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.
Introduction
Traditionally, consultations between veterinarians, pet owners, and their pets have largely occurred face-to-face in the same physical location. Recent advancements in technology and internet innovation have enabled veterinarians to consider practicing veterinary medicine virtually.1,2 In the context of veterinarian-client-pet consultations, information and communication technologies (ICTs) currently being used to provide virtual care include telephone, email, asynchronous texting/messaging, synchronous texting/messaging, and videoconferencing.3 Predating the coronavirus disease of 2019 (COVID-19) pandemic, virtual consultations offered the promise to increase access and convenience of care for pet owners.1,4 In addition, veterinary medicine is likely to experience the disruptive effect seen in other nonmedical fields, including the retail and travel industry, with pet owners demanding convenient, real-time access to digital care for their pets, preferably with their own veterinarian.4,5 Understanding virtual veterinary care is more important than ever and needed to assist veterinary professionals in navigating this new landscape.
Virtual veterinary care straddles a difficult position between the fast-changing field of technology and the practice of veterinary medicine. Therefore, it is important to recognize factors that may affect adoption and utilization of virtual veterinary consultations. In human medicine, evaluation of patient and caregivers’ perspectives is considered essential to ensure optimal outcomes when utilizing virtual consultations.6 In veterinary medicine, research based on face-to-face veterinarian-client interactions demonstrates that client satisfaction is associated with adherence to treatment recommendation,7 which in turn is likely to affect patient health outcomes. Client dissatisfaction, expressed as complaints, has been found to have a negative effect on veterinarians’ job satisfaction and psychological distress and well-being.8 Client satisfaction and loyalty are considered essential for ensuring a practice’s financial health.9 Therefore, exploring pet owner perceptions of virtual consultations will allow factors that may affect the client experience to be identified and ideally addressed.
Despite the growing interest in virtual veterinarian-client-patient consultations, there are relatively few studies looking at the client perspective.2,10,11 Previous studies, including a survey of cat owners during the COVID-19 pandemic,10 suggest that owners are open to using virtual consultations, but an exploration of factors that may influence satisfaction remains limited. The primary objectives of the present study were to further explore virtual veterinarian-client-patient consultations by investigating pet owners’ use of ICTs for veterinary care and examining pet owners’ attitudes toward virtual veterinarian consultations.
Methods
An online questionnaire-based cross-sectional study of pet owners was performed from January 5, 2021, to March 30, 2021. The Checklist for Reporting Results of Internet E-Surveys (known as CHERRIES) statement was followed for this paper.12 The study protocol was approved by the University of Guelph Research Ethics Board (REB No. 20-08-017).
Questionnaire design
The following 7 definitions were provided at the beginning of the questionnaire to support consistent interpretation of questions:
Texting/messaging: written or visual communication sent electronically from one technological device (eg, smartphone) to another. May include photos or prerecorded videos.
Asynchronous: communication not occurring in real time.
Synchronous: communication occurring in real time.
Live videoconferencing: audiovisual communication occurring in real time.
Consultation: face-to-face or virtual interaction with a veterinarian to get advice about preventative, illness, or emergency care for a specific pet.
Face-to-face (in-person): you and the veterinarian are in the same physical space or room.
Virtual (remote): you and the veterinarian are not in the same physical space or room. The interaction occurs using at least one of the following technology platforms: telephone, email, asynchronous texting/messaging, synchronous texting/messaging, or live videoconference.
The questionnaire contained 4 sections (38 items), with items from sections 1, 2, and 4 asked of all participants (Supplementary Material S1). Section 1 consisted of 4 questions. The first question of section 1 asked participants to identify, using a multiple-choice format, which of 5 different ICTs (ie, telephone, email, asynchronous texting/messaging, synchronous texting/messaging, and live videoconferencing) they had ever used to receive veterinary care for their pet. The second question in this section asked participants to evaluate, on a visual analog scale from 0 to 100, their level of comfort (0 = extremely uncomfortable, 100 = extremely comfortable) using each of the 5 different ICTs listed previously. The third question in this section used a multiple-choice format and asked participants to select from a list all the technological issues that may prevent them from doing a virtual consultation (ie, no internet access, unreliable internet access, no access to computer/tablet, unreliable access to computer/tablet, no access to phone, unreliable access to phone, or no limitations). The final question in this section asked participants to rank their order of preference for 6 methods of interaction with a veterinarian (face-to-face and 5 virtual ICTs listed previously), with the first ranking representing the most preferred option, all the way down to the sixth ranking representing the least preferred option.
