Relationship-centered veterinary care is a collaborative veterinarian-client partnership in which there is mutual understanding and recognition of the client's perspectives and expertise in the pet's care through shared negotiations and balance of power.1 This communication model is recognized as an important framework for an ideal health-care system because it identifies the nature of relationships as a fundamental component of the successful delivery of high-quality health care.2 Adherence has been described as an outcome that arises from a collaborative and mutual relationship with the health professional and implies that clients make intentional choices concerning treatment regimens on the basis of the diagnosis and their beliefs about the illness and the accompanying treatment options.3,4
Research in veterinary medicine on client adherence and its determinants in companion-animal practice is limited. In contrast, human-medical researchers have developed a wealth of knowledge and evidence regarding the physician-patient relationship to understand the roles that physicians and patients play during their interactions and the impact of these relationships on important medical outcomes, including patient adherence,5–11 patient and physician satisfaction,12–15 and patient health.16–18 Only recently has the role of the veterinarian-client-patient interaction become a focus in relation to client adherence in veterinary medicine. Ineffective communication has been found to produce a lack of client understanding or belief in the importance of the veterinarian's recommendation.19–21 Although several studies22–25,a have recently been conducted to develop a better understanding of veterinarian-client-patient interaction in veterinary practice, much of the research to date has been primarily descriptive in nature, with little investigation into the impact of veterinarian-client-patient interactions on the outcomes of care.
The primary focus of the limited adherence research in veterinary medicine has been on short-term antimicrobial treatment in dogs,26–30 with recent research on adherence expanding to include other areas of veterinary care such as vaccinations,19,31,32 heartworm medications,19,32,33 dental procedures,19,32,34 and medical diets.19,32 The overall purpose of the study reported here was to explore the relationship between veterinarian-client-patient interactions and client adherence specific to dental and surgical procedures and to test the a priori hypotheses that adhering clients have greater appointment-specific satisfaction than do nonadhering clients5,8,9,11 and that RCC is positively associated with client adherence.6,35 Research in human medicine has shown patient satisfaction to be an important outcome of physician-patient interactions and to be correlated with patient adherence.5,8,9,11 Furthermore, the human medical literature advocates that RCC interactions promote higher patient satisfaction, which in turn contributes to improved patient adherence.6,35
Client satisfaction questionnaire
Roter interaction analysis system
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Coe JB, Adams CL, Bonnett BN. Prevalence and nature of cost discussions during clinical appointments in companion animal practice. J Am Vet Med Assoc 2009; 234:1418–1424.
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Client-, pet-, veterinarian-, practice- and appointment-related demographic variables each tested for an unconditional association (P < 0.20) with client adherence to a dentistry recommendation, surgery recommendation, or both.
|Education completed||< grade 12|
|College or university|
|Annual income (Canadian dollars)||≤ 35,000|
|Pet primary caregiver||Yes|
|Relationship with pet||Member of the family|
|Another mouth to feed|
|No. of visits to a veterinarian/y||—|
|Years of clinical practice (y)||—|
|Communication skills training||Yes|
|Practice||Scheduled appointment duration (min)||15|
|Cost of a regular office visit (Canadian dollars)||—|
|Cost of a routine cat neuter (Canadian dollars)||—|
|Cost of a routine cat spay (Canadian dollars)||—|
|Verbal dominance score||—|
|Measured duration of appointment (min)||—|
— = Not categorized.
Five tasks of the clinical interview and 10 corresponding communication composites, each assessed in 3 directions (veterinarian to client, client to veterinarian, and veterinarian to pet) for a total of 30 items tested for an unconditional association (P < 0.20) with client adherence to a dentistry recommendation, surgery recommendation, or both.
|Information gathering||Biomedical questioning|
|Lifestyle and social questioning|
|Information giving||Biomedical information|
|Lifestyle and social information|
|Relationship building||Positive talk|
|Activation and partnership||Activation and partnership|