Euthanasia of dogs and cats by veterinarians in New Zealand: protocols, procedures and experiences

AIMS

To collect data on protocols used by New Zealand veterinarians to perform euthanasia of dogs and cats, and to explore opinions towards the training they received in euthanasia during veterinary school.

METHODS

A cross-sectional survey was administered to all veterinarians registered with the Veterinary Council of New Zealand. The survey asked respondents about their practices' policies for euthanasia; protocols for performing euthanasia of dogs and cats; opinions towards euthanasia training received in veterinary school; and subsequent experiences with euthanasia in practice. Descriptive statistics were provided for all quantitative study variables and thematic analysis was performed on the free-text comments.

RESULTS

The survey was completed by 361/1,448 (24.9%) veterinarians in companion or mixed animal practice. The mean number of dogs and cats euthanised each month were 7.2 (median 5; min 0; max 60) and 7.9 (median 5; min 0; max 60), respectively. Fewer than half of respondents reported that their clinic had a standard protocol for euthanising dogs (147/361; 40.7%) and cats (157/361; 43.5%). For euthanasia of dogs, 119/361 (32.9%) always used sedation while 71/361 (19.7%) indicated that they would not use sedation. For euthanasia of cats, 170/361 (47.1%) always used sedation while 53/361 (14.7%) indicated that they would not use sedation. Placement of IV catheters, methods for patient restraint, preferences towards the presence of owners during euthanasia, services provided with euthanasia, and discussions with owners were also highly variable and handled case-by-case depending on the client, patient, and clinical scenario. When asked about the euthanasia training received at veterinary school, it was generally ranked as below satisfactory, with approximately one third of respondents indicating that they received no training in dealing with emotional clients (113/361; 31.3%), sedation protocols for euthanasia (107/361; 29.6%), or managing compassion fatigue (132/361; 36.6%). Most respondents (268/361; 74.2%) received no formal training in euthanasia after graduation and learned from experience or discussions with colleagues. Providing animals and owners with a good experience during the euthanasia process was highlighted as important for managing compassion fatigue.

CONCLUSIONS

Euthanasia is a common procedure in companion animal practice and there is considerable variation in how veterinarians approach both the technical and non-technical elements. Training provided during veterinary school was generally considered below satisfactory, particularly regarding managing compassion fatigue and clients' emotional needs.

CLINICAL RELEVANCE

Providing veterinarians with additional training on adapting their euthanasia protocols to different clinical scenarios may improve the experience for patients, owners and veterinary staff.

Broadening the Veterinary Consultation: Dog Owners Want to Talk about More than Physical Health

Few veterinary professionals use formal quality of life (QOL) assessment tools despite their recommendation from veterinary governing bodies to enable holistic welfare assessments and target welfare improvement strategies. Perceived barriers include resistance from owners, and this study aimed to elucidate understanding of dog owner engagement with conversations and tools relating to QOL. An online survey that investigated owner experience, comfort, and opinions about vet-client discussions on topics connected to canine health and well-being, including QOL, was completed by 410 owners. Almost all owners (95.8%) were reportedly comfortable discussing QOL, yet only 32% reported their vets had addressed it. A high proportion of owners (70.8%) expressed interest in assessment tools, but only 4.4% had experienced one, none of which were QOL tools per se. Semi-structured interviews of a sub-set of four owners provided a more in-depth examination of their experience of a health and well-being assessment tool. Thematic analysis generated three themes: 'Use of assessment tools supports client-vet relationship and empowers owners', 'Owners want to talk about holistic dog care', and 'Owner feelings on the wider application of assessment tools'. Overall, our findings suggest that owners want to broaden the veterinary consultation conversation to discuss QOL and are interested in using tools, and therefore veterinary perceptions of owner-related barriers to tool application appear unfounded. Indeed, tool uptake appears to improve the vet-client relationship and boost owner confidence.

Veterinarians' use of shared decision making during on-farm interactions with dairy and beef producers

BACKGROUND

The objectives of this study were to explore the level of shared decision making (SDM) between veterinarians and dairy and beef producers during on-farm interactions and to identify factors associated with veterinarians' use of SDM behaviours.

