Cindy L. Adams

Sentinels of Safety: Service Dogs Ensure Safety and Enhance Freedom and Well-Being for Families With Autistic Children:

Children with autism might display unpredictable and volatile behavior that places them in considerable physical danger and creates stress for the family. Families of autistic children often have limited freedom and experience difficulty with everyday activities. In this qualitative ethology study, we examined the effect of integrating service dogs into ten families with an autistic child. Data included participant observation, video recordings of family—parent—dog interaction, and semistructured interviews with the parents. The themes were (a) the dog as a sentinel of safety, (b) gaining freedom through enhanced safety, facilitating public outings and family activities, and (c) improving social recognition and status, in which the presence of the dog promoted awareness of autism and affected social interaction. The triadic relationship between parent, autistic child, and service dog constantly evolves. This research provides valuable information for parents interested in having a service dog for their autistic child, and has implications for long-term human—animal companionship for children with special needs and their caregivers.

Veterinarian-client-patient communication during wellness appointments versus appointments related to a health problem in companion animal practice

OBJECTIVE To compare the clinical interview process, content of the medical dialog, and emotional tone of the veterinarian-client-patient interaction during wellness appointments and appointments related to a health problem in companion animal practice. DESIGN Cross-sectional descriptive study. SAMPLE POPULATION A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. PROCEDURE For each practitioner, 6 clinical appointments (3 wellness appointments and 3 problem appointments) were videotaped. The Roter interaction analysis system was used to analyze the resulting 300 videotapes. RESULTS Wellness appointments were characterized by a broad discussion of topics, with 50% of data-gathering statements and 27% of client education statements related to the pets lifestyle activities and social interactions. Wellness appointments included twice as much verbal interaction with the pet as did problem appointments, and the emotional atmosphere of wellness appointments was generally relaxed. There were more social talk, laughter, statements of reassurance, and compliments directed toward the client and pet. In contrast, during problem appointments, 90% of the data gathering and client education focused on biomedical topics. Coders rated veterinarians as hurried during 30 of the 150 (20%) problem appointments; they rated clients as anxious during 39 (26%) problem appointments and as emotionally distressed during 21 (14%). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that veterinarian-client-patient communication differed between wellness and problem appointments. Owing to the emphasis on biomedical content during problem appointments, veterinarians may neglect lifestyle and social concerns that could impact patient management and outcomes, such as client satisfaction and adherence to veterinarian recommendations.

Dog-walking and sense of community in neighborhoods: Implications for promoting regular physical activity in adults 50 years and older

This study investigates whether dog-ownership and neighborhood characteristics are associated with sense of community (SC) and neighborhood-based recreational walking (NRW) for older adults. A random sample of adults ≥50 years of age (n=884) provided information on SC, dog-related factors, neighborhood walking, and socio-demographics in telephone and postal surveys. Associations between dog-ownership, neighborhood characteristics, and NRW were estimated using logistic regression (i.e., odds ratios (OR)). Frequent dog-walkers (≥4 times/wk) were more likely than those not owning a dog to report a heightened SC (OR=1.94, p<.05) and to achieve ≥150min/wk of NRW (OR=10.68, p<.05). SC was also tested but not found to mediate associations between neighborhood characteristics, dog-ownership and NRW. Older adults who walk dogs often in their neighborhoods may benefit from both increased physical activity and heightened sense of community to an extent that supports healthy aging. Longitudinal studies are needed to explore directions of associations among these factors.

Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice

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 patients 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.

Prevalence and nature of cost discussions during clinical appointments in companion animal practice

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 veterinarians 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 veterinarians 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.

Analysis of solicitation of client concerns in companion animal practice

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 clients 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.

Veterinarian satisfaction with companion animal visits

OBJECTIVE To measure veterinarian satisfaction with companion animal visits through an adaptation of a previously validated physician visit satisfaction scale and to identify demographic, personality, appointment, and communication factors that contribute to veterinarian visit satisfaction. DESIGN Cross-sectional descriptive study. SAMPLE Random sample of 50 companion animal practitioners in southern Ontario, Canada, and convenience sample of 300 clients and their pets. PROCEDURES For each practitioner, 6 clinical appointments were videotaped, and the resulting 300 videotapes were analyzed by use of the Roter interaction analysis system. The physician satisfaction scale, Rosenberg self-esteem scale, and interpersonal reactivity index were used to measure veterinarian visit satisfaction, self-esteem, and empathy, respectively. Linear regression analysis was conducted to study the relationship between factors and veterinarian visit satisfaction. RESULTS Veterinarian visit satisfaction ranged from 1 to 5 (mean ± SD, 3.97 ± 0.99) and differed significantly between wellness appointments (mean scale score, 4.13) and problem appointments (mean scale score, 3.81). Various elements of client and veterinarian communication as well as personality measures of veterinarian self-esteem and empathy were associated with veterinarian satisfaction. The specific factors differed depending on the nature of the appointment. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that veterinarian visit-specific satisfaction is enhanced through the use of communication that builds relationships with clients and is associated with degrees of veterinarian empathetic concern and veterinarian self-esteem. The implications extend to overall job satisfaction and its potential link to the health and well-being of individual veterinarians.

