Farmer-veterinarian communication during herd health visits on dairy farms in Flanders, Belgium

Well-developed clinical communication is crucial for dairy practitioners in providing effective herd health and production management (HHPM) advisory services, as they have potential to enhance farmer satisfaction and adherence to veterinary advice. However, there is limited knowledge regarding specific communication skills veterinarians use during HHPM visits. Understanding veterinarians' communication is essential for developing targeted educational interventions to enhance veterinarian-farmer interactions during HHPM visits. The objective of the study was, therefore, to investigate veterinarians' communication during HHPM visits on Flemish dairy farms. Dairy veterinarians audio-recorded HHPM visits on dairy farms in Flanders, Belgium. Composite communication processes were assessed using the Calgary-Cambridge Guide (CCG), and global scores and specific behavior counts were assessed with a modified Motivational Interviewing Treatment Integrity code (MITI). Twenty-seven participating veterinarians recorded 127 visits with 120 unique dairy farmers. The CCG communication processes "History taking," "Presenting information," and "Safety net and follow-up" were most prevalent. Veterinarians with ≤10 years practice experience provided the farmer with a "Safety net and a follow-up" more often than veterinarians with >10 years of experience. Other CCG processes such as "Agenda setting" and "Needs determination" were often lacking. However, veterinarians who had previously participated in communication skills training determined the needs of the farmer more often than participants who had not. Veterinarians who conducted ≥15 HHPM visits per month more fully performed "History taking" and "Creating a plan" than veterinarians with <15 HHPM visits per month. Participants displayed inconsistent efforts to incorporate "Partnership" and "Empathy." In modified MITI coded audio segments of 20 min, on average, veterinarians gave information 12 times, made a persuasive statement 3 times, asked 3 open questions, and 6 closed questions. This study indicated areas for improvement in dairy veterinarians' communication and highlighted the need for ongoing education and research in this area to enhance veterinary practice and animal health.

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.

A Need for Targeted Teaching of Shared Decision-Making as Identified from an Assessment of Client-Centered Communication Skills Training with Companion Animal Veterinarians

Shared decision-making has been increasingly discussed as a communication practice within veterinary medicine, and it is gaining more traction for diagnostic and treatment planning conversations and specifically offering a spectrum of care. This teaching tip describes the data from an investigation of veterinarians' shared decision-making in a pre-test/post-test communication skills training intervention that used a client-centered, skills-based communication approach. Practice teams from a purposive sample of four companion animal veterinary clinics in Texas participated in a 15-month communication skills intervention, including interactive group workshops and one-on-one communication coaching. To assess the outcome of the intervention, for nine participating veterinarians, appointments recorded pre- (n = 85) and post-intervention (n =  85) were analyzed using the Observer OPTION 5 instrument to assess shared decision-making. The intervention effect was evaluated using mixed logistic regression, adjusting for appointment type. The communication intervention did not significantly impact participating veterinarians' demonstration of shared decision-making (pre = 25.42, n = 55; post = 28.03, n = 56; p = 0.36). Appointment type was significantly associated with veterinarians' OPTION 5 scores (p = .0004) and health problem appointments (OPTION 5 = 30.07) demonstrated greater shared decision-making than preventive care appointments (OPTION 5 = 22.81). Findings suggest that client-centered, skills-based training traditionally used in veterinary curricula and continuing education may not foster the use of shared decision-making, which is a higher-order communication approach that may require a dedicated process-oriented training. This teaching tip highlights the need for a targeted stepwise approach to teach shared decision-making.

Assessing the effect of a canine surgical-neutering educational programme on the knowledge and confidence of Indian veterinary participants

India has a large, free-roaming dog population, encompassing both owned and stray dogs. Canine surgical neutering is often a central component of dog population management and rabies control initiatives. The provision of practical, surgical training opportunities remains a major challenge for veterinary educational establishments worldwide to ensure competency in this routine procedure. A 12-day educational programme, focusing on surgical neutering skills, was developed to address this need. A questionnaire comprising 26 questions covering surgical and clinical topics, and a self-assessment of confidence in undertaking five common surgical procedures, was completed immediately before and after finishing the programme. A total of 296 participants attended, with 228 achieving the inclusion criteria for the study. Total knowledge scores increased significantly after the training programme (mean score pre-18.94, 95% CI 18.13-19.74; post-28.11, 95% CI 27.44-28.77, p < 0.05) with improvements seen in all categories (surgical principles, anaesthesia, antibiotic use and wound management). After accounting for other participants' characteristics, scores increased, on average, by 9 points after training. Being female was associated with significantly higher overall scores, while compared to younger and older age groups, those aged 25-34 were associated with lower overall scores. Amongst those with post-graduate qualifications, overall scores increased with age. Furthermore, there was an increase in self-rated confidence by participants in undertaking all five procedures. This study demonstrates that a targeted training programme can improve veterinary participants' knowledge and confidence in canine surgical neutering and may provide an effective way to develop surgical expertise amongst veterinarians engaged in dog population management initiatives.

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.

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.

