Conversation Analysis of Clients' Active Resistance to Veterinarians' Proposals for Long-Term Dietary Change in Companion Animal Practice in Ontario, Canada

The impact of nutrition on animal health requires effective diet-related treatment recommendations in veterinary medicine. Despite low reported rates of veterinary clients' adherence with dietary recommendations, little is known about how clients' resistance to nutritional proposals is managed in the talk of veterinary consultations. This conversation-analytic study investigated clients' active resistance to veterinarians' proposals for long-term changes to cats' and dogs' diets in 23 segments from 21 videotaped appointments in Ontario, Canada. Clients' accounts suggested the proposals themselves or nutritional modifications were unnecessary, inappropriate, or unfeasible, most often based on patients' food preferences, multi-pet feeding issues, current use of equivalent strategies, or current enactment of the proposed changes. Resistance arose when veterinarians constructed proposals without first gathering relevant diet- and patient-related information, soliciting clients' perspectives, or educating them about the benefits of recommended changes. Veterinarians subsequently accommodated clients' concerns more often when resistance involved patient- or client-related issues rather than clients' lack of medical knowledge. The design of subsequent proposals accepted by clients frequently replaced dietary changes in the initial proposals with nutritional or non-nutritional alternatives and oriented to uncertainty about adherence. This study provides evidence-based findings for developing effective communication training and practice guidelines in nutritional assessment and shared decision-making.

Authority in therapeutic interaction: A conversation analytic study

A paradigmatic shift toward postmodern, collaborative practice in family therapy raises questions about how therapists can use professional authority to facilitate change and how clients can assert their knowledge and agency. We used conversation analysis to investigate how the authority to know and to determine here-and-now action (i.e., who does what, and how, in therapy) was negotiated and accomplished in 10 sessions of emotion-focused therapy involving chair work. Therapists were observed to rely on a particular interactional sequence structure: stepwise entry into a directive, in which directives were preceded by a question-answer sequence. We show how instances where clients' views were elicited prior to the delivery of a directive resulted in different interactional consequences from instances where therapists straightforwardly directed clients to perform some action. The study offers evidence concerning how therapists can facilitate chair work collaboratively and responsively.

Patient Simulations Improve Dietetics Students' and Interns' Communication and Nutrition-Care Competence

OBJECTIVE

To investigate the impact of simulated patients on dietetics students' and interns' communication and nutrition-care competence.

DESIGN

Pre-post observational study in which students' communication and nutrition-care competence was evaluated during the first and final clinical nutrition simulations in winter, 2017.

SETTING

University of Guelph, Canada.

PARTICIPANTS

Seventeen undergraduate students enrolled in Applied Clinical Skills (NUTR*4120) and 15 graduate students/interns enrolled in Practicum in Applied Nutrition II (FRAN*6720).

VARIABLES MEASURED

Selected communication and nutrition-care performance indicators (PI) (undergraduates = 18; graduate = 33) included in the Canadian Integrated Competencies for Dietetic Education and Practice, each measured out of a maximum of 3 points.

ANALYSIS

Grand means of communication and nutrition-care PI scores were compared across 2 time points using paired t tests, at a significance level of .05.

RESULTS

Undergraduates' (n = 15) communication and nutrition-care PI scores increased by 0.9 ± 0.35 (49.7%) and 0.8 ± 0.22 (45.8%) points, respectively (both P < .001). Graduate students' communication and nutrition-care PI scores increased by 0.4 ± 0.45 (18.5%) and 0.7 ± 0.59 (37.9%) points, respectively (both P < .01).

CONCLUSIONS AND IMPLICATIONS

Simulated patients incorporated into clinical nutrition courses increase dietetics students' and interns' communication and nutrition-care competence. More research using comprehensive practice-based competency assessment tools is needed in larger samples of students and interns.