Professional and veterinary competencies: addressing human relations and the human-animal bond in veterinary medicine.

PURPOSE The purpose of this study was to determine the nature and degree of coverage of human relations and the human-animal bond in veterinary curricula across North America. The attitudes and opinions of a cohort of veterinary students and alumni about human relations skills and human-animal bond training in the veterinary program was also investigated. METHOD Twenty veterinary schools across North America were contacted and data were collected regarding their coverage of human relations and the human-animal bond in the curriculum. A survey was developed to measure attitudes and opinions about this type of training. The survey was disseminated to students in years 1 to 4 and alumni from the Ontario Veterinary College (OVC). Data were analyzed descriptively. RESULTS Based on availability of contact people, 20 schools in North America were contacted, and all participated in the study. Each of the veterinary schools surveyed has incorporated strategies for teaching human relations skills through required courses, electives, guest speakers, and/or community service programs. The overall participation rate for OVC students was 53%. Ninety-nine percent of all students surveyed agreed that their ability to deal with people using effective human relations skills was a concern, and all students said they would like to receive more training in this area. There was a 41% participation rate for OVC alumni. Fifty-five percent of alumni said they had learned enough in the veterinary program to employ effective human relations skills in practice, yet 65% felt they had not received enough instruction in addressing the human-animal bond specifically. CONCLUSIONS It is apparent that veterinary schools recognize the need to prepare entry-level practitioners to deal with the human-animal bond and with human relations. It is also evident that students and practitioners value receiving information of this nature in the curriculum and desire further training. Specific learning objectives for veterinary curricula have been outlined based on findings from this study.

Use of the measure of patient-centered communication to analyze euthanasia discussions in companion animal practice

OBJECTIVE To characterize veterinarian-client communication with undisclosed standardized clients (USCs) during discussions regarding euthanasia of a pet. DESIGN Descriptive study. SAMPLE POPULATION 32 companion animal veterinarians (16 males and 16 females) in southern Ontario. PROCEDURES During 2 clinic visits, 2 cases (a geriatric dog with worsening arthritis and a cat with inappropriate urination) designed to stimulate discussion regarding euthanasia of a pet were presented by different USCs (individuals trained to consistently present a particular case to veterinarians without disclosing their identity). Discussions were audio recorded and analyzed by use of the measure of patient-centered communication (MPCC [a tool to assess and score physician communication behaviors]). Veterinarian and client statements were classified by means of 3 patient-centered components: exploring both the disease and the illness experience, understanding the whole person, and finding common ground. RESULTS 60 usable recorded discussions were obtained (31 veterinarians; 30 discussions/case). Overall, MPCC scores were significantly lower for the geriatric dog case. For both cases, veterinarians scored highest on finding common ground and lowest on exploring both the disease and the illness experience. Lack of exploration of client feelings, ideas, and expectations and the effect of the illness on the animals function resulted in low scores among veterinarians. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the use of USCs and the MPCC are feasible methods for analysis of veterinarian-client communication during companion animal euthanasia discussions. Findings suggested that some veterinarians do not fully explore client concerns or facilitate client involvement in euthanasia decision making.

Challenges of Service-Dog Ownership for Families with Autistic Children: Lessons for Veterinary Practitioners

The purpose of this paper is to describe the challenges of service-dog ownership for families with autistic children. Through a qualitative interview process, this study has found that the integration of a service dog into a home environment is a highly dynamic and interactive process with numerous benefits and challenges. Public-access issues, learning to interpret dog behavior, the time constraints of increased social interactions, and the time of year the dog is placed into the family are important components affecting parental satisfaction. Parent, family, and child challenges included the dog being extra work, finding added time to maintain training, financing care for the dog, and the impact on family dynamics. These factors and challenges were appraised in order to understand the impact that they could have on the perceived success of the placement, parental satisfaction, and the dog itself. Despite the effects and consequences of these challenges, the parents overwhelmingly reported that having a service dog to keep their child safe and to provide companionship was well worth the many inconveniences of service-dog ownership. Most importantly, attention needs to be drawn to these challenges to promote the safety of both the child and the dog, minimize stress on the family, and encourage veterinary support of these highly dynamic relationships.