Section 2 evaluated participants’ agreement with 8 statements regarding communication with veterinarians. Each statement was evaluated within 2 different contexts: virtual and face-to-face consultations. Statements were based on an adapted version of the communication section of the Primary Care Patient/Client Virtual Care Experience Survey created by the Association of Family Health Teams of Ontario.13 The statements were all adapted to start with 1 consistent measurement, namely “I am confident that….” We further adapted the statements to replace “healthcare provider” with “veterinarian” and include the word “pet” where appropriate. All items in this section used the same visual analog scale from 0 to 100 (0 = completely disagree, 100 = completely agree) to identify participants’ agreement.
At the start of the third section, participants were asked whether they had experienced a consultation with a veterinarian about a specific pet in the previous 6 months (yes or no). Participants who answered “no” skipped this section and went directly to the final section. Participants who answered “yes” were then asked a multiple-choice question about what type of interaction they had with the veterinarian during their most recent consultation (face-to-face, virtual, or combination of face-to-face and virtual). Based on their response to this multiple-choice question, participants were then asked 1 of 2 questions. Participants who answered “face-to-face” were asked, “On a scale of 0 to 10, how likely are you to recommend a face-to-face consultation with a veterinarian to a friend or colleague?” Participants who answered “virtual” or “combination of face-to-face and virtual” were asked, “On a scale of 0 to 10, how likely are you to recommend a virtual consultation with a veterinarian to a friend or colleague?” The 2 previous questions were designed on the basis of the Net Promoter Score (NPS), an easy-to-use, 1-item instrument originally introduced as a measurement of customer sentiment toward a product, brand, or company.14 Responses were collected using an 11-point rating scale (0 = not at all willing, 10 = extremely willing) and classified according to the NPS system (promoters = 9 to 10, passives = 7 to 8, and detractors = 0 to 6).14 The NPS was then calculated by subtracting the percentage of detractors from the percentage of promoters, ranging from –100 (all participants are detractors) to +100 (all participants are promoters). An NPS of > +1 is considered good, with a NPS of > +50 considered excellent.15
The final section ascertained demographic characteristics of respondents using multiple-choice questions. Participants were also asked 4 questions related to their primary care (regular) veterinary practice.
The survey was pretested with a convenience sample of 6 pet owners known to the principal author (DS), representing a range of education levels and experience with pet ownership. Individuals pretesting the survey were asked to provide feedback on branching and question flow, any ambiguity with questions, and potentially missing or unclear response options. Small changes addressing clarity of questions were incorporated into the final questionnaire.
Participant recruitment
Snowball sampling16 was used to recruit participants. The invitation was posted on social media platforms (Facebook, Instagram, Twitter, and LinkedIn) belonging to the research team, their colleagues, and the Ontario Veterinary College. Four English-language Facebook groups based in Canada and/or the US, found by entering the terms pet owner, dog owner, and cat owner in the search bar, agreed to post information about the survey on their message boards. In addition, 2 animal shelters, 3 veterinary corporate groups, and 1 veterinary practice–buying group, all based in Canada, agreed to distribute information about the survey on their social media channels.
There were 2 inclusion criteria for participation in the study: participants must be 18 years of age or older and must have owned a pet at some point in the previous 6 months. Implied consent was obtained from all participants by proceeding with the questionnaire. Data was collected using standard online survey software (Qualtrics). Participants were incentivized in the form of a draw for a $25 gift card from an online retailer (www.amazon.ca; odds of 1 in 100) and an offer to receive an executive summary of the results at the conclusion of the study.
Questionnaire analyses
Questionnaires were included in the final analyses if participants completed the first 2 sections of the survey. Results are reported as a proportion of total respondents for each question; therefore, denominators may vary due to missing values. Descriptive statistics were calculated for categorical variables (frequencies) and continuous variables (mean, SD, median, and range). Normality of continuous variables was assessed using graphical analysis. The Pearson χ2 test was used to evaluate the association between internet access and urbanization of location. The ranking question was evaluated using marginal frequencies (ie, distribution of each of the choices).17 The nonparametric Friedman 2-way ANOVA test was used to compare participants’ ranked preference for the 6 communication modalities (face-to-face, telephone, email, videoconferencing, synchronous, and asynchronous texting).18 Post hoc analysis was done using the sign test for the comparison of each pair using a P value adjusted with the Bonferroni correction method to < .003.19,20 The Wilcoxon signed rank test was used to compare paired responses between virtual and face-to-face experiences for the 8 items related to veterinarian communication.
