triathlons.
WORKING ON IT
Shutterstock.comDelivering a cancer diagnosis is hard. Make it easier by incorporating these simple communication considerations from CVC educator Sue Ettinger, DVM, DACVIM (oncology), who's no stranger to delivering bad news.
Be aware: Knowing is half the battle
Before you talk to clients, think about any potential struggles they might be facing-worries that they don't have enough time or money to treat the pet, a general fear of death and dying, or past or current experiences with cancer. If your team is emotionally involved in the case, you'll need to consider their possible feelings of guilt about the difficult diagnosis and the extra work they may need to do to comfort emotional clients.
Know where to do it: Hint-it's not over the phone
Avoid phone faux pas
If you need to communicate over the phone, make sure it's a good time before launching into your spiel. (Hint: If you hear kids in the background or the client is driving, it's probably not a good time.)
Sometimes Dr. Ettinger will share a basic diagnosis over the phone and then ask the client to come in for a 15-minute consultation. We all want to get difficult conversations done as quickly as possible, but if you're not mindful of the conversation's setting, there's a good chance you'll need to repeat the information (which isn't ideal for anyone involved).
We often call clients with bad news, but this is far from ideal. (If you've ever played the “telephone” game, you know why.) The best way to communicate is in person, where obstacles between you and the owner are minimized. No standing behind the counter, says Dr. Ettinger. Whether it requires sitting or standing, be face-to-face with the owner. Deliver the news in a quiet, private room with an extra set of ears, if possible.
Do it right: Set up your “SPIKES”
Dr. Ettinger recommends the SPIKES protocol to deliver bad news. Here's how it works:
SET up the interview. Ensure that the conversation takes place somewhere private and that any significant others that should be present are there. Sit down, if possible.
Assess the client's PERCEPTION. Figure out what the client knows and understands by asking open-ended questions, such as “What have you been told about Fluffy's situation so far?” and “What is your understanding of why we did the testing today?”
Get the client's INVITATION. Don't assume that all clients want every particular on their pet's condition. Not everyone can cope with so many details. Ask whether the client wants all the results or would prefer a summary to focus more on the treatment plan. If the client doesn't want all the details during the initial discussion, offer to provide them at a later date or give them to a trusted friend or relative.
Give KNOWLEDGE and information. It's important to avoid clinical jargon (unless the client demonstrates knowledge and aptitude with medical language). To avoid overwhelming the client, periodically ask whether what you're saying makes sense.
Address the client's EMOTIONS with empathetic responses. It's surprising to me how much it means to clients when you simply say, “This is hard. I'm sorry.” Acknowledging that the situation is Sucksville (Population: your client) validates the client's feelings, shows that you understand and builds a bridge between veterinarian and client. Also try, “I know this isn't what you wanted to hear. I wish the news were better.”
SUMMARIZE and STRATEGIZE. Clients appreciate it when you come to the conversation with a clear plan. Outline a treatment plan and costs before you go into the exam room, complete with scheduling. Include pain management and symptom control as well as other things the client will want to look out for.
Toss the “shot put mentality”
Dr. Ettinger recommends sharing information like you're playing Frisbee-not shot put. If you go about it in the latter manner, you'll lob a heavy mess of information at the client, all while hoping he or she magically absorbs what you're trying to say. Instead, if you deliver information like you're playing Frisbee, the client will be engaged, communication will be back-and-forth, and information will be retained.
Dr. Sarah Wooten is a member of the American Society of Veterinary Journalists and divides her professional time between small animal practice in Greeley, Colorado, public speaking on associate issues, leadership, and client communication, and writing.