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Persuading the Client Without Any Pressure

Lisa J. Hunter, MSW, LSW, Colorado State University College of Veterinary Medicine and Biomedical Sciences

Jane R. Shaw, DVM, PhD, Colorado State University College of Veterinary Medicine and Biomedical Sciences

November / December 2018|Peer Reviewed|Web-Exclusive

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Persuading the Client Without Any Pressure

Sherman, a 12-year-old male domestic shorthair cat, has been deteriorating over the past few weeks. His owners have been vigilant about maintaining his subcutaneous fluids, diet, medications, and overall care since he was diagnosed with chronic renal disease more than a year ago. They expressed their wishes to do everything possible for him. Today, Sherman is lethargic, anemic, hypertensive, anorexic, dehydrated, and his kidney values are substantially elevated.

Making Decisions

Making decisions concerning a patient’s treatment, health, and wellbeing is a collaborative process. Decision making is the interplay between the client’s perspective and understanding of the information and guidance from the veterinary team. These veterinary team–client conversations build the foundation for the client’s ultimate consent or adherence—or not—to diagnostic and treatment options.1

Achieving Informed Consent

Veterinarians, under common law and, in some cases, state statutes, are duty bound to provide clients with “sufficient information to validly consent to treatment,”2 which entails providing the necessary and relevant information to ensure client understanding. (See What to Disclose for Informed Consent.) Also, clients must be educated in a manner that accounts for each individual’s unique perspective, educational background, previous experience, and literacy level.3

What to Disclose for Informed Consent2

  • Diagnosis
  • Treatment options
  • Advantages and disadvantages of each treatment option
  • Costs
  • Risks and benefits
  • Who will perform the procedure (ie, veterinary nurse, specific veterinarian)
  • Who will provide the care (ie, veterinary assistant, veterinary nurse, specific veterinarian)
  • Where the care will be provided (ie, the practice, an emergency clinic, or the pet’s home) 

Walking the Ethical Tightrope

Veterinarians play an important role in the decision-making process by educating and informing clients about the examination, test results, diagnosis, and recommended treatment options and by giving advice on prognosis and potential outcomes.4 This role, which is based on power, authority, and expertise—combined with the trust that clients impart upon veterinary professionals—opens the door for veterinarians to influence clients and the choices they make for their pet.4

This influence may be necessary and appropriate to improve patient health and quality of life5 while maintaining respect for the client’s autonomy and his or her right to make decisions for their pet. However, using paternalistic influence (eg, the veterinarian trying to persuade the client to continue treating the pet when the client is asking for euthanasia) could be inappropriate and unacceptable.5 The veterinarian must walk an ethical tightrope between advocating for the needs of the patient and the rights of the client.

Balancing Act

The end goal is striking a balance where the client’s wishes are respected and the patient’s welfare is ensured. Informing without pressuring can be attained through a relationship-centered approach. Coming from a mutual stance improves adherence6 and resulting patient health outcomes, reduces complaints,7 and increases client9,10 and veterinarian satisfaction.11 Working in partnership with clients establishes a platform of trust and joint negotiation whereby veterinarians and clients work together to create a care plan.

Communicating for Partnership

Communication skills that foster relationship-centered care include warning shot, empathy, reflective listening, partnership, and asking permission.

I have some difficult news to share [warning shot]. I am afraid that Sherman’s kidneys are no longer functioning or responding to treatment.

I imagine this is such a difficult situation for you and Sherman [empathy].

It sounds like you were hoping that I had more treatments options to offer you today [reflective listening].

We have been fighting and doing everything we can to treat Sherman [partnership]. Now, we may need to consider other options [warning shot].

I am wondering if we can discuss euthanasia as an option for Sherman [asking permission]. 

Eliciting the Client’s Perspective

Understanding the client’s perspective creates an awareness of the beliefs and wishes that form the basis for his or her reasoning, which enables the veterinary team to explain information and tailor recommendations to fit that perspective. When client decision making does not align with veterinary recommendations, eliciting the client’s perspective can help create a shared understanding and fosters respect for his or her choices.6

We are a team, and it is important for me to understand your wishes moving forward [partnership].

Would you share your views on euthanasia [eliciting client perspective]?

I am hearing that you would feel you are betraying your promise to Sherman to keep fighting by considering euthanasia [reflective listening].

If Sherman could talk to us, what do you think he would want at this stage [eliciting client perspective].

Final Thoughts

Informing without pressuring means partnering versus influencing clients through coercion or paternalism. When the veterinary team elicits the client’s perspective and provides the information needed to make an informed choice with the team’s guidance, the result is a mutually agreed upon care plan that benefits the welfare of the patient and respects the client’s wishes.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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