"It's Like Having a Map": An Exploration of Participating Pet Owners' Expectations of Using Telemedicine to Access Emergency Veterinary Care

(1) Background: Telemedicine is increasingly recognized as a potential way to help overcome barriers to accessing veterinary care. This study explored pet owners' perspectives on telemedicine services in situation they viewed as veterinary emergencies, focusing on both their access-to-care challenges and their expectations of such services. (2) Methods: Semi-structured, one-on-one interviews were conducted with 18 pet owners in Ontario, Canada. All participants were unable to access in-person care, leading them to a veterinary telemedicine service. Interviews were supplemented by an online questionnaire to collect demographic information. Thematic analysis was conducted on all interview transcripts. (3) Results: Participants' expectations of telemedicine were largely informed by their uncertainty about their pets' health in emergency situations. Anxiety was common, leading them to seek telemedicine for reassurance. Participants expected advice and guidance, viewing the process as collaborative. While acknowledging the benefits of telemedicine in their situation, participants also acknowledged the inherent limitations of this type of service, articulating a general preference for in-person veterinary care. (4) Conclusions: When in-person care is unavailable, telemedicine can offer pet owners valuable guidance, clarity, and comfort, although many pet owners may continue to prefer face-to-face consultations for comprehensive care.

Assessing pet owners' knowledge and comprehension of veterinary medical terminology

BACKGROUND

Veterinary communication plays a key role in client satisfaction, patient outcomes and clinician wellbeing. Communication assessment tools can help to facilitate improvement strategies.

METHODS

Over a 5-month period, pet owners attending a small animal hospital were asked to complete a survey assessing their understanding of commonly used veterinary terms and phrases, either online or in paper format. Scores were used to identify areas requiring improvement and investigate the effect of demographic characteristics on owner understanding.

RESULTS

A total of 378 completed questionnaires was received. Over 97% of owners rated the quality of veterinary communication as good or moderate to good. However, approximately one-fifth believed that communication could be improved. While veterinary terms and phrases were broadly understood, none was correctly interpreted by all respondents, and common misconceptions were identified. Respondents with prior medical knowledge scored higher.

LIMITATIONS

The survey methodology allows for misinterpretation of questions, response bias and non-compliance with the requirement that respondents do not receive help in completing the survey from external sources.

CONCLUSION

While pet owners generally perceived veterinary communication to be good, some commonly used terms and phrases were frequently misinterpreted. Vets should therefore be encouraged to use lay terms when communicating with clients and to take time to confirm that their intended message has been fully understood.

Client experiences with veterinary professionals: a narrative inquiry study

AIMS

To use a narrative inquiry approach to explore animal owner experiences and feelings during engagement with veterinary services with the goal of understanding what a "good experience" looks and feels like from a client perspective.

METHODS

Semi-structured interviews were conducted with 30 animal owners, primarily companion animal owners of New Zealand European ethnicity, via video call or telephone. Interviews were transcribed and analysed using inductive thematic analysis.

RESULTS

The participants narrated both positive and negative experiences with veterinary professionals, the impacts of those experiences and subsequent actions by the client. Four main themes emerged. The first identified features of the practice, beyond the standard provision of veterinary services, that had attracted participants, e.g. specific services offered. The next theme concerned the overall experience for the participants, where clients felt welcomed and cared for at all stages of the interaction. The third theme focused on building and maintaining quality relationships. We found that the principles of relationship-centred care apply and that when these factors were absent, conflict appeared more likely. The fourth theme considered factors that impacted the client-veterinary professional relationship. Our findings suggest that clients were more forgiving of poor outcomes if there was a good match and a strong existing relationship between the veterinary clinic and the client, and if the poor outcome was managed well by the veterinary practice. Managing poor outcomes well was strongly aligned with having honesty and integrity.

CONCLUSIONS

The narratives provided insights into client experiences and what is important to them when seeking animal healthcare in terms of the features that a specific veterinary practice offered them and the connections with the personnel at the veterinary practice. Relationship-centred care was key but required a good client fit to the practice to begin with.

CLINICAL RELEVANCE

The themes outlined in this article offer a framework for veterinary practices to assess their current performance against client priorities. By identifying areas for improvement, practices can develop plans to enhance both client satisfaction, and staff and overall practice well-being.

Veterinary Students Acknowledge the Importance of Competent Communication to Enhance Client Adherence to Antimicrobial Recommendations

Adherence to antimicrobial recommendations varies and is influenced by client-veterinarian communication, making adequate training related to communication and antimicrobial stewardship, especially important for veterinary students. Prior research suggests that veterinary medical students underestimate clients' antimicrobial knowledge and adherence to instructions, as well as veterinarians' communication competence. These perceptions could impact future interactions with clients, including recommendations for treatment. The purpose of this qualitative study was to explore students' perceptions of client knowledge and adherence. Eleven focus groups were conducted with 33 veterinary students across all years of the curriculum to learn more about their perceptions of the efficacy of veterinary communication related to antibiotics and client adherence to instructions for antibiotic use. Results from this research show that students acknowledge the importance of communication to adherence, and this is especially important when engaging clients in discussion of antibiotics. More specifically, analysis of the transcripts revealed five main themes: the importance of client education and health literacy, navigating client expectations, barriers and enablers to client adherence, navigating generational differences among colleagues and clients, and the importance and impact of role modeling in the clinical setting. Results of this research have implications for training the next generation of veterinarians to confidently communicate about antibiotics, enhance client adherence, and increase the likelihood of positive patient outcomes.

Veterinary Students Underestimate Cat and Dog Owner Adherence and Knowledge Regarding Antimicrobial Use and Resistance

The purpose of this study was to explore students' perceptions related to cat and dog owners' (a) knowledge of antibiotics and antimicrobial resistance, (b) expectations and preferences related to antibiotic use, and (c) preferences and experiences related to veterinarian-client communication preferences and experiences. This project compared students' responses to those provided by cat and dog owners in a previous study. Because that prior research suggested that students' perceptions can shift over time, we also explored whether progression throughout the DVM curriculum impacted students' views of cat and dog owners. DVM students (n = 584) from seven schools in the Southeastern Veterinary Education Consortium completed an online survey based on prior research of cat and dog owner behavior and preferences. Results indicate that DVM students overestimate cat and dog owner's expectations for antibiotics and underestimate cat and dog owners' adherence to veterinary directions for antibiotic use. Similarly, fewer DVM students than cat and dog owners agreed that veterinary communication about antibiotics, their side effects, and their cost occurs during visits with a sick pet. Where significant, more students in later DVM class years had a positive view about client knowledge/adherence and veterinary communication. This lack of confidence in clients' knowledge and competence and in the quality of veterinarian-client communication indicates a need to educate students on their perceptions of veterinary-client communications, as well as reinforcing that clients generally listen and trust veterinarians' recommendations regarding antimicrobial prescribing and stewardship.

Client's understanding of instructions for small animals in a veterinary neurological referral center

BACKGROUND

It is not known how much information clients retrieve from discharge instructions.

OBJECTIVE

To investigate client's understanding of discharge instructions and influencing factors.

ANIMALS

Dogs and cats being hospitalized for neurological diseases.

METHODS

Clients were presented questionnaires regarding their pet's disease, diagnostics, treatments, prognosis and discharge instructions at time of discharge and 2 weeks later. The same questions were answered by discharging veterinarians at time of discharge. Clients answered additional questions regarding the subjective feelings during discharge conversation. Data collected included: data describing discharging veterinarian (age, gender, years of clinical experience, specialist status), data describing the client (age, gender, educational status). Raw percentage of agreement (RPA) between answers of clinicians and clients as well as factors potentially influencing the RPA were evaluated.

RESULTS

Of 230 clients being approached 151 (65.7%) and 70 (30.4%) clients responded to the first and second questionnaire, respectively (130 dog and 30 cat owners). The general RPA between clinician's and client's responses over all questions together was 68.9% and 66.8% at the 2 time points. Questions regarding adverse effects of medication (29.0%), residual clinical signs (35.8%), and confinement instructions (36.8%) had the lowest RPAs at the first time point. The age of clients (P = .008) negatively influenced RPAs, with clients older than 50 years having lower RPA.

