Loss and grief are universal human experiences. A pet owner’s emotional response to the loss of their pet is often as intense as the grief experienced following the loss of a family member or friend. Studies have shown that 30% of pet owners will experience significant grief following the loss of a pet and 50% will question their decision following euthanasia.^14,15 Given the intense and sometimes conflicting emotions that attend client bereavement, responding to anticipated and actual pet loss with sensitivity and compassion is vital to the mission of animal hospice.

Although the grief response ranges from emotional to stoic depending on the individual, it is generally helpful for the bereaved pet owner to express their emotions to an empathetic listener. The attending veterinarian or other staff members can fill this role. Regular, empathetic communication is the hallmark of effective client support during EOL treatment and after a patient’s death. The veterinary healthcare team has a responsibility to see the EOL case experience through the client’s eyes and to provide nonjudgmental support.

How clients view the veterinary team’s response following the loss of a pet is a critical factor in their continued advocacy for and loyalty to the practice. Studies in human medicine have demonstrated a correlation between empathetic physician-patient communication and an improvement in patient emotional health, compliance with physician recommendations, and satisfaction with their healthcare.¹⁶

^{Client support during EOL care}

Grief is the natural response to loss and is a dynamic process that changes over time. There are many ways to feel and express normal and healthy grief during the continuum of caring for a dying loved one. Grief can be manifested by emotional, spiritual, cognitive, or physical distress. It is useful for veterinarians to view the normal grief response that their clients experience in terms of the five stages described by Elizabeth Kubler-Ross in her seminal work on bereavement: (1) denial, (2) bargaining, (3) anger, (4) depression, and (5) acceptance.¹⁷ It is appropriate to inquire if the pet owner has experience with human EOL or hospice care when discussing their pet’s EOL care plan.

Genuine and empathetic interaction with a bereaved client is a skill that can be learned and improved. Asking open-ended questions is an excellent technique for assessing how a client is handling EOL caregiving responsibilities or bereavement over the loss of their pet. Examples include queries such as “How are you managing?” and “What concerns do you have?” The hospice team members can then validate the extent of the difficulty or grief the individual is experiencing. Reflective listening techniques, such as acknowledging that you heard what the client said and then summarizing the individual’s comments, are helpful for facilitating what is always a difficult topic of discussion.

Conversations about EOL, death, and grief with a bereaved client are never easy. Descriptions of various verbal and non-verbal communication techniques appropriate for veterinarians involved in EOL discussions with clients are available from a variety of sources.^18-20 For example, client communication programs for healthcare professionals are available from the Institute for Healthcare Communication in New Haven, Connecticut, and from the International Veterinary Communication Institute in Ontario, Canada. Among the many available resources are the Colorado State University College of Veterinary Medicine Frank clinical communication workshops designed to improve veterinarians’ communication skills. Other training opportunities are available at many veterinary conferences.

It is appropriate for veterinary team members to suggest to a bereaved client that professional grief-support counseling may be helpful. This recommendation should be accompanied by reassuring the client that most people whose pets have undergone EOL care experience grief and an often-profound sense of loss.¹⁴

Experts recommend that veterinary professionals focus on four specific roles in dealing with clients who have experienced the death of a pet: (1) educator, (2) supporter, (3) facilitator, and (4) a resource and referral guide. Specific actions related to each role are listed in Figure 2.¹⁸ Several universal principles that apply to each of the four client support roles are also shown in the figure. Healthcare team members often use one or more phrases intended to be consoling that can be perceived by the client as insincere or out of bounds (Figure 2).²¹Team members should be careful to avoid these expressions, termed “the clichés of grief.”