Columns , Communication

Don’t confuse the issue

Shared decision-making between the veterinary team and pet owner promotes better patient outcomes.

Don’t confuse the issue
The goal of shared decision-making is to achieve greater pet owner compliance and better patient outcomes.

I’ve noticed a trend in exam room communications that can lead to fewer clients complying with treatment recommendations. The problem is that pet owners are often given a list of treatment options without enough education and guidance from the veterinary team. When this happens, confusion sets in and pet owners defer or decline recommendations. The fix is not as simple as changing the wording of our recommendations. I’ll explain the process of shared decision-making and how the veterinary team can help clients make decisions that lead to the best patient outcomes.

Much has been written about shared decision-making and the forming of collaborative partnerships with patients in human medicine and clients in veterinary medicine. Shared decision-making in veterinary medicine supports engaging pet owners collaboratively so that they can make medical care decisions and choose a treatment plan that is best for their pet and family. It involves serving as a guide for clients rather than paternalistically telling them, “This is what you need to do” or “This is what I recommend.”

During shared decision-making, don’t assume what pet owners want or whether they can afford a particular treatment. Transparent options are critical, but don’t give clients a long list and then have them decide without you thoroughly educating them about the choices.

The goal of shared decision-making is to achieve greater pet owner compliance and better patient outcomes. Here are three best practices.

Build Trust

Veterinarians and team members who are compassionate and friendly toward pets and clients help build client loyalty. However, being nice isn’t enough to achieve the goal of improved compliance. The missing piece is to mindfully use specific communications that lead to deeper trust and serve to bring the pet owner into the decision-making process.

Notice, the word “mindfully” in the above paragraph. Communication skills are most effective when people understand why they are helpful and when to use them. Let’s look at two skills that build trust and create a collaborative partnership with pet owners.

The first is knowing why and when to use open-ended questions. Those that build rapport include “How did you decide to get a Papillon?” and “Tell me how your son is doing in soccer?” These are excellent questions for engaging clients, but they don’t contribute to shared decision-making. To accomplish it, veterinarians can ask open-ended questions while performing the physical exam and during discussions about medical conditions. They might ask, “Tell me what you know about heart failure in dogs” or “How did you decide to feed this diet?”

These questions are helpful because they:

  • Avoid making assumptions about what pet owners know.
  • Show respect for clients’ knowledge and decision-making power.
  • Help teams to better tailor client education.
  • Improve appointment efficiency.

The second skill needed to build trust and connect with pet owners is to understand why and when to use empathy statements. These are valuable because they:

  • Help clients understand that you see them and their pets as unique individuals.
  • Demonstrate that the team cares about the client’s emotions.

Empathy statements can be used throughout client conversations and whenever a client expresses concern verbally or with body language. An effective empathy statement you can use might include leaning in, making eye contact and saying, “I can see how difficult it has been for you to take care of Tigger.” Pausing after an empathy statement encourages the client to voice her feelings and thoughts about medical care. This helps to promote collaborative partnerships.

Improve Client Education

Research and surveys show that veterinary teams don’t always provide pet owners with enough information and answers to all their questions. I’ll never forget finishing a dinner meeting presentation and having one of the waitresses tell me her veterinarian referred her to a website to read about how to care for her pregnant dog. She was disappointed and questioned the value of her visit to the practice.

Sometimes, veterinarians give clients a list of all possible rule-outs for the pet’s medical condition followed by a list of multiple treatment options. They might sound like this: “We could do …,” “Sometimes we do …,” “You could give antibiotics …,” “We can see whether medication helps,” “X-rays and lab testing would be helpful.” Aside from the tentative language used in those statements, the primary problem is the lack of client education regarding the pet’s clinical signs and no explanations about the treatment options.

The best way to improve client education while fostering shared decision-making is to offer specific details about the pet’s medical condition and the pros and cons of treatment options. For example, in the case of a vomiting dog, the veterinarian could say, “Based on Max’s clinical signs and physical exam, the most likely causes of his vomiting are non-specific gastroenteritis or pancreatitis. However, we can’t rule out the possibility of an obstruction, liver disease or other endocrine diseases. Since his vomiting could be associated with an upset stomach or a more serious medical condition, let’s discuss the pros and cons of two different treatment plans. How does that sound to you?”

Next, the doctor would detail the risks and potential outcomes of choosing conservative care, such as medication and a bland diet, versus a treatment plan that includes diagnostic testing to rule out more serious conditions. This client communication puts the focus on the pet and client rather than on what the veterinary team wants. This is not to say that teams shouldn’t communicate which treatment plan they think will lead to the best outcome.

Explain the Benefits

I’ve observed that veterinarians aren’t always clear on which treatment plan might be best for the patient. This occurs for multiple reasons, such as:

  • Uncertainty about the diagnosis or whether testing will lead to answers.
  • Fear that pet owners will perceive the veterinarian as being too aggressive.
  • Assumptions that the client has financial constraints.
  • Attempts to be transparent by providing all possible options.
  • Striving to form a collaborative partnership with the client.

Being transparent about different treatment options doesn’t mean we avoid making clear recommendations. Likewise, collaborative communication doesn’t mean we fail to educate clients about the value of specific treatments. If pet owners are left to believe that two or three treatment options are equally beneficial, they likely will gravitate toward the least expensive and least scary plan. Since clients generally don’t have the medical knowledge to decide which treatment or products are best, they need the veterinary team to provide guidance.

Rather than simply saying “I recommend laboratory testing,” here are phrases that bring the client into shared decision-making and communicate a clear recommendation:

  • “I need to evaluate some tests so I can rule out the serious medical conditions we discussed and better determine the best treatment for Max. What questions do you have about proceeding with the CBC and chemistry profile?”
  • “The benefit of laboratory testing is we will gain valuable information that will help us know how to best treat Sophie. The risk of not doing the testing is that we may not uncover whether she is dehydrated or has evidence of pancreatitis.”

Changing exam room communications to focus on shared decision-making builds trust with pet owners and leads to better patient outcomes, which means more pets will get the care they deserve.

Talk the Talk columnist Dr. Amanda L. Donnelly is a speaker, business consultant and second-generation veterinarian. She is the author of “101 Practice Management Questions Answered” and serves on the Today’s Veterinary Business editorial advisory board.

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