CONCLUSIONS AND CLINICAL IMPORTANCE

Clients can only partially reproduce information provided at discharge. Only clients' increasing age influenced recall of information. Instructions deemed to be important should be specifically stressed during discharge.

Decision making on antimicrobial use: Cat and dog owners' knowledge and preferences for veterinary communication

BACKGROUND

Veterinarians' understanding of cat and dog owners' perceptions about antimicrobial use will enhance their ability to communicate with clients to uphold antimicrobial stewardship guidelines.

METHODS

A total of 571 cat and dog owners were surveyed via an online platform to understand their antimicrobial knowledge and preferences for veterinary communication in antimicrobial use decision making. Data were analysed descriptively and inferentially to determine relationships between variables.

RESULTS

Cat and dog owners' backgrounds had an impact their antimicrobial knowledge. Women, individuals with a university degree, those with a health/science background and those identifying as white had a higher level of knowledge of antibiotics and antibiotic resistance. Owners' trust in veterinarians positively impacts adherence to recommendations. Where there was a strong preference for one type of messaging regarding antimicrobial use and stewardship, the owner's background was not predictive of a difference in response.

LIMITATIONS

The study population was mostly white, which reflects the US population and the reported distribution of pet owners who own dogs and cats. Respondents may have been susceptible to recall bias and/or social desirability bias.

CONCLUSION

Veterinarians should tailor their communication to meet clients' level of knowledge and rely on competent communication to enhance understanding and facilitate adherence to antimicrobial stewardship guidelines.

Identifying the target population and preventive strategies to combat feline obesity

Feline obesity continues to be a priority health and welfare issue. Most research surrounding obesity currently focuses on obesity treatment. However, treatment for feline obesity is slow, often unsuccessful and not without consequences. Identifying high-risk populations for obesity onset is crucial for developing and implementing preventive strategies. This review identifies post-gonadectomy kittens aged 5-12 months as the primary target population for obesity prevention in domestic cats and highlights dietary and feeding management strategies to be implemented for obesity prevention.

Exploring veterinary professionals' perceptions of pet weight-related communication in companion animal veterinary practice

BACKGROUND

Pet obesity is commonly encountered by veterinary professionals, yet little is known about their perception of communicating about pet weight. The objective of this study was to explore veterinary professionals' perception of discussing pet obesity with clients.

METHODS

An online survey targeting veterinary professionals was distributed via social media and veterinary organisation newsletters. Topics included respondents' perceptions of weight-related communication, factors related to approaching weight conversations and implicit weight bias.

RESULTS

A total of 102 respondents to the survey were included in the final analysis. Avoidance of discussing pet obesity with certain clients was common (53.9%; 55/102). The most endorsed term for describing pets with excess weight to clients was 'overweight' (97.1%; 99/102). The pet's body condition score was rated the most important factor to consider when deciding how to approach a weight discussion with clients. Although only 29 participants completed the implicit association test (IAT), most of these participants were identified as having an unconscious preference for thin people. The small sample size limited the vignette analysis to descriptive only, and the IAT results should be interpreted cautiously.

CONCLUSION

This exploratory, cross-sectional study provides early insight into veterinary professionals' perceptions of pet obesity-related communication and suggests the presence of weight bias in the profession that warrants further investigation.

Veterinarians' use of shared decision making during on-farm interactions with dairy and beef producers

BACKGROUND

The objectives of this study were to explore the level of shared decision making (SDM) between veterinarians and dairy and beef producers during on-farm interactions and to identify factors associated with veterinarians' use of SDM behaviours.

METHODS

A cross-sectional sample of food-animal veterinarians and their clients were recruited in Ontario, Canada. Their on-farm interactions were audio-video recorded. The recordings were analysed using the 'Observing Patient Involvement in Decision Making' (observer OPTION5 ) instrument to determine the level of SDM utilised during preference-sensitive decisions. A logistic regression model was developed to assess factors associated with a preference-sensitive decision occurring. Meanwhile, a linear regression model was developed to identify factors associated with the level of SDM used.

RESULTS

Forty-one veterinarians participated, and 186 unique veterinarian-producer interactions were audio-video recorded and OPTION5 score was calculated. SDM scores were low and comparable to other studies using the OPTION5 instrument. The only factor associated with whether a preference-sensitive decision occurred was the length of the veterinarian and producer's relationship (in years). As the length of their relationship increased, a preference-sensitive decision was less likely to occur. The use of SDM behaviours was found to decrease as veterinarian burnout score increased. These findings demonstrate that SDM behaviours are being used by food-animal veterinarians, yet an opportunity exists to further implement more producer-centred SDM skills into on-farm interactions.

LIMITATIONS

Small portions of veterinarian-producer conversation occurred outside of audio-video-recorded interactions and were not included in the analysis.

CONCLUSION

The results of this study aid in further understanding on-farm interactions between veterinarians and producers and can help to further improve veterinary communication curricula.

Dirofilaria immitis prevention messaging: Knowledge and attitudes of students from North America attending the Ross University School of Veterinary Medicine, St Kitts

Background

The expansion of vector-borne diseases is considered to be a threat to pet health. Some diseases such as heartworm disease have effective individual prevention methods; however, population-level disease control is limited by the lack of treatment compliance by pet owners. Veterinarians have a primary role in increasing compliance by educating owners on the appropriate prevention measures. Veterinary educational approaches targeting prevention strategies could strengthen prevention messaging at a clinic level.

Methods

A knowledge and attitude study was conducted with incoming Ross University School of Veterinary Medicine students as a preliminary assessment of this hypothesis.

Results

Seventy-three students were interviewed using a tested and standardised questionnaire during their first weeks and 38 answered the same questionnaire one year later. All of the participants had previous experience in a veterinary clinical setting. Knowledge about the disease was variable, usually higher in former veterinary technicians. Unfortunately, knowledge of heartworm prevention was low. In addition, willingness to share knowledge on disease prevention did not change even after one year in veterinary school.

Discussion

These results suggest that additions within the veterinary and veterinary technician school curriculum may be required to improve knowledge about disease prevention and ultimately promote better communication with pet owners and veterinary clinical teams.

Discussion of cost continues to be uncommon in companion animal veterinary practice

OBJECTIVE

To determine the prevalence and nature of cost conversations occurring during veterinarian-client-patient interactions within companion animal practice.

SAMPLES

60 randomly selected, practicing veterinarians working in 55 practices across southern Ontario, Canada, and 909 of their clients, sampled by convenience.

PROCEDURES

A cross-sectional descriptive study including 917 video-recorded appointments. Associations between veterinarian, client, or appointment-level factors and occurrence of a cost conversation were evaluated using multi-level logistic regression.

RESULTS

215 of 917 (23.4%) videos included a discussion of cost between the veterinarian and client. Cost conversations involving veterinarians primarily focused on conveying the price in relation to the time or service being offered (74.0% [159/215]), whereas the benefit to the future health and wellness of the patient was conveyed in 14.4% (31/215) of veterinarians' cost conversations. Costs were most frequently discussed by veterinarians in relation to diagnostic testing (44.2% [96/215]). The odds of a cost discussion occurring were greater during problem appointments versus wellness (P = .011) or recheck (P = .029) appointments, for feline versus canine patients (P = .037), as appointment duration increased (P < .001), and as a client's number of visits in the past year decreased (P = .049).

CLINICAL RELEVANCE

Discussing cost of care in veterinary practice continues to be relatively uncommon. Opportunities exist for veterinary professionals to frame their communication of the cost of veterinary care in relation to the benefits offered to the future health and wellbeing of the veterinary patient.

On-site communication skills education increases appointment-specific client satisfaction in four companion animal practices in Texas

Objective

To assess the impact of a 15-month, in-practice communication skills intervention on client visit satisfaction.

Sample

4 purposely selected veterinary clinics, 9 veterinarians, and 930 appointment-specific client satisfaction surveys.

