Search Results

You are looking at 11 - 20 of 35 items for

  • Author or Editor: Jason B. Coe x
  • Refine by Access: All Content x
Clear All Modify Search

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.

Full access
in Journal of the American Veterinary Medical Association

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.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To evaluate veterinarian-client communication before and after a 15-month on-site communication skills training intervention.

PROCEDURES

Multipractice, pretest-posttest intervention study.

SAMPLE

A convenience sample of 4 companion animal practices owned by a single practice group in Austin, Texas (n = 9 veterinarians; 170 audio recordings).

RESULTS

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.

CLINICAL RELEVANCE

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.

Full access
in Journal of the American Veterinary Medical Association

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.

Full access
in Journal of the American Veterinary Medical Association

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.

Free access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To classify a sample of veterinary professionals into distinct organizational-commitment profiles and to identify associations between psychosocial aspects of the workplace and organizational-commitment profile membership.

SAMPLE

487 veterinary employees who worked for a corporate veterinary organization in Canada.

METHODS

Survey components measured for this study included the Three-Component Model (TCM) Employee Commitment Survey–Revised, the Copenhagen Psychosocial Questionnaire, and participant demographics. First, latent profile analysis was used to identify distinct organizational-commitment profiles based on 3 components of commitment (affective, continuance, and normative). Next, the Mann-Whitney U test was used to compare participants’ intention to leave their hospital on the basis of organizational-commitment profile. Finally, logistic regression was performed to assess the association between perceived psychosocial workplace characteristics and organizational-commitment profile membership.

RESULTS

2 organizational-commitment profiles were identified: Affective/Normative (AC/NC) Dominant (n = 388) and Mid-Low Commitment (99). Participants in the Mid-Low Commitment Profile had a significantly higher intention-to-leave score (median, 3.0) than participants in the AC/NC Dominant Profile (median, 2.0; P < .001). Psychosocial factors found to predict membership in the AC/NC Dominant Profile included the following: influence at work (OR, 2.08; P < .001), meaning of work (OR, 1.38; P = .067), rewards/recognition (OR, 1.63; P = .007), and quality of leadership (OR, 1.85; P = .0003). Members of the AC/NC Dominant Profile also experienced greater work-life conflict (OR, 1.65; P = .003) compared to the Mid-Low Commitment Profile.

CLINICAL RELEVANCE

Findings identified potential psychosocial aspects of the workplace that can be considered to support more desirable organizational-commitment profiles that are likely to lead to favorable outcomes for veterinary practices and their employees.

Open access
in Journal of the American Veterinary Medical Association

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.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

Discrete choice methods (DCMs) are a suite of research techniques for identifying individual preferences using choice information. Widely utilized by other fields yet rarely employed in veterinary research, DCMs have tremendous potential to improve veterinary healthcare by understanding and incorporating owner and veterinary professionals' (encompassing veterinarians, veterinary clinicians, technicians, receptionists, attendants, etc) preferences to optimize the care continuum. DCMs have several advantages over other stated preference methods, such as ranking and ratings, including improved data quality and actionability. However, they are not a panacea, and limitations that may affect DCMs' application to the veterinary field are outlined alongside realistic mitigation strategies. The information provided aims to increase awareness of DCMs and their utility in veterinary research and encourage greater uptake as a more robust method for measuring preferences.

Open access
in American Journal of Veterinary Research

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.

Full access
in Journal of the American Veterinary Medical Association

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.

Open access
in Journal of the American Veterinary Medical Association