Shifting Our Mindsets to Spectrum of Care Practice

Despite years of discussing ways to improve access to veterinary care, the most common barrier to care for pet owners—finances—continues to grow. The 2025 Lifetime of Pet Care Study by Synchrony found that lifetime costs of care increased significantly for both dogs and cats between 2022 and 2025 (11.65% and 19.4%, respectively).¹ Additionally, the number of pet owners reporting unexpected veterinary expenses that caused financial concern increased from 1 in 3 to nearly 1 in 2.¹

PetSmart Charities and Gallup surveyed pet owners in late 2024 and early 2025 and found 52% of pet families reported declining recommended veterinary care in the past year.² Of those pet owners who took their pet to the vet but declined care, cost was the reason given in 71% of cases.² But what may be more concerning from an access to care perspective is that the majority of these pet owners (73%) reported that they were not offered a lower-cost alternative.²

The data show that our work to improve access to veterinary care is far from finished. While the ultimate solutions will require collaboration between multiple stakeholders and systemic change in the animal health industry, there are changes that can be made by individual veterinarians and their teams that can help support clients who struggle with cost and other barriers to care.

The Need for a Spectrum of Care

Costs of veterinary care have risen rapidly over the past decade, up around 60% since 2014.³ This rise outpaces inflation and is driven by many factors, including rising costs of goods, supplies, and equipment as well as increased staffing costs.⁴ Additionally, veterinary medicine continues to evolve in complexity—with increased specialization, advanced technology, innovative drugs, and novel therapeutic options—which influences costs of care and the recommendations that veterinarians make for their clients.⁴

It is essential that veterinarians and their teams remember that despite ever-advancing technology and treatment options, there remains a wide range of diagnostic and treatment options for most conditions. This range of options has become known as the spectrum of care (SOC) or contextual care.^5-7 Veterinary teams that embrace SOC practice are curious, creative, and compassionate and prioritize clear communication to maximize outcomes for their patients and clients. See FIGURE 1 for an algorithm outlining the SOC approach.

Figure 1. Algorithm for the spectrum of care approach to veterinary practice.

Evaluating Curiously

Practicing SOC requires veterinarians to consider both the humans in the room as well as the patient. While we must advocate for our patients’ welfare with our recommendations, we should consider the individual barriers that a client may be facing.^8,9 In fact, the 2024 update to the Principles of Veterinary Medical Ethics now includes offering contextual care to clients.¹⁰

While many start the SOC conversation with finances, there are a wide range of barriers that may alter the diagnostic and treatment plan for a given patient. These can be broken down into several categories^8,9:

• Patient factors, including temperament; fear, anxiety, and stress levels during transport and in the clinic; and medication tolerance.
• Client factors, including financial limitations, transportation, scheduling limitations for follow-up appointments and medication administration, personal goals and values, other caregiving responsibilities, past experiences, medical knowledge level, physical limitations, and caregiver burden.
• Veterinarian and veterinary team factors, including experience; knowledge of available options; personal comfort levels, morals, and ethics; education and training; and skill level.
• Clinic factors, including proximity to a specialty hospital, scheduling availability, equipment, staffing, and payment options.

It is essential that veterinary teams take the time to engage in goals-of-care conversations with their clients and identify barriers that could be a factor in each appointment. This is achieved through open-ended inquiries, which invite clients to share their stories, perspectives, concerns, and opinions.¹¹ Veterinary professionals must not only ask these questions but stop and listen to the client’s response without interruption. These basic communication skills lay the foundation for building a partnership with the client, which is essential for maximizing outcomes in SOC practice.

Beginning this dialogue early in the appointment can help veterinary teams anticipate potential barriers. This can help the veterinarian customize the options presented, but the information should not be used to make assumptions about what a client might choose or limit which options are discussed. Dialogue about the client’s goals and potential barriers should continue throughout the appointment as more information about the patient’s condition is learned through the physical examination and diagnostic testing.

Thinking Creatively and Critically

Developing a range of diagnostic and treatment options requires a combination of creative and critical thinking on the part of the veterinarian. Integrating the patient’s history, signalment, and physical examination findings to create a differential diagnosis list is the first step to creating diagnostic recommendations.

