Spectrum of care: more than treatment options

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

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

Exploring the Experiences of Visiting Veterinary Service Providers in Indigenous Communities in Canada: Proposing Strategies to Support Pre-Clinical Preparation

Many Indigenous communities in Canada lack access to veterinary services due to geography, affordability, and acceptability. These barriers negatively affect the health of animals, communities, and human-animal relationships. Canadian veterinary colleges offer veterinary services to Indigenous communities through fourth-year veterinary student rotations. Ensuring that the students and other volunteer veterinary service providers (VSP) are adequately prepared to provide contextually and culturally appropriate care when working with Indigenous peoples has not been explicitly addressed in the literature. We explored the experiences of VSP delivering services in unfamiliar cultural and geographic settings and identified: what pre-clinic training was most helpful, common challenges experienced, and personal and professional impacts on participants. Fifty-two VSP (veterinarians, animal health technicians and veterinary students) who participated in clinical rotations offered by five Canadian veterinary colleges between 2014 and 2022 completed online surveys. Respondents shared their pre-clinic expectations, sense of preparedness to practice in a remote Indigenous community, their clinical and community experiences, and any personal and professional impacts from the experience. Data were analyzed using a directed content analysis approach. Respondents highlighted which pre-clinic training was most valuable and what they felt unprepared for. Community infrastructure and resources were concerns and many felt unprepared for the relational and communication barriers that arose. VSP were uncomfortable practicing along a spectrum of care with limited clinical resources. Many VSP identified positive personal and professional impacts. Our findings suggest that pre-clinic orientations focused on contextual care in limited resource settings could better prepare VSP to serve underserved Indigenous communities.

A picture of purpose: exploring veterinary students' motivations through photo elicitation

Understanding the motivations that drive veterinary students is essential for supporting their academic success, wellbeing, and professional satisfaction. This qualitative study utilized photo elicitation, a visual and narrative research method, to explore the personal, emotional, and professional "whys" of 14 veterinary students pursuing a Doctor of Veterinary Medicine (DVM) degree. Participants submitted photographs and reflective narratives describing their motivations and how these motivations supported their journeys. Thematic analysis revealed five key themes: (1) Deep Emotional Bonds with Animals, (2) Overcoming Personal Adversity, (3) The Influence of Role Models, (4) Desire to Make a Difference, and (5) Community and Service. These findings highlight the central role of formative experiences, relationships, and values in shaping students' aspirations and perseverance. The study underscores the potential for reflective practices, such as photo elicitation, to reconnect students with their intrinsic motivations, fostering resilience and long-term satisfaction in veterinary practice. Integrating principles such as compassionate advocacy, spectrum of care, and community engagement into veterinary education may better align training with students' values, enhancing their preparation for impactful and fulfilling careers.

A Unique Spectrum of Care Tool Provides a Self-Regulated Learning Opportunity and Facilitates Client Communication

Providing only the most state-of-the-art, intensive, and expensive level of treatment available does not meet the needs of every pet owner and pet. To overcome this barrier, veterinarians are working to provide spectrum of care (SOC) options to pet owners. This teaching tip describes the creation of a Spectrum of Care Options Presentation and Explanation (SCOPE), a tool that can serve a variety of educational purposes and improve delivery of care across the spectrum of care. The SCOPE considers andragogy, evidence-based medicine, and pet owner preferences related to communication as well as the cost of care. The use of a SCOPE during oncology consultations led by an intern on an oncology service rotation demonstrated its utility in identifying evidence-based SOC options for pets with cancer, serve as a self-regulated learning experience for the participating intern, and elicit pet owner and pet contextual issues impacting the care plan. The SCOPE can be used to promote the implementation of SOC in veterinary medicine. The SCOPE is flexible and may be adapted for use in disciplines other than oncology and with a variety of learners, such as veterinary students, or in early career mentoring programs.

American College of Veterinary Radiology and European College of Veterinary Diagnostic Imaging consensus statement on imaging report foundations

Imaging reports are official medicolegal documents, detailing the conduct and interpretation of imaging studies in patient care. They serve as the primary means of communication for radiologists and significantly influence clinical decisions. This consensus statement, produced by a panel of the American College of Veterinary Radiology and European College of Veterinary Diagnostic Imaging board-certified veterinary radiologists through a modified Delphi method, addressed three key competency domains: basic patient care documentation, crafting meaningful reports, and ethical practice within legal boundaries. Meaningful reports move beyond documenting findings and providing impressions having qualities that foster effective communication for the betterment of patient care.

