Beyond the Buzzwords: Contextualizing Spectrum of Care

Welcome back to Tails from the Lab, a veterinary podcast.

As you may have noticed, we’ve made some exciting changes around here.

I am your new co host, Dr. Brad Ryan, senior professional services veterinarian at Antech diagnostics.

And I’m Dr. Holly Brown, a clinical pathologist and chief veterinary educator at Antech.

Together we’ll be discussing real patients and bring in expert guests to offer deeper insights into the laboratory diagnostics used to solve interesting and challenging cases.

Tails from the Lab is a production of Antech Diagnostics. The intent of this podcast is to provide education and guidance with the understanding that any diagnostic testing and treatment decisions are ultimately at the discretion of the attending veterinarian within the established veterinarian patient client relationship.

Just a quick note before we jump into today’s episode. Our guest today is Dr. Michelle Evason, who is employed by Antech. We’re sharing this so you have full transparency about the relationships involved.

Welcome to today’s episode of Tails from the Lab. It is my pleasure today to welcome my colleague and friend, Dr. Michelle Evason.

For those of you who have not met Michelle or heard her speak before, she is a veterinarian and board certified internist.

She has spent her career both in academia and in industry, in the pet food sector as well as in diagnostics. She currently serves as the Director of Veterinary Education and Outreach for Antech Diagnostics, part of MARS Science and Diagnostics.

And for those of you who have heard Michelle speak before or seen her publications, you will know that she does not just speak to the diagnostic tests in a vacuum, but rather inclusively of the pet for which these diagnostic tests are designed, the families that come with these pets, as well as the veterinary teams caring for the pet’s health.

And in that way, she supports veterinary teams in practicing contextualized care.

And that will be the focus of today’s talk. Let’s jump right in.

Well, I am very grateful today to welcome Dr. Michelle Evason onto the podcast.

I had specifically asked for this time with Michelle to talk to her a little bit about a new publication that’s come out, an actual digitized toolkit, if you will, published last month, this month in JAVMA.

I in particular want to talk. So Michelle and I work together in education for Antech and, and this is a topic around spectrum of care that we’re gonna talk to.

And I had the opportunity to be really enlightened by Michelle during my entrance into this education role early on around the importance of spectrum of care. Beyond the buzzwords, I think that we’re familiar with and understanding more about the tangible toolkits and tools that we can use to take something that sounds like a buzzword but put it into practice and to actually elevate our practice by practicing with this contextualized care right in the relationship building that we do.

And I thought maybe I would like our listeners to have the experience that I did, which might be first with you starting around some definitions and understanding your perspective on spectrum of care.

Of course, and I think you’re absolutely right, Holly. As is usually the case, I think sometimes it can get a little lost or bogged down in some of those terms that we use because a lot of different terms are used these days and it’s really been quite a journey.

So my husband, actually Dr. Jason Stull, and a focus group, I think it was in 2018, published an article on spectrum of care. And that’s when the term spectrum of care was first defined, actually.

So providing evidence based options in conjunction with clinical expertise, and it sort of ties into that big component that I just mentioned, or evidence based veterinary medicine, which the definition of that being using the best relevant evidence in conjunction with clinical expertise.

And that part’s really important to provide evidence based options for a veterinary patient and their client. Right.

And so then dovetailing onto that spectrum of care is using that evidence based veterinary medicine and going back to the pet owner and giving them these evidence based options that enable for shared decision making for that particular pet, pet owner and their environment.

Contextualized care is another term that’s been a lot these days, which is a slightly different definition, but I think these days even more, the term that’s used has been published most recently by Dr. Jason Coe and his team.

And that’s actually contextualizing spectrum of care. So taking all of these terms and wrapping them into one big umbrella which incorporates that evidence based veterinary medicine, the importance of the veterinary team’s clinical experience, their resources, their training, their communication, their goals, the pet and their breed, their age, their clinical signs, along with that client, that pet owner, their goals, the human animal relationship, their beliefs and values, and taking all of those things and then informing a spectrum of options and next having a contextualized conversation with the pet owner to reach a shared decision.