Procedures

The study was designed as a multipractice, preintervention-postintervention study. Practice teams participated in a 15-month communication skills intervention that included interactive group workshops and one-on-one communication coaching with the entire practice. Client Satisfaction Questionnaires were completed 3 months before (mean, 55 questionnaires/veterinarian) and after (mean, 48 questionnaires/veterinarian) the intervention. The impact of the intervention and factors associated with client visit satisfaction were evaluated with mixed logistic regression.

Results

Client satisfaction scores were dichotomized owing to extreme negative skewness. In total, 57% (284/496) of clients were completely satisfied on pretest questionnaires, and 67% (290/434) were completely satisfied on postintervention questionnaires. The odds of clients being completely satisfied were significantly higher after the communication skills intervention (OR = 1.56; P = .002). When controlling for the intervention, predictors of client visit satisfaction included appointment type (odds of being completely satisfied were significantly higher for recheck appointments than for preventative care appointments [OR = 1.71; P = .02] and health problem appointments [OR = 1.99; P = .003]) and duration of the veterinarian-client relationship (probability increased by 0.52 with each 1-year increase in relationship duration; P = .008).

Clinical Relevance

Results suggested that the client-centered, skills-based communication intervention resulted in increased client visit satisfaction. Findings contribute to current evidence that client-centered communication and duration of the veterinarian-client relationship promote client satisfaction during veterinary visits.

Caregiver burden, treatment complexity, and the veterinarian-client relationship in owners of dog with skin disease

BACKGROUND

Increasing complexity of treatment plans is associated with higher levels of caregiver burden in owners of dogs with skin disease. It is possible that elevated caregiver burden resulting from treatment complexity could, in turn, affect the veterinarian-client relationship.

HYPOTHESES/OBJECTIVES

We expected that treatment complexity, caregiver burden, and the client's perception of the veterinarian-client relationship would be related to each other. We also expected an indirect effect of caregiver burden on the cross-sectional association between treatment complexity and the veterinarian-client relationship, and that this effect would be robust to adjustment for the dog's skin disease course and severity.

PARTICIPANTS

Participants were 349 owners of dogs with skin disease recruited through online consumer panels.

MATERIALS AND METHODS

Cross-sectional online assessments were completed for caregiver burden, treatment plan complexity, veterinarian-client relationship, and skin disease course and severity. Demographic information also was collected.

RESULTS

The indirect effect of caregiver burden on the relationship between treatment complexity and veterinarian-client relationship was statistically significant, accounting for 42.76% of the variance in the model. After controlling for disease severity and course, that effect remained statistically significant, accounting for 37.76% of the variance.

CONCLUSIONS AND CLINICAL IMPORTANCE

Findings support the notion that greater treatment complexity is related to the owner's perception of the veterinarian-client relationship via caregiver burden. Efforts to reduce caregiver burden by using the simplest effective treatment may benefit the veterinarian-client relationship.

Veterinary professionals’ weight-related communication when discussing an overweight or obese pet with a client

OBJECTIVE

Pet weight may be difficult for veterinary professionals to address with clients, particularly when pets are overweight or obese. The objective of this study was to characterize the communication processes and content of weight-related conversations occurring between veterinary professionals and clients.

SAMPLE

Audio-video recordings of 917 veterinarian-client-patient interactions involving a random sample of 60 veterinarians and a convenience sample of clients.

PROCEDURES

Companion animal veterinarians in southern Ontario, Canada, were randomly recruited, and interactions with their clients were audio-video recorded. Interactions were reviewed for mentions of weight, then further analyzed by means of a researcher-generated coding framework to provide a comprehensive assessment of communication specific to weight-related interactions.

RESULTS

463 of 917 (50.5%) veterinary-client-patient interactions contained an exchange involving the mention of a single patient’s (dog or cat) weight and were included in final analysis. Of the 463 interactions, 150 (32.4%) involved a discussion of obesity for a single patient. Of these, 43.3% (65/150) included a weight management recommendation from the veterinary team, and 28% (42/150) provided clients with a reason for pursuing weight management.

CLINICAL RELEVANCE

Findings illustrate opportunities to optimize obesity communication to improve the health and wellbeing of veterinary patients.

Evaluating third- and fourth-year veterinary students' communication skills knowledge and performance at Colorado State University

OBJECTIVE

To assess the impact of a communication program on a cohort of veterinary students' knowledge and performance of communication skills.

SAMPLE

Class cohort of veterinary students at Colorado State University.

PROCEDURES

Year 3 students' knowledge of communication skills was evaluated using quizzes, administered before and after the fall 2016 and spring 2017 Clinical Communication Skills-I and II junior practicum. In year 4, student performance of 22 Calgary-Cambridge Guide communication skills was assessed by coding video-recordings of student-client interactions collected during their second and fourth weeks of the Community Practice rotation in the summer and fall of 2017 and spring of 2018. The impact of training, association with demographic factors, and correlation between knowledge and performance of communication skills were investigated.

RESULTS

In year 3, 136 students completed both fall and spring quizzes; in year 4, 65 week-2 and 29 week-4 appointments were video-recorded during Community Practice rotation. Students' knowledge assessed via quizzes containing skill spotting and skill demonstrating questions increased significantly after the fall and spring junior practicums; however, knowledge of communication skills was not associated with performance during year 4 Community Practice rotations. Communication skills most frequently demonstrated by students during the fourth year Community Practice rotation were open-ended questions, closed-ended questions, empathy toward the client and patient, providing "chunks" of information, and signposting. Students received high quality scores for non-verbal behaviors and logical clinical interview structure.

CLINICAL RELEVANCE

Results suggest that experiential learning techniques, including a flipped classroom approach, role-play, and communication laboratories contributed to increased student knowledge of communication skills.

Use of health parameter trends to communicate pet health information in companion animal practice: A mixed methods analysis

BACKGROUND

Reviewing patient health parameter trends can strengthen veterinarian-client-patient relationships. The objective of this study is to identify characteristics associated with veterinarians' communication of health parameter trends to companion animal clients.

METHODS

Using a sequential exploratory mixed methods design, independent pet owner (n = 27) and veterinarian (n = 24) focus groups were conducted and analysed via content analysis to assess perceptions of how health parameter trends are communicated by veterinarians. Subsequently, a quantitative assessment of video recorded veterinary appointments (n = 917) compared characteristics identified in focus groups with health parameter trend discussions in practice. A mixed logistic model was used to assess characteristics associated with the occurrence of weight trend discussions.

RESULTS

Fifteen characteristics relating to veterinarians' use of health parameter trends were identified across focus groups. Veterinarians discussed 77 health parameter trends in relation to bodyweight (57/77), blood work (15/77) and other health parameters (5/77), within 73 (73/917) appointments. The odds of a weight trend discussion were higher if the veterinarian identified the pet as overweight or obese compared to an ideal bodyweight (odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.15-4.09; p = 0.016).

CONCLUSION

Mention of a health parameter trend was uncommon and rarely included use of visual aids. Health parameter trends related to bodyweight were discussed reactively, rather than proactively.

Discharge summaries provided to owners of pets newly diagnosed with cancer exceed recommended readability levels

OBJECTIVE

To analyze the readability of discharge summaries distributed to owners of pets newly diagnosed with cancer.

SAMPLE

118 discharge summaries provided to pet owners following initial consultation.

PROCEDURES

A database search identified records of new patients that had been presented to the North Carolina State Veterinary Hospital medical oncology service between June 2017 and January 2019. Owner-directed portions of the summaries provided at the time of discharge were copied and pasted into a document and stripped of all identifying information. Readability of summaries was assessed with the use of 2 previously established readability calculators: the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) tests.

RESULTS

Mean ± SD FKGL was 11.9 ± 1.1 (median, 11.9; range, 8.6 to 15.5; target ≤ 6), and the mean ± SD FRE score was 43 ± 5.9 (median, 42.7; range, 25.5 to 58.1; target ≥ 60). There were no significant differences in FKGL or FRE scores among discharge summaries for patients with the 4 most common tumor types diagnosed or the described treatment options. Ninety-three percent (110/118) of summaries were scored as difficult or very difficult to read.

CLINICAL RELEVANCE

Owner-directed written information regarding a diagnosis of cancer at a single teaching hospital exceeded readability levels recommended by the American Medical Association and NIH and was above the average reading level of most US adults. Efforts to improve readability are an important component of promoting relationship-centered care and may improve owner compliance and patient outcomes.

