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Abstract
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.
Abstract
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.
Abstract
Objective—To explore the relationship between veterinarian-client-patient interactions and client adherence to dental and surgery recommendations and to test the a priori hypotheses that appointment-specific client satisfaction and relationship-centered care are positively associated with client adherence.
Design—Cross-sectional study.
Sample—A subsample of 19 companion-animal veterinarians and 83 clients from a larger observational study consisting of 20 randomly recruited veterinarians and a convenience sample of 350 clients from eastern Ontario.
Procedures—Videotaped veterinarian-client-patient interactions containing a dentistry recommendation, surgery recommendation, or both were selected for inclusion from the larger sample of interactions coded with the Roter interaction analysis system. Client adherence was measured by evaluating each patient's medical record approximately 6 months after the videotaped interaction. The clarity of the recommendation, appointment-specific client-satisfaction score, and relationship-centered care score were compared between adhering and nonadhering clients.
Results—Among the 83 veterinarian-client-patient interactions, 25 (30%) clients adhered to a dentistry recommendation, surgery recommendation, or both. The odds for adherence were 7 times as great for clients who received a clear recommendation, compared with clients who received an ambiguous recommendation from their veterinarian. Moreover, adhering clients were significantly more satisfied as measured after the interview. Interactions resulting in client adherence also had higher scores for relationship-centered care than did interactions leading to nonadherence.
Conclusions and Clinical Relevance—Veterinarian use of a relationship-centered care approach, characterized as a collaborative partnership between a veterinarian and a client with provision of clear recommendations and effective communication of the rationale for the recommendations, has positive implications for client adherence.
Abstract
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.
Abstract
OBJECTIVE
To explore pet owners’ use of information and communication technologies (ICTs) during virtual veterinarian-client-patient consultations and to examine pet owners’ attitudes toward virtual consultations.
SAMPLE
714 pet owners.
METHODS
In an anonymous online survey distributed using snowball sampling, all participants were asked about utilization of ICTs, preferred method of interaction (face-to-face and 5 ICTs), opinion on virtual communication, and demographics. Sentiment toward virtual veterinarian consultations was measured for participants who had experienced a “virtual only” or “combination virtual and face-to-face” consultation in the previous 6 months using the Net Promoter Score. For these participants, multivariable logistic regression was used to explore factors associated with recommending virtual consultations.
RESULTS
92% (583/632) of participants resided in Ontario, Canada. Most (85.6% [611/714]) participants had experience using the telephone for veterinary care, while only 5.2% (37/714) had used live videoconferencing. Participants ranked face-to-face interactions as most preferred (P < .001), followed by telephone and then live videoconferencing. Participants were significantly (P < .001) less confident communicating during virtual consultations, particularly for building rapport. For participants experiencing a virtual consultation in the previous 6 months (n = 348), the overall Net Promoter Score was neutral at –1.43. Participants were divided about recommending virtual consultations, with 33.3% (116/348) being promoters and 34.8% (121/348) being detractors. Age of participant and comfort using videoconferencing were positively associated (P < .05) with recommending virtual consultations.
CLINICAL RELEVANCE
Although participating pet owners significantly preferred face-to-face consultations with veterinarians, many appear willing to consider virtual consultations. Further exploration of pet owners’ preferences and concerns around virtual care, including communication, is needed.
Abstract
OBJECTIVE
To explore veterinarians’ use of virtual veterinarian-client-patient consultations before and during the coronavirus disease 2019 (COVID-19) pandemic and examine veterinarians’ attitudes toward virtual consultations.
SAMPLE
135 companion animal veterinarians in Canada, the US, and Europe.
METHODS
An anonymous online survey was distributed to gather participating veterinarians’ use of information and communication technologies and their perception of virtual consultations’ effect on patient care, client communication, and their own well-being. Willingness to recommend virtual consultations was evaluated using the Net Promoter Score. Multivariable logistic regression explored factors associated with willingness to recommend virtual consultations.
