To understand burden transfer, we first need to start with the concept of caregiver burden. Caregiver burden is the strain felt by someone taking care of a loved one with an illness. Facing the problems and challenges of daily life that spring up while providing care for a loved one can be draining.
Our past work showed that even if that loved one has four legs, caregiver burden still happens! When pet caregiver burden is present, higher levels of stress, symptoms of depression and anxiety, and lower quality of life go right along with it.
But our paper published today in the Journal of the American Veterinary Medical Association shows that the stress does not end with the pet owner. When a veterinary client experiences pet caregiver burden, it may be passed on to the veterinarian.
So What Exactly is Burden Transfer?
The idea of burden transfer is built upon the notion that stress never exists in a vacuum. When is the last time you felt stressed out, and no one in your life knew about it? When we feel stress, no matter the cause, we tend to demonstrate it. The people around us feel our stress, too.
Burden transfer starts with the actions of a person taking care of a seriously ill pet. Is that person more likely to express anger, anxiety, or indecisiveness? Burden transfer views many of the sick pet owner’s actions as being potentially related to caregiver burden—but it doesn’t stop there. It then turns to examine how those behaviors impact the veterinarian.
Our research found 5 factors involved in burden transfer. These factors are a "DANCE" of the veterinarian-client interactions that occur in the context of pet caregiving:
"Daily Hassles" are everyday interactions, like when a pet owner wants impossible predictions about their pet’s future, or has difficulty making decisions about their pet’s care. These are interactions that veterinarians have with clients all the time. Individually, these actions aren’t especially stressful… but add them up, and for some veterinarians, they could lead to extra hours in the day, or feelings of exasperation.
"Affect" behaviors involve interactions with pet owners who display especially difficult emotions, for example, anxiety, sadness, or anticipatory grief—emotions that might be prominent when that client needs euthanasia counseling. Like Daily Hassles, these situations are a common part of veterinary medicine. In contrast, however, emotions run particularly high during these interactions. That can be stressful for many veterinarians.
"Non-adherence/Inconsiderate" interactions are things that pet owners might do without even realizing their veterinarian could be affected. Most veterinarians will tell you that they give pet owners advice based on what they truly believe is best for the pet. When a client declines a recommended treatment or work-up, the veterinarian may be left to wonder, “Does my client not trust me? Did I not effectively communicate their pet’s needs?” Other behaviors, like no-showing for appointments fit with this factor, too.
"Confrontations" are the most stressful. Life is imperfect, and so is medicine. We all want the best outcomes for our pets, but sometimes things don’t go that way. When a client becomes upset about a pet’s health status and will not pay for services or makes a complaint, these interactions can leave the veterinarian feeling defensive, or second-guessing his or her own medical judgment. These interactions do not happen frequently, but when they do, they tend to be highly stressful for the veterinarian.
"Excess Communication" is so common that it gets its own category! When a pet is sick, the owner will naturally call or email with questions and concerns. Now add a high level of caregiver burden, stress, and anxiety to that mix—that pet owner is going to have even more worries, and will reach out for support even more. Like the Daily Hassles, Excess Communications are not individually very stressful, but have a cumulative effect. Added up over the course of a busy day, the extra calls and emails can mean going home to the family many hours later than scheduled.
Importantly, as described in a previous blog post—although burden transfer arises from these difficult interactions, how often these situations occur does not predict stress and burnout for veterinarians nearly as well as the veterinarian’s own reaction to the specific situations. That’s good news. It means that working with veterinarians to change their reactions to these situations could be a very effective way to reduce their stress and burnout.
How Does Burden Transfer Differ from Other Stressors in Veterinary Medicine?
Burden transfer emerges from a wide range of different veterinarian-client interactions that occur when that client is providing care for a sick pet.
These include situations like the veterinarian needing to provide euthanasia counseling, or working with clients who are experiencing anticipatory grief. For that reason, the “Affect” component of burden transfer overlaps with the concept of compassion fatigue, the phenomenon of a health care professional caring so much, for so long, that they just can’t care anymore.
Similarly, burden transfer may arise from interactions with a client who is declining a recommended treatment, including euthanasia. When a veterinarian is unable to take the course of action that he or she believes is best for the pet, for example, when euthanasia appears to be the only way to end an animal's suffering but the client does not agree--moral distress may occur. In that particular situation, burden transfer and moral distress overlap.
However, burden transfer in general is a much broader concept—incorporating not just situations involving grief or a moral quandary, but any aspect of pet owner behavior that is due to the difficulties of sick pet caregiving.
By examining the entire DANCE of difficult veterinarian-client interactions, we can understand which domains are the most difficult for an individual veterinarian. Instead of using general stress reduction techniques, we may be able to apply more targeted methods. We hope this will help veterinarians reduce their stress and burnout, and achieve greater well-being.
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The information offered on this website does not constitute psychological or veterinary medical advice. Please consult with an appropriate professional who can make recommendations for your specific situation.