Dairy producer satisfaction and knowledge transfer with the veterinary-administered risk assessment and management plan in a voluntary Johne's disease control program

The Atlantic Johne's Disease Initiative (AJDI) aims to control Mycobacterium avium ssp. paratuberculosis infection by using veterinary-administered risk assessments to identify high-risk management practices and prompt changes in management behavior. Objectives for this study were to measure producer satisfaction with the veterinary-administered risk assessment and management plan (RAMP) process in a voluntary Johne's disease (JD) control program, compare RAMP-specific satisfaction results based on herd JD status, and measure knowledge transfer from certified veterinarians to producers during the RAMP. A satisfaction questionnaire was adapted to the RAMP process in the AJDI to measure producer satisfaction. The questionnaire included 9 RAMP-specific producer satisfaction items, 1 global RAMP satisfaction item, and 16 questions to assess producer knowledge and knowledge translation about JD, bovine viral diarrhea (BVD), and bovine leukosis virus (BLV) during the RAMP (BVD and BLV used for comparison purposes). A total of 133 dairy producers in the AJDI (79.6% response rate) completed the questionnaire by telephone. The RAMP-specific satisfaction was high among the AJDI producers surveyed, and these results were not found to differ based on herd JD status. The lowest satisfaction scores and the highest number of "unable to assess" responses were for the item relating to cost. Factors that contributed to RAMP-specific producer satisfaction were not identified from the demographic and herd information available in this study. The knowledge scores indicated moderate knowledge about JD and fair knowledge about BVD and BLV. Evidence of knowledge translation from the RAMP was mixed in this study. Bovine viral diarrhea knowledge scores were not found to differ based on whether or not the certified veterinarian discussed BVD during the preceding RAMP, but BLV knowledge scores were higher among dairy producers that discussed BLV during the preceding RAMP. Strengths and gaps in producer knowledge about these 3 infectious diseases were identified. By using this producer questionnaire, interventions aimed at improving the content, delivery, and satisfaction of RAMP in JD control programs, such as the AJDI, can be developed.

Measuring veterinary client preferences for autonomy and information when making medical decisions for their pets

OBJECTIVE

To adapt the 3 scales of the Autonomy Preference Index to veterinary medicine and validate the 3 new scales to measure pet owner preferences for autonomy and information when making medical decisions for their pets.

SAMPLE

10 small-animal veterinarians and 10 small-animal clients at a veterinary school-based community practice (pilot study) and 311 small-animal clients of the practice (validation study), of which 47 participated in a follow-up survey.

PROCEDURES

Wording of items in the Autonomy Preference Index was adapted, and instrument wording was finalized on the basis of feedback obtained in the pilot study to create 3 scales: the Veterinary General Decision-Making Preferences Scale (VGDMPS), Veterinary Clinical Decision-Making Preferences Scale (VCDMPS), and Veterinary Information-Seeking Preferences Scale (VISPS). The 3 scales were then validated by means of administering them to small-animal clients in a clinical setting.

RESULTS

The 3 scales had acceptable reliability and validity, but clients expressed concern over item wording in the VGDMPS during the pilot study. Overall, results showed that clients had a very high preference for information (mean ± SD VISPS score, 4.78 ± 0.36 on a scale from 1 to 5). Preferences for autonomy varied, but mean values reflected a low-to-moderate desire for autonomy in clinical decision-making (mean ± SD VCDMPS score, 2.04 ± 0.62 on a scale from 1 to 5).

CONCLUSIONS AND CLINICAL RELEVANCE

The VCDMPS was a reliable and valid instrument for measuring client preferences for autonomy in clinical decision-making. Veterinarians could potentially use this instrument to better understand pet owner preferences and tailor their communication approach accordingly.

The use of the roter interaction analysis system in assessing veterinary student clinical communication skills during equine wellness examinations in rural Kentucky, USA: A pilot study

BACKGROUND

Effective clinical communication can aid veterinarians in building good client relationships, increase adherence to recommendations and, ultimately, improve patient health and welfare. However, available information on veterinary communication in the equine context is limited. The objective of this study was to describe the communication of veterinary students in the equine environment who had previous communication training. Additionally, we assessed the suitability of the Roter Interaction Analysis System (RIAS) for the analysis of audio-video recordings of equine wellness consultations.

METHODS

Twenty-seven equine wellness consultations performed by second-year Ross University School of Veterinary Medicine students were recorded in rural Kentucky, United States of America. Recordings were submitted to a professional coder who applied the RIAS to the equine context by expanding or adjusting code definitions.

RESULTS

A substantial amount of utterances (i.e. segments of speech) were allocated to core communication skills including building rapport (30%), facilitation and client activation (24%) and education and counselling (23%). There was a large variation in utterances used among consultations of the same veterinary student and students; they did not appear anxious or nervous.

CONCLUSIONS

Students made use of core communication skills, indicating that experiences from pre-clinical training could be transferred to equine practice. Furthermore, this study demonstrated that the RIAS could be considered for consecutive studies aiming to provide observational data on clinical communication in the equine context.

Communication, Veterinary-Client-Patient Relationship, and Teledentistry

Communication is the basis of any relationship. Communication can help strengthen the relationship between veterinarians, their clients, and their colleagues throughout the profession. Different models of communication have been demonstrated including the directive model, consumerism model, and relationship-centered model. When veterinarians refer to a specialist, they view the referral as an extension of the care they provide. Therefore, developing a relationship with the specialist is an important facet of patient care. Creating an appropriate veterinary-client-patient relationship (VCPR) helps the patient receive the best care possible. This needs to be considered when offering telemedicine or teledentistry to clients or referring veterinarians.

Attitude of Veterinarians Toward Self-Informed Animal Owners Affects Shared Decision Making

The aims of this study were to investigate the role of the veterinarian characteristics (e.g., age, gender, self-estimation, use of the internet), and their attitudes concerning animal owners seeking self-information. A particular focus was laid on any association between shared decision making (SDM), age and gender. In an online survey, 527 German veterinarians were asked about their attitude regarding SDM principles and their experiences with self-informed animal owners. The factors associated with veterinarians' perception of SDM were investigated in a multivariable linear regression model. A recently published structural equation model consolidated the application of SDM, empathic behavior, and veterinarians' evaluation of self-education as latent factors. Interconnected questionnaire items were processed using an exploratory factor analysis to 11 interpretable factors. Veterinarians who assumed therapy failure was associated with themselves had significantly higher rates of SDM (p = 0.002). In contrast, SDM was significantly lower (p = 0.002) if they assumed that therapy failure was due to the animal's owners. SDM was negatively associated with the perceived quality of the pet owners' self-information (p < 0.001) and if skepticism was perceived as the reason for seeking the self-information (p = 0.001). Veterinarians who advised against self-information (p = 0.006) and those who assumed that self-information of animal owners goes along with uncertainty (p = 0.001) had low SDM values (p = 0.006). Asking the animal owner for self-information (p = 0.001), and recommendations of good information sources (p = 0.022) were positively associated with SDM. Looking at the influence of age and gender on the application of SDM, older people and males rated higher. However, the evaluation of the latent factor SDM was based on the self-estimation of the participants. Assuming that younger women were less self-confident, we cannot exclude that young female participants self-evaluated their SDM skills lower than older male participants, although both groups would objectively have the same SDM level. Practitioners who have a positive attitude toward animal owners, who enjoy contact with animal owners and welcome their interest in further (self-)information, show empathic behavior, and have a positive attitude toward SDM are more likely to have better veterinarian-animal owner-relationships.

