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Describing Veterinarian-Client Communication During Euthanasia Discussions

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Describing Veterinarian-Client Communication During Euthanasia Discussions Lea Nogueira, DVM Cindy L. Adams, MSW, PhD Department of Population Medicine – PowerPoint PPT presentation

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Title: Describing Veterinarian-Client Communication During Euthanasia Discussions


1
Describing Veterinarian-Client Communication
During Euthanasia Discussions
  • Lea Nogueira, DVM
  • Cindy L. Adams, MSW, PhD
  • Department of Population Medicine
  • Ontario Veterinary College
  • University of Guelph

2
Outline
  • Background
  • Study Objectives
  • Methods
  • Sampling
  • Data collection
  • Analysis
  • Significance

3
Euthanasia and Pet Death
  • Euthanasia is a common procedure
  • 8 euthanasias/vet/month (range 3-20) (Hart et al,
    1990)
  • Veterinarians and veterinary staff experience the
    death of their patients at a ratio of 51 (Hart
    and Hart, 1987)
  • Veterinarians and students report discomfort
    (Tinga et al, 2001)

4
The Euthanasia Decision
  • The decision to euthanize a pet involves a triad
  • Pet
  • Owner
  • Veterinarian
  • Outcome affects the health and well-being of all
    three parties

5
Communication Challenges During End-of-Life
Conversations
  • Discomfort with emotion
  • Time constraints
  • Missing information
  • Difficult decision making
  • Pet considerations
  • Financial considerations

6
Communication and End-of-life Discussions
  • No research to date.
  • In medicine, communication about end-of-life
    issues is often lacking or conducted poorly.
    (Fisher et al, 1998 Covinsky et al, 2000 Roter
    et al, 2000)
  • Veterinarians are not using essential skills.
    (Shaw et al, 2004)

7
Communication and Important Outcomes
  • Communication is related to important outcomes
    including
  • Malpractice claims
  • Physician satisfaction
  • Patient satisfaction
  • Patient adherence
  • Patient health
  • Patient-centered medicine
  • Finding common ground
  • Relevance to end-of-life discussions in
    veterinary medicine

8
Study Objectives
  • To describe the components of veterinarian-client
    communication during end-of-life discussions.
  • To determine concordance of beliefs between
    veterinarians and clients regarding the
    communication that takes place.
  • To assess the use of standardized clients, as a
    method of assessing veterinarian-client
    communication.

9
Methodology Sampling
  • Subject selection
  • Eligible licensed companion animal
    veterinarians practicing within a one hour radius
    of the University of Guelph.
  • College of Veterinarians of Ontario database
  • Stratified random sample of 32 companion animal
    veterinarians (16 male, 16 female)
  • 32 x 2 obs./subject 64 observations

10
Data Collection
  • Standardized client method
  • Accurately and consistently portray a specific
    case
  • Medical and veterinary education
  • Used in medical research to evaluate physician
    performance in the clinical setting
  • (Kinnersley and Pill, 1993 Hutchison et al,
    1998 Carney et al, 1999)
  • Advantages and limitations

11
Data Collection cont
  • 2 standardized cases, both relating to euthanasia
  • Illness, old age, behaviour
  • Each participant will be visited by both
    standardized clients
  • Undisclosed visits.
  • Study validity

12
Data Collection cont
  • Audio recorded
  • Exit questionnaires
  • Client and veterinarian perceptions
  • Satisfaction
  • Detection

13
Data Analysis
  • The Measure of Patient-Centered Communication
    (MPCC) (Stewart et al, 2003)
  • Focused and specific to the patient-centered
    method
  • Assessment tools
  • Accompanying body of research

14
Data Analysis
  • The MPCC cont (Stewart et al, 2003)
  • Coding and scoring of 3 components
  • Exploring both the disease and the illness
    experience
  • Understanding the whole person
  • Finding common ground

15
Statistical Analysis
  • Descriptive statistics
  • Overall score
  • Component scores
  • Individual variables of interest
  • Concordance / agreement between vet and client
  • Exit questionnaires
  • Comparisons
  • Veterinarian characteristics
  • Client and veterinarian perceptions
  • Client satisfaction

16
Anticipated Significance
  • Communication styles
  • Relationship between communication styles and
    important outcomes
  • Provide the scaffolding for
  • Future research
  • Continuing education programs
  • Communication curricula in veterinary education

17
Thank you
  • Dr. Cindy Adams
  • Advisory Committee
  • Dr. Carl Ribble
  • Dr. Brenda Bonnett
  • Dr. Jane Shaw
  • Department of Population Medicine, OVC

18
  • Questions?

19
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