Discussing euthanasia is particularly emotional for veterinary team members and pet owners because of the strength of the bond people have with their patients and pets. Just as the COMFORT model is useful when breaking bad news, the SPIKES six-step model[1] can provide a useful framework for discussions around euthanasia.The acronym SPIKES stands for:
Setting
Perception
Invitation
Knowledge
Empathy
Summary and Strategy
Setting up the conversation
Mentally prepare by reviewing the patient’s notes and any test results. Find a calming, quiet place in which to have the conversation, where you are unlikely to be interrupted. You may want to consider having a box of tissues close to hand and your client may wish to have a friend or family member with them. Try to sit down for these discussions – you are letting your client know that you are in no rush, and it may also help them to relax. Open your discussion by establishing rapport and expressing empathy to set the client at ease.
- “I know it’s been a tough week for you”
- “How are you feeling and your family feeling about all this?”
What is the client’s Perception?
Gain an understanding about what the client already knows about the pet’s condition and prognosis. Use open questions to better assess the client’s beliefs and values about euthanasia and end-of-life care. If appropriate, you can ask the client about her or his previous experience with making an end-of-life decision for a pet.
- “What ideally would you like us to do for Mittens?”
- “What do you think Taylor’s quality of life is at this time? What are your thoughts about that?”
- “What are the conditions under which you would feel that it’s not fair to Teddy to keep fighting this illness?”
- “I understand you had a previous experience of having to decide on euthanasia. What considerations helped guide you in that?”
Invitation
It’s always useful to gain permission from a client for sharing information of any kind, and particularly so in a discussion that might include euthanasia considerations. Ask the client if it is alright with them if you talk to them about euthanasia. Express it in terms that help the client feel that the decision is not all on them, it’s a shared one.
- “Is it alright if we talk about euthanasia now?”
If the need to decide on euthanasia is not immediate, it can still help to broach the topic earlier in a disease process:
- “While we are hoping for the best from Lizzie’s treatment, it makes sense to think ahead so we can optimize her quality of life no matter what happens.”
Giving information and Knowledge
Pre-empt the discussion about euthanasia by acknowledging what the client may be experiencing.
- “I know how hard a decision like this is to make about Cleo. I can imagine you’re feeling a flood of emotions right now.”
Using skills like the ‘warning shot’ and ‘chunk and check’, covered earlier in this topic, can help you to deliver the necessary information and guide the discussion. Provide accurate information about the animal’s condition in language that the client will understand and relate to.
- “It looks like Tanner is finding it hard to eat comfortably. Have you ever had toothache?”
If the client isn’t quite ready to make a euthanasia decision, let them know how to track changes in their pet’s condition that might signal that it’s time to decide.
- “One thing you might notice is that Fritz might stop wanting to eat or drink water, or he might suddenly find it hard to even get up and walk around. If you see a big change like this, give us a call.”
Address emotions with Empathy
This is important in any type of communication with clients, but you should try to identify, acknowledge, and support your client’s emotional responses. You should use exploratory questions to try to understand your client’s perspective and validate their responses. You can also use moments of silence and display compassion with nonverbal gestures to show that you care very much about your client’s feelings and the wellbeing of their pet.
- “I know that this is not the discussion anybody wanted to be having today.”
- “You have been the best Pet Mom for Philly. It’s clear how much you love her.”
Summary and Strategy
In these situations, it is not uncommon for a client to have stopped hearing what you were saying part way through what is usually an emotional and upsetting conversation. Make sure you summarize everything you talked about and agreed on, including a plan for next steps and if appropriate, when and under what conditions to follow-up. If a decision is made to euthanize, offer information on resources the client can tap into for support groups and services.
- “So, we agreed that you would continue to monitor Reggie’s eating, drinking and mobility, and to call me if you see a sharp decline in any of these.”
- “Take time to enjoy the weekend at the beach with Brownie. We’ll schedule an appointment for you to bring her in next Wednesday.”
- “The Civic Center actually has a support group for pet owners who’ve lost their dog or cat. Would you like me to give you some information on them?”
[1] Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP, 2000. SPIKES – A Six- Step Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist 5:302-311
