Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 1: demographic and work-related factors

Occupational stressors are commonly encountered in small animal veterinary practice and have been associated with burnout. The working context of veterinarians differs by specialty, and this can potentially lead to variable exposures to risk factors for burnout. The aim of this study was to explore differences in demographic and working conditions of veterinary general practitioners (GPs) and emergency practitioners (EPs) to compare exposure to different potential stressors. An anonymous, online survey was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 participant responses were analyzed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Significant differences (P < 0.05) in the demographics and work-related exposures were found between the two groups. GPs were found to be older than EPs with a greater number of years of experience in their field (P < 0.001). Most veterinary GPs worked only day shifts (207/236, 87.7%); where EPs worked a greater variety of shift patterns, with "only day shifts" being the least common shift pattern (P < 0.001). Most GPs worked a set and predictable roster pattern (195/236, 83.6%), while most EPs did not (51/83, 61.5%). EPs worked more weekends and public holidays (P < 0.001). The EP group performed more hours of work each week but worked less overtime. The main contributing factors for overtime were scheduling factors for GPs and staffing issues for EPs. EPs were commonly not able to take meal-breaks and GPs' meal-breaks were commonly interrupted by work. EPs were more frequently exposed to patient death, euthanasia (including for financial reasons), emotionally distressed clients and delivering negative news (P < 0.001). Both groups indicated that most work environments were collegiate and supportive, and a minority reported toxic colleagues (11.8%) or management teams (26.9%). Just under one-half of respondents reported having witnessed or experienced workplace bullying. Of our respondent group, 52.0% (166/319) were not satisfied with their remuneration. Desire to leave their principal area of practice was prevalent among this survey group (192/319, 60.2%) with approximately one-third considering leaving the veterinary profession. We discuss the implications of these workplace factors, including mitigation strategies.

Measuring mental ill-health in the veterinary industry: A systematic review

Many instruments have been developed to examine and quantify symptoms of psychopathology. The main objective of this systematic review was to examine the instrument choice employed to measure mental ill-health in professionals working in the veterinary industry and reporting of psychometric testing of these instruments by researchers. 78 papers were reviewed. A total of 73 different instruments used to measure 19 symptoms of mental ill-health were identified. Quality assessment of included papers indicated 9 were low, 63 were moderate, and 6 were high quality. Reliability testing was conducted and reported in 36 papers and validity testing was reported in 23 papers. There is considerable heterogeneity in instrument choice measuring symptoms of mental ill-health in this population and inconsistency in conducting and reporting psychometric testing of instruments across studies. Adopting commonly employed instruments that yield high quality data in psychometric testing of instruments would be beneficial at advancing understanding in this field.

Assessment of owner perceptions of caregiver burden, veterinarian-client relationship and satisfaction with the provider in canine pruritus: An experimental vignette study

BACKGROUND

Complicated treatments for skin disease are linked to owner-caregiver burden and poorer perception of the veterinarian-client relationship, regardless of disease severity.

HYPOTHESES/OBJECTIVES

Using experimental vignettes, we explored the impact on owner perception of the interaction of treatment complexity and skin disease outcomes. We hypothesised that: (i) vignette conditions involving injection therapy would result in lower burden, better veterinary-client relationship and greater satisfaction relative to multimodal therapy conditions; (ii) the vignette condition of injection therapy with a completely effective outcome would be superior to all other conditions; (iii) ineffective vignette conditions would be inferior to all other conditions; and (iv) the vignette condition injection with a mostly effective outcome would be similar or superior to the multimodal therapy with a completely effective outcome condition.

PARTICIPANTS

Three hundred and nine owners of pruritic dogs recruited from a general veterinary practice, pet-related podcast, or social media dog allergy group.

MATERIALS AND METHODS

Participants were presented with six counterbalanced online vignettes representing three levels of treatment effectiveness (Completely Effective, Mostly Effective, Ineffective) and two treatment regimens (Multimodal, Injection). Measurements of participant perceptions of caregiver burden, veterinarian-client relationship and satisfaction were recorded.