Beginning with the End in Mind: Creating a Practice that Centers Equity-Part 2

The concept of equity recognizes historical and current barriers and promotes thriving for veterinary teams and people and animals in the community. It is possible to design equitable workplace systems to prevent and respond to harm using learnings from human medicine and the social sciences. These systems are grounded in the principles of health equity and must incorporate both formal policies and intentional cultivation of supportive culture and relationships. This article is part 2 of 2 articles reviewing how the concept of equity applies and could transform well-being in companion animal veterinary practice in North America.

2024 AAHA Community Care Guidelines for Small Animal Practice

Community care is a creative way of thinking about health care that mobilizes resources within a community and consists of four core principles: recognition of the urgency of access-to-care for the veterinary profession, collaboration within community networks, family-centered health care, and redefining the gold standard of care. The AAHA Community Care Guidelines for Small Animal Practice offer strategies to help busy veterinary practitioners increase access to care within their practice and community by optimizing collaborative networks. While these guidelines do not claim to provide exhaustive solutions to access-to-care issues, they propose a starting point from which private practices can explore and implement workable solutions for their community and their practice. Broadening the scope of care to reach all people with pets requires multimodal, collaborative, and creative solutions both within and outside of the veterinary profession. These solutions can begin with greater communication and collaboration between private veterinary practices and nonprofit veterinary practices, with the goal of keeping pets in their homes with their loving families as much as reasonably possible.

Evidence-based veterinary medicine-potential, practice, and pitfalls

Understanding and incorporating evidence-based veterinary medicine (EBVM) into clinical practice and research continues to pose a challenge for our profession despite over 2 decades of increasing awareness of this concept. Reasons for this include a lack of understanding of its importance to the practice of medicine, veterinary literature that often fails to adhere to evidence-based standards, inadequate attention to teaching EBVM at the university level, and the inherent reluctance of clinicians to alter historical practice styles. For many practitioners, EBVM continues to be an abstract concept they believe requires advanced training in statistics and epidemiology resulting in them relying on less robust sources for clinical guidance. This unfortunately results in suboptimal care for our patients and delayed medical advancements for our profession. As part of the 20th anniversary of the founding of the Evidence-Based Veterinary Medicine Association (EBVMA), we are refocusing our efforts to highlight the need for dedicated teaching of EBVM at the university level, for rigorous adherence to established research reporting guidelines, for expansion of EBVM infrastructure, and for the provision of easily accessible tools that permit clinicians to incorporate EBVM into their daily practice. As the quality of veterinary literature improves, so too will development of more effective clinical practice guidelines that ultimately can be widely adopted if they are flexible enough to support the triadic relationship between veterinarians, our clients and our patients. Ultimately, EBVM is not an end unto itself, but rather a means to improve the quality of care we provide our patients.

Behaviors suggestive of pain: the perceptions and veterinary-related decisions of cat guardians in the USA

OBJECTIVES

The aim of the study was to assess cat guardians' concern levels and veterinary care decisions pertaining to behaviors that might signify pain before and after receiving brief pain-related educational information. The secondary aims were to evaluate cat guardians' perceptions of the usefulness of a modified version of the Colorado State University Feline Acute Pain Scale (CSU-FAPS) in identifying their cat's pain level, determining if they should take their cat to the veterinarian and describing their cat's pain to their veterinarian.

METHODS

Participants were recruited through Prolific. An electronic survey was created in Qualtrics and distributed via a link offered in Prolific.

RESULTS

A total of 362 surveys were completed by participants who resided in the USA and were the primary caretaker of at least one cat. Significant differences between participants' concern levels before and after pain-related educational information were found for two of the three scenarios. Significant differences were found between participants' veterinary-related behavior choices before and after pain-related educational information for all three scenarios. The most common reasons for not seeking immediate veterinary care included elements related to cost and stress for guardian and cat during veterinary visits. The majority of participants reported finding the CSU-FAPS useful for identifying their cat's pain level (90%), determining if they should take their cat to the veterinarian (86%) and describing their cat's pain to their veterinarian (92%).