So I think right now, as we head into 2026, that’s sort of where we stand when it comes to this.

And I know that was a lot, so I’ll stop talking for a moment.

No, I appreciate all of it because, and I think in particular, I think when I used to think of spectrum of care I thought it meant we need to offer cheaper options.

Absolutely.

That was my takeaway. Right, yeah. Which meant compromising medicine in my mind.

Right. And so switching this to talk about contextualized care that’s actually taking account finances may or may not even be part of that spectrum of options that we’re offering.

Right? Absolutely. And I think the other thing that is nice about it is like, we all, all of us in the profession face challenges, and we’ve all been in a position with a pet owner where cost was a concern.

Except that using this sort of broader, more branching term like contextualizing spectrum of care, it also loops in things like access to care. Right.

You know, I say this all the time, but you can tell from my accent immediately I’m from Canada. And there are certainly parts of the United States where a pet owner getting their dog or cat to a veterinary clinic, that’s a larger issue.

Setting aside costs entirely, of course, there are also cultural aspects as well. So, again, wanting to be broad so that we can bring all of those things in and have them very much be part.

I’ll use the word of context. And the next, I think big key term, and this is one that veterinarians identify. Identified themselves, is how do we talk options? Right. Because it is about options.

And I think more and more we’re getting away from.

And this is at the point in the conversation why I always take ownership for this, because as a specialist that spent a lot of my career in academia teaching veterinary students, residents and interns, I taught that there was usually one best option. Right. A gold standard, if you will, although I detest that term.

So I taught generations of veterinary students and residents and interns to practice that way. And I was wrong. Right.

And I have become part of pushing spectrum of care, contextualized care forward because I know that I was wrong and I know that we need to meet pet owners, and we also need to meet veterinarians in practice where they’re at in these conversations, and provide them with a toolkit.

And I know we were kind of moving around to the most recent publication that came out, JAVMA, and that was actually myself and two excellent collaborators of mine, both Jason’s, Dr. Jason Stull, who, full disclosure, is my husband, and also Dr. Jason Coe, who is an extremely talented communicator expert at the Ontario Veterinary College in Guelph in Canada.

So just such a lovely resource, and what we wanted to do is put together a publication through JAVMA so that it would be accessible online.

Anyone could go to read it and we really did want it to be a toolkit. So we didn’t publish it as a paper in the traditional sense. We did it as JAVMA’s new video tutorial.

So it’s a technical tutorial video. And in that video it is long. And so if folks are pushed for time, I always recommend sort of splitting it into sections. But the point of it is you can start and stop whenever you want because we all know that you guys are busy out there.

And it walks through.

How do I get through the steps of contextualizing spectrum of care? Right. So if I feel like I want to learn how to offer evidence based veterinary medicine, the first part of the technical tutorial is on that.

And then if I really want to focus on communication, the next part of the technical tutorial video is about that.

And because I’m a clinician, and I know most of us in veterinary medicine are clinicians, we really wanted to weave it in and around an actual case just to show how this toolkit could work and be adapted for any case that you’re faced with in clinical practice, whether it’s reactive medicine that I call it.

And the case example that we used in this technical tutorial video is a DKA case, Right. Because that’s one that is commonly presenting to general practitioners. And it’s really hard to know sometimes how to talk to pet owners about options or even what the options are or if there’s evidence for those different plans, treatment management, diagnostic, et cetera.

And because a case is. It makes it real. Right. And of course, as always,

Holly and I, we both do a lot of case based teaching. And it’s.

That case was a real case. It was a case that I had in clinical practice, and it was how we walked through it. I think the other big piece about it is sometimes pulling through and digging through evidence can feel intimidating or it can feel time consuming.