RESULTS

Injection with perfect outcome was superior to other conditions (p < 0.001). Conditions with poor effectiveness were inferior (p < 0.001). Comparison of Injection with a mostly effective outcome to Multimodal treatment with perfect outcome yielded small-to-medium effects of preference for the latter in veterinarian-client relationship and satisfaction (p < 0.01); no difference was observed for caregiver burden. When good effectiveness was assured, injection was preferred (p < 0.001).

CONCLUSIONS AND CLINICAL RELEVANCE

Owners preferred a Completely Effective outcome and were prepared to select the Injection regimen or Multimodal therapy to achieve this; Injection was preferred when effectiveness was assured.

Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care

AIM

This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed.

RELEVANCE

Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery.

SERIES OUTLINE

This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.

Predictors of Suicide Risk and Mental Health Outcomes among Hong Kong Veterinarians: A Cross-Sectional Study

The professional quality of life (ProQOL) in the veterinary profession has gained increasing attention, yet little is known about its association with the mental health status of Hong Kong veterinarians. This study aimed to examine the impact of elements that make up ProQOL on the risk of suicide, depression, and anxiety among Hong Kong veterinarians. All veterinarians registered and practicing in Hong Kong at the time of recruitment were eligible to take part in the e-survey study between 1 January and 31 March 2022. Binary logistic regression was used to analyze the data from 56 participants. The results showed that 22.0% of the participants were at risk of suicide, 19.6% had current suicidal ideation, 29.4% had depression, and 29.4% had anxiety symptoms. The findings suggested poor mental health status among Hong Kong veterinarians and were comparable to or more prevalent than those reported in Anglophone and European countries. Results from the binary logistic regression suggested that burnout was a predictor of depressive symptoms, and that secondary traumatic stress showed potential in predicting suicide risk. Our study, however, did not find conclusive evidence supporting compassion satisfaction as a predictor of reduced symptoms of common mental issues. Further investigation into contextual factors affecting the mental health of veterinarians in Hong Kong is warranted. Improving the profession's mental health literacy and self-efficacy should be prioritized as a suicide prevention strategy to enhance mental health awareness.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Validation of the Burden Transfer Inventory‐abbreviated and examination across veterinary medicine positions and settings in the United States

Background

Burden transfer, when veterinary client caregiver burden underlies stressful encounters with providers, elevates risk for occupational distress in veterinary medicine. To date, burden transfer has been primarily examined in veterinarians working in general practice, using methods that are time consuming. The current work validates an abbreviated Burden Transfer Inventory (BTI‐A) and explores burden transfer across positions of employment and veterinary settings.

Methods

Participants completed online measures of burden transfer, stress and burnout. A BTI‐A with items representing each BTI domain was created with an initial validation sample (n = 1151 veterinarians). Confirmatory psychometric analyses were conducted in a cross‐validation sample (n = 440 veterinarians and support staff), followed by exploration of the BTI and BTI‐A across veterinary settings and position of employment.

Results

The BTI‐A correlated with the full‐length BTI (r = 0.89–0.96) shows good internal consistency (α = 0.72–0.88) and 1‐month test–retest reliability (r = 0.69–0.74). The BTI‐A correlated significantly (p < 0.001) with stress and burnout. Exploratory comparisons suggested group differences including greater reactivity in general compared to specialty referral/emergency practice (p = 0.02).

Conclusion

The BTI‐A can be used in place of the original measure when brevity is important. Use of the BTI‐A may help guide allied mental health professionals in providing support for wellbeing in veterinary healthcare team members.

Reducing occupational distress in veterinary medicine personnel with acceptance and commitment training: a pilot study

AIMS

To determine whether an educational programme targeting the reaction of veterinary personnel to difficult client interactions reduced burden transfer, stress and burnout in veterinary staff.