CONCLUSIONS AND RELEVANCE

Guardians' interpretations of and subsequent actions to behaviors that might suggest pain carry great implications for feline health and wellbeing. After exposure to brief pain-related educational material, guardians in our study reported significant increases in stated concern related to their cat's change in behavior and intention to seek veterinary care. These findings suggest that even very brief pain-related educational material can have a positive impact on cat guardians' perceptions of feline behavior changes and increase the possibility they obtain appropriate veterinary care.

Development and Implementation of a Veterinary Spectrum of Care Clinical Rotation Aligned with the CBVE Model

Spectrum of care (SOC) has recently been described in the literature, yet it is not an entirely new concept within the veterinary profession. Practitioners in general veterinary practice have long needed to provide a broad range of unique care options for their patients and clients, particularly those for whom referral is not possible. More recently, graduates and their employers have reported that new veterinarians often lack the competence and confidence to provide a broad array of care options, while training in ever more specialized tertiary-referral environments. To better prepare veterinary learners to cope with the variable nature of general veterinary practice and to better meet employer demands, The Ohio State University College of Veterinary Medicine purposefully backward designed learning experiences in a new outcomes-based curriculum so that SOC is emphasized and aligned with the foundation offered by the Competency-Based Veterinary Education (CBVE) model. A unique set of subcompetencies and educational goals were collaboratively developed and used to define a new final year rotation, with additional input provided by an advisory panel of practicing SOC veterinarians from private practice. Ideal caseload characteristics, case numbers, appointment length, daily activities, and other elements were defined, and final year student performance was monitored during implementation to assess progress in meeting key developmental milestones. Incorporating spectrum of care training at The Ohio State University shows promise for developing confidence and competence in new graduates, while also increasing their skills, and perhaps improving their mental health.

"Veterinary medicine is not finished when I have diagnosed an incurable disease, that's when it starts for me." A qualitative interview study with small animal veterinarians on hospice and palliative care

In the wake of recent medical developments in small animal practice, curing animals of their illnesses and restoring their health can be realized better than ever before. However, the growing medical possibilities are also leading to an increase in demand for better care for patients suffering from terminal illnesses. Consequently, the field of animal hospice and palliative care has become increasingly available, enabling veterinarians to optimize the quality of life of patients, such as dogs and cats, who no longer have a prospect of full recovery. Using qualitative, semi-structured interviews with 20 small animal veterinarians involved in hospice and palliative care, we investigated the factors that motivate veterinarians to become involved in hospice and palliative care and explored the importance of relationships, communication, time and infrastructure in this area. Findings show that personal experiences with their own pets or during training or work life motivated veterinarians to provide this service. Although veterinarians highlighted the importance of empathetic-driven relationships, they were aware that keeping an emotional distance from the patient and caregiver is significant to provide successful care. Further, veterinarians emphasized their high investment of time that resulted primarily from the increased frequency and provided opportunities to communicate with caregivers. The overall conclusion is that having time for patients and the patients' caregivers is one of the most important aspects of work in this field. However, as it will be also shown, veterinarians must consider aspects of self-care management by reflecting on their own time and energy resources while caring for animals and their caregivers.

Veterinarians' Self-Reported Behaviors and Attitudes toward Spectrum of Care Practices

Access to veterinary care for animal owners is an important part of keeping animals healthy and keeping pets and people together whenever that is appropriate. Insufficient financial and other resources to allocate to veterinary care are major barriers for pet owners to receiving preventative, sick, and emergency services. The veterinary community has begun to incorporate offering a range of diagnostic and treatment options more intentionally in response to clients' inability to pay and to a lesser extent to mitigate other barriers to care. Many veterinarians are nonetheless oriented toward providing specialized and more sophisticated care based on their training. This study sought to identify the self-reported behaviors, knowledge, attitudes, and beliefs of veterinarians about offering a spectrum of care options (SoC) to clients. The finding that many reported offering SoC is encouraging. However, veterinarians who report comfort and confidence in a variety of aspects of clinical care were most likely to offer SoC. Practitioners in the field for 20 or more years were less likely to offer SoC to clients with financial limitations. Rural veterinarians were more likely to offer SoC to any client compared to urban veterinarians. These results provide a point of reference and potential focus for veterinarians who are not currently offering SoC as well as an exploration of veterinarians' reported knowledge, behaviors, attitudes, perceptions, and concerns about SoC.