METHODS

A cross-sectional sample of food-animal veterinarians and their clients were recruited in Ontario, Canada. Their on-farm interactions were audio-video recorded. The recordings were analysed using the 'Observing Patient Involvement in Decision Making' (observer OPTION5 ) instrument to determine the level of SDM utilised during preference-sensitive decisions. A logistic regression model was developed to assess factors associated with a preference-sensitive decision occurring. Meanwhile, a linear regression model was developed to identify factors associated with the level of SDM used.

RESULTS

Forty-one veterinarians participated, and 186 unique veterinarian-producer interactions were audio-video recorded and OPTION5 score was calculated. SDM scores were low and comparable to other studies using the OPTION5 instrument. The only factor associated with whether a preference-sensitive decision occurred was the length of the veterinarian and producer's relationship (in years). As the length of their relationship increased, a preference-sensitive decision was less likely to occur. The use of SDM behaviours was found to decrease as veterinarian burnout score increased. These findings demonstrate that SDM behaviours are being used by food-animal veterinarians, yet an opportunity exists to further implement more producer-centred SDM skills into on-farm interactions.

LIMITATIONS

Small portions of veterinarian-producer conversation occurred outside of audio-video-recorded interactions and were not included in the analysis.

CONCLUSION

The results of this study aid in further understanding on-farm interactions between veterinarians and producers and can help to further improve veterinary communication curricula.

A Scalable and Effective Course Design for Teaching Competency-Based Euthanasia Communication Skills in Veterinary Curricula

Veterinary staff must be able to navigate end-of-life care with sensitivity and skill to create the best possible outcome for the patient, client, and veterinary team collectively. Despite the clear importance of euthanasia communication and procedural skills in veterinary practice, recent graduates of veterinary programs identified gaps between skills deemed important in clinical practice and skills emphasized in the curriculum. Little time is allocated to euthanasia procedural or communication training across the board in US veterinary programs. Thus, it is of paramount importance to establish intentional and well-designed instruction and assessment of euthanasia communication skills for veterinary trainees. A course on veterinary euthanasia communication skills was designed to emphasize themes and topics essential for a competent veterinarian. Through course evaluations, students expressed the sentiments that this course improved their euthanasia communication skills, that euthanasia communication skills are essential for their careers, and that the course content should be integrated into the core curriculum. This article presents a scaffold for the instruction and assessment of veterinary euthanasia communication skills in alignment with a competency-based veterinary education (CBVE) framework and outlines specific learning interventions used in the course that are scalable and may be extracted and incorporated into existing courses.

Using electronic health records to explore negotiations around euthanasia decision making for dogs and cats in the UK

BACKGROUND

End-of-life decision making for animals happens daily in veterinary practice. However, access to such discussions as they happen is difficult, in view of the highly emotional circumstances of end-of-life consultations. Despite the expanding literature on euthanasia, few studies have explored the circumstances of euthanasia disagreement or delay.

METHODS

To explore euthanasia discussions in veterinary practice, consultations recorded in electronic health records in a UK veterinary surveillance database (SAVSNET) were examined. From a sample of 2000 identified consultations, 69 canine and 76 feline consultations were purposively sampled for detailed thematic analysis. Specifically, consultations were selected if they involved a decision to delay euthanasia, including disagreement about the timing of euthanasia.

RESULTS

Reasons identified for euthanasia refusal or delay included client-related factors (e.g., allowing other family members to say goodbye, differing opinions on the quality of life) and veterinary surgeon-related factors (eg, the wish to carry out further investigations or to try a new treatment). In the instance of refusal or delay, palliative treatment was commonly provided to preserve animal welfare.

CONCLUSION

This study illustrates some of the processes used to negotiate end-of-life decision making in dogs and cats. Its findings shed light on the importance of palliative care in providing owners with time to decide.