Employability as a Guiding Outcome in Veterinary Education: Findings of the VetSet2Go Project

This paper presents a mini-review of employability as a guiding outcome in veterinary education-its conceptualisation, utility, core elements and dimensions, and pedagogical approaches-through a summary of the findings of a major international project with the same aims (the VetSet2Go project). Guided by a conception of the successful veterinary professional as one capable of navigating and sustainably balancing the (sometimes competing) needs and expectations of multiple stakeholders, the project integrated multiple sources of evidence to derive an employability framework representing the dimensions and capabilities most important to veterinary professional success. This framework provides a useful complement to those based in narrower views of competency and professionalism. One notable difference is its added emphasis on broad success outcomes of satisfaction and sustainability as well as task-oriented efficacy, thus inserting "the self" as a major stakeholder and bringing attention to resilience and sustainable well-being. The framework contains 18 key capabilities consistently identified as important to employability in the veterinary context, aligned to five broad, overlapping domains: veterinary capabilities (task-oriented work performance), effective relationships (approaches to others), professional commitment (approaches to work and the broader professional "mission"), psychological resources (approaches to self), plus a central process of reflective self-awareness and identity formation. A summary of evidence supporting these is presented, as well as recommendations for situating, developing, and accessing these as learning outcomes within veterinary curricula. Though developed within the specific context of veterinarian transition-to-practise, this framework would be readily adaptable to other professions, particularly in other health disciplines.

Companion animal veterinarians' and veterinary clients' perceptions of information exchanged while communicating about blood tests

BACKGROUND

Blood tests play a vital role in veterinary medicine, as they enable veterinarians to make decisions about their patients' medical care and provide opportunities to engage clients in veterinary care. The objective of this study was to explore perspectives of veterinary clients and veterinarians on current reporting practices for blood tests ordered in companion animal practice. The type of information communicated and client information seeking behaviours were examined.

METHODS

Two online surveys were distributed using snowball sampling: one targeting veterinary clients and one targeting veterinarians.

RESULTS

In total, 529 veterinary client and 416 veterinarian surveys were included in analyses. Significant differences were found between what blood test information veterinarian respondents felt they provided clients and what client respondents perceived they received with regard to their pet's blood tests. Almost 60% of clients somewhat or strongly agreed that they search the Internet if they do not understand why a test was ordered or what the results mean. Half of clients reported that they never receive a written report of their pet's blood work, 81% of whom were interested in receiving a copy.

CONCLUSION

Results of this research demonstrate opportunities to improve veterinarians' and clients' communication about blood tests.

Effect of personal, food manufacturer, and pet health statements made by a veterinarian during a pet wellness appointment on a dog or cat owner's decision to consider changing their pet's diet

OBJECTIVE

To investigate the effect of statements made by veterinarians during a pet wellness appointment on a pet owner's decision to consider changing their pet's diet.

SAMPLE

Pet owners who presented their dogs and cats for wellness examinations from December 2018 to February 2019 to a veterinary medical teaching hospital or an affiliated low-cost community clinic.

PROCEDURES

Pet owners completed part 1 of the survey, which included questions on various pet characteristics (eg, signalment and current diet) and pet owner's degree of satisfaction with their pet's diet, after a veterinary medical student obtained the pet's medical history and examined the pet. At the conclusion of the wellness appointment, owners completed part 2, which included pet owner demographics (eg, gender and highest educational level) and statements regarding personal, food manufacturer, and pet health that could be made by a veterinarian regarding a pet's diet to which owners were asked to react.

RESULTS

84 dog and 36 cat owners completed the survey. Statements based on pet health and personal (veterinarian) preferences were the most and least effective, respectively, on owners to consider changing their pet's diet. Pet owner gender and pet species did not alter the findings. Most (93%) pet owners were at least somewhat willing to change their pet's diet on the basis of a veterinarian's recommendation.

CONCLUSIONS AND CLINICAL RELEVANCE

When a pet's diet is discussed in the context of a pet's health, a primary care veterinarian consulting with a pet owner during a wellness appointment may be most persuasive to the owner for changing their pet's diet.

Evaluating shared decision-making between companion animal veterinarians and their clients using the Observer OPTION5 instrument

BACKGROUND

Communication practices used by veterinarians can impact client's involvement in decision-making. The objective of this study was to evaluate the level of client involvement in veterinary care decisions and factors impacting client involvement.

METHODS

A random sample of practising companion animal veterinarians and a convenience sample of pet owners were recruited. Each consultation was audio-video recorded and analyzed using the Observer OPTION⁵ instrument, adapted from human medicine, to assess veterinarians' level of shared decision-making. A mixed linear model was used to assess statistical associations between veterinarian, client and appointment-level factors and OPTION⁵ scores.

RESULTS

Sixty veterinarians and 909 of their clients were audio-video recorded during a consultation, of which 717 interactions included a decision identified for analysis using the OPTION⁵ instrument. Elements consistent with shared decision-making were uncommon, with a mean OPTION⁵ score of 22.6 (median = 20.0; sd = 13.05; range = 0-75) out of 100. OPTION⁵ scores were positively associated with the length of the appointment and negatively associated with the veterinarian's years in practice when controlling for statistical interaction between client income and appointment type.

CONCLUSION

Findings suggest an opportunity exists for veterinarians to incorporate more client involvement through increased use of shared decision-making behaviours during veterinary consultations.

Motivation and Experience Matters: What Veterinary Mentors Think About Learning Communication Skills: A Qualitative Study

Communication skills are a core competence in veterinary medicine. These skills play a pivotal role in professional success in the animal health professions. Over the last few decades, there has been an increased focus on communication skills in veterinary curricula. Conversely, we know less about the knowledge and motivation behind the communication skills of those veterinarians in different work domains who are acting as mentors outside the university. In 2016, semi-structured interviews (n = 16) were conducted with German practitioners in workplaces ranging from companion to farm animal practice, and throughout the veterinary industry, veterinary research, and government service. We combined two qualitative methods: a thematic analysis approach and the generation of types to identify characteristics associated with the acquisition of communication skills. In the current study, three main themes were developed: "Motivation," "Experiences with the acquisition of communication skills," and "Communication skills training during formal education." Within the identified themes, we recognized three types of communicators: "self-experienced," "extrinsic-experienced," and "unexperienced." We found that acquisition of communication skills was closely linked to motivation; therefore, motivation must be considered when developing communication skills curricula for learners and educators. By extrapolating the findings of this explorative study, we determined that intrinsically motivated mentors from the field should be a main source of veterinary education to promote further development in communication training. This qualitative study also determined that most non-university veterinary mentors had only a basic knowledge of teaching and learning communication skills, leading us to recommend formal training. Interchange between practicing veterinarians and veterinary educators and curriculum coordinators can foster relevant curricular modifications.

2021 AAHA Nutrition and Weight Management Guidelines for Dogs and Cats

The guidelines discuss the components of a systematic approach to nutritional management of dogs and cats. A nutritional assessment, including a body condition score and muscle condition score, is a screening evaluation that should ideally be performed at every examination. Individualized nutritional recommendations, based on the nutritional assessment, should be designed to achieve and maintain an appropriate body weight and meet nutritional requirements. Communicating nutritional recommendations to clients is a challenging aspect of nutritional management because pet owners may interpret the practice team's guidance as advocacy for a particular pet food brand or a judgment of the client's ability to properly care for the pet or of the owner's own nutritional status. The guidelines discuss approaches for effective, nonjudgmental communication of dietary recommendations to clients and strategies to increase acceptance of and adherence to veterinary nutrition recommendations. Other pet nutrition topics of current interest include recommendations for particular pet life stages, breeds, and disease conditions; risk factors for nutritional deficiencies and obesity; and considerations for home-prepared diets.

Compassion Fatigue: Understanding Empathy

In clinical medicine, empathy is considered a central feature of holistic caretaking and successful patient interaction. It is unclear whether characteristics of empathy are innate, learned, or a combination of both. The means to evaluate clinical empathy are ill-defined, but perception of empathy has been shown to influence patient outcomes as well as professional well-being. This article reviews what is known about empathy in a medical setting and how it relates to negative mental health outcomes, such as compassion fatigue.

Comparison of food-animal veterinarians' and producers' perceptions of producer-centered communication following on-farm interactions

BACKGROUND

Human medicine has demonstrated that a patient-centered physician-patient relationship is more effective than the traditional physician-centered model. Objectives were to explore food-animal veterinarians' and producers' perceptions of producer-centered communication (VPPC and PPPC), during on-farm interactions and examine associated factors.