METHODS

Employees of three small-animal veterinary hospitals in the south-western United States of America were recruited and randomised to intervention (educational programme; n = 16) or control (no intervention; n = 18) groups. Participants of this randomised, parallel arms trial completed pre-programme assessment including the Burden Transfer Inventory (BTI), Perceived Stress Scale, and Copenhagen Burnout Inventory. Assessment was followed by two, group-format educational sessions, based on acceptance and commitment training, tailored to reducing reactivity to difficult veterinary client interactions (intervention group only). After training was completed, both groups were assessed using the same measures and the intervention participants provided use and acceptability ratings.

RESULTS

Intervention participants rated the programme as useful and appropriate, and reported that programme techniques were used a median of 43 (min 9, max 68) times during the 2 weeks prior to retesting. Relative to pre-programme scores, median post-programme scores for reaction (subscore of BTI) to difficult client interactions decreased in the intervention group (33 vs. 54; p = 0.047), but not in the control group (51 vs. 59; p = 0.210). Changes in median scores for stress and burnout from pre- to post-programme were non-significant for both groups.

CONCLUSIONS

This pilot and feasibility trial showed high rates of acceptability and use by participants, as well as promising reductions in burden transfer. A larger scale clinical trial with follow-up at extended time points is needed to more fully examine the efficacy of this novel programme.

CLINICAL RELEVANCE

Preliminary findings suggest this programme may be a useful approach to reducing occupational distress for individuals working in veterinary practice.

Benefits of practice ownership among US private practice veterinarians extend to professional quality of life

Objective

To estimate the effects of practice ownership on wellbeing of US private practice veterinarians.

Sample

1,217 practice owners and 1,414 associate veterinarians (ie, nonowners) who participated in the 2021 AVMA Census of Veterinarians and Practice Owners Survey.

Procedures

A professional quality of life instrument was used to measure compassion satisfaction (CS; a positive attribute), burnout (BO), and secondary traumatic stress (STS) in practice owners and nonowners both as scores and as score categories (low, moderate, and high CS, BO, and STS). For hypothesis tests, propensity score matching was used, with owners (n = 595) matched to nonowners (595) on several demographic and employment factors.

Results

Owners had significantly (P < .001) higher CS scores (mean ± SE, 34.1 ± 0.3) and lower BO scores (26.1 ± 0.3) than nonowners (32.8 ± 0.3 and 26.9 ± 0.3, respectively), but STS scores were comparable between groups (27.4 ± 0.3 and 27.5 ± 0.3; P = .55). The prevalence of low CS scores and high BO scores was significantly (P < .001) higher for nonowners versus owners (53.8% vs 42.7% and 51.6% vs 46.4%, respectively). Both owners and nonowners had a high prevalence of high STS scores (81.8% and 83.2%, respectively; P = .53).

Clinical Relevance

Results suggested that practice ownership confers a benefit to private practice veterinarians in terms of CS and BO, but not STS. The prevalence of poor CS, BO, and STS scores was higher than reported previously for 2016 to 2018, suggesting an impact of the COVID-19 pandemic. The high prevalence of high STS scores in both groups warrants attention and action to protect the welfare of the veterinary workforce and support optimal patient care.

An acceptance and commitment training program reduces burden transfer, stress, and burnout among veterinary healthcare teams

OBJECTIVE

To determine whether an acceptance and commitment training (ACT) program targeting reactions to difficult client interactions would reduce burden transfer, stress, and burnout among veterinary healthcare teams.

SAMPLE

Small animal veterinary hospital employees randomly assigned to participate in an ACT program (intervention group; n = 72) or to not undergo the training program (control group; 71).

PROCEDURES

The study was designed as a randomized, controlled, parallel-arms trial. All participants completed prestudy assessments of burden transfer, stress, and burnout. The ACT program consisted of 3 small-group–format educational sessions tailored to reducing reactivity to difficult veterinary client interactions; sessions were delivered via video teleconference. At the end of the educational sessions (posttest) and 1 month later (1-month follow-up), assessments of burden transfer, stress, and burnout were repeated, and participants in the intervention group provided ratings of program helpfulness and frequency of use for techniques taught in the program.

RESULTS

Participants receiving the program rated it as helpful and reported frequent use of program techniques. Relative to the control group, the intervention group showed significantly reduced burden transfer, stress, work-related burnout, and client-related burnout after completing the educational sessions. These improvements were maintained at the 1-month follow-up.

