How to Approach the Spectrum of Care in Veterinary Medicine

Finances often impact pet owners' decisions regarding their pets' health. Many veterinarians will present various diagnostic and treatment options to clients that represent different price points in an attempt to find some level of treatment for a pet. This is one component of practicing a spectrum of care.

What is the spectrum of care?

The spectrum of care is “a continuum of acceptable care that considers available evidence-based medicine while remaining responsive to client expectations and financial limitations.”¹ Providing clients with various options is not a new way to practice, but the term "spectrum of care" has risen in popularity in the past several years.

Having a defined term for this style of practice allows veterinarians and stakeholders to discuss the best ways to implement it, especially in the education of future veterinarians, who may have less exposure to this during their schooling. 

While finances are the most common barrier to caring for pet owners, it is essential to remember that many other factors affect the decisions pet families make about their pet's care. Some of these include the pet's prognosis, ability to travel to appointments and administer at-home treatments, ability to travel to a specialist, and patient compliance with treatments. 

Practicing a spectrum of care allows veterinarians to maximize patient outcomes and quality of life within their families' individual limitations while meeting the profession's moral, legal, and ethical obligations. Offering a range of options means clients can often receive some level of care for their pet, even if it is not considered the traditional gold standard.

A Practical Approach to Spectrum of Care When Finances Are Limited

For clients with limited finances, choosing which diagnostics and treatments to pursue is essential. Extensive information can be obtained from the signalment, a thorough history, and physical examination. 

Consider three vomiting patients: a 10-week-old male Doberman puppy, a 2-year-old male neutered Labrador, and a 10-year-old female Pitbull. Your differential list for each patient was started based on signalment alone. History information — such as vaccine history, duration and frequency of vomiting, the likelihood of ingesting foreign objects, and timing of the last heat cycle — will narrow the differential list further and help prioritize diagnostic recommendations.

When choosing diagnostic tests, veterinarians should consider the following questions:

• Will the results of the test change your treatment plan or recommendations?
• What information are you looking to obtain?
• In cases of marked financial limits, is there another way to get the information you want?

Answering these questions will help to develop recommendations to maximize diagnostic yield while preserving some client funds for treatment. Once a definitive diagnosis has been reached — or at least the differential diagnosis list narrowed down — a treatment plan can be discussed.

5 Tips to Make Spectrum of Care Conversations Successful

Communication is critical when practicing a spectrum of care. Veterinarians must know what limitations they need to navigate concerning patient care, and clients must understand the available options. Here are five tips to improve the success of spectrum of care communication.

1. Use open-ended questions to elicit barriers that individual pet families are facing

Some clients are very open about their limitations, while others may be more reluctant to provide this information. Using open-ended questions can help to determine what barriers a client may be facing, which can help the veterinarian decide which options may be the best fit for an individual patient and family.

These questions might include:

• What is your budget today?
• Do you have pet insurance?
• What are your goals for your pet’s treatment/today’s visit?
• What questions do you have about your pet’s diagnosis or treatment plan?

2. Utilize shared decision-making to guide clients to the best option for their individual pet

Veterinarians should present options to clients that include traditional “gold standard” to more conservative options. While many veterinarians are taught to offer these options from the most extensive to the least extensive, clients often assume the first option presented is the best and may feel guilty if it is not feasible for them. Thus, veterinarians are encouraged to give options in an order that prioritizes the best fit for the client.

The ultimate decision lies with the client, with the guidance of the veterinary healthcare team, who are responsible for providing education about potential outcomes and next steps associated with each option presented. 

3. Get team members involved in the conversation

Veterinary team members should share a spectrum of care mindset. They should be comfortable discussing options with clients and may include their own experiences or observations with different treatment options, which may help the client be more comfortable with their final decision. Team members are also excellent at eliciting information about client limitations when taking initial histories.

4. Keep thorough documentation and obtain informed consent

Some veterinarians fear they may open themselves to liability by providing options that differ from the traditional gold standard. Veterinarians can protect themselves by including the gold standard in the range of options discussed, thoroughly documenting all client communication, and establishing informed consent related to the option elected.

5. Remain compassionate and prioritize empathy

The diagnostic and therapeutic choices a client makes are affected by many factors. They do not reflect the strength of their bond with their pet. It is important to withhold judgment about a client's choices and ensure that team members do the same. 

Take Home Points

Practicing with a spectrum of care approach allows veterinarians and their teams to offer various options to clients that consider individual limitations–the most common of which is financial. Offering a range of options improves patient outcomes and allows veterinary teams to provide some care for more patients.

Clients are often more satisfied knowing they can do something for their pets, even if their resources are limited. Success when practicing a spectrum of care requires veterinary teams to focus on clear client communication, ultimately easing stress in cases limited by finances.