METHODS

A cross-sectional sample of food-animal veterinarians and their clients were recruited in Ontario, Canada. Immediately following on-farm veterinarian-producer interactions, the producer and veterinarian independently completed a questionnaire assessing PPC. Symmetry of paired responses between veterinarians and producers was examined. Employing listwise deletion, independent mixed linear regression models were developed to determine factors associated with PPPC and VPPC, respectively.

RESULTS

Two hundred and three paired veterinarian and producer survey responses were analysed. Significant asymmetry (p-value < 0.05) was observed, with veterinarians assessing PPC lower than producers. Based on data from 32 veterinarians and 159 producers, the only factor associated with PPPC was veterinarian burnout (PPPC decreased with burnout). Based on data from 32 veterinarians and 155 producers, factors positively associated with VPPC included veterinarian compassion satisfaction (VPPC increased with compassion satisfaction), length of interaction (VPPC increased with length of interaction) and producers identifying as female (VPPC higher with female producers).

CONCLUSION

Producer's positive PPPC is encouraging, yet veterinarians should be aware that mental health parameters may impact producers' and their own perceptions of PPC. Further examining veterinarians' delivery of PPC is important for food-animal practice.

Desire for information and alternative therapies of pet owners is associated with empathy and partnership-building of veterinarians

OBJECTIVES

The relationship between the pet owners' desire for information and preference of alternative therapies and the veterinarians' ability to build partnership and communicate empathically was investigated using quantitative multifactorial analysis.

MATERIALS AND METHODS

In an online survey, 1270 German pet owners were asked about their experience of veterinary appointments regarding communication and relationship building. Additional questions included the type and number of pets, years of animal husbandry, age, gender and education level. The factors associated with the pet owners' desire for further information and alternative therapies were analysed in two multivariable linear models. A recently published structural equation model consolidated the following as latent factors: veterinarian's empathic communication, veterinarian's partnership building, pet owners' desire for further information and pet owners' desire for alternative therapies (e.g. non-veterinary practitioners).

RESULTS

The two veterinarian-related factors of empathic communication and partnership building were positively associated with each other, but negatively associated with the pet owners' desires. Dog owners and participants who owned animals for more than 2 years expressed less desire for further information. The desire for further information decreased with increasing age. The desire for alternative therapies was more among animal owners of more than 2 years and those visiting the same veterinary practice for over 2 years.

CLINICAL SIGNIFICANCE

Veterinarians' empathic communication and partnership building are key factors that satisfy clients' desires for information and alternative therapies. This comprises communicational skills regarding information sharing, as well as emotional aspects.

Pet owners' and veterinarians' perceptions of information exchange and clinical decision-making in companion animal practice

One of the most complex aspects of the veterinarian-client-patient interaction is the clinical decision-making process. Research suggests that the approach to communication used by veterinarians can impact veterinary clients’ involvement in the decision-making process and their ultimate satisfaction. Using different approaches to the decision-making process may affect how information is exchanged and consequently how decisions are made. The objective of this study was to determine pet owners’ expectations with respect to information exchange and decision-making during veterinarian-client-patient interactions and to compare veterinarians’ perceptions of those expectations and the challenges they face in meeting them. Five pet owner focus groups (27 owners) and three veterinarian focus groups (24 veterinarians) were conducted with standardized open-ended questions and follow-up probes. Thematic analysis of the transcribed data was conducted to identify trends and patterns that emerged during the focus groups. Three pet owner-based themes were identified: 1) understanding the client; 2) providing information suitable for the client; and 3) decision-making. In addition, three barriers for veterinarians affecting information exchange and decision-making were identified: 1) time constraints; 2) involvement of multiple clients; and 3) language barriers. Results suggest that pet owners expect to be supported by their veterinarian to make informed decisions by understanding the client’s current knowledge, tailoring information and educating clients about their options. Breakdowns in the information exchange process can impact pet owners’ perceptions of veterinarians’ motivations. Pet owners’ emphasis on partnership suggests that a collaborative approach between veterinarians and clients may improve client satisfaction.

Partners in Sickness and in Health? Relationship-Centered Veterinary Care and Self-Educated Pet Owners in Germany: A Structural Equation Model

In recent years, the web has become a widely used source for health information. Pet owners seem to respond to the supply of medical information on the Internet by increasing their self-education. However, after more than a decade of the digital revolution, little is known about the Internet's impact on the veterinarian-pet owner relationship. Recent research has raised concerns regarding the increase in self-education among pet owners. However, reasons suggest that the Internet might be a valuable source of pet-owner education for veterinarians. In particular, relationship-centered approaches of care might benefit from the information provided. Our study aimed to determine the perception of German veterinarians with regard to pet owners' self-education on different aspects of veterinary care. An online survey was conducted for German veterinarians from November 2016 to June 2017. Data were analyzed using exploratory factor analysis and structural equation modeling. Within the structural equation model, we evaluated how the veterinarians' attitude toward relationship-centered care might affect the evaluation of pet owners' self-education. A total of 585 valid questionnaires were completed. The majority of veterinarians (83.6%) welcomed the principles of shared decision-making. Practically, all veterinarians reported a noticeable increase in pet owners' self-education within the last few years. Perceptions on self-education's impacts on veterinary practice varied among the participants. A beneficial impact of self-education was reported regarding the general quality of veterinary care and quality of follow-up care. Most concerns were related to a negative impact on the veterinarian-pet owner relationship and the pet owners' demands on the veterinarians' work after self-education. Moreover, many participants were afraid that unfiltered information may unsettle pet owners and, therefore, advised them against self-education. The structural equation model confirmed the hypothesis that a veterinarian's positive attitude toward shared decision-making, empathic behavior, and his/her evaluation of self-education were associated. Therefore, we concluded that while there are beneficial potentials, there seem to be barriers that prevent the effective use of the Internet as a supportive medium in veterinary care. Further research and training are needed to enable the use of the Internet as an ancillary medium.

Factors associated with food-animal producer visit-specific satisfaction following on-farm interaction with a veterinarian

BACKGROUND

Effective communication has been found to have positive associations with client satisfaction, client adherence and veterinarian satisfaction in companion animal medicine. Better understanding the role of communication on these outcomes, specifically producer satisfaction, is likely to benefit food-animal medicine. Objectives were to identify factors associated with producer visit-specific satisfaction following on-farm veterinarian-producer interactions and evaluate the validity of the Client Satisfaction Questionnaire for use in food-animal medicine.

METHODS

A cross-sectional sample of practicing food-animal veterinarians and their producer clients were recruited in Ontario, Canada. Immediately following the veterinarian-producer interaction, producers completed a questionnaire that assessed their visit-specific satisfaction and their perception of the producer-centeredness of the interaction. Veterinarians completed a questionnaire that assessed their perception of the interaction's producer-centeredness. A linear regression model was developed to identify factors associated with producer visit-specific satisfaction.

RESULTS

Forty-one veterinarians and 207 producers participated. Factors associated with producer visit-specific satisfaction included producer age (satisfaction decreased with age), producer gender (males less satisfied) and producer perception of producer-centeredness score (satisfaction increased with producer perception of producer-centeredness score).

CONCLUSION

Findings raise awareness of the importance of a producer's perception of producer-centeredness in food-animal practice and encourage its use by food-animal veterinarians in working towards positive outcomes.

A cross-sectional study of pet owners' attitudes and intentions towards nutritional guidance received from veterinarians

BACKGROUND

Beliefs of pet owners strongly influence their decision-making surrounding their pets' diet. Thus, nutritional guidance is an essential component of veterinary practice and integral to managing rising rates of pet obesity. This study examined pet owners' trust of, perceived effectiveness of, and intentions to follow nutritional guidance received from their veterinarian in managing their pets' diet.

METHODS

A cross-sectional study of 1402 dog and cat owners in the USA and Canada was conducted using an online questionnaire tool. Data were analysed using descriptive statistics and logistic regression modelling.

RESULTS

Clients are concerned about the effectiveness of veterinary nutrition recommendations. Cat owners were more likely than dog owners to consider the nutritional guidance they receive from veterinarians effective for their pets' diet (1.75, P=0.04). Length of pet ownership, feeding dry diets and frequency of veterinary visits were all positively associated with owners considering veterinary nutritional guidance to be effective in managing pets' diet.

