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- Author or Editor: Jason B. Coe x
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Abstract
OBJECTIVE To identify actions taken by owners to socialize puppies < 20 weeks of age, to determine factors affecting attendance of structured puppy classes, and to examine associations between class attendance and owner response to various undesirable puppy behaviors.
DESIGN Cross-sectional study.
SAMPLE 296 puppy owners (each with 1 puppy).
PROCEDURES Participants completed a survey at enrollment (to gather data regarding owner demographics and puppy characteristics) and again when puppies were 20 weeks of age (to gather information on socialization practices and owner responses to misbehavior and signs of fear in their puppy). Responses were compared between owners that did (attendees) and did not (nonattendees) report attending puppy classes.
RESULTS 145 (49.0%) respondents reported attending puppy classes. Class structure differed greatly among respondents. Attendees exposed their puppies to a greater number of people and other dogs than nonattendees as well as to various noises and situations. Puppies of attendees were less likely than puppies of nonattendees to have signs of fear in response to noises such as thunder and vacuum cleaners as well as to crates. Fewer attendees reported use of punishment-based discipline techniques than did nonattendees. Almost one-third of puppies received only minimal exposure to people and dogs outside the home during the survey period.
CONCLUSIONS AND CLINICAL RELEVANCE A notable number of puppies < 20 weeks of age in this study received few early socialization opportunities, which could lead to behavior problems and subsequent relinquishment. Opportunities exist for veterinarians to serve an important role in educating puppy owners about the importance of early puppy socialization and positive reward training.
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 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 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 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 compare veterinarians' and pet owners' perceptions of client expectations with respect to veterinarian-client communication and to identify related barriers and challenges to communication.
Design—Qualitative study based on focus group interviews.
Participants—6 pet owner focus groups (32 owners) and 4 veterinarian focus groups (24 companion animal veterinarians).
Procedures—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.
Results—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).
Conclusions—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.
Abstract
Objective—To determine prevalence and nature of cost discussions between veterinarians and pet owners during clinical appointments in companion animal practice.
Design—Cross-sectional descriptive study.
Sample Population—20 veterinarians in companion animal practice in eastern Ontario and 350 clients and their pets.
Procedures—200 veterinarian-client-patient interactions were randomly selected from all videotaped interactions and analyzed with the Roter interaction analysis system. Additional proficiency codes and blocking functions were developed to capture the prevalence, nature, and context of cost discussions.
Results—58 of the 200 (29%) appointments that were analyzed included a discussion of cost. During 38 of these 58 (66%) appointments, the discussion involved costs associated with the veterinarian's time or with services provided by the veterinarian. Overall, reference to a written estimate was made during only 28 of the 200 (14%) appointments. Cost discussions were most common during appointments in which a decision related to diagnostic testing or dentistry was made. Appointments were significantly longer when a cost discussion was included than when it was not.
Conclusions and Clinical Relevance—Results of the present study suggested that discussions related to cost were relatively uncommon during clinical appointments in companion animal practice and that written estimates were infrequently used to aid these discussions. When discussions of cost did occur, veterinarians appeared to focus on explaining costs in terms of the veterinarian's time or services provided by the veterinarian, rather than on the medical information that could be obtained or the benefits to the future health or function of the pet.
Abstract
Objective—To examine veterinarian solicitation of client concerns in companion animal practice.
Design—Cross-sectional descriptive study.
Sample—20 veterinarians in companion animal practice in Eastern Ontario and 334 clients and their pets.
Procedures—Beginning segments of 334 appointments were coded for a veterinarian solicitation (open- or closed-ended question) used to elicit client concerns. Appointments including a solicitation were analyzed for completion of the client's response and its length. The association between veterinarian solicitations at the beginning and concerns arising at the closure of the interview was examined.
Results—123 (37%) of the coded appointments contained a veterinarian solicitation, of which 93 (76%) were open-ended and 30 (24%) were closed-ended solicitations. Client responses to a solicitation were interrupted in 68 of 123 (55%) appointments. Main reasons for incomplete client responses were veterinarian interruptions in the form of closed-ended questioning (39/68) and noninterrogative statements (18/68). Median length of time clients spoke before interruption was 11 seconds (range, 1 to 139 seconds; mean, 15.3 seconds; SD, 12.1 seconds). The odds of a new concern arising during the closing segment of an appointment were 4 times as great when the appointment did not contain a veterinarian solicitation at the beginning of the interview.
Conclusions and Clinical Relevance—Not soliciting client concerns at the beginning of an interview increased the odds of a concern arising during the final moments of the interaction. This required the veterinarian to choose among extending the appointment to address the concern, ignoring the concern at a possible cost to client satisfaction, or deferring the concern to another visit.
Abstract
Objective—To explore the nature and content of information publicly posted to Facebook by early-career veterinarians.
Design—Cross-sectional descriptive study.
Sample—352 early-career veterinarians.
Procedures—Publicly accessible Facebook profiles were searched online from March to May 2010 for profiles of early-career veterinarians (graduates from 2004 through 2009) registered with the College of Veterinarians of Ontario, Canada. The content of veterinarians’ Facebook profiles was evaluated and then categorized as low, medium, or high exposure in terms of the information a veterinarian had publicly posted to Facebook. Through the use of content analysis, high-exposure profiles were further analyzed for publicly posted information that may have posed risks to an individual's or the profession's public image.
Results—Facebook profiles for 352 of 494 (71%) registered early-career veterinarians were located. One-quarter (25%) of profiles were categorized as low exposure (ie, high privacy), over half (54%) as medium exposure (ie, medium privacy), and 21% as high exposure (ie, low privacy). Content analysis of the high-exposure profiles identified publicly posted information that may pose risks to an individual's or the profession's reputation, including breaches of client confidentiality, evidence of substance abuse, and demeaning comments toward others.
Conclusions and Clinical Relevance—Almost a quarter of veterinarians’ Facebook profiles viewed in the present study contained publicly available content of a questionable nature that could pose a risk to the reputation of the individual, his or her practice, or the veterinary profession. The increased use of Facebook and all types of social media points to the need for raised awareness by veterinarians of all ages of how to manage one's personal and professional identities online to minimize reputation risks for individuals and their practices and to protect the reputation and integrity of the veterinary profession.
Abstract
Objective—To compare veterinarians' and pet owners' perceptions of client expectations with respect to the monetary aspects of veterinary care and identify challenges encountered by veterinarians in dealing with pet owners' expectations.
Design—Qualitative study based on focus group interviews.
Participants—6 pet owner focus groups (32 owners) and 4 veterinarian focus groups (24 companion animal veterinarians).
Procedures—Independent focus group sessions were conducted with standardized open-ended questions and follow-up probes. Content analysis was performed on the focus group discussions.
Results—Pet owners expected the care of their animal to take precedence over monetary aspects. They also expected veterinarians to initiate discussions of costs upfront but indicated that such discussions were uncommon. Veterinarians and pet owners differed in the way they related to discussions of veterinary costs. Veterinarians focused on tangibles, such as time and services. Pet owners focused on outcome as it related to their pet's health and well-being. Veterinarians reported that they sometimes felt undervalued for their efforts. A suspicion regarding the motivation behind veterinarians' recommendations surfaced among some participating pet owners.
Conclusions—Results suggested that the monetary aspects of veterinary care pose barriers and challenges for veterinarians and pet owners. By exploring clients' expectations, improving communication, educating clients, and making discussions of cost more common, veterinarians may be able to alleviate some of the monetary challenges involved in veterinarian-client-patient interactions.
