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This article reviews the Empathy for Itch campaign, created by the Canadian Academy of Veterinary Dermatology, which seeks to transform itch management for companion animals. It introduces the campaign, discusses why it is needed, and outlines how its tools can be integrated into general veterinary practice, with a focus on the leadership role for veterinary nurses in managing chronic pruritus and supporting long-term patient care and client success.
Take-Home Points
- Chronic pruritus affects not only the physical health of companion animals but also their behavior, their emotional wellbeing, and the quality of life of their caregivers.
- An empathy-centered approach to communication can transform how clients experience and engage with chronic disease management.
- Integrating simple, practical tools into daily practice can make addressing pruritus more consistent and effective.
- Supporting client understanding and setting realistic expectations are critical to long-term treatment success.
- Veterinary nurses are uniquely positioned to strengthen continuity of care and positively impact quality of life for dermatology patients.
Pruritus, particularly chronic pruritus associated with underlying allergies, is the primary presenting complaint for veterinary dermatology patients.1-3 Skin allergies also happen to be the No. 1 insurance claim for dogs.4
Chronic pruritus takes a large toll on quality of life. Studies of humans living with chronic pruritus show the negative impact is equal to that of living with chronic pain, with up to 20% of those affected considering end of life.5,6
The burden on caregivers of affected pets is also significant. Watching a beloved pet suffer brings up many emotions: guilt for not acting sooner, frustration when treatments bring only partial or temporary relief, and anxiety when managing multimodal treatments and long-term medications. Add recurrent appointments with repeated diagnostics to the mix, and a client’s emotional and financial currency can be rapidly depleted, resulting in an even more stressful situation.
A recent survey done by the American College of Veterinary Dermatology confirmed that the tipping point for clients losing faith in a primary care clinician and leaving to find alternative care is after spending approximately $900 or after 3 visits if their pet’s condition has not been resolved.7 Notably, this survey also concluded that the time and cost to cure for a patient is reduced by at least 25% when there is a referral to a veterinary dermatologist early in the process. An unexpected finding was that, when referred, clients had an improved perception of their primary care veterinarian, which boosted their confidence in them and improved bonds with their primary care clinic.8
Client education is key to success with dermatology cases. Without appropriate education, clients can easily misinterpret treatment adjustments as uncertainty or failure rather than an expected part of managing chronic disease. Setting realistic expectations is an important part of client education when managing lifelong conditions like allergies. This is where the Empathy for Itch (EFI) campaign can be a game changer.
Overview of the Empathy for Itch Campaign
The Canadian Academy of Veterinary Dermatology (CAVD) created the EFI campaign in response to common communication challenges encountered in the management of allergic skin disease (Box 1). It encompasses educational materials for both veterinary professionals dealing with itchy patients and pet owners struggling with caring for an itchy pet (Box 2). Many EFI tools were created based on responses from a Canada-wide survey of general veterinary practices.
- Chronic pruritus requires ongoing management.
- Treatment goals emphasize control rather than cure.
- Client education is a continuous process.
- Empathy enhances adherence and trust.
- Veterinary nurses are essential educators and advocates.
The EFI toolbox for veterinary professionals includes educational materials for clinics to use in improving their own continuing education and for client education. Among other tools, it contains visual aids and conversation guides to help care teams explain the chronic nature of allergic dermatitis and pruritus, outline realistic treatment goals, and validate client experiences (Box 3).
The entire care team shapes how clients perceive and engage with the patient’s treatment plan; therefore, using 1 core resource ensures all team members are delivering the same messaging to clients.
The toolbox itself includes:
- “Ask a Veterinarian” videos that feature veterinary dermatologists answering the top 10 questions most often asked by the owners of pruritic pets. Knowing a specialist’s response to these questions not only may be enlightening but also reinforces consistent messaging when veterinary professionals are asked the same questions by clients.
- Clinical videos, such as “The Real Cost of Veterinary Dermatology” and “Working Up an Itchy Pet.”
- Client education videos, such as “All About Itching in Your Pet,” “How to Bathe Your Pet,” and “All About Doing a Diet Trial.”
