A boarded oncologist shares his approach to mitigating the emotional toll of caring for terminal patients
Caregiver burden can be defined as the mental and emotional strain caused by caring for a chronically or terminally ill pet (or family member). The results of a 2017 study of 238 pet owners found that caregivers of pets with chronic or terminal disease had “significantly higher levels of caregiver burden and stress, greater symptoms of depression and anxiety, and lower quality of life” than those of healthy pets.1
Craig A. Clifford, DVM, MS, DACVIM (Oncology), addressed caregiver burden as part of his session “Palliative care from an oncologist’s perspective” at the 2022 Atlantic Coast Veterinary Conference in Atlantic City, New Jersey.2
Anticipatory grief and “treating” the client
A key part of caregiver burden is the stress of emotionally processing the future death of a beloved pet. “During this time period, while we're trying to do palliative care, they're going to have anticipatory grief,” said Clifford.2 He explained that patients attempting to mentally prepare for this difficult moment will have many questions and may feel overwhelmed.
He said that during this period, it’s important for veterinarians to be aware of it, have empathy, and periodically check-in as pet owners process their grief. Clifford reminded the audience, “This becomes their life—the short time period they have [left with their pet]—and that's where they rely on us for help.”2 To that end, modifying treatment as necessary, in collaboration with client communication, to maximize quality of life and reduce pain is paramount. Whether it's adjusting pain medication to minimize suffering or utilizing appetite stimulants for pets that are undereating, palliative care can help the pet and owner improve the quality of their remaining time together.
Clifford shared that he recommends clients take as many photos as possible during this time to create lasting memories, and that this can help the client have a more positive outlook on their situation. “We want to treat the disease and the patient, and on some levels, we're treating the owner, too,” said Clifford.2
The knock-on effects of caregiver burden
Caregiver burden not only affects the pet owner, but it also impacts the veterinarians, technicians, and other staff who interact with an emotionally taxed client. With end-of-life care and oncology patients, Clifford explained, the team may be communicating with the client as much as every other day, over a long period of time. “It's hard on us, too; there's no doubt about it,” said Clifford.2 Naturally, this has the potential to play into the burnout and compassion fatigue issues plaguing veterinary medicine today.