"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.

Risk Communication on Zoonoses and Antimicrobial Resistance-How Do Exotic Pet Owners Perceive the Communication of Their Veterinarians?

Exotic animals traded and kept as pets can transmit a variety of diseases to humans and other animals, and vice versa. Therefore, it is essential for pet owners, particularly vulnerable groups, to be informed about associated risks. Veterinarians play a crucial role in informing pet owners about health risks associated with zoonotic pathogens and antimicrobial resistance (AMR) and should, therefore, have good communication skills to effectively transfer information to pet owners. Thus, exotic pet owners in Germany were surveyed on animal husbandry, veterinary consultation and risk communication. To evaluate the perception of communication, a self-developed questionnaire was used to derive a communication score. The perception of veterinarian communication received a high average score showing a high level of satisfaction. The duration of the veterinarian-client relationship was associated with better communication perception, and the frequency of communication on zoonoses and AMR was associated with the presence of a permanent veterinarian. However, the results indicated that the frequency of disseminated information on zoonoses and/or AMR from veterinarians was lower than desired by the pet owners. Therefore, more educational material on zoonoses and AMR should be made available, and the awareness concerning risk communication should be increased by further education and training at universities.

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.

A Qualitative Study of How On-Campus Faculty and Off-Campus Preceptors Evaluate Veterinary Students' Professionalism

Professionalism is defined and described in a variety of ways that differ considerably in details and quantity. While professionalism has become increasingly important, educators' opinions regarding the types of professionalism vary. The objective of this qualitative study was to evaluate faculty and preceptors' perspectives regarding veterinary medical students' professionalism during their clinical rotations. A thematic content analysis was performed to classify 2,014 comments. Five main themes emerged: (a) work ethic and attitude; (b) effective interactions with clients and delivering patient care; (c) effective interactions with health care professionals; (d) punctuality, task completion, and organization; and (e) commitment to improving competency in self and others. The importance of professionalism was stressed by both groups of faculty and preceptors through written comments; however, the magnitude of each theme differed. The results indicate that without understanding professionalism elements, the lack of conceptual clarity and consensus related to expected behaviors and attitudes would make it challenging to assess professionalism appropriately. The themes identified can be used to begin a discussion about expected behavior among faculty, preceptors, and students, therefore prompting a reasonable assessment of professionalism, as well as avoiding unprofessional behavior.

2023 AAHA Senior Care Guidelines for Dogs and Cats

Veterinary professionals are taught to recognize that "old age is not a disease." However, clients may have the perception that older dogs and cats undergo an unavoidable physical, mental, and behavioral decline attributable simply to old age. The veterinary team's role includes providing medical care and support to senior pets to maintain their quality of life, as well as supporting and educating clients on proper senior animal care and addressing any misconceptions about the aging process. These Guidelines describe a systematic approach to the healthcare of the senior pet that is based on an evidence-guided assessment of both healthy and unhealthy canine and feline patients. By using evidence-guided medicine, which may include conventional and integrative approaches as well as environmental management for the senior pet, the patient's quality of life can be enhanced and potentially extended during this vulnerable life stage. Developing a senior program for the veterinary practice requires appropriate training of the entire healthcare team and includes a robust client education program that focuses on the wellbeing of the senior pet. Palliative and hospice care should be included in the education and information provided for both the veterinary team and the families of senior pets.

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.

Scoping review of end-of-life decision-making models used in dogs, cats and equids

BACKGROUND

End-of-life decisions for companion animals can be stressful for veterinarians and owners, and when delayed result in poor animal welfare. Delayed euthanasia has been identified as a particularly prominent issue for horses. This scoping review aimed to identify the available literature on veterinary decision-making models, which can support end-of-life planning.

METHODS

A protocol was preregistered, and a structured literature search was performed on six electronic databases. Publications were reviewed against specifically developed eligibility criteria. Data from original studies and narrative-type reviews were extracted separately, and the components of each model were charted.