And my husband Jason does a really great job of teaching veterinary students how to do it practically and quickly. And to prove it, I did it as well in the technical tutorial video just to show that even dumb clinicians like me can actually do it.

I really appreciate it. I told you, I was surprised. That was a pleasant surprise. You know, in watching this, this video tutorial was having that. And it’s not even just a tidbit of information.

Right. A really practical way to get evidence quickly in your hands to guide these discussions with owners. Right. That it’s not just my experience or I think.

Right. Adding in that question mark. That’s. That Insecurity, potentially, for the clinician who’s speaking and trying to guide an owner or come to a shared decision, but bringing that evidence forward and having pretty easy access to it. And I. You always have such a sympathetic and empathetic voice for the veterinarians and the veterinary teams to say, like, I know your days are busy.

I know you have a lot on your plate. I also know that I promise you, having done it myself, as you explain, right, It’s a muscle that you can flex, right?

You can learn to use this. You’ll get better at it, you’ll get faster at it, and you will use this tool and it’ll be really useful in practice, Right. In framing these conversations.

Absolutely. And part of the reason. So thank you. I’m glad I come across as empathetic. I think part of it is because I’ve been there, right.

So I have practiced in veterinary medicine for probably more years than I want to confess, although my teenagers would be happy to confess for me, I’m sure that’s what they do.

And I remember being in these situations. I also remember being the specialist, the internist on the phone with veterinarians during COVID Not during COVID Right. And trying to do a lot with a little.

Or again, having access to care concerns. Right. Like I. Again, during COVID That’s sort of the immediate example. What do I do if I can’t send it?

Right. And trying to walk through this in a way that.

And, you know, like, of course, I get it, right? We all want to do the very best that we can for that pet and also that pet owner for a lot of different reasons.

And so it’s a very emotional time for the pet owner as. As well as for us as veterinary team members. And that includes the technicians, of course, as well, because they’re seeing this, they’re helping us with it.

We’re having these conversations in this dialogue with them as well. And so I am very empathetic. I also really wish, and I will sometimes share a story about how I remember in my internship having a pet owner come in who had a blocked cat, right. And I felt so stuck because I didn’t know what else to give them as options.

And it. It was. It was awful.

And that cat ended up being euthanized. And I wish that I could go back in time and have more options, right? And ones where there was literature or. I came close to finding literature or evidence so I could put them into a framework of tools like Dr. Jason Coe’s value matrix tool.

And then go through those and categorize them for particular pet owner and also attach a cost to them so that we could reach an informed decision, a shared decision that worked for them and for me and also so that we could both feel good about it.

I think that’s really so true because I was thinking when we all want to practice the best medicine and we all want to feel good about what we’re doing, right? But I.

But really seeing. And we’ll talk a little bit more about that value matrix, seeing that come to life and having those conversations, I actually think the reward as a practitioner is making the right decision for that pet at that time, for that honor with those priorities and values.

Right.

I actually think it doesn’t have to be that gold standard thing that doesn’t always pay off, right. That doesn’t always get you where you want.

And it’s sort of like, again, you know, the evolution of your career. Right? Because one of the things that I always found in practice is that maybe there isn’t evidence and in dog and cat medicine there often isn’t.

Right? Or we have very small studies. And so what do you do when you don’t have a lot of information? And knowing that you can still find evidence and speak options was really empowering for me.

Again, I love the value matrix as a tool because what I would hear out in practice from practicing veterinarians and also in the specialty framework, because even though clients do come to referral centers, usually knowing that the cost will be higher, you still bump up against, well, we have to stop now, right? Like this is a common thing that happens. And so being able to have these conversations and being able to answer veterinarians who say, well, if I don’t practice gold standard, the state boards or the provincial regulations are going to come after me.

And so being able to ease those concerns when you show them a tool like the value matrix, whereas everything is plugged in, well, that’s actually what the regulatory and the state boards are wanting us as veterinarians to do, because that is an informed conversation, right?

