"The wonders of high-tech cancer care are best complemented by the humanity of high-touch care. Simple kindnesses can help to diffuse negative emotions that are associated with cancer diagnosis and treatment-and may even help to improve patients' outcomes." (J Oncol Pract. 2017 Nov)
In this Path to Empowerment Blog we are going to focus on the importance of six types of kindness in the cancer care setting. I hope that the ideas presented here will serve to strengthen the relationship between veterinarians and pet parents and empower both to create a supportive environment that will help minimize the trauma that both experience as a result of "cancer", which is a highly emotionally charged topic for everyone.
My hope is that together we can create greater fulfillment, happiness and well-being for pets, pet parents, and the veterinarians who love them.
The Relationship between Kindness and Healing
It is through greater understanding and compassion in all our relationships that we are able to make progress in creating a more harmonious world for ourselves and those we share it with. This truth also extends to the Veterinarian-Pet Parent relationship. And, as the quote above reinforces, this kindness supports healing and improves patient outcomes.
The November 2017 article in the journal of oncology practice cited above, entitled "The Role of Kindness in Cancer Care", goes on to say this:
"On the basis of our experience in cancer care and research, we propose six types of kindness in cancer care. These mutually reinforcing manifestations of kindness-exhibited by self-aware clinicians who understand that how care is delivered matters-constitute a powerful and practical way to temper the emotional turmoil of cancer for patients, their families, and clinicians themselves."
Lets take a closer look at each of the six types of kindness proposed in this scientific oncology journal. By increasing understanding, compassion and awareness, veterinarians and pet parents can work together to create a supportive environment where healthy respectful communication and mutual trust can facilitate healing.
The Good News
We all have the power to work together to create a more positive experience, even in the midst of heartbreak and challenging emotions.
Six Steps Toward A Compassionate Care Model for Pets with Cancer
ONE
deep listening , whereby clinicians take the time to truly understand the needs and concerns of patients and their families
The current medical model does not always provide time for this very important aspect of Veterinary Oncology. High volume clinical models often provide very little time for discussion and deep listening. In addition to this, the high stress and extreme expectations of private practice and pet parents can often deplete the capacity of veterinarians to engage with pet parents in this way.
This is why compassion from all parties in the care team (this means both the veterinarian and the pet parents) is so vital to supporting an ideal patient-client-doctor experience. And healthy self-care practices for both veterinarians and pet parents are vital in creating the bandwidth for all parties to interact with kindness and consideration, thereby creating an atmosphere that supports healing for not only the pet, but the pet parent.
Whenever possible, adequate time should be scheduled for an appointment where a discussion of cancer is anticipated. For example, I allot 90 minutes to 2 hours in my schedule for all new Integrative Oncology Consultations with the intention of providing the time needed to slow down and listen. This extended appointment time is important so that needs and concerns can hopefully be effectively addressed and an individualized care plan implemented. Although I cannot see as many patients, I feel I am better able to provide the type of care that I want to be able to provide. And this translates into more job satisfaction and less emotional stress for me.
Additionally, healthy boundaries must be set by the veterinarian so that deep listening is not transferred into emotional counseling, which is not the job or training of the veterinarian. However, deep listening can facilitate comprehensive care and recommendations that take into account the emotional needs of the pet parents (such as providing information on grief support) and a treatment approach that is tailored to the concerns and goals of the individual pet and family can be implemented.
TWO
empathy for the patient with cancer, expressed by both individual clinicians and the care culture, that seeks to prevent avoidable suffering
Almost without exception the first concern pet parents express to me is that they don't want their beloved pet to suffer. Because of the wide array of experiences with humans who undergo western medicine treatments for cancer, many pet parents are scared of these same therapies for their pets. In veterinary medicine we are also dealing with the facts that:
1) Pets do not understand they "have cancer", so they are not emotionally invested in living a long time. They understand how they feel every day, and how their human parents and family feels and interacts with them. This, in my opinion, should be the primary consideration when formulating a compassionate treatment approach focused on quality of life, with quantity of life an important secondary ideal goal.
