Veterinarian-client Communication Research Articles

Flemish equine veterinarians' perceptions on the use of and client communication about complementary and alternative veterinary medicine.

Complementary and alternative veterinary medicine (CAVM) is increasingly popular in horses. As CAVM usage could have risks, client-veterinarian communication about CAVM is crucial. Evaluating equine veterinarians' attitude towards CAVM, their CAVM usage and veterinarian-client communication about CAVM. Cross-sectional study. A telephone survey was conducted among equine veterinarians providing ambulatory care on a daily or weekly basis. The first section of the survey included questions about the veterinarians' attitude towards CAVM and their CAVM usage. The second section focused on veterinary-client communication about CAVM. When herbs are included as CAVM modality, 83% of the participants applied CAVM. Nighty-eight percent had already communicated with horse owners about CAVM and 81% agreed to be open to talk about CAVM. However, 95% agreed that sometimes CAVM usage takes place without disclosure to the veterinarian. The majority of participants communicated about CAVM on a weekly (40%) or daily (22%) basis, most often in person during consultations (99%) or via phone (32%). The median percentage of conversations about CAVM initiated by the owner was 50% (range 50%-80%). When the veterinarian initiated the conversation, this was usually by mentioning it as a treatment option, mostly in addition to conventional treatments. Some participants directly asked about CAVM use in the information-gathering phase. A convenience sample was used due to lack of data on the number of equine veterinarians in Flanders. Potential favourability bias with higher participation of veterinarians interested in CAVM. Equine veterinarians generally had a positive attitude towards CAVM use, although this depended on the specific modality. Veterinarian-client communication about CAVM occurs frequently in ambulatory care. An open dialogue with horse owners about CAVM is important to provide information about CAVM and thus enable them to make informed decisions concerning CAVM usage, together with their veterinarian.

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

To evaluate veterinarian-client communication before and after a 15-month on-site communication skills training intervention. Multipractice, pretest-posttest intervention study. A convenience sample of 4 companion animal practices owned by a single practice group in Austin, Texas (n = 9 veterinarians; 170 audio recordings). 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. 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.

O.37.5 - When it’s time to say goodbye: veterinarian-client communication during pet euthanasia: Presenter(s): Annelies Decloedt, Ghent University, Belgium

O.37.5 - When it’s time to say goodbye: veterinarian-client communication during pet euthanasia: Presenter(s): Annelies Decloedt, Ghent University, Belgium

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

To compare pet owners' and veterinarians' perceptions of veterinarian-client conversations concerning pet weight and identify challenges related to communication about weight. Veterinarians (n = 24) and pet owners (27) in southern Ontario, Canada. 3 veterinarian and 5 pet owner focus groups were conducted with a semistructured interview format. Thematic analysis of verbatim transcripts was conducted. 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. 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.

Question design in veterinary consultations: Question forms and client responses in accomplishing problem presentation in a Malaysian context

Question design by medical practitioners has been shown to have important consequences on how patients present their problems in clinical consultations. Linguistic structure of questions as part of question design implements different communicative and pragmatic functions, and hence, affects patients’ response in different ways. This study examined types of questions asked by veterinarians in the problem presentation phase of the clinical consultation in relation to their linguistic forms and functions. Veterinary illness consultations were video-recorded and veterinarians’ question types, their linguistic forms and clients’ response in the interaction were identified and examined. The results show that the general inquiry question implemented using the open-ended wh-question structure and the closed-ended declarative interrogative are the preferred forms used by veterinarians to solicit patients’ presenting problems from clients. Also, alignment of the linguistic form of questions with their pragmatic functions and the discourse goal of problem presentation affects clients’ ascription of veterinarians’ actions. The findings from the study can inform veterinarian communication training for more effective veterinarian-client communication to accomplish problem presentation in clinical consultations.

New York State dairy veterinarians’ perceptions of antibiotic use and resistance: A qualitative interview study