Perceptions and opinions of pet caregivers in mainland and Hong Kong China about surgery, pain management, and anesthesia in dogs and cats

Small animal caregivers' perceptions and previous life experiences play a pivotal role in patient care, making effective communication fundamental within the veterinary business. Despite the large and growing scale of the pet industry, data on small animal client-centered information about veterinary services in Mainland China (MC) and the Hong Kong Special Administrative Region (HKSAR) China are lacking. The objective of this study was to investigate the perceptions and opinions of small animal caregivers about surgery, pain management, and anesthesia in dogs and cats in these geographical regions through a validated online survey using content validity index. A total of 2080 valid answers were collected by convenience sampling over 45 days. Descriptive statistics were used to summarize data; the chi-square test and generalized linear models were used to test the associations between demographics and responses. Overall, caregivers appeared favorable toward the use of analgesia in their pets, with concerns over the potential adverse effects produced by analgesic drugs. Joint pain and ear infections were generally rated as conditions that would be less prone to require analgesia. Significant associations were observed for demographic factors such as gender, age, and geographical area, whether participants were healthcare providers, and whether their pets had undergone surgery before. Although many respondents expressed uncertainty in recognizing pain in their pets and administering analgesics, they also expressed a desire to learn and to be informed. This study highlights areas and factors that may determine the perceptions and opinions of small animal caregivers that form a unique human-animal bond in China. Client communication should be addressed on a case-by-case basis and adapted to the geographical area, as the individual background and demographics may have an ultimate impact on treatment goals and patient care.

Veterinary Curriculum Leaders: Motivators, Barriers, and Attributes

Curriculum leaders (individuals with responsibility for an institution's veterinary curriculum) play a vital role in driving local curriculum priorities, development, and accreditation. This study aimed to describe the career paths of curriculum leaders and identify what motivates them, the barriers they face, and the knowledge, skills, and attributes they perceive as essential for the role. Self-determination theory was used to identify tensions experienced within the role. An international online survey targeted at those identifying as curriculum leaders was completed by 45 participants. 91% of participants held a doctoral level qualification and/or clinical Boards; 82% had additional training in leadership; 38% had additional formal training in education. Motivators included a desire to make a difference, personal satisfaction with teaching and working with students, and social influences. Participants experienced barriers relating to self-development and achievement of their curriculum goals; participants described essential knowledge (of the profession, educational theory, and wider higher education context) and skills (leading teams, change management, and communication). Attributes considered important related both to self (open-minded, patient, resilient, able to see the big picture as well as detail) and relationships with others (approachable, listener, respectful and respected, supportive, credible). Tensions arose in participants' need for autonomy (experiencing barriers to achieving their goals), in their social relatedness (achieving curriculum goals while working with colleagues with conflicting priorities), and in perceptions of necessary competence (a need, but lack of opportunity, for advanced training in educational theory). The findings may help institutions more effectively support and train current and future curriculum leaders.

Enhancing Primary Care Learning in a Referral Hospital Setting: Introducing Veterinary Clinical Demonstrators

With the majority of veterinary graduates entering primary care practice (PCP), there is increasing recognition of the importance of preparing students to practice across a broad spectrum of care (SoC). The traditional model of veterinary training, focused on the referral hospital environment, can make this challenging. In 2018, Bristol Veterinary School recruited five primary care (PC) veterinary surgeons as veterinary clinical demonstrators (VCDs) who collaborated with rotation-specific specialists to help enhance student focus upon day-one skills and to emphasize SoC relevance of the referral caseload. To evaluate the initiative, two separate online surveys were disseminated to clinical staff and final year veterinary students. The survey was completed by 57 students and 42 staff members. Participants agreed that VCDs helped students feel prepared for a first job in primary care practice (students 94.7%; staff 92.7%); helped students to focus on the primary care relevance of referral cases (students 96.5%; staff 70.8%); helped students develop clinical reasoning skills (students 100%; staff 69.3%), practical skills (students 82.4%; staff 72.5%), and professional attributes (students 59.6%; staff 71.4%). Thematic analysis of free-text comments revealed the benefits and challenges associated with implementing the role. The data gathered helped to guide the role's ongoing development and to provide recommendations for others who may be looking to implement similar educational initiatives to help prepare graduates to practice across a spectrum of care.

