Tough talks: At international conference, veterinary student presents research on resuscitation orders and client communication
Veterinary emergency and critical care professionals have hard conversations with clients about their pets every day. One common discussion centers on a difficult and emotional question: In the case of cardiopulmonary arrest, does the pet owner want the veterinary team to attempt resuscitation or not?
Anna Horowitz, third-year veterinary student at the Virginia-Maryland College of Veterinary Medicine, recently presented an abstract at the International Veterinary Emergency and Critical Care Symposium (IVECCS). Her research seeks to better understand who is having this conversation, what they are saying, and how they feel about it. Horowitz is working on this project alongside clinical associate professor of emergency and critical care Bobbi Conner, who directs the Veterinary Teaching Hospital’s intensive care unit, and Auburn University anesthesiologist Erik Hofmeister.
“IVECCS is the premier conference for veterinary emergency and critical care (ECC) specialists,” Conner said. “Most of the submissions are from veterinarians who are either already specialists in ECC or are residents-in-training. Anna was the only student presenting an abstract at IVECCS this year, and she absolutely knocked it out of the park."
To gather more information about client communication around resuscitation, the abstract’s authors created a survey and sent it to a large veterinary emergency and critical care listserv. A total of 467 veterinarians, veterinary technicians and assistants, receptionists, and other staff responded.
The project’s ultimate goal is to work towards communications training for veterinary professionals so that they have the support and confidence to communicate these options to clients.
No pet owner wants to think about what might happen in the worst case scenario, but clients need to be informed about the risks, benefits, and costs of resuscitation. One difficult part of communicating the risks of CPR is that many clients believe that it has a higher success rate than it actually has.
In humans, the success rate for CPR in a hospital setting is between 24 and 40 percent; it’s less than 10 percent for pets who receive CPR in a veterinary hospital.
Horowitz’s firsthand experience was the driving force behind this research. When Horowitz was an undergraduate working at a veterinary emergency room, she was tasked with asking a client for a code status, which describes what kind of intervention veterinary professionals should perform in the case of cardiopulmonary arrest – whether they should attempt cardiopulmonary resuscitation (CPR) or if the pet will have a do-not-resuscitate (DNR) order.
After Horowitz presented these options and explained to the client what they meant, the man began to cry.
"I thought, 'That's definitely not how this conversation is supposed to go,” Horowitz said. “And I went home, and since we have this conversation with clients all day every day, I looked it up, looking for guidelines or a script, and there was totally nothing. We don't really see anything in veterinary medicine about how to have this conversation."
"Our goal should be twofold: to get informed consent from the client so that they understand what is going to happen, what the risks are, what the benefits are, and what the costs are — and we need to respect the gravity of this conversation and speak and act in a way that cares for the client's emotions.”
With the survey data, Horowitz and her co-authors are developing a better understanding of the communication around CPR and DNR orders. For example, though many of the emergency and critical care professionals who answered the survey are trained in CPR, almost none have had formal training on how to discuss resuscitation with clients.
“A lot of people are having the experiences I had, of trial and error,” said Horowitz.
Additionally, they found that about a quarter of the time, non-medical support staff like receptionists are the ones having the conversation. None of the non-medical support staff who answered the survey were trained in CPR. Horowitz points out that it may be difficult for them to convey this information accurately without firsthand knowledge and expertise.
In the future, research like this can help push towards learning modules and training tools so that veterinary medical professionals have more guidance and more clients come away from the experience feeling comfortable with their decision.
“Anna has done a phenomenal job in all aspects of this research project — from project design, organization, implementation, and presentation,” said Conner. “I look forward to continuing to work with her and I know we’ll see great things from her throughout what I expect will be a long, productive career in veterinary medicine."