How to Have ‘The Talk’ on End-of-Life Care
Why using the SPIKES model may be helpful when talking about euthanasia.
One of the most difficult conversations to have in the veterinary industry is “the talk”—the end-of-life and euthanasia discussion.
How does one approach clients to tell them their beloved companion must cross the rainbow bridge after 15 or more years together? How does a veterinary practitioner discuss options or bring up memorial keepsakes? What do you do if euthanizing is the only ethical and humane option but the client doesn’t want to let go?
Veterinarians experience these scenarios every day, but no one ever warns them. Rarely is a practitioner given a heads-up on what to expect when she walks into the exam room—the client’s mindset, whether the owner has come to terms with the decision, the chance that Doctor Google was wrong. All these drastically affect the conversation a veterinarian is about to have with the individual.
Weighing the Decision
Ultimately, the final decision rests with the client. However, it’s up to the professionals to guide the client to the appropriate and humane decision. Clients may do whatever they can if there’s hope the pet’s quality of life can be maintained through medical care, surgery or ongoing therapy. But what if the quality of life being maintained is quite poor, causes undue stress on the pet or cannot be maintained at all? Then the decision for euthanasia must be explored.
Approaching the subject of euthanasia can be difficult, especially for a new veterinarian. One suggestion is to follow the SPIKES model as a standard for end-of-life communication.
Create a supportive setting where the client can take the time to process the conversation and express feelings. Also, establish a rapport during this time by inquiring about the pet and how the client is feeling and by acknowledging how difficult the situation is.
Determine how much information the client wants about their pet’s illness through open-ended questions such as “What are your concerns?” Some individuals process detailed information well during emotional events while others do not. This is an opportunity to determine the pet’s quality of life and the client’s perspectives and values on end-of-life care.
Ann Fischer, DVM, owner of House Paws Home Veterinary Care in Minneapolis and president of the Veterinary Hospitals Association board of directors, said the discussion requires sensitivity and compassion.
“End-of-life care means that we value the client’s opinions of what they feel and also make sure we are honoring the patient’s needs for quality of life and pain control,” she said.
Once a veterinarian determines the amount of information the client wants, ask for permission to share, especially on the topic of euthanasia. Suggested statements include, “Is it all right if we discuss some of the specifics regarding your pet?” and “We can hope for the best in your pet’s care, however we do need to plan for the future so that your pet’s quality of life is ensured.”
During this stage, share the bad news in stages. Provide a “warning shot,” followed by easy-to-understand pieces of information that avoid technical words. Pause, ask for permission to continue and gauge understanding, and then continue about the pet’s condition.
After the condition has been explained and understood, provide details on how the condition may be monitored. Don’t forget to ask permission to discuss the euthanasia procedure. During this time, the client may become emotional. It’s important to provide emotional support and give the client time to digest the news. Dr. Fischer emphasizes that end-of-life care can involve many things.
“Every client handles this different depending on their individual abilities and their companion’s response to having this done,” she said.
“It’s never a right or wrong situation, and you have to be sensitive to the individual abilities of a caretaker/owner to be able to perform, or not be able to perform, these tasks.”
Throughout the conversation, display compassion through body language, gentle tones, slow speech and caring facial expressions. Using language like “I’m right here for you” or “I can only imagine how overwhelming this must be” shows that you empathize with the client.
After giving the client the time to gather herself, summarize what has been discussed. Determine a plan for treatment or follow-up, identify who can support her during this difficult time and provide brochures or other informational pieces that discuss end-of-life issues.
The knowledge phase is when veterinary staff must determine what the client wants done with the pet’s remains.
Sara Williams, DVM, MPH, the owner of Northwest Animal Hospital in Plymouth, Minn., noted that clients may have difficulty making a decision about urns or keepsake items during such an emotionally stressful time.
Offset the stress, Dr. Williams said, by making the situation as comfortable for the client as possible. She suggested offering a bottle of water and lots of tissues.
“It’s such a simple but kind gesture that is often overlooked,” Williams said. “I think it lets clients know we are thinking of their comfort as well as their pets.”
Gently inquire about what the client’s wishes will be after cremation. If the clinic offers memorial keepsakes, hand out materials that can be reviewed at home. Williams and her staff provide an urn book and website links. Some owners may need this time to determine what they want done or discuss options with their family.
Approach this conversation gently and empathetically, as pushing sales will worsen an already stressful moment.
During the Procedure
Some clients may not want to be present during the euthanasia procedure. Remember, this is the client’s choice and she may not be able to emotionally or physically handle it. If the owner chooses to stay, be clear about each step of the process and explain what she can expect.
Athena Diesch, MSW, LICSW, a social worker at the University of Minnesota Veterinary Medical Center, provides this sage advice: “Be 100 percent clear of what could happen, what will happen and what very rarely happens but could. It’s much easier to talk about the hard stuff in the beginning rather than after it happens.”
Clients don’t necessarily realize that their companion’s eyes won’t close, or that muscle twitches and bowel movements are normal. Warning clients about everything will help avoid awkward and painful situations and make the experience less traumatic.
Diesch recommends giving the client an out during the process.
“Prior to beginning, I offer clients an option to stay for the full procedure or leave if it gets to be too much,” she said. “This is especially important to offer if children are present. It takes the pressure off the client knowing that they can leave and come back if necessary.”
Providing handouts during the initial consultation before the euthanasia appointment is made is an alternative as well. Walk the owners through the stages, offer honest assurances and provide materials that confirm statements so the owner can reference them later in a more private setting.
For veterinary professionals, an emotional toll may be taken. It’s important that clinic staff take time to remember the patient, too.
“After the clients leave the room, I always put my hand on the patient’s chest just to double check and wish them well on their next journey,” Williams said. “It helps me to acknowledge their death and the role I played in their life, and it is a ritual for me.
“As a medical professional, it’s easy to just move on to the next case rather than give yourself time to grieve, but that’s not a healthy, long-term solution,” she added.
Everyone has a different way of honoring a companion, “And that doesn’t mean they have to have their ashes back if they elect cremation,” Fischer said.
“I’ve had a lot of clients plant a memorial garden, plant a special tree or treasure a clay paw print we made,” Fischer said.
If a client is having an especially hard time handling the loss, recommend local support groups she can join or suggest reading materials to help her through the grief journey.
Stephanie Duncan is communication coordinator at the Veterinary Hospitals Association, a cooperative based in South Saint Paul, Minn.
Originally published in the March 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!