Workplace psychosocial factors are associated with veterinary employees' organizational commitment to their current veterinary hospital

OBJECTIVE

To classify a sample of veterinary professionals into distinct organizational-commitment profiles and to identify associations between psychosocial aspects of the workplace and organizational-commitment profile membership.

SAMPLE

487 veterinary employees who worked for a corporate veterinary organization in Canada.

METHODS

Survey components measured for this study included the Three-Component Model (TCM) Employee Commitment Survey-Revised, the Copenhagen Psychosocial Questionnaire, and participant demographics. First, latent profile analysis was used to identify distinct organizational-commitment profiles based on 3 components of commitment (affective, continuance, and normative). Next, the Mann-Whitney U test was used to compare participants' intention to leave their hospital on the basis of organizational-commitment profile. Finally, logistic regression was performed to assess the association between perceived psychosocial workplace characteristics and organizational-commitment profile membership.

RESULTS

2 organizational-commitment profiles were identified: Affective/Normative (AC/NC) Dominant (n = 388) and Mid-Low Commitment (99). Participants in the Mid-Low Commitment Profile had a significantly higher intention-to-leave score (median, 3.0) than participants in the AC/NC Dominant Profile (median, 2.0; P < .001). Psychosocial factors found to predict membership in the AC/NC Dominant Profile included the following: influence at work (OR, 2.08; P < .001), meaning of work (OR, 1.38; P = .067), rewards/recognition (OR, 1.63; P = .007), and quality of leadership (OR, 1.85; P = .0003). Members of the AC/NC Dominant Profile also experienced greater work-life conflict (OR, 1.65; P = .003) compared to the Mid-Low Commitment Profile.

CLINICAL RELEVANCE

Findings identified potential psychosocial aspects of the workplace that can be considered to support more desirable organizational-commitment profiles that are likely to lead to favorable outcomes for veterinary practices and their employees.

Companion animal veterinarians discuss aspects of one health with pet owners during most veterinary appointments

OBJECTIVE

To examine the prevalence and context of one-health conversations between veterinarians and clients in companion animal practice.

SAMPLE

A random selection of 60 companion animal veterinarians; a convenience sample of 917 interactions from Southern Ontario, Canada. Of these, 100 audio-video-recorded interactions including 47 of 60 veterinarians were randomly selected for inclusion in this study.

METHODS

Audio-video recordings were made of veterinarian-client-patient interactions between November 2017 and January 2019. A researcher-generated coding framework was developed and used to assess the prevalence and content of one-health topics communicated during veterinary appointments.

RESULTS

Of the interactions assessed, 60 were preventive care and 40 were health problem appointments. Further, 78% (78/100) included at least 1 discussion related to one health. One-health topics included zoonoses (28% [28/100]), animal behavior (25% [25/100]), illness/disease (20% [20/100]), activity level/exercise (16% [16/100]), nutrition (16% [16/100]), dentistry (6% [6/100]), body weight (3% [3/100]), animal welfare (3% [3/100]), dog/cat bites (2% [2/100]), cannabis (2% [2/100]), and aging (1% [1/100]). Zoonotic diseases were mentioned in 65 appointments, 28 of which evolved into a one-health discussion. Antibiotics were discussed in 27 appointments, none of which were discussed in relation to one health (eg, antimicrobial resistance).

CLINICAL RELEVANCE

Findings suggest that one-health topics are raised within most veterinary appointments. Opportunities exist for more comprehensive one-health conversations between veterinarians and their clients, particularly in relation to zoonotic diseases and antimicrobials.

On-site communication skills education increases client-centered communication in four companion animal practices

OBJECTIVE

To evaluate veterinarian-client communication before and after a 15-month on-site communication skills training intervention.

PROCEDURES

Multipractice, pretest-posttest intervention study.

SAMPLE

A convenience sample of 4 companion animal practices owned by a single practice group in Austin, Texas (n = 9 veterinarians; 170 audio recordings).

RESULTS

After intervention, visits were 8 minutes longer (P = .005), and veterinarians' client-centered scores increased significantly (2.30 vs 2.72; P = .006). Veterinarians' biomedical questions decreased by nearly a third (P = .0007), while veterinarians' facilitation (ie, partnership-building) statements were 1.15 times as great (P = .04) after intervention due to an increase in asking for the client's opinion (P = .03) and use of back-channel statements (P = .01). Agenda-setting skills, including agenda-setting questions (P = .009), summary of the client's agenda (P = < .0001), and a check for remaining concerns (P = .013), increased significantly after intervention. Clients asked 1.9 times as many lifestyle-social related questions (P = .02) and provided 1.3 times as much lifestyle-social information (P = .0004) after the intervention. Additionally, clients offered 1.4 times as many emotion-handling statements (P = .0001), including showing concern (P = .03) and optimism, reassurance, or encouragement (P < .0001), after intervention. Paraverbally, clients presented as more anxious/nervous (P = .03) and emotionally distressed/upset (P = .02) after the intervention.

CLINICAL RELEVANCE

Results suggest that client-centered communication skills increased after intervention. This study builds upon previous case-based studies examining practice-based communication training, emphasizing that long-term interventions positively enhance veterinarian-client communication, which is likely to have a positive impact on client and patient care.

Veterinary technicians contribute to shared decision-making during companion animal veterinary appointments

OBJECTIVE

To describe and compare veterinary professionals' use of shared decision-making during companion animal appointments.