- In-clinic tools, including the Dermatology History Form, the Itch Scale, the Cytology Quantification Guide, and the Journey Guide.
- Links to recorded continuing education events, podcasts, and webinars for the veterinary team.
The “For Pet Parents” section of the website provides owners of itchy pets with a wide array of client-oriented educational resources, including photos of different degrees and markers of allergic dermatitis, “Ask a Veterinarian” videos, downloadable forms, and a survey to help them recognize problems and when to seek veterinary care (Box 4).
Several downloads are available on this page:
- Treating the Itchy Dog Journey Map, which lays out step by step how veterinarians work up a pet’s discomfort
- Itch Scale, which helps owners identify just how itchy their animal is (this can be quite a revelation for some owners)
- Dermatology History Form, along with a more detailed form for diet history and an easy-to-read information sheet/visual aid about performing an elimination diet trial that helps set up realistic expectations for clients and reinforces collaboration with the care team
- Owner survey, which helps clients recognize that their pet has a problem and when to seek veterinary care
A defining feature of both professional and client materials is the emphasis on emotional intelligence. Rather than focusing on diagnostics and medications, these resources encourage veterinary professionals and pet caregivers to address the emotional context in which chronic skin disease exists. This includes acknowledging frustration, normalizing uncertainty, and reinforcing that long-term management is a process, rather than a failure.
All these tools complement evidence-based veterinary care and are meant to enhance the delivery of care by improving clarity, consistency, and trust. When used by all care team members, these tools ensure that clients receive unified messaging regardless of which team member they interact with.
Veterinary nurses are central to every stage of a patient’s journey of care. This includes repeated interactions and appointments, reviewing patient history, client education, patient discharges, treatment demonstrations, and follow-up communications. Veterinary nurses are often the primary bridge between the treatment plan and the client’s day-to-day experience. The EFI campaign was developed to support all of these interactions by providing communication tools that provide empathy and emotional validation, set realistic expectations, and emphasize collaborative care to improve quality of life for patients.
Allergic Skin Disease and Chronic Pruritus
Pruritus should be seen not as an isolated problem but rather as the tip of the iceberg. It is a clinical sign that reflects an underlying disease process.9,10 In companion animals, allergic skin disease (insect bite hypersensitivity, cutaneous adverse food reaction, or atopic dermatitis) is the most common cause of chronic itching,1,2,11 which causes affected animals to lick, chew, bite, rub, and scratch. Allergic skin disease is a result of a combination of genetic predisposition, immune dysregulation, environmental exposure, and compromised skin barrier.
Allergic skin disease cannot be cured; however, it can often be effectively managed with a combination of diagnostics, targeted therapy, and ongoing reassessment. Clinical signs often wax and wane in response to seasonal allergen loads, environmental changes, stress, and/or comorbidities. Secondary overgrowth of bacteria and/or yeast can lead to dysbiosis of the microbial skin population, resulting in infections that can significantly exacerbate pruritus if not identified and addressed in a timely manner.
Because chronic pruritus is dynamic rather than static, treatment plans are often reassessed and adjusted over time. Medications may be started, modified, or discontinued based on patient response, tolerance, and disease progression. From a medical perspective, this adaptive approach is appropriate and thoughtful care. From a client’s perspective, without prior education and expectation setting, these changes can be confusing and discouraging if the chronic nature of allergic skin disease is not understood.
Veterinary nurses are instrumental in helping clients understand that long-term management is expected. Framing chronic pruritus in the same context as other lifelong conditions, such as osteoarthritis or endocrine diseases, can be very helpful in normalizing the need for ongoing care. The EFI tools support this reframing by providing language and visual aids that emphasize the journey to comfort, control, and improved quality of life rather than cure.
The Client’s Emotional Experience
The emotional currency that pet owners spend on chronic pruritus should not be underestimated (Box 5). Understandably, clients are distressed by witnessing persistent scratching, chewing, or licking behaviors, especially if these behaviors are disrupting sleep or causing visible self-trauma. Clients are often overwhelmed by multimodal approaches to treatment involving administering medications, performing topical therapy, and having recheck appointments.