RESULTS

A total of 2211 publications were identified, 23 met the inclusion criteria and were included in the final review. Eight were original research studies and 15 were narrative reviews or similar. Publications were not indexed uniformly, increasing the difficulty of discovering relevant sources. The end-of-life decision-making process comprised three stages: (1) making the decision, (2) enacting the decision and (3) aftercare. Twenty key components of decision-making models were identified, although no publication reflected all of these.

CONCLUSIONS

A lack of original research studies and equine-specific publications was identified. Shared decision-making models for euthanasia in veterinary practice should include all three stages and consider species-specific issues.

Impacts of COVID-19 on Owner's Veterinary Healthcare Seeking Behavior for Dogs With Chronic Conditions: An Exploratory Mixed-Methods Study With a Convenience Sample

This mixed-method study explored the impacts of the COVID-19 pandemic on owners' veterinary healthcare seeking, with particular focus on dogs with chronic conditions. A convenience sample of 719 UK dog owners completed an online survey (December 2020-January 2021). Differences in treatment provision and respondents' decisions to seek care across acute, preventative, chronic conditions and for end-of-life care were explored. Multivariable logistic regression models were used to identify factors associated with seeking care for any health issue compared to deciding against it, and urgency to seek care given symptom that could indicate chronic conditions. Open-ended questions were analyzed by thematic analysis. Significant (p-value < 0.05) differences in care seeking decisions were identified regarding access to veterinary care and the way treatment was provided across all health issues. The top reasons for not seeking care across all health issues were a lack of access to a veterinarian (30%, n = 56/187) and a reluctance for a dog to go to the clinic unaccompanied (20%, n = 38/187). Variables related to stronger dog-owner relationship, higher confidence in seeking care, perception of: benefits of veterinary care, dog's high susceptibility to illness and high severity of dog's condition, increased the odds of seeking, and urgency to seek, care. A dog's chronic illness diagnosis reduced the odds of seeking care during the pandemic, reportedly due to difficulties in accessing care for non-urgent issues. Qualitative analysis showed that limited access to routine consultations, delays in test results and restricted access to complementary treatments, led some owners of dogs with chronic conditions to believe that their dog's welfare had deteriorated during the pandemic. Pandemic control measures necessitated changes to how consultations were run. These changes were often viewed favorably, but dog-client separation during consultations were considered problematic, sometimes delaying veterinary advice-seeking, including for euthanasia. Separating owners from their dogs during veterinary consultations should be avoided wherever possible due to impacts on dogs, owners and healthcare seeking. Interventions to improve veterinary healthcare seeking could target attitudes toward benefits of seeking care, improve owners' self-efficacy and capitalize on the dog-owner bond. Such interventions should be implemented alongside interventions aimed at removing structural barriers to accessing healthcare.

A Call for Compassionate Empathy: Analysis of Verbal Empathic Communication between Veterinary Students and Veterinary Clients and their Dogs

In human medicine, empathy contributes to enhanced patient satisfaction and trust, decreased litigation, and increased adherence to medical recommendations. Understanding client perspectives is crucial in the empathic process; failure to explore these perspectives has been linked to decreased client satisfaction in veterinary consultations. This article explores how veterinary clients verbally expressed emotional concerns during consultations and how veterinary students addressed them. The "Model of Empathic Communication in the Medical Interview" by Suchman et al., is the starting point for a thematic analysis of consultation transcripts. Clients expressed multiple emotional concerns both directly by using explicit words (coded as empathic opportunities-EO), and indirectly (coded as potential empathic opportunities-PEO), throughout the consultations. Indirect examples prevailed and included stories about previous experiences with pet illnesses and pet care received elsewhere. Clients used explicit words, including "fear" and "panic." Students usually responded with a biomedical focus, including asking medical questions and giving medical explanations. Although students demonstrated various communication skills, they failed to demonstrate a complete verbal compassionate empathic response (a novel code) that includes exploring and verbalizing accurate understanding of the clients' perspectives and offering help based on this understanding. These findings suggest that strategies to teach compassionate empathy and support its use in the clinical setting are not fully effective, and veterinary students risk entering practice unprepared to employ this vital competency. The authors also introduce an operational definition for compassionate empathy.

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.

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.

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.