Evaluation of a novel communication and consultation skills model (WISE COACH) on dog owner perceptions of veterinarians and projected spending on veterinary care

OBJECTIVE

To assess the impact of a novel communication and consultation skills model (WISE COACH [WC]) on dog owner perceptions of veterinarians and projected spending on veterinary care.

SAMPLE

1,200 US dog owners who had visited a veterinarian within the prior 18 months.

PROCEDURES

Video recordings of 2 staged client consultations were made, with the veterinarian following the WC recommendations in one video and not following them in the other (control). Participants were randomly assigned to view one of the videos and completed an online survey to assess their perceptions and projected spending. Qualitative responses were coded to identify themes.

RESULTS

The veterinarian was rated significantly higher in the WC video than in the control video for the characteristics first impression, skilled and knowledgeable, cares about me, cares about my pet, and communicates clearly, and was rated significantly lower for the characteristic rushed or abrupt. Participants who viewed the WC video were significantly more likely to follow the veterinarian's recommendations, return to see the veterinarian, and recommend the veterinarian. They were also approximately 1.4 times as likely to approve the full recommended treatment plan, and their projected total spending was approximately 15% higher than projected spending for participants who viewed the control video.

CLINICAL RELEVANCE

Results showed improved client perceptions, client retention, quality of patient care, and financial metrics when the veterinarian followed the WC recommendations. Further study is needed to determine whether this model may also improve veterinarian well-being by improving client relationships and decreasing resistance to recommendations.

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.

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.

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.

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.

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.

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.

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.

Measurement of leadership skills development among veterinary students and veterinary professionals participating in an experiential leadership program (the Veterinary Leadership Experience)

OBJECTIVE

To evaluate outcomes associated with an experiential leadership program (the Veterinary Leadership Experience [VLE]) among participants 1 year after program completion.

SAMPLE

157 veterinary students and 61 veterinary professionals who participated in the 2015 or 2016 VLE.

PROCEDURES

Participants completed various instruments to assess emotional intelligence, psychological flexibility, resilience, and client-communication skills prior to (pretest) and 1 year after (posttest) attending the VLE; pretest and posttest findings were compared for all but client-communication skills, for which only posttest responses were analyzed. An additional posttest instrument assessed the impact that the VLE had on key knowledge areas (ie, self-awareness, self-management, social awareness, relational competence, communication skills, and conflict management skills) and overall impact.

RESULTS

1 year after completing the VLE, participants reported that the program had a high impact on all key knowledge areas; the impact on social awareness and overall impact was significantly higher for veterinary students than for veterinary professionals. Veterinary professionals reported a greater increase in emotional intelligence after program completion than did veterinary students. For each assessed client-communication skill, the percentage of veterinary professionals who reported increased confidence in that skill after program completion was lower than the corresponding percentage of veterinary students. Resilience and psychological flexibility scores did not increase after program completion.

CONCLUSIONS AND CLINICAL RELEVANCE

Assessment of the effectiveness and long-term outcomes of experiential leadership programs is important to understanding whether such programs are having the intended effect. Veterinary students and veterinary professionals who were assessed 1 year after completing the VLE reported improvements in leadership skills foundational to the program.

Development and Validation of a Novel Measure for the Direct Assessment of Empathy in Veterinary Students

Empathy is a requisite clinical skill for health professionals and empathy scores have been positively associated with professionalism, clinical competency, confidence, well-being, and emotional intelligence. In order to improve empathy in the veterinary field, it is critical to measure the construct of empathy accurately. Most research has relied on self-reporting measures to assess empathy, while some studies have recently implemented the use of simulated client encounters in veterinary education. Building on this research, the aim of the current study was to develop and validate a novel quantitative assessment tool-the Empathy Clinical Evaluation Exercise (ECEX)-designed to measure empathy based on directly observable behaviors, using simulated clients. To evaluate empathy, evaluators used the ECEX to assess the performance of student clinicians in a simulated client encounter, which contained a pre-determined number of opportunities designed to elicit empathic responses from student clinicians. Statistical analysis suggests the test has a high degree of inter-rater reliability. In addition, there was moderate correlation between average empathy scores using ECEX and previously validated measures of empathy, compassion satisfaction, and burnout. Using these methods, we found the majority of students we studied had increased empathy scores at the completion of their primary care rotations. These results provide preliminary support for the use of the ECEX as a direct and quantitative tool for the assessment of empathy. Health professionals could use this novel empathy assessment tool to teach students, evaluate teaching strategies, and improve communication competencies in a wide variety of clinical settings. Our broad aim was to examine the utility of a direct and quantitative assessment tool for measuring empathy-the ECEX-in order to answer the following questions: (1) Does the tool have good inter-rater reliability? (2) Does the tool correlate with previously validated empathy measures? and (3) Does the tool correlate with similar constructs of compassion fatigue and burnout? Our secondary aim was to evaluate the change in empathy scores over the course of a 4-month (16-week) primary care rotation (pre- to -post).

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.