CONCLUSION

Identifying these perspectives can aid in developing strategies to provide nutrition support to pet owners to improve their perceptions of, self-efficacy with, and compliance with veterinary nutrition recommendations.

Implications of a Novel Method for Analyzing Communication in Routine Veterinary Patient Visits for Veterinary Research and Training

The patient-centered clinical method (PCCM), a model developed to characterize communication during patient-physician visits in the 1980s, identifies elements of patient-orientated, physician-orientated, and shared dialogue during the encounter. The model also includes elements that reflect the emotional aspects of these interactions, recognizing expressions of feelings and exchanges related to both personal and medical interests. Fifty-five routine veterinary patient visits in the United Kingdom and United States were analyzed using the novel application of a PCCM adapted for veterinary patient visits. The patient visits were video recorded, transcribed, coded, and analyzed for frequency and proportion of PCCM elements observed. Elements representing the greatest proportion of patient visits were related to gathering information and shared decision making. Those representing the smallest proportion were related to signs of the presenting condition and effects of the condition on the clients' lives. Dialogue during the patient visits flowed iteratively and back and forth between the veterinarian and the client perspective. The findings suggest that patient visits are focused more on gathering information and planning rather than exploring effects of the health problem on the client's life, and that patient visits flow very iteratively and randomly between veterinarian and client perspectives. Both of these topics should be studied further and given emphasis in the way that communication models are developed and taught in order to enhance client-centeredness in veterinary patient visits.

[Compliance of dog and cat owners in preventive health care]

Regular preventive health care is an essential part of our pets' health and quality of life. Preventive healthcare appointments can result in the prevention of disease development as well as lead to the detection and subsequent treatment of existing health problems at an early stage. In order to achieve optimal health care, the owners' compliance is of most importance in addition to the veterinary advice. However, dog and cat owners often seem to be unaware of the necessity for preventive health care appointments, often as a result of poor communication by the veterinarian. Educational conversations concerning the necessity of regular preventive health examinations are therefore essential. Communication is one of the key factors in building an owner-veterinarian relationship. Veterinarians are advised to invest sufficient time for communication, be aware of their verbal and non-verbal statements, and enable the owner to participate in treatment decisions. Older animals are presented less often for preventive health care appointments than younger animals, although the prevalence of age-related and chronic diseases increases with age. Owners should therefore be informed on the fact that early detection and treatment of these diseases increases their animals' health and survival. Cats are seen less frequently in preventive health care than dogs; many owners are not aware of the characteristics of cats tending to hide signs of disease. Another reason lies in the fact that many cats are stressed by being captured and transported in addition to the visit in the veterinary practice itself. Veterinarians therefore should educate cat owners concerning stress-reducing transportation measures and design their practice in a more cat-friendly fashion. Compliance can also be influenced positively by appropriate practice management, such as offering monthly instalment payments, establishing annual preventive care plans, as well as regular re-scheduling strategies. In addition to enhancing the animals' health, this can also result in increased owner satisfaction.

Measuring satisfaction in the small animal consultation and its relationship to consult length

BACKGROUND

Measuring satisfaction is a useful metric of success of any interaction, but very few validated instruments exist for measuring the satisfaction of the veterinary surgeon (vet) and the client in veterinary consultations. Additionally, there has been no research examining the impact of consultation length on satisfaction. The aim of this observational study was to investigate the use of a single-question graphic scale to assess vet and client satisfaction and the impact of consultation length on satisfaction.

METHODS

Information on consultation timing was collected for 65 health problem consultations across six practices. These measurements were compared with postconsultation measurements of client and vet satisfaction.

RESULTS

A comparison between the long-form and single-question satisfaction instruments demonstrated significant correlation for both vet and client tools (ρ=0.609, P<0.005 and ρ=0.483, P<0.005, respectively). The average client satisfaction with the consultation was high; however, vet satisfaction levels were significantly lower (U=1073, P<0.005). Increased consult length was associated with increased vet satisfaction (ρ=0.332, P=0.007) but not increased client satisfaction.

CONCLUSION

These results demonstrate that the graphic scale is an appropriate proxy for the pre-existing long-form questionnaires available for both vets and clients. Further research is required to examine the disparity identified between vet and client satisfaction.

Evaluation of communication skills training programs at North American veterinary medical training institutions

OBJECTIVE

To describe how North American veterinary medical teaching institutions (VMTIs) provide communication skills training to students.

SAMPLE

Faculty coordinators of communication skills training programs (CSTPs) at 30 North American VMTIs.

PROCEDURES

An online survey instrument was designed and administered to each respondent followed by a telephone (n = 28) or in-person (2) interview. The survey and interview process were designed to evaluate all aspects of CSTPs, such as communication framework used, program format, number of student-contact hours, staffing models, outcome assessment, faculty background, program priorities, and challenges. Descriptive results were generated, and guidelines for future development of CSTPs were recommended.

RESULTS

27 US and 3 Canadian VMTIs were represented, and communication skills training was required at all. Twenty-five CSTPs used the Calgary-Cambridge Guide framework. Respondents provided a mean of 33 student-contact hours of training, primarily in the first 3 years of the veterinary curriculum in lecture (mean, 12 hours), communication laboratory (13 hours), and self-study (8 hours) formats with formative feedback. Communication skills training was integrated with other disciplines at 27 VMTIs. Most CSTPs were coordinated and taught by 1 faculty member with a < 0.50 full-time equivalent commitment and no administrative support. Stated priorities included acquisition of resources for CSTP faculty, administrative support, and video-equipped facilities; increasing integration of CSTPs into curricula; and assessment of educational outcomes.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that support for CSTPs and recognition of their value continue to grow, but a lack of resources, faculty expertise, validated methods for outcomes assessment, and leadership remain challenges.

Investigation of the effects of a practice-level communication training program on veterinary health-care team members' communication confidence, client satisfaction, and practice financial metrics

OBJECTIVE

To investigate effects of an intensive 2-day practice-level communication skills training program (CSTP) with a 3-month follow-up communication in practice program (CIPP) on veterinary health-care team members' communication confidence, client satisfaction, and practice financial metrics.

SAMPLE

5 US companion animal veterinary practices.

PROCEDURES

Following pilot testing at 1 veterinary practice, communication skills training was performed on-site at 4 practices. The 2-day CSTP focused on veterinary communication-specific content. The CIPP included in-practice training sessions every other week to reinforce and build upon communication skills. Team members' communication skills confidence (before and after the CSTP and after the CIPP) and client satisfaction with veterinary visits (2 months before and 3 months after the CSTP) were assessed with surveys. Practice-level financial metrics were collected for 18 months. Variables of interest were compared among time points.

RESULTS

Measures of team member communication skills confidence and initiation of client conversations regarding the value of goods and services were significantly greater after the CIPP than before the CSTP. Composite communication skills confidence scores 3 months after the CSTP were positively correlated with the mean practice transaction charge and percentage change in the number of heartworm tests performed in the 3 months after the CSTP, compared with results for the same 3 months in the previous year. Measurements of client satisfaction were high before and after the CSTP. There was no significant change in financial metrics in the 3 months after CSTP, compared with the same 3 months in the previous year.

CONCLUSIONS AND CLINICAL RELEVANCE

This study highlighted opportunities to increase veterinary health-care team members' communication confidence and identified future considerations for communication training in veterinary workplaces.

Use of the Health Belief Model to identify factors associated with owner adherence to elimination diet trial recommendations in dogs

OBJECTIVE

To use the Health Belief Model to identify factors associated with owner adherence to elimination diet trial (EDT) recommendations by veterinarians for dogs with suspected cutaneous adverse food reactions (CAFRs).

SAMPLE

192 owners of dogs prescribed an EDT between April 1, 2012, and April 1, 2017.

PROCEDURES

Owners of dogs prescribed an EDT to diagnose CAFRs were identified through review of medical records from a single veterinary dermatology specialty practice. Identified owners were invited to participate in an anonymous online survey that was developed on the basis of the Health Belief Model. Multivariable logistic regression was used to evaluate associations between potential predictor variables and 100% adherence to EDT recommendations.