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.

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.

Community Veterinary Medicine Programs: Pet Owners' Perceptions and Experiences

Many American pet owners struggle financially, and the COVID-19 pandemic has only exacerbated this problem. Yet, the positive effects that companion animals have in people's lives create the need for supportive systems to ensure that financial limitations, and other barriers, do not preclude pet ownership. To help address these barriers, and reach underserved communities, various forms of community-based veterinary medicine programs have been developed across the country. This study assesses two community-based veterinary programs in North Carolina, USA. In addition to perceptions surrounding veterinary services, this study paid specific attention to communication and respect; two additional elements needed for successful community-based veterinary programs. Surveys were given to clients accessing Asheville Humane Society (AHS) mobile veterinary care clinic and Asheville Humane Society (AHS) Affordable Pet Care Clinic. Results of the anonymous survey indicate that the majority of clients had positive veterinary care experiences in terms of both veterinary services and client communication. In conclusion, low-cost or free community veterinary programs—with effective communication, empathy, and cultural competence—can help open the door to future positive veterinary experiences for disadvantaged pet owners.

"What Would You Do?": How Cat Owners Make End-of-Life Decisions and Implications for Veterinary-Client Interactions

Cats are the most common companion animals in New Zealand. Advances in veterinary care means that cats are living longer and there are many older cats. End-of-life decisions about cats are complicated by owner-cat relationships and other psychosocial factors. Our study explored the ways in which end-of-life decisions were being made by owners of older and chronically ill cats in New Zealand and the role of their veterinarian in the process. Qualitative data were gathered via retrospective semi-structured interviews with 14 cat owners using open-ended questions. Transcripts of these interviews were explored for themes using template analysis and nine themes were identified. Four were animal-centered themes: cat behavior change, pain was a bad sign, signs of ageing are not good, and the benefits of having other people see what owners often could not. Five were human-centered themes: veterinarians understanding owners' relationships with their cat, normalizing death, the need for a good veterinarian to manage end of life, veterinary validation that owners were doing the right thing, and a strong desire to predict the time course and outcome for their cat. End-of-life decision making is complex, and the veterinarian's role is often poorly defined. Our owners appreciated the expertise and validation that their veterinarian provided but continuity of care was important. Future research aimed at exploring the veterinarian's perspective during end-of-life decision making for cats would be a valuable addition to the topic.

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.

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.

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.

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.

"You can be blind because of loving them so much": the impact on owners in the United Kingdom of living with a dog with osteoarthritis

BACKGROUND

There is growing awareness that caring for a chronically ill pet may have a detrimental impact on their owner's quality of life. Companion animal orthopaedic disease has received little research interest in this context. Canine osteoarthritis is known to negatively affect the welfare of many dogs in the United Kingdom, but its consequences for their owners has not previously been described. The aim of this study was to use a qualitative methodology to explore the impacts on a dog owner that occur following their dog's diagnosis with osteoarthritis. Owners of osteoarthritic dogs based in the United Kingdom (UK) were recruited through veterinary practices to participate in semi-structured interview about life with their dog. Interviews were transcribed verbatim and thematic analysis was used to construct key themes. This publication describes the theme that focused on the impact(s) that the dog's condition had had on the life of their owner.

RESULTS

Forty owners of 35 dogs of a range of breeds and ages were interviewed. A wide range of negative impacts on the physical, mental and financial health of owners were described. Few had any prior experience of canine osteoarthritis, and owners of young dogs appeared to be particularly affected by the diagnosis. Owners detailed increasing worry over time about their pet's condition, frequently combined with a growing need to physically assist their dog. Sometimes this led them to seek information about, and purchase, adjunctive therapies and products. The dog's reduced mobility and need for medications progressively limited their own lifestyles and ability to have time away from their pet. Owners typically described a strong bond with their dog as a motivator to provide ongoing care.

CONCLUSIONS

The negative impacts on owners of caring for an osteoarthritic dog appear multi-faceted and may be sustained over many years, particularly if the dog is young at diagnosis. Owners may be highly motivated to improve their dog's mobility and to reduce the impact the condition has on their own lives, yet they may be unsure how to achieve this. Veterinary professionals should inform and support these owners as much as possible.

Unconventional diets and nutritional supplements are more common in dogs with cancer compared to healthy dogs: An online global survey of 345 dog owners

This survey aimed to investigate and compare diet type and supplement use between dogs (Canis lupus familiaris, L.) with cancer and a population of owner-reported healthy dogs and to assess the sources of information dog owners consult. Respondents were mainly from English-speaking countries. Dogs were considered healthy (N = 213) if owners reported them to be in good health. Dogs were included in the cancer group (N = 132) if the owner reported that their dog had been diagnosed with cancer. An online survey was distributed to clients presenting to a tertiary oncology service, clients presenting to a local primary care veterinary practice, and through social media. Owners of dogs with cancer spent more time researching pet health (P < .001), pet nutrition (P < .01) and nutritional supplements (P < .001) than owners of healthy dogs. While veterinarians were most commonly reported to be an information source for both groups, owners of healthy dogs more likely consulted pet stores and owners of dogs with cancer tended more to social media groups and blogs. Healthy dogs were more likely fed commercial dry food (P < .001), whereas homemade cooked (P < .001) and raw diets (P < .05) were more prevalent among dogs with cancer. Supplement use, especially cannabidiol products, mushroom extracts or turmeric/curcumin, was also more common for this group (P < .001). Alternative diets and supplements were more popular among owners of dogs with cancer compared to owners of healthy dogs. These findings highlight the need for nutritional counselling and education of pet owners regarding nutrition-related topics, especially when their dog is diagnosed with cancer.

An Exploratory Study of Veterinary Professionals' Self-Reported Support of Bereaved Clients Before, During, and After Companion Animal Euthanasia in Southwestern Ontario, Canada

Veterinary professionals are recognized as an important source of support for many veterinary clients, particularly during companion animal euthanasia and end-of-life care. While many veterinary professionals recognize the importance of their role, many also report feeling unsure about what methods of support are most effective. Furthermore, few evidence-based guidelines currently exist to inform veterinary professionals on the support of grieving clients. To begin bridging this gap, this study qualitatively explored how veterinary professionals currently report supporting grieving clients before, during, and after companion animal euthanasia. Findings suggest that veterinary participants in this study strive to be meaningful sources of support for grieving clients and employ an array of support practice to do so. However, opportunities exist for veterinary professionals to better explore clients' needs, expectations, and feelings as they relate to companion animal euthanasia, including offering more grief-related resources and access to professional counseling services.

Retrospective survey of owners' experiences with palliative radiation therapy for pets

OBJECTIVE To describe animal owners' experiences with palliative radiation therapy (PRT) of pets and identify factors influencing satisfaction with their pets' treatment. DESIGN Retrospective, cross-sectional study. SAMPLE 118 owners of dogs, cats, or rabbits. PROCEDURES Medical records were searched to identify animals that underwent PRT between 2004 and 2013. Signalment, tumor-related data, and outcome information were recorded. Owners completed an electronic survey assessing satisfaction with treatment (ie, satisfaction with the decision for their pet to undergo PRT and indication that they would choose PRT for their pet again), expectations regarding PRT, and perceptions of their pets' quality of life (QOL) and signs of discomfort from acute adverse radiation effects. Additional data regarding practical aspects of treatment, pet death, communications with veterinarians, and owner demographics were collected. Variables were tested for association with measures of owner satisfaction. RESULTS 92 of 116 (79%) owners were satisfied with the decision to have their pets undergo PRT. Most (92/118 [78%]) owners reported their pet's QOL improved after PRT; these owners were significantly more likely to be satisfied than those who did not report improved QOL. Owners who perceived their pets had discomfort from adverse radiation effects (38/116 [33%]) were significantly less likely to be satisfied than owners who did not report this observation. Measures of satisfaction were not associated with patient survival time. Twenty-one of 118 (18%) owners indicated they expected PRT would cure their pet's tumor. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that short life expectancy should not deter recommendation of PRT for pets. Protocols that minimize risk of acute adverse effects may be advantageous. Veterinarians should attempt to ensure that owners understand the goals of PRT.