2) While pets may not experience fear of the future or fear of side effects from treatment, they do experience fear. And fear is a type of suffering. The nature and severity of this fear is highly variable from pet to pet. It is important when formulating a care plan that this type of suffering is minimized. And the way that happens is going to be different for every pet. When the measures outlined in step five below are not effective, especially if the fear is severe or dangerous to the pet or veterinarian, sometimes the most compassionate decision is to not treat the cancer but to focus on quality of life and other interventions to maximize well-being to the extent possible within the limitations of these stress responses.
3) Pets, while they don't have goals of the future, are very resilient. More so than people who are undergoing similar treatments or situations. It is, therefore, an important responsibility of the Veterinary Oncologist to help weigh the risk versus benefit of various treatment interventions. And to help pet parents understand that certain personifications and assumptions about how their pet will respond, emotionally or physically, to a certain treatment may not be accurate or likely. For example, if short term pain such as surgery or side effects from radiation is likely to result in cure or extremely improved longevity, these side effects may be deemed acceptable when considering the long term perspective and goals of the family. Additionally, while the idea of an amputation may be very traumatic for us as humans, many pets adapt extremely quickly with a normal quality of life and minimal pain after this procedure. So, like all things, effective communication with consideration of the individual pet's personality and diagnosis is vital to a compassionate care plan.
THREE
generous acts of discretionary effort that go beyond what patients and families expect from a care team
This is a big topic that can get into how our expectations affect our experiences. Before I get into what I feel the essence of this point is, I want to address two important ideas about expectations.
I will start by first bringing to light the reality that the expectations pet parents have of their pet's veterinary team are often incongruent with the expectations they have of their human physicians. While this isn't universally true for all pet parents, this topic is one that bears mentioning here as it is a significant source of stress for the veterinary team. The expectations on a veterinarian's time and resources are often far different than what people expect from their human doctors. There are many reasons for this, but one I believe plays a significant role is that pet parents are generally paying out of pocket for care, which sets their expectations and what they feel entitled to demand at a different level. It is in this way that compassion, respect and understanding from all parties involved is vital for the success of a Compassionate Care Model.
On the other side of this, it is true that most veterinarians went into the field of veterinary medicine because they genuinely care about pets and their people. This softness of heart can often be an obstacle to the ability to keep healthy boundaries and assist pet parents in understanding guidelines of communication and respect of their time and resources. This is one place that setting clear guidelines and policies can be helpful at minimizing misunderstandings and frustrations from all sides.
Having said all this, the essence of this third point is that the extra effort to go beyond what is absolutely necessary expresses a caring that can be very nurturing to the recipient of these generous acts of kindness. The positive impact that these simple acts have on others is beyond measure, and is something we should all consider in our daily interactions. It is also an interesting truth that the person doing the act of kindness benefits likewise, as these simple acts of kindness bring a sense of meaning and purpose to our job and life and relationships in general.
The key word here is "discretionary". When practicing generosity, in yogic philosophy, they say "start with carrots and potatoes". This means to give within your means in a way that allows these acts to be done with joy and authenticity. This is the secret key to expanding our capacity for kindness. We start small, in the ways that we are able. And as we nourish ourselves and find greater joy and meaning in life through how we are helping others and making a positive difference in the world, we develop a greater capacity for genuine kindness and compassion.
These generous acts of kindness can be an expression of care and gratitude from both sides. And in this way nurture a relationship of mutual care and respect that creates a healing space for everyone. The key here is to understand this point from the perspective of what you can do to give, not what you expect to get. And to do that in a healthy way that acknowledges and honors the capacities of your current state of emotional and physical well-being.
FOUR
gentle honesty, whereby the truth is conveyed directly in well-chosen, guiding words
It isn't always possible to avoid discussing difficult and stressful topics.
A challenging aspect of veterinary medicine, and oncology in particular, is that we often must deliver upsetting news. And the word "Cancer" often carries a bigger emotional charge for people given personal experiences with the disease and treatments in human medicine.
While nobody enjoys being the bearer of this information, honesty and a frank discussion on the realities of the medical situation are important to developing an effective and compassionate treatment strategy and providing time for pet parents to emotionally prepare for what may be ahead. This also provides a framework for developing a plan of action which can empower pet parents to focus on the actions they can take to improve well-being for their beloved pet regardless of the situation.