- Frustration related to recurrent or persistent clinical signs
- Concern regarding long-term
medication use - Confusion when treatment plans evolve over time
- Guilt associated with perceived lack of improvement
- Emotional and financial fatigue related to ongoing care requirements
Concerns about long-term or lifelong medication are common and can include misinformation and hesitancy about immunomodulatory treatments. Financial considerations can further compound stress, especially when diagnostics or ongoing treatments are required for sustained quality of life. Without client education and communication, these concerns can lead to nonadherence or client disengagement and resentment.
Empathetic communication acknowledges these emotionally charged concerns without judgment. Veterinary nurses can validate the challenges of managing chronic disease while reviewing the importance of consistent care. Treatment should be presented as a responsibility between the veterinary team and the caregiver. This approach fosters trust and promotes collaboration to find what will work best for each individual and increase chances of success.
The Veterinary Nurse’s Role
Veterinary nurses have an influential position in the management of chronic pruritus (Table 1). They are often responsible for obtaining or reviewing patient history, collecting diagnostic samples, educating clients about disease processes, demonstrating treatment techniques, and reaching out to clients for follow-up communication. These repeated interactions put veterinary nurses at the center of the client experience, often fostering strong client bonds with clinics.
Veterinary nurses also play an important role in assessing and advocating for patient quality of life. Observations about sleep patterns, activity level, temperament changes, and owner perception of their pet’s comfort provide valuable insight regarding disease progression and treatment success. Documenting all of the above helps to reinforce a holistic approach to patient care and supports ongoing evaluation.
Client education is, in the author’s opinion, the cornerstone of the veterinary nurse’s role in managing chronic pruritus. Being able to translate complex disease or treatment concepts into clear, accessible language requires both clinical knowledge and proficient communication skills. EFI tools assist veterinary nurses by reinforcing consistent messaging that aligns with standard-of-care dermatology, while allowing them to remain approachable and supportive. Through repeated client education and reinforcement, veterinary nurses help ensure that clients understand not only what they are being asked to do but why and how it will help to improve their companion animal’s quality of life.
Integrating Empathy for Itch Tools Into the General Practice Workflow
For change to be sustainable, it must be incorporated into an existing workflow rather than added in as an extra task. EFI tools are most effective when they are easily accessible and routinely incorporated into patient care processes.
Electronic medical records systems can support integration by including templates or prompts related to chronic pruritus management. Documenting any client interactions, client concerns, emotional responses, or adherence challenges helps to ensure continuity and supports consistent follow-up and messaging from all team members.
Educational materials and visual aids like the Itch Scale and the Journey Map, or a QR code linked to the Pet Parent landing page, can be incorporated into exam rooms. Team preparedness can happen easily at staff meetings with an emphasis on empathy-centered communication and encouraging veterinary nurses to use tools like the Itch Scale to help consistently document quality-of-life indicators.
Empowering veterinary nurses to take on an active role in dermatology cases not only improves efficiency and elevates patient care but also builds professional expertise, leading to more job satisfaction.
Initial Contact
Upon booking an appointment for a pruritic pet, client service representatives should direct clients to the EFI Pet Parent landing page to have them download a dermatology history form. Having a succinct dermatologic history is essential and helps narrow the differential diagnosis. Ideally, clients will fill out the form and return it to clinic staff for review prior to their appointment.
Clients should also be encouraged to explore the EFI Pet Parent landing page. In doing so, they will be pre-educated on pruritus in pets and the answers to the most commonly asked questions. This process streamlines appointments, allowing veterinary care teams to make the most of their limited time with patients and their caregivers.
Initial Presentation and Intake
The initial visit sets the tone for all future interactions. During intake, veterinary nurses can use empathetic language to acknowledge the client’s concerns and establish realistic expectations. Statements that recognize the challenges in managing chronic itch help clients to feel heard and supported. For example, the author often lets clients know that she lives with 2 allergic dogs and understands what they are going through. In her experience, clients seem relieved and feel heard, taking the nervous energy in the room down a notch.