Common Neurologic Problems: Impact on Patient Welfare, Caregiver Burden and Veterinarian Wellbeing

Most neurologic diseases are incurable. Palliative care is vital in the treatment of companion animals with serious or chronic neurologic disease. A Neuropalliative Care Core Skill Set includes multifaceted communication competencies and symptom management. Because some of the most common clinical signs of neurologic disease are also associated with stress of caregiving, veterinarians should understand their clients' unique potential for caregiver burden. Acknowledging caregiver burden in their clients, means that veterinarians treating patients with neurologic disease must be proactive in building their own resilience to the occupational stress inherent in treating their patients and supporting their patients' caregivers.

Being Nice Is Not Enough-Exploring Relationship-Centered Veterinary Care With Structural Equation Modeling. A Quantitative Study on German Pet Owners' Perception

During the last years, the philosophy of relationship-centered care gained increasing attention in veterinary medicine. Relationship-centered care is based on a joint venture between pet owner and veterinarians and therefore offers the opportunity to satisfy the pet owners' need for participation in medical decision-making and to provide the best care for the patient. Although research on relationship-centered care in the veterinary consultation is still limited, the available findings suggest that the characteristics of relationship-centered care reflect the pet owners' expectations on satisfactory veterinary care. In this study a quantitative survey was conducted among German pet owners that collected information regarding their perception of the veterinarians' communication during the last appointments. Questionnaires were available online and paper-based. Data were analyzed using exploratory factor analysis and structural equation modeling using SAS. First aim of the study was to explore structural equation modeling (SEM) as an opportunity to evaluate quantitative data in the field of research on relationship-centered care. Further, SEM was used to evaluate associations between the implementation of different characteristics of relationship-centered care in the veterinary practice (empathic communication, partnership-building) and latent outcome variables regarding the pet owners (pet owners' need for further information, consultation of competing health care providers). N = 1,270 valid questionnaires were completed. Participants owned small companion animals (55.6%), horses (7.6%), or both (36.9%) within the last 2 years. Results of SEM suggest that partnership-centered and empathic communication decreased the pet owners' needs for further information (e.g., from online sources) and their need to consult alternative health providers (e.g., homeopaths). Especially addressing the pet owners' worries and fears, discussing pros and cons of diagnostic and therapeutic options as well as providing the required amount of information were shown to be large influence factors within the model. Therefore, veterinarians are recommended to implement the concept of partnership-centered care in their daily practice, for it may increase pet owners' loyalty and satisfaction. Results may motivate future research in this field. Further development of the proposed model assumptions may enable valuable progress in the field of quantitative research on relationship-centered care.

Evaluating Dog- and Cat-Owner Preferences for Calgary-Cambridge Communication Skills: Results of a Questionnaire

Veterinary client retention by companion animal practices is influenced by whether the client feels connected to the healthcare provider. Effective communication between the veterinarian and the client facilitates that connection. To prepare new graduates for success in clinical practice, many colleges of veterinary medicine are now incorporating communication into the curriculum to emphasize its importance in establishing and maintaining the veterinarian-client relationship. A 2016 focus group study by Englar et al. evaluated dog and cat owner communication preferences for Calgary-Cambridge Guide (CCG) communication skills and concluded that dog and cat owners may have different communication needs. This study was conducted to confirm whether species-based communication preferences exist among veterinary clients. A questionnaire was distributed online and on-site, within veterinary teaching hospitals and private practices. Based upon 215 submissions from dog owners and 166 from cat owners, the communication preferences of dog and cat owners overlap. Both dog and cat owners prioritize reflective listening as the most important foundational CCG communication skill, and both prioritize asking permission as the most important core CCG skill. However, dog owners valued open-ended questions more than cat owners, and cat owners valued empathy more than dog owners. Survey limitations were largely demographic: participants were predominantly female and between the ages of 18-40 years. Survey data may therefore not be representative of the perspective of males and/or those >40 years of age.