Approaching these discussions with sensitivity also can help to alleviate stress for the veterinarian who is delivering the information. This is because by creating a safe space for pet parents to receive and integrate the information, drastic or confrontational emotional responses which are often jarring and upsetting for the veterinarian can be minimized. When people feel heard and understood, anger and blame (which are common responses to upsetting news) can often be minimized in an environment of trust, compassion, cooperation and a focus on empowerment.
FIVE
care that is delivered by using a variety of tools and systems that reduce stress and anxiety
In our clinic we try to provide a comfortable environment to help offset the stress of an oncology office visit. Some of the measures we implement to reduce stress for our patients and pet parents are:
Relaxing music:
We play music which has shown to be calming for dogs in our exam rooms.
Fear Free handling:
We try our very best to minimize the fear and stress pets experience during their exam and treatment. This is done with gentle, slow handling; food treats when appropriate; positive reinforcement and praise after procedures.
Calming pet-safe aromatherapy
(which can be turned off if needed) in our exam and treatment rooms.
Getting down to their level (when safe and appropriate):
I normally try to avoid the use of an exam table when doing assessments and physical exams. Instead I sit on the floor or a chair with the pet, introducing myself, and any instruments I am putting on my patient, slowly as needed. I am able to do this due to a good yoga practice, strength and flexibility :) I realize this option may not be available to everyone, and it may not be safe with every patient. But I do find it makes a big difference in fear and stress for both patient and pet parent in many situations.
Comfortable seating:
In my Acupuncture rooms we have couches where pets can sit with their people during the consultation, exam and acupuncture treatments.
Situational Anxiolytic Medications:
When a pet has a severe amount of anxiety, sometimes short term situational medication with drugs that decrease anxiety can be extremely helpful for both pet and pet parent. While I'm generally not a fan of medicating a problem, there are just some situations where gentleness, love and the other measures listed above are not enough to create a stress free experience. The important point to note here is that I don't recommend sedatives. These just make the pet sedate, aware and fearful, with less ability to respond to their environment. Newer medications are available which mitigate anxiety, and can be wonderful assistants in creating a more pleasant and safer experience for everyone involved.
SIX
support for caregivers, whose physical and mental well-being are vital components of the care their loved ones receive
One of the most challenging situations for many pet parents is the lack of support and understanding from family and friends regarding their emotional responses to, or decision to treat, cancer in their four-legged family member. Differing, and oftentimes widely disparate, personal views on the value of a pet's life complicate this issue. In these situations, pet parents can feel exceptionally isolated and unsupported in their decisions.
On the other side of the coin is the guilt or fear of judgement that often accompanies a decision not to treat, whether that be for monetary or personal reasons. It is, therefore, important to understand that life is never "black and white" and there is no one decision that is the only right one for every situation.
While the veterinarian's job is to act as an advocate for our pet patients, it is ultimately the pet parent's responsibility to determine which road forward to take. This is important to understand and to emphasize when taking a Compassionate Care approach.
While OVRS, where I work, does have a grief support service available for pet parents, many clinics and veterinary hospitals do not. Additionally, most veterinary hospitals are not affiliated with large institutions which can provide these other family caregiver support services. But it is, in my experience, a very important part of a Compassionate Care Model for cancer care in pets which is in deficit in veterinary medicine (and human medicine as well). This was one of the main motivating factors in the creation of Metta Pets: to provide a place for pet parents to feel empowered and find resources on wellness practices that can be implemented to improve their Self-Care as they care for their pet after a diagnosis of cancer.
This is where perspective and personal responsibility are the determining factor. While the resources may be available, they won't do anything if they are not implemented into a daily routine. These Self-Care Practices are equally vital for the health of the pet parent, veterinarian and the veterinary care team.
So, I encourage you, whether you are a pet parent or in the veterinary field, to take some time to reflect on your self-care needs and what you can do to nourish your emotional and physical well-being. This is necessary for us to be our best self, to be able to offer all we can to each other and the pets we care for, and to have the capacity to continually care for others.
Some Past Blogs with Self-Care Ideas: