Effect of question design on dietary information solicited during veterinarian-client interactions in companion animal practice in Ontario, Canada

Conversation Analysis of Clients' Active Resistance to Veterinarians' Proposals for Long-Term Dietary Change in Companion Animal Practice in Ontario, Canada

The impact of nutrition on animal health requires effective diet-related treatment recommendations in veterinary medicine. Despite low reported rates of veterinary clients' adherence with dietary recommendations, little is known about how clients' resistance to nutritional proposals is managed in the talk of veterinary consultations. This conversation-analytic study investigated clients' active resistance to veterinarians' proposals for long-term changes to cats' and dogs' diets in 23 segments from 21 videotaped appointments in Ontario, Canada. Clients' accounts suggested the proposals themselves or nutritional modifications were unnecessary, inappropriate, or unfeasible, most often based on patients' food preferences, multi-pet feeding issues, current use of equivalent strategies, or current enactment of the proposed changes. Resistance arose when veterinarians constructed proposals without first gathering relevant diet- and patient-related information, soliciting clients' perspectives, or educating them about the benefits of recommended changes. Veterinarians subsequently accommodated clients' concerns more often when resistance involved patient- or client-related issues rather than clients' lack of medical knowledge. The design of subsequent proposals accepted by clients frequently replaced dietary changes in the initial proposals with nutritional or non-nutritional alternatives and oriented to uncertainty about adherence. This study provides evidence-based findings for developing effective communication training and practice guidelines in nutritional assessment and shared decision-making.

Survey of Belgian owners' perspectives on quality of life and difficulties during a weight-loss programme in obese cats

OBJECTIVES

The aims of this study were to determine owners' perception of their cats' quality of life (QoL), and whether there is a correlation with weight-loss variables, as well as to identify the main difficulties owners encounter during controlled weight loss in their obese cats.

METHODS

The study was carried out as an e-questionnaire survey addressed to owners of cats starting a weight-loss programme. The e-questionnaire was provided at a single time point after the conclusion of the study (24 weeks).

RESULTS

Nineteen completed questionnaires were included. Eighteen cats had a lower weight at the end of the weight-loss period, two of which had successfully reached their target weight. Mean weight loss was 13.84% body weight at a rate of 0.53% weight loss/week. Although the perceived QoL was not correlated with weight-loss variables (P >0.05), it increased over time, even in cats that did not reach their target weight, and was statistically correlated with increased activity (r = 0.73; P <0.01), mobility (r = 0.78; P <0.01) and play time (r = 0.61; P <0.01). The main difficulties encountered by owners were not giving (32%) or permitting the cat to eat extra food (26%). The main presumed difficulty for the cat was having its food decreased over time (53%). Most owners considered their cats happy (42%) and quite happy (53%) during the study, and no statistically significant correlations were found between the weight loss, food-seeking behaviour and stress parameters (P >0.05).

CONCLUSIONS AND RELEVANCE

Although several difficulties were encountered throughout the study, increased QoL and energy levels in their cats were noticed by owners. A positive perspective on weight-loss programmes is important to keep owners motivated and achieve the target weight in their cats. Furthermore, this survey provides insights into the perceived difficulties of weight-loss regimens in cats.

Animal obesity: What insights can a one health approach offer when it comes to veterinarians 'making every contact count'?

There is an overweight/obesity crisis in both human and companion animal populations globally. Veterinarians have an ethical obligation to protect animal welfare and, therefore, have a duty to intervene by supporting their clients in changing care plans to mitigate and prevent pet overweight/obesity. Currently, there is limited evidence in veterinary contexts for when and how this can be done effectively. In contrast, a more comprehensive body of literature has been developed on how human healthcare practitioners 'make every contact count' (MECC). This review begins by briefly exploring the cross-species multifactorial causes of overweight/obesity, before considering the literature regarding whether veterinarians reliably address overweight/obesity and the obstacles they encounter. The review then explores the evidence from human healthcare contexts in terms of how person-centred and health 'coaching-style' MECC interventions have supported weight management in adult and child populations and the barriers practitioners face when implementing these interventions. The final section interprets this literature to provide a fresh 'lens' through which veterinarians' concerns can be understood. Recommendations are made for enhancing veterinarians' capacity to develop the knowledge and skills needed for successful outcomes when MECC. Opportunities for developing local multi-stakeholder/agency teams taking a 'one health' approach are considered.

Pet owners’ and companion animal veterinarians’ perceptions of weight-related veterinarian-client communication

OBJECTIVE

To compare pet owners’ and veterinarians’ perceptions of veterinarian-client conversations concerning pet weight and identify challenges related to communication about weight.

SAMPLE POPULATION

Veterinarians (n = 24) and pet owners (27) in southern Ontario, Canada.

PROCEDURES

3 veterinarian and 5 pet owner focus groups were conducted with a semistructured interview format. Thematic analysis of verbatim transcripts was conducted.

RESULTS

Pet owners valued weight as an important health indicator for pets yet did not expect to discuss weight extensively at every appointment. Owners expected veterinarians to provide options and tailor recommendations when discussing weight management. Owners appeared more concerned with underweight animals, whereas veterinarians focused on obese animals. Veterinarians identified communication challenges, including the perception that owners are uninterested in discussing weight and conversations can become adversarial. Veterinarians reported various benefits and challenges of using humor to address pet weight and emphasized that weight-related conversations often depend on the existing veterinarian-client relationship.

CLINICAL RELEVANCE

Some perceptions of pet owner expectations expressed by veterinarians in this study align with owner preferences, yet several opportunities exist for changes to veterinarians’ approaches to weight-related communication with clients.

Veterinary professionals’ weight-related communication when discussing an overweight or obese pet with a client

OBJECTIVE

Pet weight may be difficult for veterinary professionals to address with clients, particularly when pets are overweight or obese. The objective of this study was to characterize the communication processes and content of weight-related conversations occurring between veterinary professionals and clients.

SAMPLE

Audio-video recordings of 917 veterinarian-client-patient interactions involving a random sample of 60 veterinarians and a convenience sample of clients.

PROCEDURES

Companion animal veterinarians in southern Ontario, Canada, were randomly recruited, and interactions with their clients were audio-video recorded. Interactions were reviewed for mentions of weight, then further analyzed by means of a researcher-generated coding framework to provide a comprehensive assessment of communication specific to weight-related interactions.

RESULTS

463 of 917 (50.5%) veterinary-client-patient interactions contained an exchange involving the mention of a single patient’s (dog or cat) weight and were included in final analysis. Of the 463 interactions, 150 (32.4%) involved a discussion of obesity for a single patient. Of these, 43.3% (65/150) included a weight management recommendation from the veterinary team, and 28% (42/150) provided clients with a reason for pursuing weight management.

CLINICAL RELEVANCE

Findings illustrate opportunities to optimize obesity communication to improve the health and wellbeing of veterinary patients.

Nutritional consulting in regular veterinary practices in Belgium and the Netherlands

BACKGROUND

Increased interest in nutrition by dog and cat owners stresses the importance of providing tailored nutritional guidance for each patient by veterinarians. The World Small Animal Veterinary Association (WSAVA) has provided guidelines to help veterinarians implement this in every-day patient care, by screening patients for the presence of nutritional risk factors, establishing tailored nutritional plans and providing adequate patient follow-up tools.

OBJECTIVES

This study aimed to assess the use of nutritional assessments in companion animal practices, and to investigate differences between Dutch and Belgian veterinarians.

METHODS

A survey was conducted among Dutch and Belgian veterinarians. Of the 423 respondents, 53% were from Belgium, and 47% were from the Netherlands.

RESULTS

Only 21% had prior knowledge of the WSAVA nutritional assessment guidelines. General trends in the usage of nutritional assessments were similar in the examined countries. Aside from weighing, diet evaluation by collecting dietary information and body condition or muscle condition scoring were used infrequently, mostly due to insufficient knowledge of the methods. Nutritional recommendations were often made as part of a treatment plan, and were mostly made by veterinarians, but in Dutch practices also by veterinary nurses.

CONCLUSION

Despite the fact that nutritional recommendations are a regular part of treatment plans, nutritional risk factors may be missed due to a lack of completely performed nutritional assessments. It remains important to promote the benefits of regular nutritional assessments to veterinarians, which will improve patients' health.