RESULTS

665 owners were invited to participate, and 192 (28.9%) completed the survey. Of the 192 respondents, 77 (40.1%) reported 100% adherence to EDT recommendations, and 115 (59.9%) reported < 100% adherence. Results indicated that the odds of owners reporting 100% adherence to EDT recommendations were significantly decreased by owner perception of barriers (adjusted OR [OR_a] = 0.86) and were significantly increased by owner knowledge regarding diets and CAFRs in dogs (OR_a = 1.30) and by self-efficacy or confidence in performing an EDT as directed (ORa = 1.18).

CONCLUSIONS AND CLINICAL RELEVANCE

Findings indicated that most prescribed EDTs were not followed strictly. Interventions to help owners reduce perceived barriers, increase self-efficacy, and improve related knowledge could improve adherence to EDT recommendations and, thereby, increase the diagnostic utility of EDTs.

Welfare of cats 5-29 months after perineal urethrostomy: 74 cases (2015-2017)

OBJECTIVES

The objective of this study was to evaluate the long-term quality of life in cats following perineal urethrostomy.

METHODS

This study comprised a retrospective case series of 74 cats with urinary obstructions that received perineal urethrostomies at the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital between September 2015 and July 2017. Medical records were reviewed for information on the number of obstructions prior to surgery, urinary tract problems at the time of surgery and other potential factors influencing long-term welfare. Owners were surveyed by telephone and text 5-29 months after their cat's surgery. Responses were compiled and analyzed to determine owner perception of welfare postsurgery, and to identify patterns in medical history and welfare outcomes.

RESULTS

In total, 105 cat owners were eligible for the survey; 74 responded. Altogether, 100% of responding individuals reported at least the same quality of life postsurgery compared with the cat's quality of life before demonstrating urinary problems (48% reported better). On a quality-of-life scale of 1-10 (10 = excellent), 100% of responding cat owners reported at least 7; 75% reported 10.

CONCLUSIONS AND RELEVANCE

Quality-of-life outcomes for cats 5-29 months after receiving perineal urethrostomy surgery were reported to be very good. Given this finding, and that perineal urethrostomy surgery should mitigate future blockages, we suggest considering perineal urethrostomy surgery as a standard tool to manage urinary obstructions in cats. The needs of the specific client and patient, including risks, costs and welfare of the cats, should drive the options for management of urinary obstructions in male cats.

Dairy veterinarians' skills in motivational interviewing are linked to client verbal behavior

Veterinarians often give advice in a persuasive form, a style that has been shown to evoke resistance to change in clients experiencing psychological ambivalence (i.e. those who see both advantages and disadvantages to changing). With this style of communication, veterinarians run the risk of counteracting their purpose to encourage clients to follow recommendations. Motivational interviewing (MI) is a client-centered communication methodology that aims to facilitate clients’ internal motivation to change. In MI, Change Talk represents clients’ own statements expressing consideration of, motivation for or commitment to behavior change and has been shown to be strongly correlated with behavior change. Sustain Talk is corresponding statements related to maintaining the status quo. The aim of this exploratory study was to evaluate the potential of MI to facilitate behavior change in veterinary herd health management (VHHM) by investigating the effect of dairy cattle veterinarians’ MI skills on client Change and Sustain Talk. We recorded VHHM consultancies on 170 Swedish cattle farms performed by 36 veterinarians, randomly distributed into 2 groups: MI veterinarians (n = 18) had received 6-month training in MI and control veterinarians (n = 18) had not received any training. Veterinarians’ MI skills were assessed using the Motivational Interviewing Treatment Integrity coding system 4.2.1 and categorized as poor_untrained, poor_trained, near moderate and moderate. Client communication was coded using the Client Language Easy Rating coding system. The effect of MI skills on Change Talk, Sustain Talk and Proportion of Change Talk(Change Talk divided by the sum of Sustain Talk plus Change Talk) was investigated using cross-classified regression models with random intercepts for veterinarian and client (farm). The models also included additional explanatory variables (e.g. type of veterinarian and client’s satisfaction with the consultation). The veterinarian’s MI skills were associated with the client’s Change Talk, but results regarding Sustain Talk or Proportion of Change Talk were inconclusive. Clients of veterinarians reaching the highest (i.e. moderate) MI skills expressed 1.5 times more Change Talk than clients of untrained veterinarians. Clients of general large animal practitioners expressed less Sustain Talk than clients of animal health veterinarians and had higher Proportion of Change Talk. Results indicate that learning to practice MI may be one means to improve adherence to veterinary recommendations and to improve efficiency in VHHM services.

The Complex Relationship Between Veterinarian Mental Health and Client Satisfaction

A relatively high risk of poor mental health has been described among Canadian veterinarians, but no published studies have explored the impact that veterinarian mental health may have on veterinary clients and patients. In order to investigate the association between veterinarian mental health and veterinary client satisfaction, veterinarians were randomly sampled and recruited throughout southwestern Ontario, Canada, from November, 2017, through January, 2019. Sixty participating veterinarians completed an enrollment survey that included psychometric scales measuring resilience, perceived stress, anxiety, depression, emotional distress, emotional exhaustion, depersonalization, personal accomplishment, burnout, secondary traumatic stress, and compassion satisfaction. Nine hundred and ninety-five companion animal clients of these veterinarians were recruited in-clinic over 2–3 days and completed a post-appointment survey including the Client Satisfaction Questionnaire. The associations between clients' satisfaction scores (as the outcome variable) and each of the veterinarians' mental health measures (as the explanatory variables) were assessed using separate, multilevel, multivariable linear regression models. The associations between client satisfaction and veterinarian mental health measures were non-linear and complex; in several of the models, relatively higher client satisfaction was unexpectedly associated with poor veterinarian mental health states, while lower client satisfaction was associated with mental health scores suggesting wellness. Given that client satisfaction may impact client adherence to medical recommendations, client loyalty, and business income, the association with veterinarian mental health may have broad implications and warrants further investigation.

Teaching Cultural Humility and Implicit Bias to Veterinary Medical Students: A Review and Recommendation for Best Practices

Cultural humility, with its concomitant understanding of the importance of the influences of diversity and inclusion, improves health outcomes in the human medical field. Recent changes to the American Veterinary Medical Association Council on Education requirements in veterinary medicine include teaching the impact of implicit bias on the delivery of veterinary medical services. Because overt enhancement of self-awareness is not fodder for traditional veterinary medical education delivery systems, in this article we review existing literature on the impact of recognition of implicit bias on health care and offer insights on ways to help veterinary students learn this skill, drawing on evidence from an inter-professional intervention called WisCARES (Wisconsin Companion Animal Resources, Education, and Social Services).

A Farrier Making Every Contact Count: A Microlevel Analysis of Farrier-Client Interaction for Partnership Working in Managing a Horse With Laminitis

There is an evidence base in human and small animal veterinary health care contexts which understands how practitioners engage in partnership working with patients and owners to support adherence to treatment/care plans. However, as yet, it is believed there is no similar evidence base for how practitioners in equine health care contexts work with equine owners. It is argued that this is essential for understanding complex equine practitioner-owner interaction involving the prevention and management of laminitis. The aim of this study was to explore farrier-client interaction where risk management for an equine recovering from laminitis was being undertaken. A case report method involved a microlevel analysis of a farrier-client consultation. The consultation was video-recorded and analyzed using a conversation analysis approach to identify the linguistic and paralinguistic features of the interaction. These were compared with conversation analyses in other health care contexts to identify the actions being accomplished within the consultation. The analysis identified a number of joint actions, including managing epistemic stance (or knowledge rights) and deploying the animal's presence to navigate problem sequences which supported progression of the consultation through a three-stage model involving "team-", "option-", and "decision-" talk, known to be associated with partnership working in human health care contexts. The study highlights the importance of developing an empirical evidence base in equine practice for how practitioners engage with owners based on a microlevel analysis of real-world interactions. It is argued this evidence base is necessary in supporting effective practitioner training in partnership working with clients to promote their adherence to treatment/care plans.