Antimicrobial resistance (AMR) limits the ability to prevent and treat infection, making AMR one of the foremost threats to human and animal health. Animal agriculture’s large use of antibiotics in food animals is an important factor in AMR. As such, policies to reduce antibiotic use and combat AMR in animal agriculture in the United States (US) have been in place or are developed. One key to the success of these policies in the US is understanding how a major stakeholder - veterinarians treating dairy cattle - perceive the scale of antibiotic use, the threat of AMR and the utility of antibiotic use policies. We interviewed 9 dairy veterinarians in New York State and conducted an iterative thematic analysis of their responses, through which five themes were identified: 1. veterinarians’ views of the frequency and reasons for antibiotic misuse, 2. their ideas on reducing antibiotic use, 3. perceptions of AMR within the dairy industry, 4. view of organic farming and how it relates to animal welfare, and 5. the impact of consumers’ beliefs on the dairy industry. Participants viewed antibiotic overuse as largely due to farmers’ concern for the welfare of their cattle and desire to treat ailments swiftly. Interviewees believed that it was possible to reduce antibiotic use through regulation, such as the Veterinary Feed Directive and improved herd management activities, such as better colostrum management, culture-based mastitis treatment, and improved housing conditions. They did not view the dairy industry as a significant contributor to AMR, particularly when compared to the human medical industry. Interviewees also offered their (unsolicited) opinion on organic dairy farming in the US and expressed frustration with the limited treatment options available in organic dairy farming and how this dynamic may potentially compromise animal welfare. Finally, they commented on the impact of consumers’ beliefs on the dairy industry, expressing frustration with how misinformation about the dairy industry has led to consumer driven changes. As consumer beliefs have an impact on the dairy industry, this influence could be leveraged to further decrease antibiotic use. These findings can help guide future efforts in veterinarian-client communication and the development and implementation of effective policies in New York State. These results also highlight the need for more quantitative research on antibiotic use in the dairy industry, as without this data it will be difficult to ascertain the true impact of policy interventions.

Horse owners' attitudes towards and motivators for using complementary and alternative veterinary medicine.

Complementary and alternative veterinary medicine (CAVM) is becoming increasingly popular in horses. Online, cross-sectional survey in 1532 horse owners. Attitude towards CAVM, subjective norms, perceived behavioural control and intention for future CAVM use were measured based on the theory of planned behaviour. Structural equation modelling was performed to characterize factors influencing intention to use CAVM. Past use of CAVM, predominantly manual therapies and herbal supplements, was reported by 72.5% of all participants. Frequently reported indications were improving horse's well-being, illness which did not resolve after conventional treatment and chronic illness. The attitude towards CAVM was positive with a median (interquartile range) score of 6 of 7 (4.75-7.00). Predictors for past CAVM use were higher owner age, alternative medicine self-use and higher education (non-university). The strongest predictor of future CAVM usage was perceived behavioural control and perceived CAVM efficacy, as well as positive attitude towards and perceived knowledge about CAVM. The veterinarian was reported as a source of information about CAVM by 86.4% of all participants. Horse owners showed a high intention to use CAVM with the owners' perceived behavioural control and perceived CAVM efficacy as the strongest predictor. Veterinarian-client communication is important to inform horse owners correctly.

Short communication: Describing mortality and euthanasia practices on Canadian dairy farms

The objective of this study was to describe mortality rates and euthanasia practices used for cows, heifer calves, and male dairy calves on Canadian dairy farms. An internet survey was administered to Canadian dairy producers between March and April 2015 to collect information on current management practices. Approximately 81% (867/1,076) and 63% (673/1,065) of respondents reported that at least one animal died unassisted and at least one animal was euthanized on the farm in the preceding 12-mo period, respectively. Overall, mean mortality was 8% for cows, and 6 and 2% for preweaning and weaned heifers, respectively. On average, 48, 76, and 89% of all reported mortality events in cows, weaned heifers, and preweaning heifers were recorded as unassisted deaths. Cows that died without assistance were necropsied more often than preweaning heifers dying without assistance; these cows were also necropsied more than cows that were euthanized. Conversely, preweaning heifers that were euthanized were necropsied more frequently than those that died without assistance. Choosing not to perform necropsies on animals that die of unknown causes could represent a missed opportunity to identify cause of death and inform changes to prevent future deaths. The use of a firearm was the most common method for euthanizing cows and heifers (54%) and male dairy calves (51%). Approximately 7% of respondents reported using blunt force to euthanize animals. The use of this method was much higher for euthanasia of male dairy calves (34%) than for heifer calves (7%). Québec respondents euthanized their animals using blunt force more often than farmers from other regions. Further, 53% of respondents using blunt force indicated it was their primary method of calf euthanasia; these results are extremely concerning. Approximately 31% of respondents who reported that they do not use blunt force to euthanize heifers and cows did report using blunt force to euthanize male dairy calves. These results can be used to inform veterinarian-client communication, broader extension tools and programs, and industry policies to improve dairy cattle health and welfare, a goal that is becoming of increasing importance from a consumer assurance perspective.