Like that is what they are wanting to occur. And so taking that fear intimidation away from that gold standard, you can see I’m making the air quotes right now, is something that I just so want to get out there to everyone, because having interacted with some of the heads of the state boards, I know that’s what they’re wanting too.

And I really.

Last thing I’ll say is what I don’t want is for any more veterinarians to leave this profession.

Because of moral distress as related to cost conversations.

And so again, I’ll get back to the emotional context of this because there are a lot of reasons that I’ve become very passionate about contextualizing spectrum of care, and I think that’s one of them as well.

And I think that when, when people are concerned in their practice about practicing a substandard medicine or making a decision that had an untoward outcome or something. Right. Is that we hear people say like the, the way to avoid the culpability is like document, document, document.

But that doesn’t, I think that leads to these medical notes that are no longer medical.

Right. If you say document, they said like they’ll comment on the discomfort of the conversation and the owner pushed for this. And, and I actually think this value matrix and we’ll try and describe it, right?

For I’m, I unfortunately quite a visual learner, but we’ll try to give it a description for those who are listening and then they can, they can look on YouTube and they can look at the article, which we’ll give some more direction to.

But having that value matrix sketched out actually becomes. Right, that conversation tool that we had this conversation and here were the choices. Right. So let’s speak, let’s try to describe it for our listeners, but with this value matrix.

Do you want to talk us through it a bit?

Absolutely. And so I sort of wish I had the slide up in front of me because I always again, come back to the case examples.

But in the publication, of course, the scenario is a dog named Avery.

I did change the name, I admit to that with DKA. And the owners have expressed their main goals for Avery, which one, they have concerns around cost.

And two, Avery plays a really important role in their family. And so their other goal for Avery is reducing hospitalization time as much as possible. Right.

And so those were the goals in the value matrix that we used as sort of their key concerns. And those were also the main things that went into some of the search terms that Dr. Jason Stull walks through in trying to find evidence around treatment for DK in hospital versus not and also reduced hospital time. And so those are the terms that we use because those were the main goals for Avery’s owners there.

And so we basically, when we’re doing the value matrix and Dr. Jason Coe does this much, much better than I do, is it basically looks like a T with the pet owner’s goals along the tops as well as the medical goals usually along the left hand side and then kind of moves through Those in terms of which options will get us either the most information or meet our goals.

Here of course, with Avery survival being a key goal for Avery 2, reduced hospital time. And then of course the final category, which is cost and so puts a clear cost associated with, with each diagnostic treatment plan to meet those key pet owner goals. So I’m not sure how, how, how well I did at describing it, but basically when this table is laid out with the evidence that matches the owner’s goals and the costs that takes into account the treatment plan management plan, that we come up with the different options of them, kind of higher cost to lower cost in this scenario and then that allows for a discussion to occur with the pet owner moving through those, I. E. The lower cost, less hospitalization time will result in this versus the other ones along the lines of the table. And that way both parties, the pet owner as well as the veterinarian, can go over those, answer specific questions.

And actually one of the things that I always mention too is that, you know, a lot of times people are like, okay, what your talking about sounds like it takes so much time.

And specifically with a DKA case, you’re often feeling like you’re having to move very quickly. Which is part of the reason we chose a diabetic ketoacidosis case as well.

Because when you have the table laid out, it actually decreases the amount of time that’s needed to have conversations.

And I know Dr. Coe has done some research to that point. It also can seem intimidating to. Okay, well I don’t am not prepared to dig through a bunch of literature.

And so that can feel like it’s very time consuming as well.

But one of the very best things about this is when you have these common scenarios,

DK may be one, Parvo might be another.

There’s a lot of ones that are out there that have spectrum of care value matrices done for them.

You can use these and reuse them and recycle them for your practice. So it’s kind of like a one and done and move on. And the very best part too is these days because spectrum of care and contextualizing spectrum of care is caught on.

