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
• Ontario Veterinary College
• University of Guelph

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Outline

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

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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)

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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

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Communication Challenges During End-of-Life
Conversations

• Discomfort with emotion
• Time constraints
• Missing information
• Difficult decision making
• Pet considerations
• Financial considerations

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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)

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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

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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.

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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

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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

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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

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Data Collection cont

• Audio recorded
• Exit questionnaires
• Client and veterinarian perceptions
• Satisfaction
• Detection

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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

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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

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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

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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

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Thank you

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

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• Questions?

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