Identification of Illness Uncertainty in Veterinary Oncology: Implications for Service

Uncertainty has been identified as the central psychological feature of illness experiences, necessitating a variety of coping strategies to effectively manage it and successfully adapt. The purpose of this qualitative study was to determine the expectations of veterinary clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer. The study consisted of 43 dog owners participating in 30 independent in-person single and dyadic interviews conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis (supplemented with content analysis) was performed on transcripts of the interview discussions. Uncertainty was inadvertently identified as a central theme of the clients' experience. The diagnosis of a serious, life-limiting cancer and its treatment appeared to move clients into a world of uncertainty, which affected their feelings, thoughts, behaviors, attitudes, and personal expectations in relation to their dog, and their expectations of the oncology service. With uncertainty appraised mostly as a danger, clients appeared to employ multiple coping strategies to reduce uncertainty in the effort to adapt to the new reality of living with and caring for a dog with cancer. The need to manage uncertainty influenced their expectations of the service, specifically for information, ongoing relationships, 24-h access, and timely care. Our findings have implications for the delivery of specialty oncology services and for client welfare. When working with owners of dogs with life-limiting cancer, results suggest health care providers can facilitate the management of uncertainty to enhance clients' psychological well-being, thereby supporting clients' successful adaptation to the cancer experience.

Conversation Analysis of Veterinarians' Proposals for Long-Term Dietary Change in Companion Animal Practice in Ontario, Canada

Nutritional changes recommended by veterinarians to clients can have a major role in animal-patient health. Although there is literature on best practices that can inform veterinary communication training, little is known specifically about how veterinarians communicate their recommendations to clients in real-life interactions. This study used the qualitative research method of conversation analysis to investigate the form and content of veterinarian-initiated proposals for long-term dietary change in canine and feline patients to further inform veterinary communication training. We analyzed the characteristics and design of veterinarian-initiated proposals for long-term nutritional modification as well as the appointment phases during which they occurred, in a subsample of 42 videotaped segments drawn from 35 companion animal appointments in eastern Ontario, Canada. Analyses indicated that veterinarians initiated proposals at various points during the consultations rather than as a predictable part of treatment planning at the end. While some proposals were worded strongly (e.g., "She should be on…"), most proposals avoided the presumption that dietary change would inevitably occur. Such proposals described dietary items as options (e.g., "There are also special diets…") or used mitigating language (e.g., "you may want to try…"). These findings seem to reflect delicate veterinarian-client dynamics associated with dietary advice-giving in veterinary medicine that can impact adherence and limit shared decision-making. Our analyses offer guidance for communication training in veterinary education related to dietary treatment decision-making.

Discourses on Discourse: Theorizing Woman in Psychology

Tseëlon presents an ambitious analysis of gender display that draws upon historical, empirical, psychoanalytic and cultural studies approaches. WiLkinson and Kitzinger offer discussions of empirical work (e.g. on sexual harassment) and considerations of discourse analysis as theory and method. The works address and exemplify the tensions between language as discourse and as situated utterance, and between relativism and commitment to political change. Reflexivity and the status of the extra-discursive emerge as central issues in the dialogue between postmodernist feminist psychology and discourse analysis.

Disclosure as Discourse

Conventional frameworks conceptualizing children's disclosures of sexual abuse are helpful in drawing links between the dynamics of abuse and its subsequent reporting (e.g. Summit, 1983) and in articulating developmental impediments to disclosure (e.g. Bussey & Grimbeek, 1995). But these models underemphasize the discursive (and, hence, social) basis of children's reports in that patterns of disclosure are depicted as individualistic phenomena. This article proposes a discursive reformulation of children's reports of sexual abuse. The concept of co-construction is applied to the research traditions of conversation analysis (e.g. Nofsinger, 1991), the discourse action model (Edwards & Potter, 1992), narrative analysis (e.g. Bruner, 1991), positioning theory (e.g. Harré & van Langenhove, 1992) and cultural discourses (e.g. Burman, 1995) to theorize children's reports of sexual abuse as socially situated collaborations. The implications of a discursive approach for concerns of power and social justice are discussed.