Predicting caregiver burden in general veterinary clients: Contribution of companion animal clinical signs and problem behaviors

Caregiver burden, found in many clients with a chronically or terminally ill companion animal, has been linked to poorer psychosocial function in the client and greater utilization of non-billable veterinary services. To reduce client caregiver burden, its determinants must first be identified. This study examined if companion animal clinical signs and problem behaviors predict veterinary client burden within broader client- and patient-based risk factor models. Data were collected in two phases. Phase 1 included 238 companion animal owners, including those with a sick companion animal (n=119) and matched healthy controls (n=119) recruited online. Phase 2 was comprised of 602 small animal general veterinary hospital clients (n=95 with a sick dog or cat). Participants completed cross-sectional online assessments of caregiver burden, psychosocial resources (social support, active coping, self-mastery), and an item pool of companion animal clinical signs and problem behaviors.Several signs/behaviors correlated with burden, most prominently: weakness, appearing sad/depressed or anxious, appearing to have pain/discomfort, change in personality, frequent urination, and excessive sleeping/lethargy. Within patient-based risk factors, caregiver burden was predicted by frequency of the companion animal’s signs/behaviors (P<.01). Within client-based factors, potentially modifiable factors of client reaction to the animal’s signs/behaviors (P=.01), and client sense of control (P<.04) predicted burden. Understanding burden may enhance veterinarian-client communication, and is important due to potential downstream effects of client burden, such as higher workload for the veterinarian. Supporting the client’s sense of control may help alleviate burden when amelioration of the companion animal’s presentation is not feasible.

Oral-Fluid Thiol-Detection Test Identifies Underlying Active Periodontal Disease Not Detected by the Visual Awake Examination.

Periodontal disease in dogs is highly prevalent but can only be accurately diagnosed by performing an anesthetized oral examination with periodontal probing and dental radiography. In this study, 114 dogs had a visual awake examination of the oral cavity and were administered an oral-fluid thiol-detection test prior to undergoing a a full-mouth anesthetized oral examination and digital dental radiographs. The results show the visual awake examination underestimated the presence and severity of active periodontal disease. The thiol-detection test was superior to the visual awake examination at detecting the presence and severity of active periodontal disease and was an indicator of progression toward alveolar bone loss. The thiol-detection test detected active periodontal disease at early stages of development, before any visual cues were present, indicating the need for intervention to prevent periodontal bone loss. Early detection is important because without intervention, dogs with gingivitis (active periodontal disease) progress to irreversible periodontal bone loss (stage 2+). As suggested in the current AAHA guidelines, a thiol-detection test administered in conjunction with the visual awake examination during routine wellness examinations facilitates veterinarian-client communication and mitigates under-diagnosis of periodontal disease and underutilization of dental services. The thiol-detection test can be used to monitor the periodontal health status of the conscious patient during follow-up examinations based on disease severity.

Survey of owner motivations and veterinary input of owners feeding diets containing raw animal products.

BackgroundThe practice of feeding of diets containing raw animal products (RAP) to pets (dogs and cats) is discouraged by veterinary organizations and governmental public health organizations. Nevertheless, the practice of feeding RAP to pets is increasing in popularity. Pet owner motivations for feeding RAP diets to pets have not been explored and the benefits of RAP diets remain largely anecdotal. We hypothesized that pet owners feeding RAP diets would not rely on veterinary advice in choosing their pet’s diet. We also hypothesized that these owners would have lower levels of trust in veterinary advice with respect to nutrition relative to pet owners not feeding RAP.MethodsAn anonymous web-based survey was developed to identify pet owner motivations for feeding RAP diets, and to characterize the veterinarian-client relationships of individuals feeding RAP diets.ResultsThere were 2,337 respondents and 2,171 completed surveys. Of survey respondents, 804 reported feeding RAP at the time of the survey. While 20% of pet owners feeding RAP relied on online resources to determine what or how much RAP to feed, only 9% reported consulting with a veterinarian in making decisions about feeding RAP. Pet owners feeding RAP reported lower levels of trust in veterinary advice both ‘in general’ and ‘with respect to nutrition’ than pet owners not feeding RAP. Most pet owners reported that a discussion regarding their pet’s nutrition does not occur at every veterinary appointment.DiscussionPet owners feeding a RAP diet have lower trust in veterinary advice than pet owners not feeding a RAP diet. Owners feeding RAP are more reliant on online resources than their own veterinarian in deciding what and how much RAP to feed. Pet owners perceive that nutrition is not discussed at most veterinary appointments. Therefore, there is room for improvement in the veterinarian-client communication with regards to nutrition.

Clients and Veterinarians as Partners in Problem Solving during Cancer Management: Implications for Veterinary Education.