RESULTS
Percentage of participating veterinarians using the telephone and videoconferencing increased significantly (P < .001) from before (83.6% and 3.0%, respectively) to during the COVID-19 pandemic (97.0% and 22.4%, respectively). Participants were significantly less confident (P < .001) about their ability to reach a diagnosis using a virtual consultation as compared to a hands-on patient examination. Participants perceived client communication to be more challenging during virtual as compared to face-to-face consultations, particularly for building rapport and expressing empathy. Participants were extremely unwilling to recommend virtual consultations (Net Promoter Score = –41.4) with 21.6% (24/111) promoters and 63.1% (70/111) detractors. Confidence doing a virtual patient examination and comfort using videoconferencing technology were both positively associated (P < .05) with willingness to recommend virtual consultations.
CLINICAL RELEVANCE
Veterinary practices and organizations interested in encouraging virtual veterinarian-client-patient consultations likely need to prioritize veterinarians’ acceptance as an initial focus. The veterinary profession would benefit from further research and education to inform virtual veterinary care.
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.
Abstract
OBJECTIVE
To establish the components of a best-practice, baseline companion animal physical exam (CAPE).
SAMPLE
25 small animal veterinary internists and 20 small animal primary care veterinarians, all teaching the CAPE at veterinary colleges in the US, Canada, and Australia.
PROCEDURES
Using the Delphi Method of Consensus, 3 rounds of online questionnaires were sent to participants. The first round included demographic questions, questions about teaching the physical exam, and an open-ended question allowing participants to record details of how they conduct a CAPE. In the second round, participants were asked to rate components of the CAPE, which were derived from round 1, as “always examine,” “only examine as needed,” or “undecided.” Following round 2, any component not reaching 90% consensus (set a priori) for the response “always examine” was put forth in round 3, with a summary of comments from the round 2 participants for each remaining component.
RESULTS
35 components of a baseline CAPE were identified from round 1. The 25 components that reached 90% consensus by the end of round 3 were checking the oral cavity, nose, eyes, ears, heart, pulse rate, pulse quality, pulse synchrony, lungs, respiratory rate, lymph nodes, abdomen, weight, body condition score, mucous membranes, capillary refill time, general assessment, masses, haircoat, skin, hydration, penis and testicles or vulva, neck, limbs, and, in cats only, thyroid glands.
CLINICAL RELEVANCE
The findings establish an expert panel’s consensus on 25 components of a baseline, best-practice CAPE that can be used to help inform veterinary curricula, future research, and the practice of veterinarians.
Abstract
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.
Abstract
OBJECTIVE
To investigate the association of demographic, career, and lifestyle factors with resilience and the association of resilience with mental health outcomes in Canadian veterinarians.
SAMPLE
1,130 veterinarians in clinical practice across Canada.
PROCEDURES
An online questionnaire was used to collect participant data and included 5 validated psychometric scales to evaluate resilience (through the Connor-Davidson Resilience Scale [CD-RISC]), perceived stress (through the Perceived Stress Scale), emotional distress (through the Hospital Anxiety and Depression Scale), burnout (through the Maslach Burnout Inventory), and secondary traumatic stress (through the Professional Quality of Life Scale). A multivariable linear regression model was used to investigate associations between CD-RISC scores and demographic, career, and lifestyle characteristics. Univariable linear regression models were used to assess the relationship between resilience scores and other mental health outcomes.
RESULTS
The strongest positive association was between CD-RISC score and overall health. The level of satisfaction with support from friends and workplace resources had positive associations with the CD-RISC score. The presence of mental illness had the strongest negative association with the CD-RISC score. Being married, working in a small animal practice, or having an associate role were negatively associated with the CD-RISC score. The CD-RISC score had negative associations with scores for perceived stress, anxiety, depression, burnout, and secondary traumatic stress.
CONCLUSIONS AND CLINICAL RELEVANCE
Models provided evidence for the role of resilience in protecting against negative mental health outcomes in veterinarians. Both personal and workplace factors were associated with resilience, presenting opportunities for intervention at each of these levels.