Introducing EFI concepts early allows veterinary nurses to frame the visit as the beginning of an ongoing management plan, rather than a 1-time solution. Tools like the Journey Map act as a visual aid to assist clients in appreciating the scope of their pet’s possible health concerns. Pet owners who understand from the start that pruritus often requires long-term care are less likely to feel discouraged when additional diagnostics or follow-ups are recommended. Veterinary nurses can encourage clients to revisit the EFI Pet Parent web page to reinforce information discussed at the initial visit.
Diagnostic Education and Rationale
Diagnostic testing is a critical piece of the puzzle for chronic pruritus cases, but owners can perceive it as repetitive or unnecessary if its purpose is not clearly explained. Veterinary nurses can use EFI tools to explain why tests such as cytology or parasite evaluation are essential for identifying contributing factors for itch and for guiding treatment plans.
By describing what they see during the dermatologic examination and explaining its significance (e.g., possible secondary infections and inflammation can significantly worsen itch), veterinary nurses educate owners on the importance of addressing all components of disease. Clear explanation supports informed consent and encourages collaboration in decision making. It also highlights the value of what is being done at that visit and future ones.
Treatment Planning and Setting Expectations
Treatment for chronic pruritus is often multimodal, which may include systemic therapy, topical treatments, environmental modification, and dietary strategies. Veterinary nurses are excellent at explaining how these components all work together to control itch and improve comfort.
Having veterinary nurses perform patient discharges by reviewing the appointment and thought process that helped in formulating the treatment plan frees clinicians to see other patients and reinforces for clients that veterinary nurses are valuable, knowledgeable members of their pet’s healthcare team. When clients are speaking with a veterinary nurse at a follow-up and have any questions, they can rest assured that they are in good hands.
Veterinary nurses should review each part of the treatment protocol and how to execute every component, including demonstrations if possible. Medications should be discussed, including proper administration, any drug interactions, and possible side effects to watch for and what to do should they occur. Veterinary nurses can support discussion regarding timelines and treatment goals as well help troubleshoot any perceived challenges. All of this support empowers clients to feel more confident in managing their pet’s treatment plan and reinforces the collaborative spirit of working with their veterinary care team.
Clients benefit from understanding that improvement may be gradual and that treatment success is measured by sustained comfort and quality of life rather than complete resolution of clinical signs.12,13 Reinforcing that treatment adjustments are often required and are expected helps prevent client frustration when any changes are needed.
Recheck Appointments and Long-Term Follow-up
Recheck visits are essential for evaluating response to therapy and keeping clients engaged. Veterinary nurses often lead these appointments, creating opportunities to bolster education and empathy and offer further encouragement. Acknowledging all the hard work that goes into managing chronic pruritus goes a long way. Revisiting EFI concepts at these appointments helps normalize ongoing management and validates client’s continued efforts.
Having veterinary nurse–led follow-up communications, including emails, texts, phone calls, or scheduled rechecks, enhances continuity of care. Early identification of any concerns or challenges with treatment allows the care team to intervene proactively to improve outcomes and client satisfaction. This, again, demonstrates the collaboration and commitment of the care team in helping clients with their loved ones.
Leadership Opportunities for Veterinary Nurses
Veterinary nurses are in an ideal position to take on leadership roles in integrating and sustaining the use of EFI resources in the clinic. Veterinary nurses influence clinic culture and can serve as champions for empathy-centered dermatologic care. By advocating for structured training, modeling effective communication with clients, and supporting colleagues, veterinary nurses contribute to both clinical excellence and a positive workplace culture.
Leadership does not require formal titles—veterinary nurses can lead by example and by sharing successful strategies with peers (see Case Example). Attending continuing education related to dermatology and communication further strengthens confidence and credibility.
Embracing leadership opportunities reinforces the essential role that veterinary nurses play in chronic skin disease management and empowers them to contribute to their practice values of empathy, collaboration, and holistic patient care.
Samson, a 4-year-old neutered male Labrador retriever, presented with a long-standing history of nonseasonal pruritus affecting the paws, ears, and ventral abdomen.