Multivariable logistic regression was used to explore associations between potential predictor variables and participants’ willingness to recommend virtual consultations to family and friends with promotor (9 and 10) and passive (7 and 8) scores classified as “willing” and detractor (0 to 6) scores classified as “unwilling.” Only participants who provided a response to the NPS question regarding virtual consultations were included in model building. Seventeen potential predictor variables were initially considered, including 6 participant demographic variables: county of residence, urbanization of residence location, gender (female, male, or other), age in years, education, and income. Four variables related to pet ownership were evaluated: pet species owned (dog only, cat only, or dog and cat), length of time as a pet owner in years, and whether the pet had complex needs (yes or no). Four variables related to being a client at a veterinary practice were evaluated: had a primary veterinary practice (yes or no), frequency of visits to practice (> once a year, every 1 to 2 years, or ≥ 3 years), length of time as a client in years, and travel time to practice in minutes. The final 4 variables were as follows: comfort using live videoconferencing (continuous), comfort using a telephone (continuous), technical limitations (yes or no), and type of recent interaction with veterinarian (virtual only or combination of virtual and face-to-face).
Collinearity between independent variables was explored using Spearman rank correlation coefficients (cutoff = 0.8). Univariable analyses were performed to screen all potential predictor variables for unconditional associations (P < .20) with the outcome.21
Manual stepwise selection using models restricted to a maximum of 12 degrees of freedom was used for model building. All possible combinations of independent variables that had an unconditional association with the outcome were used to identify the most parsimonious main effects model. Independent variables that had not made it into the main effects model but were considered as potential confounders were tested for confounding. Any variable that, when added to the model, changed the effect estimates for other factors of interest by > 30% was retained as a confounder.21 Next, all biologically plausible 2-way interactions between independent variables in the final main effects model were assessed. Data-recording errors were investigated for observation(s) that appeared to be outliers, had leverage, or were influential on the model. If there were no issues, the model was repeated without the observation(s) to determine whether there was any change in direction or significance of the coefficients.
Stata IC (version 17.0; StataCorp LLC) was used for all statistical analyses. A P value of < .05 was considered statistically significant unless otherwise stated.
Results
A total of 1,074 participants accessed the questionnaire online, of which 841 participants met the inclusion criteria and 714 (84.9% [714/841]) completed the first 2 sections of the questionnaire and were included in the final analyses (Table 1). Of these participants, 18.2% (130/714) were recruited from social media belonging to the research team or their colleagues, 3.4% (24/714) through the Ontario Veterinary College’s social media channels, 31.4% (224/714) from pet owner Facebook groups, 5.2% (37/714) from shelter organization, and 41.1% (299/714) from social media channels of various corporate or practice-buying groups across Canada. The majority of participants were residents of Canada (95.9% [632/659]), specifically Ontario (92.2% [583/632]); were female (91.8% [604/658]); and had a mean age of 46.7 years (SD, 14.2; median, 48; range, 19 to 81 years). The majority of participants (79.8% [474/594]) had an annual household income ≥ $50,000 and had a postsecondary degree or diploma (79.2% [518/654]).
Pet owner participant demographic characteristics (n = 714). Missing values account for discrepancies in totals.