CLINICAL RELEVANCE

Findings support the usefulness of this program in reducing occupational distress in veterinary medicine. Future work is needed to examine whether it is similarly effective in formats that could be more broadly disseminated (eg, asynchronous, self-paced, independent learning).

Pet owners' feedback on psychological support service in an Italian veterinary hospital

The emotional stress experienced by pet caregivers, induced by negative diagnoses, clinical problems, and/or long-term therapies should be taken into serious consideration by the veterinarians to prevent these individuals from the risk of experiencing incapability of dealing with the great burden and the eventual reduction of compliance. Understanding the client's affective state may enhance the veterinarian's empathic response and effective communication. To understand better the unmet needs of clients, we collected data on service requests at the clinic and emotions that caregivers felt in the veterinarian setting. Understanding these difficulties may represent a first step to initiate the development of a psychological intervention targeting problems experienced by the caregivers. Assuming these difficulties according to the service requested for the pet, the owners might be interested in psychological support provided directly by the veterinary hospital. Our survey showed that a large percentage of owners expressed feelings related to caregiving in the veterinary setting, irrespective of the type of assistance needed, including apparently easy procedures. At the same time, they expressed a strong intention to receive a professional support. However, the crucial role of the psychological support is still difficult to accept even when it can be perceived as a right choice.

Caregiver burden, treatment complexity, and the veterinarian-client relationship in owners of dog with skin disease

Background

Increasing complexity of treatment plans is associated with higher levels of caregiver burden in owners of dogs with skin disease. It is possible that elevated caregiver burden resulting from treatment complexity could, in turn, affect the veterinarian–client relationship.

Hypotheses/Objectives

We expected that treatment complexity, caregiver burden, and the client’s perception of the veterinarian–client relationship would be related to each other. We also expected an indirect effect of caregiver burden on the cross‐sectional association between treatment complexity and the veterinarian–client relationship, and that this effect would be robust to adjustment for the dog’s skin disease course and severity.

Participants

Participants were 349 owners of dogs with skin disease recruited through online consumer panels.

Materials and methods

Cross‐sectional online assessments were completed for caregiver burden, treatment plan complexity, veterinarian–client relationship, and skin disease course and severity. Demographic information also was collected.

Results

The indirect effect of caregiver burden on the relationship between treatment complexity and veterinarian–client relationship was statistically significant, accounting for 42.76% of the variance in the model. After controlling for disease severity and course, that effect remained statistically significant, accounting for 37.76% of the variance.

Conclusions and clinical importance

Findings support the notion that greater treatment complexity is related to the owner’s perception of the veterinarian–client relationship via caregiver burden. Efforts to reduce caregiver burden by using the simplest effective treatment may benefit the veterinarian–client relationship.

Effects of a cognitive-behavioral skills building program on the mental health outcomes and healthy lifestyle behaviors of veterinary medicine students

OBJECTIVE

To evaluate the effects of a cognitive-behavioral skills building program (ie, MINDSTRONG; The Ohio State University) on the mental health outcomes and healthy lifestyle beliefs and behaviors of Doctor of Veterinary Medicine (DVM) students.

Sample

DVM students (n = 62) before beginning their program at a large public Midwest land-grant university.

Procedures

All 171 incoming DVM students (class of 2024) were required to take the cognitive-behavioral skills building program (7 weeks in length) before starting their 2020 school year. Students were given the option to consent to the study portion of the program. Consenting participants completed a pre- and postsurvey containing demographic questions and 5 valid and reliable scales, including the Patient Health Questionnaire-9 that assesses depressive symptoms, the Generalized Anxiety Disorder-7 that evaluates anxiety, the Brief Inventory of Perceived Stress that measures stress, and the Healthy Lifestyle Beliefs and Healthy Lifestyle Behaviors scales. Descriptive statistics described sample characteristics, paired t tests assessed changes over time in the outcomes Personal Wellness Assessment, and Cohen's d determined effect sizes.