His owner was directed to the EFI Pet Parent landing page, where they downloaded and filled out Samson’s history form. They reported multiple previous treatments with only partial improvement and expressed concerns about the need for ongoing medication. At the initial appointment, they remarked on the educational materials on the EFI site and asked good questions about the possible underlying causes for Samson’s pruritus.
During intake, the veterinary nurse acknowledged the owner’s frustration at previous treatment responses and introduced the concept of chronic disease management using the EFI Journey Map as a visual aid. Samson’s owner rated his itching as a score of 7/10 using the Itch Scale.
Examination and Diagnosis
The veterinary nurse performed a dermatologic exam and showed Samson’s owner specific areas of concern that had increased erythema. The client consented to in-house cytology, which confirmed that a secondary infection was contributing to inflammation and itch. Cytology results were recorded using the Cytology Quantification Scale.
Discharge and Follow-up
During discharge, the veterinary nurse reviewed the rationale behind Samson’s treatment protocol and how each part of the protocol was going to help improve his quality of life. It was emphasized that Samson would most likely require long-term management with an emphasis on improving his quality of life as a primary goal.
At veterinary nurse–led follow-ups and recheck visits, reasons for adherence were reinforced and the concerns about long-term therapy were addressed. The Itch Scale and Cytology Quantification Scale were used to track Samson’s positive response to treatment. Further communications revealed that although Samson had nonseasonal pruritus, it was worse in the spring and fall. Strategies were reviewed for managing any flares during increased allergen loads.
Over time, the owner reported improved confidence in Samson’s management plan. Samson had decreased pruritus (rated as 2–3/10 on the Itch Scale), and sustained improvement in comfort, behavior, and overall quality of life.
Importance of Unified Messaging in Chronic Disease Management
Owners of pets managing chronic pruritus often receive and process information over multiple visits. Inconsistent explanations about disease chronicity, treatment goals, or expectations can inadvertently undermine confidence in the veterinary team. For example, if a team member describes allergic skin disease as “manageable, but lifelong” and another team member suggests that a specific treatment may “fix the problem,” clients may develop unrealistic expectations or perceive contradictions in care.
Unified messaging is a must and ensures that all team members convey a shared understanding of chronic itch and how it is managed. EFI tools support this consistency by providing common language and visual aids that can be used by veterinarians, veterinary nurses, and support staff alike. When the entire team reinforces the same core concepts, such as long-term management, quality of life improvements, and the likelihood of treatment adjustments, clients are more likely to trust the process and remain engaged as partners in care.
Veterinary nurses are often the most frequent communicators in these cases, making them natural leaders in maintaining consistency. By reinforcing shared language during intake, treatment discussions, discharges, and follow-up interactions, veterinary nurses ensure that the client experience remains coherent and supportive.
Successful management of chronic pruritus cases requires teamwork. It depends on a cohesive team culture that prioritizes consistent messaging, shared expectations, and empathy-centered care.
Impact on Patient Outcomes and Team Wellbeing
Empathy-centered communication has a meaningful impact on client satisfaction, adherence, and trust. In chronic pruritus cases, this translates directly to improved patient comfort and more sustainable long-term management.
For veterinary nurses, active involvement in dermatologic care of patients fosters job satisfaction and reduces frustration associated with chronic cases. Recognizing empathy as a clinical skill reinforces the value of the veterinary nurse’s role and builds a more cohesive and resilient veterinary healthcare team.
Summary
By integrating resources from the EFI campaign into the management of chronic skin disease cases, veterinary nurses are able to enhance both clinical outcomes and the client experience. The EFI approach reinforces every team member’s role in education, continuity, and advocacy, supporting sustainable care for patients with lifelong dermatologic disease and improving practice culture.
References
- Miller WH, Griffin CE, Campbell KL. Diagnostic methods. In: Miller WH, Griffin CE, Campbell KL, eds. Muller and Kirk’s Small Animal Dermatology. 7th ed. Elsevier; 2013:57-108.