| Variables | n (%) |
|---|---|
| Country of residence (n = 659) | |
| Canada | 632 (95.9) |
| US | 20 (3.0) |
| Europe | 7 (1.1) |
| Province of residence (n = 632) | |
| Ontario | 583 (92.2) |
| Other | 49 (7.8) |
| Urbanization of residence location (n = 635) | |
| Rural | 130 (20.5) |
| Suburban | 288 (45.4) |
| Urban | 217 (34.2) |
| Gender (n = 658) | |
| Female | 604 (91.8) |
| Male | 45 (6.8) |
| Gender not listed | 2 (0.3) |
| Prefer not to answer | 7 (1.1) |
| Education (n = 654) | |
| Less than high school | 5 (0.8) |
| High school diploma or equivalent | 49 (7.5) |
| Some college or university | 82 (12.5) |
| College diploma | 146 (22.5) |
| Bachelor’s degree | 203 (31.0) |
| Graduate degree | 112 (17.1) |
| Professional degree | 57 (8.7) |
| Annual household income (n = 594) | |
| <$20,000 | 26 (4.4) |
| $20,000–$34,999 | 45 (7.6) |
| $35,000–$49,999 | 49 (8.3) |
| $50,000–$74,999 | 82 (13.8) |
| $75,000–$99,999 | 118 (19.9) |
| $100,000–$149,999 | 144 (24.2) |
| > $150,000 | 130 (21.9) |
Usage of and comfort with virtual care technology
Participants reported significantly (P < .001) different utilization of the 5 ICTs. Most participants had used the telephone (85.6% [611/714]) or email (57.0% [407/714]) to receive veterinary care. A minority had used asynchronous texting/messaging (21.0% [150/714]) and synchronous texting/messaging (13.0% [93/714]), and a very small percentage used live videoconferencing (5.2% [37/714]). The majority of participants indicated they were extremely comfortable using the telephone, email, asynchronous texting/messaging, and synchronous texting/messaging (Table 2). Participants reported being slightly less comfortable using videoconferencing technology.
Pet owner participant comfort with using different information and communication technologies (ICTs). Missing values account for discrepancies in totals.
| ICT modality | n | Median (mean, SD, range) |
|---|---|---|
| Telephone | 700 | 100 (95.1, 13.6, 10–100) |
| 681 | 100 (95.1, 15.7, 0–100) | |
| Asynchronous texting/messaging | 599 | 100 (93.9, 17.2, 0–100) |
| Synchronous texting/messaging | 592 | 100 (93.8, 16.5, 0–100) |
| Videoconferencing | 552 | 100 (90.5, 19.7, 0–100) |
Technical limitations with virtual consultations
The vast majority of participants (90.5% [609/673]) reported that they had no technical issues that inhibited their ability to have virtual consultations with veterinarians. For those that had a technical limitation, the largest 2 challenges were limited/unreliable internet access (7.4% [50/673]) and, to a much lesser degree, limited/unreliable access to technological hardware including computer and tablet (1.2% [8/673]). Participants living in self-described rural locations were significantly (P < .001) more likely to express limited/unreliable internet access as a limitation to using virtual veterinary consultations, as compared to both suburban and urban locations.
Preference for using face-to-face and different ICTs for virtual consultations
A total of 567 participants provided a complete ranking of the 6 items in this question and were included in the ranking analysis. Participants demonstrated a significant preference (P < .001) for face-to-face interactions over all other ICT modalities included in the study. The marginal distribution results showed that 85.2% (483/567) of participants ranked face-to-face interactions as the most preferred option (Table 3). Participants also showed significant preferences (P < .001) for the type of ICT they would like to use for virtual veterinarian consultations. The telephone was the most preferred (P < .001) ICT modality, with 88.4% (501/567) of participants placing it in 1 of the top 3 positions. Live videoconferencing was the second most preferred ICT yet showed a bimodal pattern, with 61.2% (37/567) of participants placing it in 1 of the top 3 positions and 23.3% (132/567) placing it in the sixth (last) position.
Marginal distribution of pet owners’ ranking of preference for face-to-face and different ICT modalities that can be used for veterinarian consultations (n = 567). Missing values account for discrepancies in totals.
| Modality | Rank 1 | Rank 2 | Rank 3 | Rank 4 | Rank 5 | Rank 6 |
|---|---|---|---|---|---|---|
| Face-to-face | 483 | 42 | 21 | 11 | 7 | 3 |
| Telephone | 22 | 256 | 223 | 37 | 16 | 13 |
| Videoconferencing | 26 | 200 | 121 | 67 | 21 | 132 |
| 33 | 51 | 127 | 160 | 108 | 88 | |
| Synchronous texting/messaging | 1 | 14 | 52 | 181 | 220 | 99 |
| Asynchronous texting/messaging | 2 | 4 | 23 | 111 | 195 | 232 |
Rows and columns sum to 567, the total number of complete rankings.
