Dine In or Drive-Through? Explanation & Planning: Part 2

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Zipper’s presurgical blood work reveals that because of his scrapping behavior, he has contracted feline immunodeficiency virus (FIV). You discussed this possibility with Mrs. Kensington while developing a plan for treating Zipper’s abscess. With this new development, it is time once again to take out your communication tools to explain this concerning finding and to involve Mrs. Kensington in decisions about Zipper’s care.

Throughout the process of initiating the clinical interview, gathering information, building the relationship, and explanation and planning, one goal has remained constant: involving the client and working collaboratively to foster an understanding of the problem(s) to provide the best treatment for the patient. In this article, we continue to build on this model of shared decision making by employing a second set of communication tools (see Tools of the Trade) for explanation and planning, assessing the client’s starting point, and relating explanations to the client’s perspective.

Sit Down or Super-Size?
“What do you feel like eating?” This question usually leads to the classic dining-out dilemma. There may be bantering back and forth as you try to find a restaurant that will please everybody’s palate, schedule, and wallet. There are other factors to consider as well: does anybody have allergies, is the establishment kid-friendly, and what do the latest culinary reviews say? The task of deciding on dinner seems suddenly daunting. This may lead to taking the easy way out by pulling into the first drive-through and ordering the same value meal for each passenger in the car. Dinner may be served, but it may not be a happy meal for all.

You may find yourself taking a similar approach when conveying information to clients during explanation and planning. The goal is to give appropriate and comprehensive information about a pet’s illness. However, instead of first assessing what a caregiver knows and eliciting information, we may unintentionally dump a “value meal” of information in his or her lap—hoping the message can be digested and absorbed, regardless of whether the client just ate, is gluten intolerant, or has high blood pressure.

Like wait staff at a restaurant, you seek client input just as clients seek yours. Offering highlights from the menu, wine pairings, or proposing substitutions encourages patrons to build the meal of their choosing. Similarly, extending choices and inviting feedback about the treatment of their animals allows clients to take ownership, leading to increased understanding, buy-in, and adherence.

Tools of the Trade
We highlight 4 key tools for explanation and planning. In this article, we cover the second set:

1. Using language that can be easily understood by clients*
2. Giving information in manageable chunks and continually checking that the client understands*
3. Assessing the client’s starting point
4. Relating explanations to the client’s perspective

*Tools 1 and 2 were covered in the May/June issue of EVT.

Empty Plate? Assessing the Client’s Starting Point
Each client brings his or her own knowledge, experiences, and ideas to the table. A client may have had prior experience with a different animal or dealt with a similar illness involving a family member or friend. Clients may have researched information on the internet, heard about a topic on television, or read about it in a magazine. Some clients work in human healthcare and have considerable medical knowledge. So, it can be useful to back up and ask a few questions to assess the client’s starting point:

“What have you heard or read about feline immunodeficiency virus?”

“You have cared for many cats in your life. Have you ever had a cat with FIV?”

“You mentioned earlier that your cousin has a cat with FIV. Tell me more about that.”

“FIV suppresses the cat’s immune system, making it hard for him to fight off infections. Has anyone in your life had a compromised immune system?”

“As we are just getting to know each other, I am curious about what you do for a living.”

Assessing what the client already knows early on can help you “serve” information that is appropriate to the individual’s level of understanding. This step also helps identify gaps, misunderstandings, or misinformation. By assessing the client’s starting point, you can also gauge what information the client desires and in how much detail and how he or she would like to be involved.

A Potluck of Prior Knowledge
As you enter into explanation and planning with your clients, it is helpful to determine what prior knowledge they are bringing to the picnic so that you know at what level to provide information. Ask clients about:

1. Similar situations with previous animals
2. Experiences with family members or friends
3. Prior knowledge of the subject
4. Internet research, information from television, books, and magazines
5. Professional background

Pairing: Relating Explanations to the Client’s Perspective
During the gathering information phase of the clinical interview, you unearthed the client’s perspective. Taking the ideas, expectations, concerns, and feelings of the client into account allows you to create a tailored plan. Take your cues from asking about the pet’s temperament and behavior, as well as the client’s finances, social support systems, thoughts, and fears:

“What are your goals in caring for Zipper?”

“Who else helps with cat-related chores?”

“What would it be like for you to make Zipper an indoor cat?”
“How do you think Zipper would respond to being an indoor cat?”

“What concerns you most about the news we discussed today?”

“How do you feel about your ability to monitor Zipper for signs of infection?”

Client perspective–related factors act as either promoters or inhibitors to the animal’s healthcare plan. By identifying strengths the client brings and challenges that need to be overcome, you can work together to find creative solutions. Developing a mutually agreed upon plan that relates directly to the client’s concerns about the problem and goals for treatment enhances buy-in and adherence.

Need a Refill? A Refresher on Client Perspective
Relating explanations to the client’s perspective involves sifting through previously gathered data and paying special attention to the client’s broader lifestyle, household, and context. This can be done by recalling the client’s:

• View of the pet’s temperament and behavior
• Financial resources
• Social support systems
• Expectations, thoughts, feelings, and fears
• Beliefs and value systems
• Role as the pet’s primary caregiver
• Ability to implement the treatment plan
• Recent life changes (eg, new birth, job change, recent move, death)
• Current stressors in the household

Putting It into Practice
As the 4 elements of explanation and planning come together, give yourself a quick litmus test after each appointment. It can be challenging to make changes in your communication style to a more interactive approach, but taking baby steps often results in big differences. So, you may want to hone in on 1 question at a time for each appointment. Give it a try and make a mental note of the outcomes achieved.

1. How did you present the information? (Lecture [shot put] versus conversational [Frisbee])
2. How did you assess the client’s knowledge of the problem? (Key skill: assessing the client’s starting point)
3. What did you learn about the client’s ideas, expectations, concerns, or feelings? (Key skill: eliciting the client’s perspective)
4. How was your use of medical jargon? (Key skill: using easily understood language)
5. How did you encourage the client’s participation? (Key skill: “chunk and check” method)
6. Whose plan was it really in the end? (Key skill: shared decision making)

If your answer to any of these questions indicates that you may have dumped the meal in your client’s lap, it may be time to slow down and go over the specials one at a time, asking for client preferences and focusing on how you can tailor the plan to your client’s needs to care for his or her pet. | EVT