Results

62 DVM students completed both surveys. Postintervention, students had significant improvements in depressive symptoms, anxiety, and healthy lifestyle beliefs and behaviors.

Clinical Relevance

Although this study used a small convenience sample of DVM students from a single university, a cognitive-behavioral skills building program demonstrated the ability to decrease rates of depression, anxiety, and suicidal ideation and improve healthy lifestyle beliefs and behaviors. Requiring DVM students to participate in such programming could provide benefit during their professional education and throughout their careers.

On-Call Duties: The Perceived Impact on Veterinarians' Job Satisfaction, Well-Being and Personal Relationships

Objective: To assess the impact of on-call duties on veterinarians' job satisfaction, well-being and personal relationships.

Design: Cross-sectional survey.

Sample: The sample was obtained from Veterinary Information Network (VIN) members in private practice within the United States.

Procedures: A link to an anonymous online survey was distributed via an email invitation to all Veterinary Information Network (VIN) members with access from August 15, 2017 to October 21, 2017.

Results: A total of 1,945 responses were recorded. The majority of those who reported having on-call duties were female associates. Composite scales were created to assess the impact of on-call shifts on job satisfaction and well-being. Multiple linear regression was conducted and found that gender (p = 0.0311), associate status (p < 0.0001), and age (p = 0.0293) were all significantly associated with on-call related job satisfaction. Additionally, multiple linear regression found that gender (p = 0.0039), associate status (p < 0.0057), and age (p < 0.0001) were all significantly associated with on-call related well-being. On-call shifts were reported by many to have a negative impact on job satisfaction and well-being; this was especially pronounced for female associates. Females had on-call related job satisfaction scores that were, on average, 1.27 points lower than that of males (lower scores equates to lower job satisfaction). Further, females' average on-call related well-being scores were 1.15 points higher than that of males (lower scores equates to higher well-being).

Conclusions and Clinical Relevance: This study suggests that on-call shifts have a negative impact on veterinarian job satisfaction, well-being and personal relationships. The negative impact on job satisfaction and well-being is greatest for female associates. Veterinary medicine has been identified as a stressful occupation that can lead to psychological distress. It is therefore important to critically assess current practices that appear to increase stress and reduce emotional well-being. For this reason, it is suggested that veterinary hospitals explore alternative options to traditional on-call shifts.

Ruminating on rudeness: Exploring veterinarians' experiences of client incivility

BACKGROUND

Interactions with clients have been identified as a key potential stressor within veterinary practice. However, there is a lack of research investigating the experience, and impact, of specific behaviours, such as incivility. The current study aimed to address this literature gap by investigating veterinarian perceptions of client rudeness.

METHOD

Telephone interviews (n = 18) were used to gather qualitative data regarding veterinarian perceptions of client rudeness. This encompassed description of an uncivil interaction, potential causes of incivility, the impact on the veterinarian and coping strategies.

RESULTS

The results indicate that veterinarians are exposed to a range of rude behaviours from clients, with suggested causal attributions spanning financial concerns, stress and worry. Adverse consequences associated with uncivil interactions included increased stress, mental health impacts and withdrawal from clients. Responses to incivility encompassed proactive pre-planning, empathy and clear communication. Support from colleagues was important to enable reflection and coping, alongside individual strategies, such as self-care.

CONCLUSION

Client incivility has the potential to adversely impact veterinarians. Appraisal of potential external causes for rudeness could facilitate constructive responses to client incivility and support coping. This should be combined with emotional support from colleagues to mitigate any negative consequences following uncivil client interactions.

Treatment complexity and caregiver burden are linked in owners of dogs with allergic/atopic dermatitis

BACKGROUND

Skin disease severity and treatment plan complexity are both related to owner experience of caregiver burden; however, to date they have not been examined simultaneously in owners of dogs with atopic or other chronic allergic dermatitis.

HYPOTHESES/OBJECTIVES

We expected to replicate and extend previous work by showing that caregiver burden is linked to treatment complexity and disease severity in this population. Moreover, we hypothesized that a relationship between burden and treatment complexity would be present in both subjective (owner report of experience) and objective (number of weekly treatments) measures, and that these relationships would exist independent of skin disease severity.

