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

Leandra J. Nogueira BordenDepartment of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Cindy L. AdamsDepartment of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Brenda N. BonnettDepartment of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Jane R. ShawArgus Institute, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80525.

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Carl S. RibbleDepartment of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Abstract

Objective—To characterize veterinarian-client communication with undisclosed standardized clients (USCs) during discussions regarding euthanasia of a pet.

Design—Descriptive study.

Sample Population—32 companion animal veterinarians (16 males and 16 females) in southern Ontario.

Procedures—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.

Results—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.

Conclusions and Clinical Relevance—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.

Abstract

Objective—To characterize veterinarian-client communication with undisclosed standardized clients (USCs) during discussions regarding euthanasia of a pet.

Design—Descriptive study.

Sample Population—32 companion animal veterinarians (16 males and 16 females) in southern Ontario.

Procedures—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.

Results—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.

Conclusions and Clinical Relevance—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.

Contributor Notes

Dr. Adam's present address is Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.

Dr. Ribble's present address is Department of Ecosystem & Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.

Supported by grants from the Ontario Veterinary College Pet Trust Fund, the Ontario Veterinary College MSc Fellowship Program, and Bioniche Animal Health Canada Incorporated.

Presented at the International Conference on Communication in Healthcare, Basel, Belgium, September 2006, and Charleston, SC, October 2007; and at the International Conference on Communication in Veterinary Medicine, Washington, DC, July 2007, and Banff, AB, Canada, November 2008.

The authors thank Samantha Jewel, Johnny Letvenuk, and Tony Fieder for acting as standardized clients; Lynda Ladner for assistance with case development and standardized client training

Dr. Bridget Ryan at the Centre for Studies in Family Medicine, The University of Western Ontario, London, ON, Canada for training in the measure of patient-centered communication

Dr. William Sears at the University of Guelph, Guelph, ON, Canada for statistical consultation.

Address correspondence to Dr. Adams (cadams@ucalgary.ca).