Perception of virtual communication with veterinarians
For all communication statements, participants were significantly (P < .001) less confident communicating with veterinarians during virtual as compared to face-to-face interactions (Figure 1). The 2 statements that showed the biggest difference were participants’ confidence in being able to establish a rapport with the veterinarian in virtual (mean, 77.5; SD, 24.1; median, 81; range, 0 to 100) as compared to face-to-face (mean, 96.9; SD, 8.4; median, 100; range, 0 to 100) consultations and participants’ confidence that their pet would receive excellent care during virtual (mean, 77.5; SD, 25.2; median, 85; range, 0 to 100) as compared to face-to-face (mean, 97.0; SD, 7.7; median, 100; range, 18 to 100) consultations. The statement that had the smallest difference was participants’ confidence in being able to talk about financial concerns in virtual (mean, 84.0; SD, 24.3; median, 100; range, 0 to 100) as compared to face-to-face (mean, 90.8; SD, 18.7; median, 100; range, 0 to 100) consultations.
Pet owners’ confidence in being able to communicate with veterinarians in virtual and face-to-face consultations (0 = completely disagree with statement, 100 = completely agree with statement). Missing values account for discrepancies in totals.
Citation: Journal of the American Veterinary Medical Association 262, 1; 10.2460/javma.23.02.0089
Willingness to recommend face-to-face and virtual consultations with veterinarians
Participants who had experienced a “face-to-face” consultation with a veterinarian in the previous 6 months were extremely likely to recommend face-to-face consultations (NPS, +86.1). This included 88.1% (133/151) of participants being promoters and 2.0% (3/151) of participants being detractors. Participants who had experienced a “virtual” or “combination virtual and face-to-face” consultation with a veterinarian in the previous 6 months were divided about recommending virtual consultations (NPS, –1.43), with 33.3% (116/348) of participants being promoters, 31.9% (111/348) being passives (neutral), and 34.8% (121/348) being detractors.
Factors associated with pet owners’ willingness to recommend virtual consultations
Eight variables showed unconditional association with the outcome and were retained for model building (urbanization of residence location, gender, age, annual household income, education, pet ownership by species, comfort using live videoconferencing, and comfort using telephone). The final logistic regression model was based on 273 participant surveys and included 2 variables: age of pet owner and comfort using videoconferencing technology (Table 4). It was found that, holding the variable “comfort using videoconferencing” constant, the odds of pet owners’ willingness to recommend virtual veterinarian consultations increased by 32% (OR, 1.32; 95% CI, 1.08 to 1.61) with every 10-year increase in age. It was also found that holding the variable “age” constant, the odds of pet owners’ willingness to recommend virtual veterinarian consultations increased by 33% (OR, 1.33; 95% CI, 1.13 to 1.56) for every 10% increase in comfort using videoconferencing technology.
Multivariable associations (P < .05) between predictor variables and willingness to recommend virtual veterinarian consultations to friends and colleagues (n = 273).
| Independent variables | Coefficient | P value | 95% CI |
|---|---|---|---|
| Age (y) | 0.28 | .007 | 0.08–0.48 |
| Comfort using videoconferencing | 0.28 | .001 | 0.12–0.44 |
Discussion
Most participants of the present study indicated a preference for face-to-face consultations with veterinarians over virtual interactions. Our results also showed that one-third of participants had a positive attitude toward recommending virtual consultations, suggesting that there is a population of pet owners that would consider using virtual care if it was available to them. Our findings are similar to a survey in human medicine in which patients were generally willing to use videoconferencing for consultations with physicians but preferred in-person care.22 Understanding and incorporating clients’ preferences for the use of virtual veterinarian consultations will help inform the future use and development of virtual care delivery in veterinary medicine.
Our study found that participants’ comfort and preference using different ICTs are important components to consider when designing a virtual care service. The majority of participants ranked the telephone as their number one option for virtual veterinarian consultations. For decades, the telephone has been the technology used most frequently by veterinarians to interact with clients.23 Therefore, familiarity, accessibility, and ease of use may have contributed to its preferential ranking by pet owners. Interestingly, despite its ubiquity, veterinary students have received very little guidance on how to communicate with pet owners using the telephone,23 suggesting more attention is likely needed within veterinary education. The inability of veterinarians to perform even a limited physical examination of the patient over the telephone and the reduction in nonverbal communication between veterinarian and client likely limit the telephone’s application for many issues such as new diagnoses and more nuanced, challenging discussions. Therefore, developing best practice guidelines and curricula to advance the use of existing and new technologies for delivering veterinary care are recommended to broaden the uptake and use of virtual veterinary care.