DESIGN

Multi-practice cross-sectional study.

SAMPLE

A purposive sample of 4 companion animal veterinary clinics in a group practice in Texas.

PROCEDURES

A convenience sample of veterinary appointments were recorded January to March 2018 and audio-recordings were analyzed using the Observer OPTION5 instrument to assess shared decision-making. Each decision was categorized by veterinary professional involvement.

RESULTS

A total of 76/85 (89%) appointments included at least 1 decision between the client and veterinary professional(s), with a total of 129 shared decisions. Decisions that involved both a veterinary technician and veterinarian scored significantly higher for elements of shared decision-making (OPTION5 = 29.5 ± 8.4; n = 46), than veterinarian-only decisions (OPTION5 = 25.4 ± 11.50; P = .040; n = 63), and veterinary technician-only decisions (OPTION5 = 22.5 ± 7.15; P = .001; n = 20). Specific elements of shared decision-making that differed significantly based on veterinary professional involvement included educating the client about options (OPTION5 Item 3; P = .0041) and integrating the client's preference (OPTION5 Item 5; P = .0010).

CLINICAL RELEVANCE

Findings suggest that clients are more involved in decision making related to their pet's health care when both the veterinary technician and veterinarian communicate with the client. Veterinary technicians' communication significantly enhanced client engagement in decision-making when working collaboratively with the veterinarian.

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

OBJECTIVE

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

SAMPLES

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

PROCEDURES

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

RESULTS

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

CLINICAL RELEVANCE

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

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

Objective

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

Sample

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

Procedures

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

Results

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

Clinical Relevance

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

Pet owners’ and companion animal veterinarians’ perceptions of weight-related veterinarian-client communication

OBJECTIVE

To compare pet owners’ and veterinarians’ perceptions of veterinarian-client conversations concerning pet weight and identify challenges related to communication about weight.

SAMPLE POPULATION

Veterinarians (n = 24) and pet owners (27) in southern Ontario, Canada.

PROCEDURES

3 veterinarian and 5 pet owner focus groups were conducted with a semistructured interview format. Thematic analysis of verbatim transcripts was conducted.

RESULTS

Pet owners valued weight as an important health indicator for pets yet did not expect to discuss weight extensively at every appointment. Owners expected veterinarians to provide options and tailor recommendations when discussing weight management. Owners appeared more concerned with underweight animals, whereas veterinarians focused on obese animals. Veterinarians identified communication challenges, including the perception that owners are uninterested in discussing weight and conversations can become adversarial. Veterinarians reported various benefits and challenges of using humor to address pet weight and emphasized that weight-related conversations often depend on the existing veterinarian-client relationship.

CLINICAL RELEVANCE

Some perceptions of pet owner expectations expressed by veterinarians in this study align with owner preferences, yet several opportunities exist for changes to veterinarians’ approaches to weight-related communication with clients.

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

OBJECTIVE

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

SAMPLE

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

PROCEDURES

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

RESULTS

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

CLINICAL RELEVANCE

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

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

OBJECTIVE

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

SAMPLE

Class cohort of veterinary students at Colorado State University.

PROCEDURES

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

RESULTS

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

CLINICAL RELEVANCE

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

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.

Risk factors affecting length of stay of cats in an animal shelter: A case study at the Guelph Humane Society, 2011-2016

There is a strong need for animal shelters to determine strategies to decrease the incidence of healthy animals being euthanized due to a lack of space. Thus, the Capacity for Care program was implemented at the Guelph Humane Society during August 2014. One objective of the Capacity for Care program is to decrease length of stay of cats within the shelter to improve individual welfare and increase the number of successful adoptions. The current study uses data collected from the Guelph Humane Society between 2011 and 2016. A Cox proportional hazards regression model was used to determine factors affecting a cat's time-to-adoption (length of stay). Cats' length of stay decreased by 24% after the implementation of the Capacity for Care program (p<0.001). Exotic breeds were found to have a length of stay 64% shorter than domestic shorthairs (p<0.01), while males had a length of stay 20% shorter than females (p<0.001). Adult cats' length of stay was 13% shorter than kittens (p≤0.01), which is expected as a result of calculating length of stay from date of admission rather than date available for adoption. This study provides evidence that the Capacity for Care program is associated with a reduced length of stay for cats; suggesting it is a suitable program to improve cat welfare and address cat overpopulation.

Use of EEG digital filtering and display for HPNS diagnosis

Divers show symptoms of a condition known as the high pressure nervous syndrome (HPNS) at depths greater than about 180 m. A symptom that possibly lends itself to an objective diagnosis is a change in the frequency content of the EEG signal with increased slow wave (theta, 4-8 Hz) and decreased fast wave (alpha, 8-13 Hz) activity. Therefore, a method was developed, first, to obtain the power in the EEG frequency bands by digital filtering and, second, to display band-indices and ratios during a dive, in a format suitable for rapid appraisal. The formulas for the cascaded 2nd order Butterworth bandpass filters are given together with the corresponding FORTRAN program. EEG signals from 3 subjects taped during the Duke University Atlantis IV dive to a depth of 650 m were analyzed and displayed by the above method as well as by a Fast Fourier Transfer signal analyzer. The results suggest the theta: alpha ratio, which is a one-parameter EEG evaluation in the frequency domain, is a valuable descriptor for the objective HPNS diagnosis.