Here are some open-ended and empathetic questions showing interest:

• What are your concerns?
• How do you feel?
• Are you overwhelmed by the diagnosis?
• To what extent will you be able to accept the caretaker’s burden?

Reflective listening:
Reflective listening is a technique involving repeating what clients say or suggest, thus showing interest in their thoughts and feelings, and making sure that you have understood their concerns. By paraphrasing clients’ meaning, you show empathy and clarify their understanding.

You may start these responses with standard phrases such as “So, you’re saying that…” and “It sounds like…” Reflective listening can also be communicated non-verbally, with nods and smiles, thus acknowledging what has been heard.

If you want a pet owner to expound without your input, try repeating the client’s last word or phrase. If a client says, “Alice has just been acting crazy,” you may respond with a simple, “Crazy?” The pet owner will instinctively elaborate for you.

Resource:
→ CLIENT COMMUNICATION: A PROCEDURE YOU CAN MASTER

Verbal communication

1. Excessive use of complex vocabulary, jargon and/or abbreviations.
2. Incorrect pronunciation of words.
3. Too much information or too little information.
4. Unclear or contradictory messages.
5. Speaking too quickly.
   
   

Non-verbal communication (how you deliver the message)

1. Lack of eye contact.
2. Non-supportive or disinterested facial expressions.
3. Inappropriate gestures and/or body posture.
4. Busy, noisy environments.
5. Lack of enthusiasm or empathy in facial expression.
6. Emotionless, mechanical or flat voice tone or body language.
7. Fidgeting with a pen, the computer etc. during the discussion.
8. Distractions from your conversation (phone call, questions from healthcare team etc.).
9. Not noticing that the listener loses focus of the message
10. Distracting filler words: Um’s, Ah’s & Urrs; slang, cursing.

Non-verbal communication

• You can enhance effective communication by using open body language: Arms uncrossed, standing with an open stance or sitting on the edge of your seat, maintaining eye contact with the person you’re talking to.
• The tone of your voice should be different when you’re addressing a child than when you’re addressing adults. 
• Take into account the emotional state and cultural background and beliefs of the person you’re interacting with.
• Consider age and gender.

Verbal communication

• Develop and provide client education in a clear and accurate manner, at a level a non-expert understands (i.e., oral and written form, including educational handouts which can be reread at home).
• Give a small portion of the information at a time and then check in with the client to see how he or she is doing.

For example: “Whether a dog develops hip dysplasia is influenced by many things. It might be due to genetics, something in the environment, or even diet. So it’s possible that your dog may even be the only dog from his litter to have clinical signs of hip dysplasia.”

= TOO MUCH INFORMATION IN ONE CHUNK!

• Speak slowly and in terms clients will understand: Keep in mind that the information is new to them and that medical terminology is frequently like a foreign language.
• Use open-ended questions: How, when, why, where …?

Close-ended questions are yes-or-no-questions. To really build a relationship with your client, you need more than a one-word answer—which means you need to ask an open-ended question. Then you can ask follow-up questions using either method, depending on what has piqued your interest. With yes-or-no questions you could cut the conversation short, leaving you with an incomplete evaluation.

•••••••••••••••••••••••
1. Relationship-building questions
These questions help the veterinarian to get to know the caretaker and get a clearer picture of the pet's general environment. These informal, open-ended questions also relax the atmosphere.

• How did you decide on your pet's name?
• Tell me about Alice's typical day.
• Tell me a bit about your household. What activities do your family members do? Who lives there? What other pets do you have?
• Tell me about where you live. Are there stairs? A fenced yard? Where does Alice sleep? 

•••••••••••••••••••••••
2. Questions assessing the caretaker’s needs and concerns
These questions help find out what the caregiver is looking for. For example, does he or she want peace of mind, comfort, or a financial estimate?

• What concerns you the most about Alice?
• How does Alice's problem affect the activity and living conditions in your home? 

•••••••••••••••••••••••
3. Questions probing the pet's needs
With these questions, you're pinpointing changes in the pet's life. What does the animal need now? These questions also help clients understand that their pet goes through different life stages.