Participants’ preference for using videoconferencing for veterinary consultations was largely split into 2 groups: those who highly ranked videoconferencing (equivalent or second to the telephone) and those who selected videoconferencing as their least preferred option. This indicated that, unlike the telephone, pet owners are polarized about the use of videoconferencing for veterinary consultations. Therefore, it is important to recognize that there is a population of veterinary clients who do not prefer to be engaged through videoconferencing. As a result, it is likely important for veterinary professionals to explore a client’s preference for videoconferencing before conducting a consultation using this form of ICT. An additional finding in our study, when controlling for the age of the participant, was that clients’ comfort using videoconferencing technologies was positively associated with the likelihood of recommending virtual veterinarian consultations to friends or colleagues. This result supports what has been suggested in the human literature,24,25 that patients may prefer to not use videoconferencing because they do not have the level of digital literacy and experience needed to be comfortable using more sophisticated technology. Access may also be a concern for some pet owners because people living in rural locations and/or lower socioeconomic households may not have access to rapid broadband internet and technological devices that support videoconferencing.26 In Canada, only 48% of rural residents have access to high internet speed (at least 50 megabits/s) needed for videoconferencing, as compared to 76% of residents living in urban areas.27 Digital literacy and access to suitable internet need to be acknowledged and managed by virtual care providers, especially in consideration of using videoconferencing for consultations, otherwise veterinary medicine is at risk of widening the “digital divide” and reducing equitable access to care.4,26
Our results also showed that willingness to recommend a virtual veterinary consultation increased with age. This result is at odds with the limited research in virtual veterinary medicine, which has not shown a difference in attitude based on age.28 Findings of the present study call for further research to explore the belief that millennials (individuals born between 1981 and 1996) are likely to be the largest drivers of virtual consultations because they tend to be technologically savvy and like to be digitally connected.1 It is unclear why younger pet owners participating in the present study did not have a more favorable attitude toward virtual consultations. Prior research has shown that individuals in the millennial cohort tend to have a strong bond with their pets and believe pet ownership is key to their own mental, physical, and overall well-being.1 In addition, research has demonstrated that millennials place high value on personal relationships with their veterinary care providers, particularly veterinarians,29 which may influence a preference for face-to-face consultations. Another possibility is the timing of the study, where older participants may have had a more positive attitude to virtual veterinarian consultations because, as has been reported,30 seniors are more likely to be concerned about their health and are more willing to take precautions as a result of the COVID-19 pandemic. Future research is needed to provide further guidance on the validity of this finding and a deeper understanding of the role of age on preference for and promotion of virtual veterinary care.
Interestingly, our study found a marginal negative NPS score (–1.43) for likelihood of pet owners to recommend virtual veterinarian consultations to a friend or colleague, suggesting that overall participants had a neutral attitude toward these types of interactions. In a previous study,31 veterinarians were found to have an unfavorable attitude toward virtual consultations, with an NPS score of –41.44 when asked whether they were willing to promote virtual consultations to colleagues. Our findings are similar to those of physicians relating to virtual care, which have identified both physician and patient acceptance as being key to successful adoption of virtual care and that physician acceptance has tended to be the greater challenge.32 Therefore, veterinary professionals’ attitudes toward virtual care may be the profession’s greatest barrier to increasing uptake and access of virtual veterinary care at this time and is a barrier requiring further research to fully understand.
Our study explored pet owners’ perception of communicating with veterinarians during virtual as compared to face-to-face consultations. Our results showed that participants felt less confident communicating with veterinarians when the interaction was virtual. This finding supports a recent study10 of 98 cat owners that found participants believed difficulty communicating with veterinarians was the biggest disadvantage to virtual consultations. Studies of traditional face-to-face veterinarian-client consultations have shown that effective communication is an important contributor to veterinarian satisfaction,33 client satisfaction,34 and pet owner adherence.7 Effective communication has also been shown to play a significant role in preventing client complaints.35 In 1 study,35 communication problems during face-to-face interactions were found to have contributed to 80% of settled cases of alleged veterinary professional negligence. Therefore, inferior experiences for either the veterinarian or the client may reinforce negative perceptions of virtual veterinary care and reduce adoption and utilization. For future consideration, building a curriculum to support veterinarians’ and student veterinarians’ communication during virtual interactions will be needed to support the successful adoption and uptake of virtual care in veterinary medicine.