There’s more and more groups that are offering these toolkit type resources so there available online as well. And we make mention of that in the article too.

And I think they serve as such a great communication tool. Right. So I think what’s really neat is that in filling it out and going across the priorities or values for that particular case, both medically.

Right. Is your contribution Right. And then the owner’s values and getting to know them enough to be able to identify and cooperate with them on what becomes their priority.

Right. Sort of at the top. And I think that that communication to even start to fill it out lays it out so nicely so that when they’re making a choice, it’s the only way they can make an informed decision is to balance.

Right. The medical with their priorities.

Right.

That would include concerns of money or whatever else. Because in many, as I mentioned, there’s other things beyond money. Right. In Avery’s case, it was we need her home.

Right.

Because of her role in the family.

Right.

It may be other logistics of getting to the hospital or not being able to be at the hospital, travel plans that are coming up, other pets at home or other logistics. There’s a lot of things that can come into play that we need to identify through good communication and conversation with the pet owner so that when it’s laid out, they can make the most informed choice.

And it’s not just about money, Right. It’s having all.

I honestly, I couldn’t have said it better, Holly and I, and I think that’s one of the other things is, you know, no other profession has so many unique and different factors associated with it.

There’s never going to be a one size fits all. And so that’s the other thing that we really try to get across is. And this publication, I think highlights that too, is that was an example built for Avery.

Right. A DKA case in a hospital in Wisconsin versus one in Canesville, Florida versus one in Regina, Saskatchewan.

It’s all going to look very different. And that’s okay, right? Again, that is sort of the nature of having contextualization of spectrum of care is because as you said, there are going to be different priorities for different pet owners.

Right. There’s only one Avery and there’s one Avery pet owner. Right. And that’s a beautiful thing and we should embrace that and empower veterinarians to do the same.

But again, using this toolkit, once you get familiar with it, and again, even a dumb clinician like me can do it. You can use it again and again and again.

Right.

It’s just kind of like how when you graduated from veterinary school, you went into general practice and you were like wowed by someone doing a seven minute spay. Well, and then you look around and one day that’s you.

And this is the exact same thing, right? Is it’s. It feels uncomfortable.

But then you practice a few times and you get there and you find loopholes, like we all do, and in this case, some of those would be other online resources where they’ve done it.

And then you can adapt and pivot those so they fit you, your practice and your Avery, whoever that might be.

And I shared so many of those same words came to mind as I think about.

Well, I really enjoy the term contextualized care. It actually, it warms me to it. Right. And understanding that we are taking into account all these different factors and, and yes, it will look different.

It’s. It’s not only, okay, that look different.

Right.

But it’s actually part of the beauty of it, which is actually what I was thinking as well. In exploring that relationship and those values and being able to meet those needs is really where we’ll find such great rewards.

Right.

I’ve told you since you taught me about this and I’ve had the pleasure of speaking with Dr. Jason Coe and hearing more about the communication aspect of this,

I practice differently even as a consulting clinical pathologist. Right. I explained to you before that I think I used to only say to get more definitive information you will need.

And I listed all the top things they could possibly do. Right. But I think when I passed that, that report back, there was a, felt like maybe an obligation to do those things to practice best medicine.

Right. Oh, we were taught that.

Yeah, right, we, we were. And, and actually again, I, you know, I’ve already taken accountability for this.

When you’re a specialist, that’s even more ingrained because, you know, of course you then do additional years being taught that way and you know, it’s really about options. And that doesn’t take away learning. As veterinarians, we have so much medical, surgical, whatever you want to say, expertise that we’re bringing. And we know from survey after survey whether I do studies on antimicrobial stewardship, whether I do ones on nutrition over and over.

Pet owners want to hear from us as members of the veterinary team.

They also need us to listen to them. And to do that, we have to do something that.

I always laugh at this point. Right. Because this is where I of course confess that I went into veterinary medicine because I vastly prefer animals, the four legged version, to people.