Comparison of veterinary health services expectations and perceptions between oncologic pet owners, non-oncologic pet owners and veterinary staff using the SERVQUAL methodology

AIM

Client satisfaction gained great importance in health care as a measurement of service quality. One of the most popular methods to evaluate client satisfaction is the SERVQUAL inquiry which measures service quality by evaluating client expectations and services towards a service in five dimensions: Tangibles, Empathy, Assurance, Reliability and Responsiveness.

MATERIALS AND METHODS

In order to evaluate if owners of pets with cancer constitute a distinctive group from the general pet owner population and if these differences were perceived by the hospital staff we applied a SERVQUAL questionnaire to 51 owners of pet with cancer, 68 owners from the general pet population and 14 staff members.

RESULTS

Owners of oncologic pets had different expectations of an ideal service granting importance to Assurance questions (6.75 vs 6.5, p= 0.045) while showing unmet needs in Reliability and Empathy dimensions. Veterinarians failed to understand these specificities and over evaluated characteristics of Tangible dimension (6.75 vs 6.25, p=0.027).

CONCLUSION

Owners of pet with cancer seem to constitute a specific subpopulation with special needs and veterinary staff should invest resources towards Assurance instead of privileging tangible aspects of veterinary services. By aligning professionals expectations with those of pet owners veterinarians can achieve better client satisfaction, improved compliance and stronger doctor-owner relationships.

2016 AAHA/IAAHPC End-of-Life Care Guidelines

End-of-life (EOL) care and decisionmaking embody the critical final stage in a pet's life and are as important and meaningful as the sum of the clinical care provided for all prior life stages. EOL care should focus on maximizing patient comfort and minimizing suffering while providing a collaborative and supportive partnership with the caregiver client. Timely, empathetic, and nonjudgmental communication is the hallmark of effective client support. Veterinarians should not allow an EOL patient to succumb to a natural death without considering the option of euthanasia and ensuring that other measures to alleviate discomfort and distress are in place. Animal hospice care addresses the patient's unique emotional and social needs as well as the physical needs traditionally treated in clinical practice. An EOL treatment plan should consist of client education; evaluating the caregiver's needs and goals for the pet; and a collaborative, personalized, written treatment plan involving the clinical staff and client. Primary care practices should have a dedicated team to implement palliative and hospice care for EOL patients. How the healthcare team responds to a client's grief after the loss of a pet can be a key factor in the client's continued loyalty to the practice. Referral to professional grief-support counseling can be a helpful option in this regard.

Which professional (non-technical) competencies are most important to the success of graduate veterinarians? A Best Evidence Medical Education (BEME) systematic review: BEME Guide No. 38

BACKGROUND

Despite the growing prominence of professional (non-technical) competencies in veterinary education, the evidence to support their importance to veterinary graduates is unclear.

AIM

To summarize current evidence within the veterinary literature for the importance of professional competencies to graduate success.

METHODS

A systematic search of electronic databases was conducted (CAB Abstracts, Web of Science, PubMed, PsycINFO, ERIC, Australian and British Education Index, Dissertations & Theses) from 1988 to 2015 and limited to the veterinary discipline (veterinar* term required). Evidence was sought from consensus-based competence frameworks, surveys of stakeholder perceptions, and empirical evidence linked to relevant outcomes (e.g. employability, client satisfaction or compliance). Data extraction was completed by two independent reviewers and included a quality assessment of each source.

RESULTS

Fifty-two sources were included in the review, providing evidence from expert frameworks (10 sources), stakeholder perceptions (30 sources, including one from the previous category), and empirical research (13 sources). Communication skills were the only competency to be well-supported by all three categories of evidence. Other competencies supported by multiple sources of empirical evidence include empathy, relationship-centered care, self-efficacy, and business skills. Other competencies perceived to be relatively more important included awareness of limitations, professional values, critical thinking, collaboration, and resilience.

CONCLUSIONS

This review has highlighted the comparatively weak body of evidence supporting the importance of professional competencies for veterinary graduate success, with the exception of communication skills. However we stress this is more indicative of the scarcity of high-quality veterinary-based education research in the field, than of the true priority of these competencies.