Life, Death, and Humanity in Veterinary Medicine: Is It Time to Embrace the Humanities in Veterinary Education?

Medical humanities is a multidisciplinary, interdisciplinary field of study that has experienced explosive growth in the United States since the 1960s. Two key components of medical humanities include, first, the use of literature, poetry, and visual arts in the education of medical students, and second, the representation or examination of medical culture by scholars in the humanities, arts, and social sciences such as literary and film creators, sociologists, and anthropologists. The American Association of Medical Colleges recently reported that as of 2018, approximately 94% of medical schools had core or elective humanities offerings in their curricula. The examination of the medical milieu by scholars across the humanities has resulted in the emergence of important specialty fields such as end-of-life care, disability studies, and health disparities research. Veterinary medicine has been slow to embrace the humanities as relevant to our profession and to the education of our students. Only sporadic, isolated attempts to document the value of the arts and humanities can be found in the veterinary literature, and valuable observations on our profession made by scholars in diverse disciplines of the humanities are largely buried in publications not often accessed by veterinarians. Here a case is made that the time is right for the emergence of a more cohesive field of veterinary humanities. Embracing the observations of humanities scholars who engage with our profession, and appreciating the ways in which the humanities themselves are effective tools in the education of veterinary professionals, will bring many benefits to our evolving profession.

Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care

AIM

This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed.

RELEVANCE

Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery.

SERIES OUTLINE

This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.

Recasting the gold standard - part II of II: communicating healthcare options along a continuum of care

SERIES OUTLINE

This is the second part of a two-part series on spectrum of care that encourages practitioners to tailor case management to the patient along a continuum of acceptable options. Part I defined the spectrum of care and broadened its approach beyond initial cost-of-care considerations. This second article introduces strategies for initiating conversations with clients about their needs, wants and expectations specific to healthcare options and case management decisions. It will explore how open inquiry, reflective listening, transparency and unconditional positive regard facilitate dialogue between providers and their clients as they collaborate on decision-making along a spectrum of care.

RELEVANCE

Contextual case management prioritizes interventions that are appropriate for both the patient and the client. To identify and explore which healthcare options represent the best fit for those impacted most by medical decisions, veterinarians need to make space for clients to feel comfortable sharing their perspectives. Clients are more likely to be engaged in decision-making when their insight is actively solicited. They have much to share with us as experts about their cat's overall health and wellness needs. Inviting clients to contribute to the consultation and being receptive to hearing what motivates their choices helps us to structure conversations around healthcare options. The ability to communicate healthcare options is as vital as the provision of healthcare, if not more so.

Impact of a Spectrum of Care Elective Course on Third-Year Veterinary Students' Self-Reported Knowledge, Attitudes, and Competencies

Veterinary services' rising cost is an increasing barrier to pet care. Spectrum of care (SpOC) refers to evidence-based veterinary medicine options along the socioeconomic spectrum. To meet growing pet owner financial constraints and pet care needs, training to equip veterinarians with competencies to provide SpOC as Day One graduates is argued to be added as part of the veterinary curriculum. Objectives of our prospective pre- and post-survey study were to (a) determine baseline self-reported knowledge, attitudes, and competencies (KACs) surrounding SpOC in third-year DVM students; (b) develop and assess impact of a SpOC course on student self-reported SpOC KACs; and (c) obtain student feedback on the course and future SpOC training. Enrolled students (n = 35) completed the pre-survey (n = 35) and post-survey (n = 33). Results indicated that students were aware of the need for SpOC training within the veterinary curriculum, and positive changes occurred in self-reported KACs from pre- to post-survey. Students tended (p = .08) to predict better outcomes in SpOC cost-barrier scenarios from pre- (34%) to post-survey (76%), such as reduced perceived likelihood of euthanasia (63%-39%) and unsuccessful outcomes (40%-27%). Most students (31/33, 94%) predicted the course would benefit them in clinical practice and had preferred future training preferences (online modules [70%], seminars [60%], webinars [58%]). Data indicate benefits in student self-reported KACs following the SpOC course, warranting formal course inclusion, with tracking of students into clinical practice to document objective KAC impacts and perhaps similar course rollout to other institutions.

