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Mention the Unmentionables

Either because of an oversight or discomfort, many hospital websites say nothing about end-of-life services. Your clients deserve better.

Mention the Unmentionables
Not addressing end-of-life services on a hospital website sends a message that death is an “unmentionable.”

Like many people now, thanks to COVID, my basement has become my gym. During morning workouts, I listen to the free version of Spotify and therefore get the pleasure of hearing repeated advertisements. One I hear constantly makes sly reference to hygiene products by singing, “Don’t just wipe, use down-there care.” We know what “down-there care” means, right?

What does this have to do with veterinary medicine? As with personal hygiene products, end-of-life topics are unmentionables — that is, too shocking or embarrassing to be mentioned by name.

I say this because of what Summer Brooks and I found when we reviewed 500 veterinary practice websites. Even though just about every website listed the hospital’s services, only a minority pointed out euthanasia and other end-of-life assistance.

We randomly selected the 500 practices from a list of 46,152. The website content was confirmed by two independent reviewers and any discrepancies were assessed by a third person. (Thanks to Jennifer Link, Phil Archer and Diane Ledford for their coding expertise.) The hospital sample consisted of primarily small animal (85%), followed by mixed practice (8%), equine (3%) and “other” (4%).

We were interested in how many websites mentioned end-of-life services and affiliated service providers. Specifically, we coded for end-of-life planning, hospice, euthanasia, aftercare options (cremation and burial), and pet-loss support resources.

By the Numbers

So, what did we find?

  1. Only 4% mentioned end-of-life planning and just 15% referenced hospice. When hospice was indicated, the majority of hospitals (93%) highlighted their services and 7% mentioned a hospice company or organization.
  2. Euthanasia, arguably the most common end-of-life service, was mentioned by 32% of the 500 hospitals. Of these, 95% indicated that euthanasia was done in-house and 5% referenced another provider.
  3. Aftercare options were found on 20% of the websites. All those hospitals provided information about cremation, and of those, 7% stated that it was done onsite. Twenty-two percent of hospitals named a specific crematory, and of those, three-fourths hyperlinked to the cremation partner. Burial options were mentioned less frequently. Of the websites that referenced body care options, 39% addressed burial. Half of those talked about home burials and 4% named a cemetery and hyperlinked to it.
  4. Online information about pet-loss support was found on 15% of the 500 websites. Of these, 41% listed a telephone hotline and 11% mentioned a support group. When a support group was brought up, all referenced an in-person group and 25% identified a virtual group. A small subset of sites that mentioned pet-loss support provided information about books (4%) or personal counseling (8%).

The Choice Is Yours

Next, we sought to better understand how the 500 hospital websites were created. Of the 349 sites that indicated a web designer, 110 different companies were identified. Most of the companies designed just one or two of the websites, but some were more popular, such as iMatrix, Doctor Multimedia, VCA, eVetSites, National Veterinary Associates, ViziSites, Roya and WhiskerCloud. Together, those companies designed one-third of the websites.

To understand how the companies design veterinary practice websites, we called and asked. The common response was that they were happy to provide customers with a template but that they encourage each hospital to personalize a website to reflect the services offered. Each company stated that a hospital could include any and all services it wanted. Yet, our review showed that most clinics ignored end-of-life services.

Get More Comfortable

All this brings us back to the notion of unmentionables. It appears that hospital website decision-makers do not feel comfortable promoting end-of-life services. Perhaps they think clients don’t want to read about it. Yet, the veterinary experience of most pet owners ultimately involves an end-of-life decision or two.

Why the discrepancy? Perhaps because our culture does not feel comfortable talking about death. We know that death happens, but talk about it? No thanks.

Should end-of-life services be included on hospital websites? Yes. Not doing it sends a message that death is (use a whisper tone here) an “unmentionable.”

Most pet owners rely on their veterinarian for end-of-life guidance, and we know that those conversations are challenging, unpredictable and therefore risky. One never knows how a client will respond or if a veterinarian’s broaching the topic in the middle of an already busy day will open a can of worms.

If you don’t feel comfortable talking about end-of-life topics, we suggest an easy solution: Provide all the information on your website and casually tell clients that everything is explained online. This way, people can explore and choose end-of-life options in the privacy of their home and confidentially access pet-loss support services.

Updating your website to include end-of-life subject matter is a proactive way to make sure your clinic supports clients throughout all the stages of their pets’ life.

Dr. Lori Kogan is a professor of clinical sciences at the Colorado State University College of Veterinary Medicine and Biomedical Sciences. She chairs the Human-Animal Interaction section of the American Psychological Association and is editor of the Human-Animal Interaction Bulletin, an open-access, online publication supported by the American Psychological Association. Summer Brooks is a San Diego registered veterinary technician and is certified in thanatology by the Association for Death Education and Counseling. She is passionate about helping pet owners navigate end-of-life care and pet loss.


HOW YOU CAN DO MORE

Veterinary professionals who refrain from talking with clients about end-of-life services or who ignore the topic online might want to reconsider.

The American Animal Hospital Association and the International Association for Animal Hospice and Palliative Care produced the 2016 End-of-Life Care Guidelines. The paper’s introduction began: “For many pet owners, the events surrounding their pets’ final life stage are as important and meaningful as the sum of all the care provided by the practice team up to that point.” (Learn more at bit.ly/3fUdmKR.)

Going even further, AAHA last fall unveiled End-of-Life Care accreditation. Many of the program’s standards are based on the 2016 guidelines. However, it’s not for everyone.

“Veterinary practices — brick-and-mortar and/or mobile — whose practice is limited to end-of-life care, as well as those practices currently accredited by AAHA that wish to add a brick-and-mortar and/or mobile end-of-life care practice, are eligible for End-of-Life Care accreditation,” the organization stated. “Practices that are not AAHA-accredited and are not standalone end-of-life care practices are not eligible.”

More information is available by emailing [email protected].

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