A Call for Compassionate Empathy: Analysis of Verbal Empathic Communication between Veterinary Students and Veterinary Clients and their Dogs

In human medicine, empathy contributes to enhanced patient satisfaction and trust, decreased litigation, and increased adherence to medical recommendations. Understanding client perspectives is crucial in the empathic process; failure to explore these perspectives has been linked to decreased client satisfaction in veterinary consultations. This article explores how veterinary clients verbally expressed emotional concerns during consultations and how veterinary students addressed them. The "Model of Empathic Communication in the Medical Interview" by Suchman et al., is the starting point for a thematic analysis of consultation transcripts. Clients expressed multiple emotional concerns both directly by using explicit words (coded as empathic opportunities-EO), and indirectly (coded as potential empathic opportunities-PEO), throughout the consultations. Indirect examples prevailed and included stories about previous experiences with pet illnesses and pet care received elsewhere. Clients used explicit words, including "fear" and "panic." Students usually responded with a biomedical focus, including asking medical questions and giving medical explanations. Although students demonstrated various communication skills, they failed to demonstrate a complete verbal compassionate empathic response (a novel code) that includes exploring and verbalizing accurate understanding of the clients' perspectives and offering help based on this understanding. These findings suggest that strategies to teach compassionate empathy and support its use in the clinical setting are not fully effective, and veterinary students risk entering practice unprepared to employ this vital competency. The authors also introduce an operational definition for compassionate empathy.

Comparison of food-animal veterinarians' and producers' perceptions of producer-centered communication following on-farm interactions

BACKGROUND

Human medicine has demonstrated that a patient-centered physician-patient relationship is more effective than the traditional physician-centered model. Objectives were to explore food-animal veterinarians' and producers' perceptions of producer-centered communication (VPPC and PPPC), during on-farm interactions and examine associated factors.

METHODS

A cross-sectional sample of food-animal veterinarians and their clients were recruited in Ontario, Canada. Immediately following on-farm veterinarian-producer interactions, the producer and veterinarian independently completed a questionnaire assessing PPC. Symmetry of paired responses between veterinarians and producers was examined. Employing listwise deletion, independent mixed linear regression models were developed to determine factors associated with PPPC and VPPC, respectively.

RESULTS

Two hundred and three paired veterinarian and producer survey responses were analysed. Significant asymmetry (p-value < 0.05) was observed, with veterinarians assessing PPC lower than producers. Based on data from 32 veterinarians and 159 producers, the only factor associated with PPPC was veterinarian burnout (PPPC decreased with burnout). Based on data from 32 veterinarians and 155 producers, factors positively associated with VPPC included veterinarian compassion satisfaction (VPPC increased with compassion satisfaction), length of interaction (VPPC increased with length of interaction) and producers identifying as female (VPPC higher with female producers).

CONCLUSION

Producer's positive PPPC is encouraging, yet veterinarians should be aware that mental health parameters may impact producers' and their own perceptions of PPC. Further examining veterinarians' delivery of PPC is important for food-animal practice.

Factors associated with food-animal producer visit-specific satisfaction following on-farm interaction with a veterinarian

BACKGROUND

Effective communication has been found to have positive associations with client satisfaction, client adherence and veterinarian satisfaction in companion animal medicine. Better understanding the role of communication on these outcomes, specifically producer satisfaction, is likely to benefit food-animal medicine. Objectives were to identify factors associated with producer visit-specific satisfaction following on-farm veterinarian-producer interactions and evaluate the validity of the Client Satisfaction Questionnaire for use in food-animal medicine.

METHODS

A cross-sectional sample of practicing food-animal veterinarians and their producer clients were recruited in Ontario, Canada. Immediately following the veterinarian-producer interaction, producers completed a questionnaire that assessed their visit-specific satisfaction and their perception of the producer-centeredness of the interaction. Veterinarians completed a questionnaire that assessed their perception of the interaction's producer-centeredness. A linear regression model was developed to identify factors associated with producer visit-specific satisfaction.

RESULTS

Forty-one veterinarians and 207 producers participated. Factors associated with producer visit-specific satisfaction included producer age (satisfaction decreased with age), producer gender (males less satisfied) and producer perception of producer-centeredness score (satisfaction increased with producer perception of producer-centeredness score).

CONCLUSION

Findings raise awareness of the importance of a producer's perception of producer-centeredness in food-animal practice and encourage its use by food-animal veterinarians in working towards positive outcomes.

Evaluation of communication skills training programs at North American veterinary medical training institutions

OBJECTIVE

To describe how North American veterinary medical teaching institutions (VMTIs) provide communication skills training to students.

SAMPLE

Faculty coordinators of communication skills training programs (CSTPs) at 30 North American VMTIs.