PARTICIPANTS

Eighty-six owners of dogs with atopic or other chronic allergic dermatitis recruited through social media dog allergy groups.

METHODS AND MATERIALS

Cross-sectional online assessments were completed for caregiver burden, treatment plan complexity and skin disease severity.

RESULTS

Caregiver burden was correlated with skin disease severity (r = 0.40) and both subjective (r = 0.37) and objective (r =0.30) measures of treatment complexity (P < 0.01 for all). Relationships between caregiver burden and treatment complexity remained significant after accounting for skin disease severity.

CONCLUSIONS AND CLINICAL IMPORTANCE

Greater treatment plan complexity is associated with higher caregiver burden in owners of dogs with atopic or other chronic allergic dermatitis. The independence of this relationship highlights the importance of simplicity in effective treatment planning.

Owner quality of life, caregiver burden and anticipatory grief: How they differ, why it matters

BACKGROUND

Understanding client perspective is important for veterinary communications, particularly during problem visits. Key client experiences of caregiver burden, anticipatory grief and quality of life (QoL) have been previously examined in this context, but never simultaneously considered.

METHODS

A sample of 393 owners of an elderly or seriously ill companion animal was recruited online to complete cross-sectional measures of psychosocial function, companion animal presentation and demographics.

RESULTS

Exploratory factor analysis demonstrated that owner caregiver burden, anticipatory grief and QoL reflect distinct constructs. Cluster analysis showed these experiences occur in four separate owner profiles: 'distressed', 'resilient', 'non-distressed' and owners experiencing strain due to 'other influences'. These groups appear to be differentially influenced by various factors, such as the companion animal's QoL, nature of the illness and the owner's attachment. They also show distinct differences in consideration of euthanasia and emotional functioning, including experience of stress and depressive symptoms.

CONCLUSIONS

Constructs of caregiver burden, anticipatory grief and QoL are not interchangeable and may differentially impact owner decisions and behaviour. The veterinarian's understanding of owner profiles relevant to these issues and distinguishing underlying features may foster effective communication.

A survey of primary care practitioners' referral habits and recommendations of allergen-specific immunotherapy for canine and feline patients with atopic dermatitis

BACKGROUND

A recent pilot study of primary care veterinarians' attitudes regarding canine atopic dermatitis and initiation of allergen-specific immunotherapy (ASIT) revealed several barriers to specialist referral (in the USA) and use of ASIT as a treatment modality.

HYPOTHESIS/OBJECTIVES

The primary objective was to collect data on referral habits and ASIT practices among a much larger cohort of primary care veterinarians located around the world, and to explore barriers to referral and management of atopic diseases of dogs and cats with ASIT.

METHODS AND MATERIALS

An online survey, administered through the Veterinary Information Network (VIN, Davis, CA, USA), asked participants to self-report their referral habits and immunotherapy recommendations, and rate barriers and motivating factors using Likert-scale responses.

RESULTS

Of 827 survey responses, 97.6% identified as primary care practitioners. A larger number of practitioners (84.5%) reported seeing atopic dogs often, compared with atopic cats (9.7%). Fewer of these veterinarians (56.6%) referred atopic cats for specialist care, compared to atopic dogs (73.5%). Timely communication, sharing long-term management of the case, and provision of local continuing education were identified as factors associated with increased willingness to refer. A higher proportion of practitioners reported recommending ASIT for dogs (44.3%) than for cats (16.0%). Only 56.0% of respondents considered success rates of ASIT to be acceptable, while 27.9% were neutral on the topic.

CONCLUSIONS AND CLINICAL RELEVANCE

Dermatology specialists might build stronger relationships with referring veterinarians through timely case follow-up and provision of continuing education regarding the long-term benefits of ASIT and symptomatic management practices.

Early caregiver burden in owners of pets with suspected cancer: Owner psychosocial outcomes, communication behavior, and treatment factors

BACKGROUND

Owners of companion animals with serious illnesses are likely to experience "caregiver burden." This topic has not been fully evaluated in veterinary oncology.