Canine Neonatal Health

This article provides a high-level overview of canine neonatal health for clinicians to use as a mental framework so that when presented with a canine neonate it is easier to construct a logical and systematic clinical approach that is less overwhelming. As early detection of the at-risk neonate results in earlier intervention, and improved health outcomes, there will be a focus on pro-active care. Where appropriate, other articles in this issue will be mentioned for a more in-depth discussion of specific areas. Key points will be highlighted throughout the text.

A Survey of Veterinary Student and Veterinarian Perceptions of Shelter Medicine Employment

Shelter medicine appears to be popular among prospective veterinarians, but there is a shortage of veterinarians entering the field to fill available positions. The reasons for this discordance are not well understand. This study describes veterinary students' interest in shelter medicine, their perceptions of common duties, and their perceptions of employment attributes in shelter medicine, compared with those of current veterinarians. The sample included 146 first-year students, 155 final-year students, and 221 veterinarians who self-completed an online survey between September 2020 and March 2021. We found high levels of interest in shelter medicine, with 40% of first- and 43% of final-year students indicating they were likely to consider working in shelter medicine. Outreach clinics (84% of first-year students, 86% of final-year students), access-to-care clinics (82%, 83%), and loan forgiveness programs (75%, 64%) encouraged many veterinary students to consider working in shelter medicine. The risk of compassion fatigue, burnout, and stress (70%, 68%); weekend work (51%, 59%); euthanasia decision making (49%, 47%); euthanasia (43%, 41%); and expected salaries of shelter veterinarians (39%, 37%) acted as deterrents. Kruskal-Wallis H tests revealed students reported more positive ratings than veterinarians for most shelter medicine duties and employment characteristics, with moderate to strong consensus within groups. Little difference appeared between first- and final-year students. This study highlights target areas for animal shelters to boost recruitment of newly graduated veterinarians. Increasing veterinary students' exposure to shelter medicine throughout their veterinary training may also help address their concerns regarding euthanasia, salary, and quality of care.

The application, value, and impact of outcomes research in animal health and veterinary medicine

Outcomes research is a relatively recent field of study in animal health and veterinary medicine despite being well-established in human medicine. As the field of animal health is broad-ranging in terms of animal species, objectives, research methodologies, design, analysis, values, and outcomes, there is inherent versatility in the application and impact of the discipline of outcomes research to a variety of stakeholders. The major themes of outcomes relevant to the animal health industry have been distilled down to include, but are not limited to, health, production, economics, and marketing. An outcomes research approach considers an element of value along with an outcome of interest, setting it apart from traditional research approaches. Elements of value are determined by the stakeholders' use of products and/or services that meet or exceed functional, emotional, life-changing, and/or societal needs. Stakeholder perception of value depends on many factors such as the purpose of the animal (e.g., companion vs. food production) and the stakeholder's role (e.g., veterinarian, client, pet-owner, producer, consumer, government official, industry representative, policy holder). Key areas of application of outcomes research principles include comparative medicine, veterinary product development, and post-licensure evaluation of veterinary pharmaceuticals and/or biologics. Topics currently trending in human healthcare outcomes research, such as drug pricing, precision medicine, or the use of real-world evidence, offer novel and interesting perspectives for addressing themes common to the animal health sector. An approach that evaluates the benefits of practices and interventions to veterinary patients and society while maximizing outcomes is paramount to combating many current and future scientific challenges where feeding the world, caring for our aging companion animals, and implementing novel technologies in companion animal medicine and in production animal agriculture are at the forefront of our industry goals.