This research explores client satisfaction with veterinarian interactions and support during cancer management. Ninety-four members of the online Pet Cancer Support group completed the electronic communication and support questionnaire. Results show that 77% of respondents (n=72) are satisfied with their veterinarian; 71% (n=67) are satisfied with the information their veterinarian provides about treatment options; and 70% percent (n=66) are satisfied with the support they receive from their veterinarian. Strong, positive correlations exist between level of satisfaction and information about treatment options (rs=.795, n=91, p<.001) and between level of satisfaction and support received from the veterinarian (rs=.759, n=90, p<.001). Problem-focused informational support and tangible support dominated clients' descriptions of support and affected their support satisfaction. Emotion-focused support was not as important, and in some cases was not expected of the veterinarian. Results suggested that clients' overall satisfaction with their veterinarian is related to their satisfaction with information about treatment options and satisfaction with the support the veterinarian provides. By providing problem-focused support, veterinarians can empower clients and enhance their sense of control, thus positively affecting satisfaction and the likelihood of a long-lasting relationship. Taken together, these findings have implications for our understanding of veterinarian-client communication related to relationship-centered care and client empowerment, as well as implications for veterinary medical education and communication curricula.

Veterinarian-Client Communication Skills: Current State, Relevance, and Opportunities for Improvement.

Communication is increasingly recognized as a core skill for veterinary practitioners, and in recent years, attention to communication competency and skills training has increased. To gain an up-to-date assessment of the current state of veterinary communication skills and training, we conducted a survey among veterinary practitioners in the United Kingdom and United States in 2012/2013. The questionnaire was used to assess the current state, relevance, and adequacy of veterinary communication skills among veterinary practitioners, to assess interest in further training, and to understand perceived challenges in communicating with clients. There was an overall response rate of 29.6% (1,774 of 6,000 recipients), with a higher response rate for UK-based practitioners (39.7%) than practitioners in the US (19.5%). Ninety-eight percent of respondents agreed that communication skills were as important as or more important than clinical knowledge. Forty-one percent of respondents had received formal veterinary communication skills training during veterinary school, and 47% had received training post-graduation. Thirty-five percent said their veterinary communication skills training during veterinary school prepared them well or very well for communicating with clients about the health of their pets, compared to 61% of those receiving post-graduate training. Forty percent said they would be interested in further veterinary communication skills training, with the preferred methods being simulated consultations and online training. While there has been increased emphasis on communication skills training during and after veterinary school, there is a need for more relevant and accessible training.

Use of the measure of patient-centered communication to analyze euthanasia discussions in companion animal practice

To characterize veterinarian-client communication with undisclosed standardized clients (USCs) during discussions regarding euthanasia of a pet. Descriptive study. 32 companion animal veterinarians (16 males and 16 females) in southern Ontario. During 2 clinic visits, 2 cases (a geriatric dog with worsening arthritis and a cat with inappropriate urination) designed to stimulate discussion regarding euthanasia of a pet were presented by different USCs (individuals trained to consistently present a particular case to veterinarians without disclosing their identity). Discussions were audio recorded and analyzed by use of the measure of patient-centered communication (MPCC [a tool to assess and score physician communication behaviors]). Veterinarian and client statements were classified by means of 3 patient-centered components: exploring both the disease and the illness experience, understanding the whole person, and finding common ground. 60 usable recorded discussions were obtained (31 veterinarians; 30 discussions/case). Overall, MPCC scores were significantly lower for the geriatric dog case. For both cases, veterinarians scored highest on finding common ground and lowest on exploring both the disease and the illness experience. Lack of exploration of client feelings, ideas, and expectations and the effect of the illness on the animal's function resulted in low scores among veterinarians. Results indicated that the use of USCs and the MPCC are feasible methods for analysis of veterinarian-client communication during companion animal euthanasia discussions. Findings suggested that some veterinarians do not fully explore client concerns or facilitate client involvement in euthanasia decision making.

A focus group study of veterinarians' and pet owners' perceptions of veterinarian-client communication in companion animal practice

To compare veterinarians' and pet owners' perceptions of client expectations with respect to veterinarian-client communication and to identify related barriers and challenges to communication. Qualitative study based on focus group interviews. 6 pet owner focus groups (32 owners) and 4 veterinarian focus groups (24 companion animal veterinarians). Independent focus group sessions were conducted with standardized open-ended questions and follow-up probes. Content analysis was performed on transcripts of the focus group discussions. Five themes related to veterinarian-client communication were identified: educating clients (ie, explaining important information, providing information up front, and providing information in various forms), providing choices (ie, providing pet owners with a range of options, being respectful of owners' decisions, and working in partnership with owners), using 2-way communication (ie, using language clients understand, listening to what clients have to say, and asking the right questions), breakdowns in communication that affected the client's experience (ie, owners feeling misinformed, that they had not been given all options, and that their concerns had not been heard), and challenges veterinarians encountered when communicating with clients (ie, monetary concerns, client misinformation, involvement of > 1 client, and time limitations). Results suggested that several factors are involved in providing effective veterinarian-client communication and that breakdowns in communication can have an adverse effect on the veterinarian-client relationship.

Laws and regulations concerning the confidentiality of veterinarian-client communication

Laws and regulations concerning the confidentiality of veterinarian-client communication