This past fall, my husband found out he has cancer. If the diagnosis wasn\u2019t bad enough, the delivery was horrendous. Tod has battled Sjogren\u2019s disease, an autoimmune disorder that attacks the secretory glands, for almost a decade. And every six months, he has a CT scan and core biopsies with a surgeon to monitor inflammation. After nearly two weeks of not hearing anything following his latest testing, Tod received a voicemail from an oncology office coordinator to schedule treatment. Tod called back immediately and left a message saying a mistake had occurred because he wasn\u2019t a cancer patient.<\/p>\n
The oncologist called an hour later. Tod conferenced me in, and after superficial pleasantries, the doctor said she was glad we could all get on the phone to discuss his lymphoma treatment options. My response: \u201cThis is how you\u2019re telling my husband he has cancer?\u201d The surgeon had forgotten to call with the biopsy report.<\/p>\n
How many times a week does your team deliver bad news to a pet owner? And how many team members have you trained to do it properly? While bad news is bad news, sharing it with a client is an art form. Many of us in veterinary practice typically acquire this invaluable personal and professional skill on our own. However, for veterinarians who never learned to deliver bad news, the responsibility can be detrimental, leading to emotional disengagement, compassion fatigue and burnout.<\/p>\n
In the human medicine world, communicating bad news has been taught using the SPIKES model. More recently, many prefer the newer BREAKS protocol, developed by three doctors from India and Nepal. Their strategy emphasizes that how bad news is shared can have a positive or negative therapeutic effect on the patient and can support the doctor emotionally.<\/p>\n
Let\u2019s investigate how to apply the BREAKS model (background, rapport, explore, announce, kindle and summarize) in veterinary medicine.<\/p>\n
On the phone with the oncologist, Tod and I sat silently in shock at the diagnosis. At some point, she awkwardly shifted gears and described lymphoma in rudimentary language. After a few minutes of consistent baby talk about a cell called a lymphocyte, I interrupted her. I clarified that I was a veterinarian who had treated canine and feline lymphoma for over two decades. Suddenly, she changed her tone and delivery.<\/p>\n
How can veterinarians avoid a situation like that one? Before speaking with a pet owner, prepare yourself with the diagnosis, treatment options, prognosis, success rates, and family and patient history. Also, consider this:<\/p>\n
While we might not have all the answers initially, we can stress the importance of a support system. Encourage the primary pet owner to bring others into the conversation. Also, disclose that your team is part of the journey.<\/p>\n
I will never forget where we were and how horrible it felt to receive that messy phone call and cancer diagnosis from someone we had never met. Your clients might feel the same way if you don\u2019t establish initial rapport.<\/p>\n
A comfortable setting is critical. If possible, have the conversation inside a private exam room when the hospital is less crowded. The room should have cozy seating so that multiple people can sit at eye level. Place tissues within arm\u2019s reach. Turn off your cell phone and the hospital paging system to avoid interruptions.<\/p>\n
Alternatively, some pet owners might prefer a video call in the privacy of their home or because coming to the hospital isn\u2019t logistically feasible or desired. Again, do it during slower periods so you are free of interruptions.<\/p>\n
Tod told me that in the time between the voicemail and the oncologist\u2019s call, he had searched Google for cancers associated with Sjogren\u2019s disease. He had jotted down \u201cMALT\u201d (mucosal-associated lymphoid tissue), \u201clymphoma\u201d and \u201cchemotherapy drugs\u201d from a few websites and was looking for patient lifespans when she called back.<\/p>\n
Our pet owners are no different. While some senior patients\u2019 standard blood tests can bring utter surprises, most clients wait anxiously to hear from us after diagnostic workups or surgeries. They might be suspicious enough after the initial visit to investigate subjects online.<\/p>\n
Two possible outcomes commonly happen in the second scenario. One is that the client is wrong after exploring and declaring a catastrophic prognosis. Your promising diagnostic announcement brings instant relief. The other is that the owner understands the seriousness of the matter and perhaps announces the disease you identified. In that instance, you confirm the bad news instead of breaking it, relieving some of the emotional pressure on you.<\/p>\n