2021 AAHA Nutrition and Weight Management Guidelines for Dogs and Cats

The guidelines discuss the components of a systematic approach to nutritional management of dogs and cats. A nutritional assessment, including a body condition score and muscle condition score, is a screening evaluation that should ideally be performed at every examination. Individualized nutritional recommendations, based on the nutritional assessment, should be designed to achieve and maintain an appropriate body weight and meet nutritional requirements. Communicating nutritional recommendations to clients is a challenging aspect of nutritional management because pet owners may interpret the practice team's guidance as advocacy for a particular pet food brand or a judgment of the client's ability to properly care for the pet or of the owner's own nutritional status. The guidelines discuss approaches for effective, nonjudgmental communication of dietary recommendations to clients and strategies to increase acceptance of and adherence to veterinary nutrition recommendations. Other pet nutrition topics of current interest include recommendations for particular pet life stages, breeds, and disease conditions; risk factors for nutritional deficiencies and obesity; and considerations for home-prepared diets.

Nutritional Considerations When Dealing with an Obese Adult Equine

Equine obesity is common, reducing quality of life and requiring dietary energy restriction. Equine obesity is identified using subjective body condition scoring. Considerations are given for life stage and health status when managing obese equines. Every effort should be made to maximize feeding duration, and minimize time spent without feed while meeting all essential nutrient requirements. Limiting total daily dry matter intake to 2% of current bodyweight per day of a low caloric, forage-based diet may result in adequate body weight loss. Weight loss and weight management plans should be monitored for success and potential gastrointestinal, metabolic, and/or behavioral complications.

How to Perform a Nutritional Assessment in a First-Line/General Practice

Inappropriate nutrition is a priority welfare challenge. Nutritional mistakes are common and can lead to adverse events, such as poor growth and performance, colic, laminitis, and obesity. A detailed nutritional assessment involving evaluating the equine patient, current diet/ration, and management is essential in creating an effective nutritional plan. Goal(s) should be established and used to inform the plan. Management or resource barriers should be considered. Effective communication and a team-based approach versus an authoritarian one are likely to enhance the success of the nutritional plan. Developing a plan should be an interactive process, adjusting as needed after intentional monitoring.

Canine and Feline Obesity Management

Obesity and overweight have an impact on more than half of pet cats and dogs. Effective and team-based communication is essential for creating an effective weight loss plan. The diet should meet all essential nutrient requirements during energy/calorie restriction. There are several ways to initiate a weight loss plan, and regular monitoring is essential for determining if a plan is working or needs to be adjusted.

Conversation Analysis of Veterinarians' Proposals for Long-Term Dietary Change in Companion Animal Practice in Ontario, Canada

Nutritional changes recommended by veterinarians to clients can have a major role in animal-patient health. Although there is literature on best practices that can inform veterinary communication training, little is known specifically about how veterinarians communicate their recommendations to clients in real-life interactions. This study used the qualitative research method of conversation analysis to investigate the form and content of veterinarian-initiated proposals for long-term dietary change in canine and feline patients to further inform veterinary communication training. We analyzed the characteristics and design of veterinarian-initiated proposals for long-term nutritional modification as well as the appointment phases during which they occurred, in a subsample of 42 videotaped segments drawn from 35 companion animal appointments in eastern Ontario, Canada. Analyses indicated that veterinarians initiated proposals at various points during the consultations rather than as a predictable part of treatment planning at the end. While some proposals were worded strongly (e.g., "She should be on…"), most proposals avoided the presumption that dietary change would inevitably occur. Such proposals described dietary items as options (e.g., "There are also special diets…") or used mitigating language (e.g., "you may want to try…"). These findings seem to reflect delicate veterinarian-client dynamics associated with dietary advice-giving in veterinary medicine that can impact adherence and limit shared decision-making. Our analyses offer guidance for communication training in veterinary education related to dietary treatment decision-making.

Leaner, Healthier, Happier Together--A Family-Centred Approach to Weight Loss with the Overweight Dog and Her Caregivers

Obesity represents a one of the most significant healthcare issues facing human and companion animal populations worldwide. A complex relationship commonly exists between owners and their companion animal, particularly around feeding behaviour. Obese companion animals commonly live alongside caregivers who are also struggling with their own body weight. This case report highlights the importance of a family-centred approach to canine obesity as a way to engage with the pet's caregivers to help maximize their compliance towards the successful implementation of a tailored weight loss programme. Lara, an overweight dog weighing 35 kilos with a body condition score (BCS) of 7-7.5/9, was referred for a nutritional assessment. A comprehensive, pro-active and multidisciplinary protocol, tailored towards a family-centred approach, was established. After a 16-week programme, Lara reached the target body weight. The caregivers' compliance was assessed as being excellent; they also reassessed their individual lifestyle and were able to increase awareness towards their own nutritional issues and body weight perception, resulting in weight loss in all caregivers. Lara's case report represents how a family-centred approach can lead to successful patient weight loss and to a modification in the caregivers' way of thinking about nutrition and their own lifestyle, with the final goal of living a healthier and longer life together.

