Adopting an interdisciplinary team approach

Because an interdisciplinary team approach can add a valuable dimension to EOL care, the task force recommends that all primary care practices have a dedicated team to implement palliative and hospice care. Moreover, it is advisable that all members of a primary care practice, clinical and administrative, be informed whenever a patient is undergoing EOL care.

In addition to EOL care provided by the primary care practice, there are veterinarians with advanced skills and an interest in providing animal hospice and palliative care in a growing number of communities. There is a need for professional training programs to ensure an advanced level of expertise and establish best practices in animal hospice care. Additionally, evidence-based research to support this rapidly evolving field is also necessary. Future recognition of hospice care and palliative medicine as a veterinary specialty is currently under consideration.

The skills required for optimal EOL care have become more advanced than many veterinary practices are equipped to provide. Partnering with human emotional and spiritual support professionals (social workers, pet loss support groups, religious leaders) for services that support pet caregivers involved in EOL care is an acceptable and even desirable adjunct to companion animal practice.²²

Speaking with one voice

It is important that the healthcare team speak with a unified voice and sense of purpose under any circumstances, particularly when EOL care is concerned. In EOL cases, each member of the veterinary healthcare team should have defined caregiving and client-support responsibilities, preferably ones that utilize individual skills, strengths, and experience. The objective is to provide seamless and consistent care for both the patient and his or her caregiver, leaving no gaps in medical or emotional support.

To this end, when new staff members are hired or when EOL care protocols are implemented, adequate training and establishment of roles and responsibilities should be provided to all staff members. No member of the veterinary staff should be left out of training. EOL training is not a static but an ongoing process due to inevitable staff turnover and evolving EOL strategies within a practice. It is also important to establish a system whereby all staff members are alerted when an EOL care case is initiated. This allows activation of appropriate interaction with the client and preparation for palliative and hospice services. Everyone, including reception, medical and technical staff, and kennel assistants, needs to understand their role in EOL care and be prepared to handle emotionally challenging situations.

Besides medical care, all veterinary healthcare team members should have the skills needed to effectively communicate with owners of pets receiving EOL care. Practice owners should consider communication skills training, including role-playing, specifically tailored for EOL care for their entire team.

Compassion fatigue

Compassion fatigue (CF) is a phenomenon defined as the emotional, social, and spiritual cost of caregiving leading to a decline in the desire, ability, and energy needed to empathize with and care for others. Ultimately, CF results in the loss of satisfaction in both the professional and personal life of the caregiver. Veterinary team members who work with EOL patients and their owners and are immersed in an environment of intense emotional and physical suffering, often of extended duration, with little group awareness and support are at higher risk of CF. Veterinarians are especially at risk for CF and depression due to the significant occupational stressors they experience.²³ It is important for the veterinary team to recognize the signs of CF in order to maintain a high level of professionalism.

CF can manifest itself in a variety of ways that are often overlooked or dismissed as “burn-out.” Anger, frustration, depression, crying, insensitivity, a negative attitude, anxiety, and irritability are all behavioral signs of CF. Physical symptoms include changes in sleeping behavior, somatic illness, lethargy, and impaired immune response. Psychological indicators include a loss of hope, increased skepticism, and excessive guilt. These changes can result in avoidance of certain clients, patients or procedures, loss of enjoyment in work, and fear or guilt about letting clients or patients down. Ultimately, CF can affect the morale of the team, either individually or collectively.

Awareness is the key to preventing or minimizing the impact of CF. The likelihood of CF becoming a chronic state or occurring in the first place is reduced when staff members have a high level of self-care, including adequate sleep, good nutrition, taking periodic breaks, and not over scheduling. Staff members who are particularly empathetic and motivated to provide patient or client support may be at higher risk of CF. Staff education on the realities of emotional exhaustion and overload that can accompany EOL cases is the best approach to avoiding, recognizing, and controlling CF. Simply being aware that CF is a normal risk of EOL care is often enough to prevent the serious consequences to team members.

Ways of effectively dealing with CF include:

1. Accepting that emotions such as CF are normal and inevitable in EOL cases.
2. Verbalizing the challenges of EOL care and avoiding “bottling it in.”
3. Approaching a colleague who may be showing signs of CF.
4. Having debriefing sessions at the end of each day.
5. Seeking professional counseling when appropriate.
6. In a staff training setting, role-playing techniques to offset theeffects of CF.

Take-away points

• Members of the veterinary healthcare team should have defined patient and client-support roles.
• Staff members who are particularly empathetic may be at higher risk for compassion fatigue.
• Partnering with other healthcare professionals for services that support clients is desirable and provides for the highest level of patient and family care.
• If a practice is unable to support optimum at-home hospice care, referrals should be made to veterinarians with advanced skills in providing animal hospice care.