- Paterson S. Core investigation and laboratory techniques. In: Jackson HA, Marsella R, eds. BSAVA Manual of Canine and Feline Dermatology. 4th ed. BSAVA; 2021:24-31.
- Hnilica KA, Patterson AP. Differential diagnoses and algorithms. In: Hnilica KA, Patterson AP, eds. Small Animal Dermatology: A Color Atlas and Therapeutic Guide. 4th ed. Elsevier; 2017:1-29.
- Chronic conditions dominate this year’s list of most common pet health problems. Nationwide. March 5, 2026. Accessed March 18, 2026. https://news.nationwide.com/chronic-conditions-dominate-this-years-list-of-most-common-pet-health-problems
- Kini SP, DeLong LK, Veledar E, McKenzie-Brown AM, Schaufele M, Chen SC. The impact of pruritus on quality of life: the skin equivalent of pain. Arch Dermatol. 2011;147(10):1153-1156. doi:10.1001/archdermatol.2011.178
- Dalgard FJ, Svensson Å, Halvorsen JA, et al. Itch and mental health in dermatological patients across Europe: a cross-sectional study in 13 countries. J Invest Derm. 2020;140(3):568-573. doi:10.1016/j.jid.2019.05.034
- Hanna B. Earlier dermatology referral rewards primary care practice (part 1): easing client expenses and enhancing patient care. dvm360. May 18, 2022. Accessed March 10, 2026. https://www.dvm360.com/view/earlier-dermatology-referral-rewards-primary-care-practice-part-1-easing-client-expenses-and-enhancing-patient-care
- Hanna B. Earlier dermatology referral rewards primary care practice (part 2): boosting client perceptions. dvm360. June 1, 2022. Accessed March 10, 2026. https://www.dvm360.com/view/earlier-dermatology-referral-rewards-primary-care-practice-part-2-boosting-client-perceptions
- Miller WH, Griffin CE, Campbell KL. Structure and function of the skin. In: Miller WH, Griffin CE, Campbell KL, eds. Muller and Kirk’s Small Animal Dermatology. 7th ed. Elsevier; 2013:1-56.
- Moriello KA. Dermatological problems in animals. Merck Veterinary Manual. Revised May 2025. Accessed March 17, 2026. https://www.merckvetmanual.com/integumentary-system/integumentary-system-introduction/dermatological-problems-in-animals
- Favrot C, Steffan J, Seewald W, Picco F. A prospective study on the clinical features of chronic canine atopic dermatitis and its diagnosis. Vet Dermatol. 2010;21(1):23-31. doi:10.1111/j.1365-3164.2009.00758.x
- Olivry T, DeBoer D, Favrot C, et al. Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Vet Res. 2015;11:210. doi:10.1186/s12917-015-0514-6
- Noli C, Minafò G, Galzerano M. Quality of life in dogs with skin diseases and their owners. Part 1: development and validation of a questionnaire. Vet Dermatol. 2011;22(4):335-343. doi:10.1111/j.1365-3164.2010.00954.x
CE Quiz
This article has been submitted for RACE approval for 1 hour of continuing education credit and will be opened for enrollment upon approval. To receive credit, take the test at vetfolio.com. Free registration is required. Questions and answers online may differ from those below. Tests are valid for 2 years from the date of approval.
1. Chronic pruritus is best described as:
a. An acute condition requiring short-term therapy
b. A behavioral disorder
c. A chronic disease requiring ongoing management
d. A self-limiting condition
2. Veterinary nurses contribute to chronic pruritus management primarily through:
a. Prescribing medication
b. Performing surgery
c. Client education and follow-up
d. Financial counseling
3. A key principle of the Empathy for Itch (EFI) approach is:
a. Minimizing discussion of disease chronicity
b. Validating client experiences and emotions
c. Avoiding treatment changes
d. Limiting recheck visits
4. Empathy-based communication improves adherence by:
a. Reducing diagnostic needs
b. Eliminating client concern
c. Building trust and understanding
d. Shortening appointment length
5. EFI tools are most effective when used:
a. Only at diagnosis
b. Only during recheck visits
c. Throughout the care continuum
d. Only in referral settings