But it also means that we have to learn to communicate and ask our pet owners what their goals are. Right.

So that it really can be us offering up that incredible knowledge that we have.

Incredible. Aside from the knowledge I myself personally offer, and then the pet owner offering the knowledge that they have on their own situation and what they know of their pet, which is also considerable. Right. And we should respect that and use all of those things to reach that shared decision.

Right.

And talk options, which is what our clients want. Right. Study after study tells us that.

Absolutely. And I think why I love this tutorial video, that It’s. It’s what, 30 minutes? Roughly around 30 minutes that we go everywhere. So some core tutorials on how we can get evidence that we can get evidence quickly to support the options we’re going to discuss with the owner.

So we have that aspect of it. We look through a case where we apply the value matrix. We learn to use this as a tool on how we fill out for an actual case where you walk them through that and then at the end, some additional communication pieces.

Because I really love that it rounds it out for. Here’s a communication tool. And sometimes it goes well.

Right. And sometimes these are challenging. Right. And sometimes we have to have conversations of how we speak with empathy. What words can we use. Right. To communicate this most effectively in the most challenging of times?

Oh, I have learned so much from Dr. Jason Coe over the course of my career, and so I’m fortunate that I’ve worked with him and known him for quite a long time, and he has illuminated for me how I. I speak to pet owners, and probably even more so how I listen to pet owners. Right. And we talked a lot about what we were going to include in this video, and all three of us felt very strongly that we did need to do exactly that.

Is frame part of this in a. Well, what if they can’t? Right. Because, of course, this is something that comes up as well. And so to ignore that and paint a rosy picture of moving through the value matrix and everything ending up sunshine and roses with a happy dog that goes home to the owners, which actually Avery does after a few days of hospitalization. But it’s not always going to be like that. And so Jason, of course, does a beautiful job talking about how you then transition the conversation to an I wish.

Right.

Because again, you’re still on the same team. And we have empathy for the pet owner that cannot do those things or that doesn’t work for them for whatever reason. Right.

And it’s a place with no judgment.

I wish it were that way, too, too. Right. It’s a way for us to express that.

Yeah. And be in that shared space with them. Right. Yeah. I. I love it. So all. All of that, all of those tools. Right. In. In one video toolkit here, so published in JAVMA just so people can access it I’m looking here back in.

It was last month, so published in August, called Spectrum of Care Toolkit. Identifying and communicating evidence based options has some really, really practical take homes that you can get in just 30 minutes from three experts in the field really sharing some really relatable options.

And I appreciate having the video aspect of it because I understand that it was important for you all because you understand that people are busy. Not everyone reads these things.

Right. I think also many of us are visual learners. Right. So even if you read it, if you didn’t see it put into action. Right. So there’s a video part of it where we walk through a PowerPoint where we can see them filling these things out without the search engine in place.

Right. The communication tools with the owners. I just think it’s an incredible piece and I hope that people check it out.

I do too. And I will also say it didn’t feel very authentic to us to be talking about options and then not provide options for how to view it. Right. And so we really wanted something where you could do exactly that is if folks were visual learners, they could listen in and do it that way.

And then of course there’s also the transcript. And so if people prefer to read it again, do it that way. And I think most of all for, for me again, because I know what it’s like to be in practice. I really wanted the ability for people to feel like they could start and stop and do it in chunks. Right.

Pick back up and go back and get more if you, if you have interest in doing that. So again, practicing what you preach, which is in this case options.

I love it. Well, thank you very much for joining. Giving some some more legs to this so people understand what they’re able to get from the video tutorial. I hope that everyone checks it out.

I think that there are a lot of take homes as I mentioned after speaking with you, after speaking with Jason Coe at other times, and the expertise that you guys bring in the perspective changes how I look at veterinary medicine and how I practice.

I’m sure it will for others as well.

Thanks for having me, Holland. A pleasure as always.

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