Information delivery and the veterinarian-horse owner relationship in the context of Hendra virus in Australia

Hendra virus (HeV) is an emerging bat-borne virus endemic in Australia that can be transmitted from horses to humans and has a high fatality rate for horses and people. Controversy surrounding HeV risk mitigation measures have strained the veterinarian-horse owner relationship. This study aimed to characterise the veterinarian-horse owner relationship in general and also in the context of HeV by analysing data derived from the 'Horse Owners and Hendra Virus: A Longitudinal Study to Evaluate Risk' (HHALTER) study. Australian horse owners were recruited via emails, social media and word-of-mouth for a series of five surveys that were administered online at six-monthly intervals over a two-year period to capture baseline knowledge, attitudes and practices of horse owners regarding HeV and any changes over time. In the current study, descriptive analyses of information sources were performed to understand the use of veterinarians as a HeV information source (Surveys 1 and 5; n = 1195 and n = 617). Ordinal logistic regression analyses were conducted to determine factors associated with the frequency of horse owner contact with a veterinarian (Survey 3; n = 636). This study found a relative increase over the study period in the proportion of horse owners who had used veterinarians as HeV information source in the last 12 months (from 51.9% to 88.3%). Owning more horses, being older, having a 'duty of care' for other people working with horses and deriving the main income from horse related business were factors associated with more frequent veterinary contact. Results suggest that traditional information sources such as workshops, information packs and risk training are likely to be used by horse owners. Smart phone applications should be considered for use in the future and require further investigation for horse health communication. The findings of this study may be helpful in optimising strategies for horse health information delivery.

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.

Understanding Non-Technical Competencies: Compassion and Communication among Fourth-Year Veterinarians-in-Training

Over the past several decades, non-technical competencies have been given an increasing amount of emphasis in veterinary medical training. However, additional research is needed to continue understanding the role that non-technical competencies play in veterinary success and wellness. An inter-related pair of non-technical competencies that needs further empirical investigation is communication and the influence of compassion on veterinarians. This research study investigated the relationship between compassion experiences and communication styles of fourth-year veterinarians-in-training using a canonical correlation analysis. The compassion fatigue resilience (CFR) model was the theoretical framework used to conceptualize how communication behaviors may contribute to compassion fatigue and compassion satisfaction. Compassion experiences were measured using a version of the Professional Quality of Life (ProQOL) scale. Communication style was measured using the Communication Styles Inventory (CSI). Results indicated that communication style is statistically significantly related to compassion experiences (n = 281; Function 1, R_c = .552, p < .001; Function 2, R_c = .369, p < .001). Compassion fatigue was found to have a statistically significant association with the communication styles of emotionality (r = .467, p < .001), impression manipulativeness (r = .191, p = .001), and verbal aggressiveness (r = .239, p = .001). Results indicated support for veterinary training programs to continue adapting their curricula to include communication training and intervention programs to address communication and compassion fatigue, as well as to consider how the relationship between these two constructs may influence the wellness and success of veterinarians-in-training and veterinarians. More research is needed to understand the role of impression manipulativeness in veterinary wellness.

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.

Difficulties experienced by veterinarians when communicating about emerging zoonotic risks with animal owners: the case of Hendra virus

BACKGROUND

Communication skills are essential for veterinarians who need to discuss animal health related matters with their clients. When dealing with an emerging zoonosis, such as Hendra virus (HeV), veterinarians also have a legal responsibility to inform their clients about the associated risks to human health. Here we report on part of a mixed methods study that examined the preparedness of, and difficulties experienced by, veterinarians communicating about HeV-related risks with their clients.

METHODS

Phase 1 was an exploratory, qualitative study that consisted of a series of face-to-face, semi-structured interviews with veterinary personnel from Queensland, Australia (2009-10) to identify the barriers to HeV management in equine practices. Phase 2a was a quantitative study that surveyed veterinarians from the same region (2011) and explored the veterinarians' preparedness and willingness to communicate about HeV-related risks, and the reactions of their clients that they experienced. The second study included both multiple choice and open-ended questions.

RESULTS

The majority of the participants from Phase 2a (83.1%) declared they had access to a HeV management plan and over half (58.6%) had ready-to-use HeV information available for clients within their practice. Most (87%) reported "always or sometimes" informing clients about HeV-related risks when a horse appeared sick. When HeV was suspected, 58.1% of participants reported their clients were receptive to their safety directives and 24.9% of clients were either initially unreceptive, overwhelmed by fear, or in denial of the associated risks. The thematic analysis of the qualitative data from Phases 1 and 2a uncovered similar themes in relation to HeV-related communication issues experienced by veterinarians: "clients' intent to adhere"; "adherence deemed redundant"; "misunderstanding or denial of risk"; "cost"; "rural culture"; "fear for reputation". The theme of "emotional state of clients" was only identified during Phase 1.

CONCLUSION

Warning horse owners about health and safety issues that may affect them when present in a veterinary work environment is a legal requirement for veterinarians. However, emerging zoonoses are unpredictable events that may require a different communication approach. Future training programs addressing veterinary communication skills should take into account the particular issues inherent to managing an emerging zoonosis and emphasise the importance of maintaining human safety. Veterinary communication skills and approaches required when dealing with emerging zoonoses should be further investigated.