Describing Veterinarian-Client Communication During Euthanasia Discussions

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

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

3. Euthanasia and Pet Death Euthanasia is a common procedure 8 euthanasias/vet/month (range 3-20) (Hart et al, 1990) Veterinarians and veterinary staff experience the death of their patients at a ratio of 5:1 (Hart and Hart, 1987) Veterinarians and students report discomfort (Tinga et al, 2001)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

18. Questions?

19. (Brown, Stewart, and Ryan, 2001)