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

Debbie L. Stoewen DVM, MSW, PhD1, Jason B. Coe DVM, PhD2, Clare MacMartin PhD3, Elizabeth A. Stone DVM, MS, MPP, DACVS4, and Catherine E. Dewey DVM, PhD5
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  • 1 Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 2 Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 3 Ontario Veterinary College, and the College of Social and Applied Human Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 4 Office of the Dean, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 5 Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada.

Abstract

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.

Contributor Notes

Dr. Stoewen's present address is Pets Plus Us, Unit 2, 1115 N Service Rd W, Oakville, ON L6M 2V9, Canada.

Supported by a grant from the Ontario Veterinary College Pet Trust Fund and a stipend from the Dean's Office of the Ontario Veterinary College.

Presented at the Institute for Comparative Cancer Investigation Cancer Research Symposium, Guelph, ON, Canada, May 2012.

The authors thank William Sears for assistance with the statistical analysis.

Address correspondence to Dr. Stoewen (debbie.stoewen@petsplusus.com).