Grooming-Related Concerns Among Companion Animals: Preliminary Data on an Overlooked Topic and Considerations for Animals' Access to Health-Related Services

Grooming is an essential health maintenance activity that is fundamental to the welfare of many companion animals. Despite the potentially serious consequences of inadequate grooming for pets and their caregivers, few studies have examined the role of access to pet grooming services and supplies in promoting and maintaining companion animal health and welfare. The goal of this paper was 2-fold: (1) To provide preliminary findings demonstrating the scope of grooming and matting concerns among animals served by a large, non-profit animal welfare organization and (2) to provide a call for research to guide effective prevention of and responses to grooming-related omissions of care. We retrospectively extracted data from five American Society for the Prevention of Cruelty to Animals (ASPCA) programs serving the New York City area: ASPCA Animal Hospital (AAH), Community Medicine (CM), One ASPCA Fund, ASPCA-NYPD (New York City Police Department) Partnership, and the Community Engagement (CE) Program. The prevalence of grooming–related concerns was relatively consistent across all three veterinary service programs (AAH: 6%; CM: 4%; One ASPCA Fund: 6%). Thirteen percent of the ASPCA-NYPD Partnership's cruelty cases involved general hair matting concerns and/or strangulating hair mat wounds (93% were long-haired dog breed types). Five percent of CE cases received grooming-related supplies to support pet caregivers' in-home grooming capabilities. Our findings underscore the need to understand the scope of grooming-related concerns among animals served by veterinarians and other community programs to improve animals' access to health-related services.

'Gold standard care' is an unhelpful term

Members of Veterinary Humanities UK argue that the vet professions should move away from using the term 'gold standard care' and instead adopt 'contextualised care', which acknowledges that different treatment pathways are able to offer equally acceptable patient journeys in different contexts.

Barriers to Care in Veterinary Services: Lessons Learned From Low-Income Pet Guardians' Experiences at Private Clinics and Hospitals During COVID-19

This qualitative study aimed to explore the experiences of low-income pet guardians in accessing veterinary care during COVID-19. Participants were recruited through a purposive sampling method: 12 individuals who applied to and met the low-income threshold to access support for veterinary fees from the Vancouver Humane Society (VHS) were invited for semi-structured in-depth telephone interviews. Participants indicated that they experienced pandemic-related barriers related to and compounded by their low-income status. Their experiences fit into three categories: the barriers to accessing veterinary care pre-and peri-COVID-19, the emotional impact of compounding barriers related to accessing veterinary care during COVID-19, and the human-animal bond and resilience in the context of COVID-19. Drawing on the One Health, One Welfare approach, we argue that veterinary and animal services should evaluate and improve their support services, particularly programs developed for low-income pet guardians. Based on the participants' recommendations, we propose that veterinary and animal services prepare for future disaster situations by increasing their financial capacity to support people needing assistance, undergoing training to better work with people experiencing financial and emotional stress, and providing easily accessible resources to better distribute knowledge about animal needs and available financial assistance programming. The suggestions are intended to benefit animals, their guardians, and both veterinary and animal service sector workers.

Ethical Challenges Posed by Advanced Veterinary Care in Companion Animal Veterinary Practice

Simple Summary

Veterinary care of companion animals, particularly dogs and cats, continues to advance, with some companion animals receiving a standard of care equal to or exceeding that of human patients. While this has the potential to improve animal welfare and benefit other stakeholders, including animal owners and veterinary team members, it also poses ethical challenges. We discuss key ethical challenges associated with AVC, including its relationship to standards of veterinary care, its potential to perpetuate poor quality of life and suffering, cost and accessibility of veterinary care, conflicts of interest, and concerns about experimentation without appropriate ethical review. We conclude by suggesting some strategies for veterinary teams and other stakeholders, such as professional bodies and regulators, to address these concerns.

Abstract

Advanced veterinary care (AVC) of companion animals may yield improved clinical outcomes, improved animal welfare, improved satisfaction of veterinary clients, improved satisfaction of veterinary team members, and increased practice profitability. However, it also raises ethical challenges. Yet, what counts as AVC is difficult to pinpoint due to continuing advancements. We discuss some of the challenges in defining advanced veterinary care (AVC), particularly in relation to a standard of care (SOC). We then review key ethical challenges associated with AVC that have been identified in the veterinary ethics literature, including poor quality of life, dysthanasia and caregiver burden, financial cost and accessibility of veterinary care, conflicts of interest, and the absence of ethical review for some patients undergoing AVC. We suggest some strategies to address these concerns, including prospective ethical review utilising ethical frameworks and decision-making tools, the setting of humane end points, the role of regulatory bodies in limiting acceptable procedures, and the normalisation of quality-of-life scoring. We also suggest a role for retrospective ethical review in the form of ethics rounds and clinical auditing. Our discussion reenforces the need for a spectrum of veterinary care for companion animals.