The diagnostic tests that can be pursued in any given case are most often limited by finances, equipment availability (e.g., advanced imaging), and patient cooperation. Veterinarians should carefully evaluate their diagnostic recommendations, considering the goal of each test. Testing that provides information that is unlikely to alter the treatment plan should be limited. Additionally, consider if there are other ways to obtain information that may be more cost effective (e.g., a PCV and blood smear instead of a CBC, a smaller chemistry panel). In some cases, diagnostics may not be feasible at all. Instead, an empirical treatment trial may be started.

When considering therapeutic options, veterinarians should keep in mind the client’s ability to adhere to the treatment plan as well as the likelihood of patient compliance. Ask clients about their comfort with administering medication by different routes, their past experiences with medicating the patient, and if their schedule allows them to medicate the pet at the planned frequency. Requirements for monitoring and follow-up should also be discussed. Treatment plans may need to be adapted based on the responses to these questions.

Evidence-based medicine should be used as much as possible to guide diagnostic and therapeutic recommendations. In the current literature, there is often more evidence to support the traditional “gold standard” approach to case management, which can make some veterinarians uncomfortable proceeding differently. Thankfully, there is a growing body of evidence to support SOC options in veterinary medicine. As more data are published, veterinarians will have more confidence discussing alternative options and can more clearly communicate anticipated outcomes to clients.

Communicating Options Compassionately

Successful SOC practice requires clear communication with clients. This allows veterinarians to determine what barriers to care need to be considered and to engage in shared decision making with the client. Shared decision making is preferred by veterinary clients and improves client satisfaction when it is used. This style of decision making has 3 components¹¹:

• Team talk, during which the partnership between veterinary team members and client is established
• Option talk, where each option is presented along with associated risks, benefits, and costs
• Decision talk, when all parties engage in a dialogue to determine the best plan

The order in which options are presented to a client can affect the decision that is made and how the client feels about that decision. Clients are often biased to believe that the first option they are offered is the best.¹² If veterinarians always present options from the most to least expensive or intensive, even if a client has expressed a limitation that would prevent them from pursuing the most expensive option, the client may feel shame or guilt for not choosing the first option.^4,12 In reality, the best choice for a pet will vary based on the individual patient and client context.

Options should be presented with empathy and in a way that tries to minimize judgment. This may look like presenting an option starting with what seems like the best fit for the client based on the initial goals-of-care conversation followed by the alternatives. For example, a veterinarian might say, “Based on what you shared earlier about your concerns for medicating Fluffy, we could try [option A]. A more aggressive approach would be [option B]. Or a less aggressive approach would be [option C].”

Veterinarians should invite clients to share their thoughts, questions, and concerns about the options, as well as the final plan, using open-ended inquiries such as, “What other questions do you have about these options?” or “Tell me how you’re feeling about the plan we’ve developed today.”

Documenting Thoroughly

Some veterinarians express concerns that pursuing plans that differ from the traditional textbook approach increase their risk of complaints and board discipline or lawsuits. In truth, as long as the minimum standard of care is met, informed consent is obtained, and all conversations are documented completely, there is no increased risk of liability.^12,13 While this does not mean that complaints won’t be filed by clients—the best protection against this is clear and compassionate communication—it does mean that SOC practice does not inherently increase liability risk when it is done well.¹² In fact, not informing clients of a full range of options may open veterinarians to liability as well.^12,13

Obtaining informed consent is essential to meeting the requirements of the regulatory boards and protecting oneself from liability. The key components to obtaining informed consent are communicating the options, including the risks, benefits, and possible outcomes, in a way that the client understands and obtaining the client’s permission to move forward with the agreed-upon diagnostic or treatment plan.¹² It is important that all options discussed are documented in the medical record, which is the best protection against liability in the event a complaint occurs. Additionally, veterinarians must remember that informed consent must be reestablished as the case progresses, particularly if the owner’s circumstances or patient’s status changes or if new information is learned that changes the available options or potential outcomes.¹²

The Future of Veterinary Medicine

It is more important than ever that the veterinary profession practices SOC as pet families face a growing number of barriers to care. Remaining blind to these barriers will only increase the number of patients going without care and risk eroding the trust that the veterinary profession has historically held. By engaging clients in goals-of-care conversation to identify barriers to care, presenting diagnostic and therapeutic plans that are based in evidence and responsive to these individual barriers, and discussing options in a way that educates clients and invites them to be an active participant in their pet’s care, veterinarians will master the art of SOC, which is, at its core, what veterinary medicine was meant to be.