Feline Obesity in Veterinary Medicine: Insights from a Thematic Analysis of Communication in Practice

Feline obesity has become a common disease and important animal welfare issue. Little is known about how, or how often, veterinarians and feline-owning clients are addressing obesity during clinical appointments. The purpose of this qualitative study was to characterize verbal and non-verbal communication between veterinarians and clients regarding feline obesity. The sample consisted of video-recordings of 17 veterinarians during 284 actual appointments in companion animal patients in Eastern Ontario. This audio-visual dataset served to identify 123 feline appointments. Of these, only 25 appointments were identified in which 12 veterinarians and their clients spoke about feline obesity. Thematic analysis of the videos and transcripts revealed inconsistencies in the depth of address of feline obesity and its prevention by participating veterinarians. In particular, in-depth nutritional history taking and clear recommendations of management rarely took place. Veterinarians appeared to attempt to strengthen the veterinary-client relationship and cope with ambiguity in their role managing obesity with humor and by speaking directly to their animal patients. Clients also appeared to use humor to deal with discomfort surrounding the topic. Our findings have implications for communication skills training within veterinary curricula and professional development among practicing veterinarians. As obesity is complex and potentially sensitive subject matter, we suggest a need for veterinarians to have further intentionality and training toward in-depth nutritional history gathering and information sharing while navigating obesity management discussions to more completely address client perspective and patient needs.

Survey of owner motivations and veterinary input of owners feeding diets containing raw animal products

Background

The practice of feeding of diets containing raw animal products (RAP) to pets (dogs and cats) is discouraged by veterinary organizations and governmental public health organizations. Nevertheless, the practice of feeding RAP to pets is increasing in popularity. Pet owner motivations for feeding RAP diets to pets have not been explored and the benefits of RAP diets remain largely anecdotal. We hypothesized that pet owners feeding RAP diets would not rely on veterinary advice in choosing their pet’s diet. We also hypothesized that these owners would have lower levels of trust in veterinary advice with respect to nutrition relative to pet owners not feeding RAP.

Methods

An anonymous web-based survey was developed to identify pet owner motivations for feeding RAP diets, and to characterize the veterinarian-client relationships of individuals feeding RAP diets.

Results

There were 2,337 respondents and 2,171 completed surveys. Of survey respondents, 804 reported feeding RAP at the time of the survey. While 20% of pet owners feeding RAP relied on online resources to determine what or how much RAP to feed, only 9% reported consulting with a veterinarian in making decisions about feeding RAP. Pet owners feeding RAP reported lower levels of trust in veterinary advice both ‘in general’ and ‘with respect to nutrition’ than pet owners not feeding RAP. Most pet owners reported that a discussion regarding their pet’s nutrition does not occur at every veterinary appointment.

Discussion

Pet owners feeding a RAP diet have lower trust in veterinary advice than pet owners not feeding a RAP diet. Owners feeding RAP are more reliant on online resources than their own veterinarian in deciding what and how much RAP to feed. Pet owners perceive that nutrition is not discussed at most veterinary appointments. Therefore, there is room for improvement in the veterinarian-client communication with regards to nutrition.

Nutritional Assessment

Nutritional assessment focuses on evaluation of animal-specific, diet-specific, feeding management, and environmental factors. Assessment includes evaluation of a patient's medical history, comprehensive diet history, and physical examination including body weight, body condition, and muscle condition. Diagnostic testing may identify comorbidities associated with obesity or concurrent health conditions that need to be considered when developing a nutrition plan. When obesity is diagnosed during the nutritional assessment this finding along with health implications must be clearly communicated to the pet owner. Careful consideration of animal-specific, diet-specific, owner-specific, and environmental factors allows the clinician to develop a specific nutrition plan tailored to the needs of pet and owner.