Effect of question design on dietary information solicited during veterinarian-client interactions in companion animal practice in Ontario, Canada

OBJECTIVE

To establish the types of initial questions used by veterinarians in companion animal practice to solicit nutritional history information from owners of dogs and cats, the dietary information elicited, and the relationship between initial question-answer sequences and later nutrition-related questions.

DESIGN

Cross-sectional qualitative conversation analytic study.

SAMPLE

98 appointments featuring 15 veterinarians drawn from an observational study of 284 videotaped veterinarian-client-patient visits involving 17 veterinarians in companion animal practices in eastern Ontario, Canada.

PROCEDURES

Veterinarian and client talk related to patient nutrition was identified and transcribed; conversation analysis was then used to examine the orderly design and details of talk within and across turns. Nutrition-related discussions occurred in 172 visits, 98 of which contained veterinarian-initiated question-answer sequences about patient nutritional history (99 sequences in total, with 2 sequences in 1 visit).

RESULTS

The predominant question format used by veterinarians was a what-prefaced question asking about the current content of the patient's diet (75/99). Overall, 63 appointments involved a single what-prefaced question in the first turn of nutrition talk by the veterinarian (64 sequences in total). Dietary information in client responses was typically restricted to the brand name, the subtype (eg, kitten), or the brand name and subtype of a single food item. When additional diet questions were subsequently posed, they typically sought only clarification about the food item previously mentioned by the client.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that question design can influence the accuracy and completeness of a nutritional history. These findings can potentially provide important evidence-based guidance for communication training in nutritional assessment techniques.

Factors influencing veterinarian referral to oncology specialists for treatment of dogs with lymphoma and osteosarcoma in Ontario, Canada

OBJECTIVE

To elucidate factors influencing practitioner decisions to refer dogs with cancer to veterinary oncology specialists.

DESIGN

Cross-sectional study.

SAMPLE

2,724 Ontario primary care companion animal veterinarians.

PROCEDURES

Practitioners were invited to participate in a survey involving clinical scenarios of canine cancer patients, offered online and in paper format from October 2010 through January 2011. Analyses identified factors associated with the decision to refer patients to veterinary oncology specialists.

RESULTS

1,071 (39.3%) veterinarians responded, of which 603 (56.3%) recommended referral for dogs with multicentric lymphoma and appendicular osteosarcoma. Most (893/1,059 [84.3%]) practiced within < 2 hours' drive of a specialty referral center, and most (981/1,047 [93.7%]) were completely confident in the oncology service. Few (230/1,056 [21.8%] to 349/1,056 [33.0%]) were experienced with use of chemotherapeutics, whereas more (627/1,051 [59.7%]) were experienced with amputation. Referral was associated with practitioner perception of patient health status (OR, 1.54; 95% confidence interval [CI], 1.15 to 2.07), the interaction between the client's bond with the dog and the client's financial status, practitioner experience with treating cancer (OR, 2.79; 95% CI, 1.63 to 4.77), how worthwhile practitioners considered treatment to be (OR, 1.66 to 3.09; 95% CI, 1.08 to 4.72), and confidence in the referral center (OR, 2.20; 95% CI, 1. 11 to 4.34).

CONCLUSIONS AND CLINICAL RELEVANCE

Several factors influenced practitioner decisions to refer dogs with lymphoma or osteosarcoma for specialty care. Understanding factors that influence these decisions may enable practitioners to appraise their referral decisions and ensure they act in the best interests of patients, clients, and the veterinary profession.

The rhetoric of experimental social psychology, 1930-1960: from caution to enthusiasm

Between 1930 and 1960, experimentation became the premier form of knowledge generation in social psychology. In journals, texts, and handbooks, experiment was now conceived as the active manipulation of an independent variable, and the sole method for the discovery of "causes." Understanding this change requires further investigation of the fine-grained discursive strategies used to promote experimentation during the 1930s and 1940s. In this paper we use discourse analysis to contrast the cautious rhetoric used by Gardner Murphy and Lois Murphy and the more enthusiastic, unhedged arguments for experimentation employed by Kurt Lewin. We argue that analysis of changes in discourse justifying experimentation can illuminate the processes by which methodological consensus was constructed.