OBJECTIVES

To examine owners of a dog or cat with suspected cancer for relationships between early caregiver burden and (a) psychosocial factors: depression, stress, and quality of life; (b) owner communication behavior; and (c) specific pet treatment plan factors.

ANIMALS

None.

METHODS

This cross-sectional, observational study recruited 164 owners of a cat or dog presenting for evaluation by a veterinary oncology service at a single referral institution. Measures of caregiver burden, psychosocial function, treatment plan elements, and demographics were collected online via owner self-report. Medical records were reviewed to identify factors including diagnosis, medications, treatment schedules, and owner communications.

RESULTS

Caregiver burden correlated with higher stress (r_s = 0.40, P < .001), greater symptoms of depression (r_s = 0.50, P < .001), and lower quality of life (r_s = 0.39, P < .001). Pet treatment plan factors related to caregiver burden included changes in care routines, perception that compliance with new routines was challenging, and difficulty adhering to medication routines. There was low correlation between caregiver burden and owner-driven communications (r_s = 0.15, P = .07).

CONCLUSIONS AND CLINICAL IMPORTANCE

Findings suggest caregiver burden is similar in owners of pets with cancer and owners of pets with other diseases. Caregiver burden is present in the earliest stages of disease. Major correlates of burden including life-disruptive treatments and schedules provide key areas for potential intervention by veterinary teams.

'No-one knows where you are': veterinary perceptions regarding safety and risk when alone and on-call

BACKGROUND

Veterinary work is considered high risk and involves working with a range of hazards, including large animals, high workload and long hours. A key potential hazard is making home visits and providing out-of-hours emergency care, where vets often work alone, without support and must travel long distances. The current study aimed to examine UK veterinary perceptions of safety culture, lone working and on-call tasks to gain a deeper understanding of the risk and hazards involved.

METHODS

An online mixed-methods survey was used to gather quantitative data relevant to practice safety culture and qualitative data regarding veterinary perception of lone working and on-call work. A sample of 76 UK veterinarians were recruited.

RESULTS

The quantitative results suggest that there may be practice safety culture issues around a lack of communication and discussion pertaining to safety, particularly in terms of maintaining personal safety. Key themes within the qualitative data included the pressure to treat patients, potentially at personal risk, and feeling unsafe when meeting clients alone and in remote locations.

CONCLUSION

These findings indicate that personal safety requires more attention and discussion within veterinary practices, and that safety protocols and requirements should be shared with clients.

Validation of an abbreviated instrument to assess veterinary client caregiver burden

Background

Caregiver burden is present in many clients managing illness in a companion animal, but current assessment tools are time‐consuming and lack normative reference values.

Objectives

Statistical reduction of items in a measure of caregiver burden to create an abbreviated version, validation of the abbreviated version, and calculation of reference values.

Animals

None.

Methods

This study was conducted using observational methods. Owners of an ill cat or dog were recruited through social media (n = 429). Veterinary clients with an ill (n = 459) or healthy (n = 961) cat or dog were recruited through a general veterinary and an academic hospital with multiple specialties. The study was conducted in 3 stages: (a) reduction of the Zarit Burden Interview (ZBI) adapted for use in pets via factor and item analyses, (b) psychometric validation of the abbreviated instrument, and (c) standardization of the abbreviated (7 items) and full (18 items) measures.

Results

A 7‐item measure showed high correlations with the full measure (r = 0.88‐0.93) and good internal consistency (α = .71‐.75) across samples of veterinary clients with an ill cat or dog. This abbreviated measure correlated significantly (P < .001) and positively with stress (r = 0.40‐0.75) and negatively with quality of life (r = −0.32 to −0.56). Reference values derived from clients with a healthy companion animal suggest “normal” burden ranges of 0 to 17 on the full measure and 0 to 8 on the abbreviated version.

Conclusions and Clinical Importance

For situations precluding full assessment of client caregiver burden, this brief 7‐item version can be used with good internal consistency and validity. Reference values can help determine if a client's caregiver burden is increased.