Tod\u2019s medical team skipped this step. Veterinary professionals who dive into a serious discussion must signal what\u2019s to come. We must deliver our statements with empathy, compassion and appropriate body postures, like leaning in slightly, making eye contact, and keeping a soft face and tone. That approach gives clients time to prepare themselves and turn their focus to the conversation. Consider announcing bad news this way:<\/p>\n
Not lecturing is equally essential. That means not delivering a large chunk of information about a disease or treatment without giving the pet owner a chance to respond or ask questions. Lecturing can also lead to differential listening, in which someone only hears desired information.<\/p>\n
Additionally, be straightforward with the diagnosis. Don\u2019t linger on lengthy explanations or immediately give analogies of other patients in similar situations. Try to speak in short, easy-to-understand sentences and not give more than three pieces of information before checking in with the pet owner. Finally, avoid acting or sounding rushed or defensive if emotions escalate. A patient, peaceful demeanor is ideal.<\/p>\n
Our phone call with the oncologist lasted 97 minutes. While I took copious notes and asked what seemed like hundreds of questions, I could only do that because of my medical background. To most people, 97 minutes of medical terms, diagnostic test recommendations and treatment options can feel like watching a foreign-language film without subtitles. Not only are the words unfamiliar, but they also make forming real-time, educated questions nearly impossible.<\/p>\n
When talking with clients<\/a>, check in periodically to ensure they understand what you said. Don\u2019t wait until after you spoke for five or 10 minutes. Instead, check in after each section \u2014 for example, following the diagnosis, pathophysiology and treatment segments \u2014 and any time a client\u2019s verbal cues or body language change. The verbal cues might include a raised voice, shorter responses, periods of silence, a reluctance to talk or a voice that starts to crack. Nonverbal body language is often more telling and can include crossed arms, a lowered head, avoiding eye contact, a furrowed brow, a clenched jaw or crying.<\/p>\n Just like with our patients, don\u2019t wait until several signs appear. Instead, pause and \u201ckindle\u201d at subtle signs.<\/p>\n I was relieved to finally hear the oncologist\u2019s recap at the end of the meeting. We discussed the next steps, scheduled appointments for the follow-up diagnostics, and talked about when Tod and I would meet the radiation oncologist. This chapter was 100% verbal. Without my note-taking, I could see how patients might feel lost after just 30 minutes.<\/p>\n A 2009 AAHA Press report, Compliance: Taking Quality Care to the Next Level<\/em>, provided startling insight and evidence as to why a summary is so important. The report found that pet owners immediately forget 40% to 80% of medical information provided verbally by practitioners. About 3 in 4 clients want written information about their pets\u2019 medication and disease.<\/p>\n We don\u2019t have to reinvent the client education wheel. Most of our hospitals have third-party resources to offer pet owners, or we can send them to reliable websites. The bottom line is not to deliver all the information verbally.<\/p>\n As someone who has delivered her fair share of difficult news to pet families, I found it eye-opening and highly emotional to be on the other side. Perhaps if we learn to teach and support the veterinary community in delivering a difficult diagnosis or poor prognosis, we can better support clients and help our colleagues manage the compassion fatigue that often develops. If we do that, we can simultaneously preserve the human-animal bond and the veterinarian-client relationship.<\/p>\n Even if you communicate empathetically, pet owners might respond with extreme emotions. Your team can use another mnemonic, NURSE, to help de-escalate the situation. Spelled out, it translates as:<\/p>\n N:<\/strong> Name what pet owners are feeling. Learn more about nonverbal body language from these sources:<\/p>\n As my husband\u2019s doctors tactlessly demonstrated, health care professionals of all types have much to learn about delivering bad news.<\/p>\n","protected":false},"author":23,"featured_media":77405,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[526],"tags":[],"class_list":["post-77402","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-february-march-2025","column-fearless","clinical_topics-client-communication"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"\nSummarize<\/h3>\n
\nANOTHER TECHNIQUE<\/h3>\n
\nU:<\/strong> Understand their points of view.
\nR:<\/strong> Respect their positions.
\nS:<\/strong> State your support to comfort them further.
\nE:<\/strong> Explore the next steps and questions.<\/p>\n
\nBODY OF EVIDENCE<\/h3>\n
\n