Specifically, our study demonstrated that pet owners felt least confident about building a rapport virtually with veterinarians. A study31 of veterinarians’ perceptions of virtual care found a similar finding in which participants indicated that their ability to build a rapport with both new and existing clients virtually was inferior to in-person interactions. Rapport can be defined as a sense of connection that is developed verbally and particularly nonverbally through facial expressions, gestures, and posture and by paralinguistic elements of speech such as pitch, pace, tone, and volume.36 Building rapport is important for both the pet owner and veterinarian because it is a vital tool for creating a positive veterinarian–pet owner relationship, which is central to the success of a consultation.37,38 Our study did not investigate pet owners’ perception of virtual communication with consideration of a previously existing or not existing veterinarian-client-patient relationship. Further investigation in this specific area is warranted.
Human virtual care research has found that patients’ satisfaction with a virtual interaction is dependent on patients’ perceived relationship-building with their physician.39 Adams and Kurtz40 highlighted nonverbal cues, emotional and cognitive empathy, and relationship-centered style of communication as contributing to strong, trusting relationships in face-to-face veterinary consultations. Kanji et al7 found that veterinarian’s voice quality perceived as sympathetic, empathetic, and not rushed was associated with veterinary clients’ increased adherence to recommendations. In a qualitative study41 at a tertiary care hospital in Ontario, clients receiving oncology care for their dogs looked for nonverbal cues exhibited by the veterinary care providers to assess the seriousness of their pet’s condition. The remote and sensory-limiting nature of virtual interactions may inhibit the expression and recognition of these behaviors. Virtual consultations require veterinarians to actively focus on building rapport with clients. This likely involves a combination of nonverbal behaviors including voice tone, pitch, and rate of speech together with summary statements, reflections, and observations to make clients feel they are being listened to. For audiovisual ICT including videoconferencing, positioning within the video frame, facial expressions (especially eye contact), and upper body posture are additional considerations. For all ICT, virtual communication training is recommended to overcome the acknowledged barrier to rapport-building by veterinarians and pet owners to support the uptake and use of virtual care in veterinary practice.
As with all studies conducted exclusively online, and particularly those using snowball sampling, this study had sampling biases.42 For example, 92% of participants resided in the province of Ontario, Canada, which may reduce the generalizability of the results to other jurisdictions. Despite efforts to achieve broad awareness of our survey by distribution through various social media platforms, the annual household income and education of our participants were higher than those found among participants of another similar pet owner survey.43 This difference likely further limits the generalizability of findings from the present study, and careful consideration should be made by readers when applying the results of the present study to other populations. At the time of data collection, many practices restricted in-person veterinarian-client consultations in favor of “curbside care” in which the patient received a hands-on physical examination without the owner being present. The veterinarian then communicated with the pet owner face-to-face and/or virtually. Unfortunately, from our survey we could not investigate pet owners’ perspectives toward curbside care as compared to other forms of virtual care (eg, virtual patient examination together with virtual client interaction). Future research should be performed to further understand the nuances associated with the different options of virtual care.
As virtual veterinarian-client-patient consultations are predicted to increase over time, more research is needed to understand pet owners’ attitudes toward and preferences for these types of interactions. The present study found many participants were willing to consider virtual consultations, particularly video visits, although they still preferred face-to-face interactions when seeking veterinary care for their animal. Further exploration into the impact of virtual care on the veterinarian-client relationship is needed to identify best practices that promote positive outcomes including veterinarian and client satisfaction and practices that will support virtual care training within veterinary education curricula. It is through a better understanding of pet owners’ perceptions of and preferences for virtual care that the veterinary profession will be able to maximize the advantages of virtual care for the benefit of veterinary clients, patients, and professionals.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org
Acknowledgments
None reported.
Disclosures
The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.
Funding
Dr Coe regularly receives research funding from, consults for, and receives honoraria from various veterinary organizations and commercial companies. Dr Coe currently holds the VCA Canada Chair in Relationship-Centered Veterinary Medicine at the Ontario Veterinary College, University of Guelph.
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