PROCEDURES

An online survey instrument was designed and administered to each respondent followed by a telephone (n = 28) or in-person (2) interview. The survey and interview process were designed to evaluate all aspects of CSTPs, such as communication framework used, program format, number of student-contact hours, staffing models, outcome assessment, faculty background, program priorities, and challenges. Descriptive results were generated, and guidelines for future development of CSTPs were recommended.

RESULTS

27 US and 3 Canadian VMTIs were represented, and communication skills training was required at all. Twenty-five CSTPs used the Calgary-Cambridge Guide framework. Respondents provided a mean of 33 student-contact hours of training, primarily in the first 3 years of the veterinary curriculum in lecture (mean, 12 hours), communication laboratory (13 hours), and self-study (8 hours) formats with formative feedback. Communication skills training was integrated with other disciplines at 27 VMTIs. Most CSTPs were coordinated and taught by 1 faculty member with a < 0.50 full-time equivalent commitment and no administrative support. Stated priorities included acquisition of resources for CSTP faculty, administrative support, and video-equipped facilities; increasing integration of CSTPs into curricula; and assessment of educational outcomes.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that support for CSTPs and recognition of their value continue to grow, but a lack of resources, faculty expertise, validated methods for outcomes assessment, and leadership remain challenges.

Public Perceptions of Veterinarians from Social and Online Media Listening

The public perception of the veterinary medicine profession is of increasing concern given the mounting challenges facing the industry, ranging from student debt loads to mental health implications arising from compassion fatigue, euthanasia, and other challenging aspects of the profession. This analysis employs social media listening and analysis to discern top themes arising from social and online media posts referencing veterinarians. Social media sentiment analysis is also employed to aid in quantifying the search results, in terms of whether they are positivity/negativity associated. From September 2017-November 2019, over 1.4 million posts and 1.7 million mentions were analyzed; the top domain in the search results was Twitter (74%). The mean net sentiment associated with the search conducted over the time period studied was 52%. The top terms revealed in the searches conducted revolved mainly around care of or concern for pet animals. The recognition of challenges facing the veterinary medicine profession were notably absent, except for the mention of suicide risks. While undeniably influenced by the search terms selected, which were directed towards client–clinic related verbiage, a relative lack of knowledge regarding veterinarians’ roles in human health, food safety/security, and society generally outside of companion animal care was recognized. Future research aimed at determining the value of veterinarians’ contributions to society and, in particular, in the scope of One Health, may aid in forming future communication and education campaigns.

Validation and preliminary data from a health-related quality of life questionnaire for owners of dogs with cardiac disease

BACKGROUND

Cardiac disease in dogs impacts the quality of life (QoL) of their owners, but owners' QoL has not been comprehensively assessed in this population.

OBJECTIVES

To develop, validate, and provide preliminary data from a health-related QoL (hrQoL) questionnaire for owners of dogs with cardiac disease.

SUBJECTS

A total of 141 owners of dogs with cardiac disease were studied.

METHODS

An owner hrQoL (O-hrQoL) questionnaire containing 20 items related to areas of a person's life that could be impacted by caring for a dog with cardiac disease was developed and administered to owners of dogs with cardiac disease. The highest possible total score was 100, with higher scores indicating a worse hrQoL. Readability, internal consistency, face and construct validity, and item-total correlations were assessed.

RESULTS

Median O-hrQoL score was 35 (range, 0-87). The questionnaire had good internal consistency (Cronbach's α = 0.933), construct validity (Spearman's r = 0.38-0.53; Kendall's τ = 0.30-0.43; P < .001), and item-total correlation (Spearman's r = 0.44-0.79; Kendall's τ = 0.34-0.66; all P < .001). Fifty percent of owners indicated a negative effect of dogs' cardiac disease on their own QoL, but all owners responded that caring for their dogs either had strengthened (n = 76; 53.9%) or had no effect on their relationship with their dog (n = 65; 46.1%).

CONCLUSIONS AND CLINICAL IMPORTANCE

The O-hrQoL questionnaire had good validity, and results suggest that owners' QoL is significantly impacted by caring for dogs with cardiac disease. Additional research on effective approaches to minimizing the negative effects of a dog's cardiac disease on the owner is warranted.