• What changes have you seen in Alice in the last year? Eating habits, activity level, sleeping habits, playfulness?
• What are Alice's favourite foods?
• What does Alice do for exercise? Have you seen any changes in her energy level?
• What other people/pets does Alice come in contact with?

• Choose a quiet place. Ensure there will be no distractions.
• Provide a preliminary warning (e.g:“I have difficult news to share”).
• Be attentive to your own and your client’s nonverbal messages.
• Make eye contact.
• Sit at the client’s level, but not too familiarly: think about the social status of the person in front of you: he/she is a client.
• Respond appropriately and facilitate a discussion on the bad news (e.g. “I see that this is shocking to you. Should I go on or do you need a moment?”).
• Finish with a plan for the next contact. Give the caretaker a handout with a summary of the information given. 
  

  ---

Did the pet caretaker understand the information?

• Offer to help the caretaker to understand the extent of the bad news: “Do you want to go through it once again so I can help you with anything that you are unclear about?”
• Encourage clients to ask questions by reassuring them that confused reactions are normal: “This is a pretty complex topic, and most people have many questions about it. It is pretty challenging to explain, too, so I want to make sure we are on the same page. Do you have any questions?”
• Provide handout information to take home. Presentations using visual and written aids are 43 percent more persuasive then unaided presentations.

The best time to discuss the pet’s disease with the client is not necessarily when the individual has just been informed of a terminal or progressive-disease diagnosis for their furry friend. Depending on the degree of attachment between the pet and its owner, the impact of such news will often evoke a strong emotional reaction. Practitioners should anticipate this reaction, respond to it by expressing empathy, and consider setting up a follow-up appointment to discuss EOL treatment options. This gives the owner time to come to terms with the new reality and to participate more fully in the development of a realistic, mutually acceptable treatment plan.

Provide handout information to take home. This way the caretaker can prepare himself for the follow-up visit and ask appropriate questions.

The follow-up visit is then an opportunity for a two-way information exchange between the veterinarian and client. An effective approach for conducting an EOL follow-up discussion is to schedule the appointment so as to give the veterinarian and caretaker time for an uninterrupted, open-ended discussion.

The client should be invited to ask questions and should not feel rushed or pressured into making treatment decisions. Regardless of the decisions that are made, the client should never feel judged.

It is often helpful for both the veterinarian and the caretaker to have a checklist of questions to ask and issues to discuss. The following chart provides a list of issues to discuss with the caretaker when an EOL or palliative care treatment plan is developed. Such a chart could also serve as a helpful handout for the client.

Practical Issues in Implementing a Palliative or EOL Care Plan:

It is the veterinarian’s duty to recommend humane euthanasia to relieve the patient’s suffering when palliative care no longer meets the animal’s physical, social, or emotional needs.
However, for some pet owners, euthanasia may not be an acceptable procedure. In such cases, high-dose palliative sedation combined with adequate analgesia is an ethical alternative = supported natural death.
An ongoing empathetic dialogue with the pet owner is essential during this stage in order to adequately communicate to the caretaker what to anticipate with the dying process as well as the post-mortem duties.

• Never rush the process—clients want, and need, your undivided attention and you have an obligation to give it to them.
• Consider the use of language: Subtle word differences can have a huge impact. Instead of saying, “When you are ready,” say “When you are as ready as you can be.”

The following communication guidelines will help the veterinary healthcare team to engage in ethical, collaborative EOL decision-making:

1. Take your time to discuss calmly all euthanasia and natural-death options with the pet owner (do not exclude or minimize any single option). This is an extremely stressful and painful time for the dog owner and this is not the time to rush because the waiting room is full.
2. Recognize that while many pet owners rely on the veterinarian’s recommendation for the best approach to their pet’s end of life, others prefer to take the primary decision-making role.
3. Describe the options to pet owners in language they can understand.
4. Describe the options in a factual and non-judgmental manner, articulating pros and cons of each option.
5. Avoid a biased presentation of information designed to steer a client’s choices in the direction of the veterinarian’s preferences.
6. Summarize the pet owner’s decision to make sure you have understood and support this decision for their pet, accepting that their values and beliefs may be different from the veterinarian’s.