In practice, the goal of veterinarians is to provide valued services to meet the needs of clients and the animals in their care.5 So, while offering the best standard of care available to them, their clients will expect to have a range of options communicated to them and receive guidance in the selection of the treatment plan most appropriate to their needs.5 Clients may experience significant financial or practical constraints or simply have different priorities in what health care they are able to support for their animals.5 Case management ought to be tailored to the patient along a continuum of acceptable options, prioritizing interventions that are appropriate for both the patient and the client with a space for clients that their veterinarian made them to feel comfortable sharing their perspectives so client can be more engaged in decision-making, within a context of pros and cons, expected and unexpected outcomes, anticipated impact on patient diagnosis and prognosis, the cost-benefit ratio and what next steps should be taken if the patient requires additional support.11

A spectrum of care approach has recently been recognized as an essential component of practice readiness that requires specific communication strategies.5 To keep pace with industry standards and community expectations, veterinary schools must provide authentic learning activities that reflect a full range of care options, that is, where there is provision and adaptation of veterinary care that suits clients’ preferences, limitations, and relationship with their pet.5 Because socioeconomic, geographic and health literacy barriers obstruct healthcare delivery, spectrum of care is an approach to the practice of medicine that addresses such barriers to positive patient outcomes allowing for the customization of care based upon case-specific factors that involve the client, veterinarian and patient.11

Care is tailored to the patient along a continuum of acceptable options.10 Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed.10 Constraints and affordances differ between primary and referral settings and by species of patient. Indeed, even within these categories, there are always differing animal factors (age, temperament, general health and environment) and human factors (resources, capabilities, preferences or circumstances of the owner, vet and veterinary clinic).10 Cost conversations are often driven by clients rather than other members of the veterinary team and few cost conversations highlight the value of diagnostic and/or therapeutic recommendations.10

Four skills that are particularly relevant to spectrum-of-care conversations include open-ended inquiry, reflective listening, transparency and unconditional positive regard (meaning that veterinarians accept clients for who they are and meet them where they are, rather than hold them to impossibly high standards). Perspective-taking and -seeking also require us to draw upon cultural humility and recognize that our clients view their patients’ care journeys through a unique lens that may be influenced by personal, familial, cultural and societal perspectives on their relationships with animals, the function and inherent value of the individual patient, as well as the uniqueness of their bond.11

Deliberation is the process by which our clients become aware that choices exist and what the impact is of those choices on client and patient alike.10 We owe it to our clients to engage in transparent dialogue about perceived and real risks versus benefits, and to solicit clients’ perspectives about what matters most to them moving forward.10 Spectrum of care grants the freedom to bridge the gaps between an all-or-none approach to healthcare delivery and allows us to shift focus on to a wider array of options, broadening the scope of the practitioner’s capacity to sift through combinations of treatments to find what is best for the patient and client in the context of their needs and abilities.10 Spectrum of care encourages practitioners to be adaptive and apply research evidence to the patients’ life context.10 Decision-making hinges on the clinician’s delivery and the client’s perceptions of pros and cons, the anticipated outcomes for and impact of each option.10