Exploring veterinarians' use of practices aimed at understanding and providing emotional support to clients during companion animal euthanasia in Ontario, Canada

BACKGROUND

During companion animal euthanasia, support of clients is equally important as the medical care of the companion animal and requires a clear and developed understanding of clients' feelings, needs and expectations. Yet, veterinarians may not be fully exploring such topics.

METHODS

A 65-item online questionnaire was developed and distributed to veterinarians (n=368) in Ontario to explore veterinarians' use of practices aimed at understanding and providing support during companion animal euthanasia. Measures included veterinarians' use of previously identified communication and support practices, empathy, years in practice and amount of time scheduled for euthanasia appointments. Data were analysed using descriptive statistics and multivariable regression.

RESULTS

Veterinarians reported consistently providing emotional support but inconsistently implementing practices that may assist in enhancing their understanding of clients' expectations, previous or emotional experiences. Veterinarians' empathy scores, years in practice and the amount of time scheduled for euthanasia were positively associated with use of these practices.

CONCLUSION

Providing adequate time (ideally >30 min) for euthanasia appointments may assist in efforts to understand clients' experiences, expectations and emotions, and provide support. Combining empathy, hands-on and self-care training in veterinary curriculum may also be valuable in improving the comfort level and skill of veterinarians in providing compassionate care.

Factors Contributing to the Decision to Euthanize: Diagnosis, Clinical Signs, and Triggers

This article reviews factors contributing to the decision to euthanize a patient by exploring the diagnosis, clinical signs, and triggers behind the choice. By investigating these triggers, the article helps guide practitioners to proactively manage areas of concern that lead to the decision of euthanasia. Included in this article is a benchmark comprehensive survey for pet families that standardizes documentation of family decision making surrounding end of life and euthanasia. Increased knowledge about diagnosis, clinical signs, and triggers may improve the technical and communication skills of professionals about specific conditions that are encountered at the end of life.

Nonpharmacologic Methods to Improve the Euthanasia Experience

Nonpharmaceutical methods to improve the euthanasia experience are equally important as the drugs used to carry out a good euthanasia. Introduction of a hospice care plan to the family and their pet is supportive of all aspects surrounding death including the euthanasia process. This article reviews the tools necessary to use a hospice care plan and covers tips on how to improve the euthanasia experience using commonsense methods that are affordable for the pet owner. The integration of pharmaceutical and nonpharmaceutical methods is paramount in providing a good death.

Communication: Difficult Conversation in Veterinary End-of-Life Care

This article demonstrates how good communication sets the foundation to provide superior comprehensive care during the stressful time surrounding end of life. Communication addressing end-of-life care in veterinary medicine has significant impact on all involved: the patient, the client, the health care team, and the practice. These conversations require training and practice to achieve mutually satisfying outcomes. Suggested guides for facilitating these conversations and several typical scenarios are presented to provide methods for future evidenced-based evaluation in effective communication. The Critical Incident Stress Management is presented as a model for mitigation of adverse consequences related to traumatic events in veterinary practice.

Impacts of the process and decision-making around companion animal euthanasia on veterinary wellbeing

A qualitative study using group and individual interviews involving 10 veterinary hospitals in Wellington County, Ontario, explored how the practices involved in euthanasia-related care impacts the wellbeing of veterinary professionals. Thematic analysis indicated two major outcomes: the goal and desire of veterinary professionals was to facilitate a 'good death' for the companion animal and navigating the euthanasia decision process was more challenging than the actual event of performing euthanasia. When successful in achieving a 'good death' and navigating euthanasia decisions, participants reported feeling that their own sense of wellbeing and the veterinary client's sense of wellbeing were improved. When unsuccessful, participants reported experiencing a reduced sense of wellbeing, reduced job satisfaction, increased emotional strain and feeling that the client was also detrimentally impacted. For many participants, navigating euthanasia decision-making consultations was seen as a greater challenge and a greater contributor to a reduced sense of wellbeing than the act of euthanasia itself. These findings suggest that there is a need for greater attention and support for veterinary professionals, particularly when navigating euthanasia decision-making consultations. Additional training and resources on navigating euthanasia consultations may assist in improving the wellbeing for veterinary professionals and the companion animals and owners under their care.