Aug
22
2007

A new study from the University of Guelph in Ontario, Canada, indicates a disparity between veterinarian and pet owner perceptions of end-of-life communications. Data presented during the International Conference on Communication in Veterinary Medicine July 12–15, 2007, in Washington, D.C., shows that while doctors believe all relevant aspects of the decision have been addressed with clients regarding end-of-life decisions for pets, clients disagree and report confusion about disease.

“This is a noteworthy topic,” said Cindy Adams, MSW, PhD, who presented new research to the private practice, academic, and industry professionals who attended the conference. “I believe,” Adams continued, “we can teach practitioners how to deal with this [issue] more effectively.” Adams has conducted research into this area. In a study published in 2000, Adams and other researchers found that clients who euthanized pets felt like murderers.

New research presented at the meeting assessed three components of doctor-patient interaction including exploration of the disease and illness, understanding the whole person, and finding common ground. Study authors asked simulated clients (people who were contracted for the study) how well veterinary professionals explained their pet’s illness/disease and reached a common understanding regarding potential options. Researchers actively sought the point of view of patients through questionnaires given after two undisclosed visits were made to one of 32 veterinarians (16 males and 16 females). In most cases, patient and veterinarian perspectives differed dramatically, Adams said.

“The results of this study suggest that important elements may be missing from euthanasia decision-making discussions, including discussion of client feelings, ideas, and expectations,” said Lea Nogueira, DVM, MSC, and lead researcher. “The results also suggest that veterinarians may not be facilitating client involvement to develop a mutually agreed upon treatment or management plan, particularly with less assertive clients.”

Nogueira used the Measure of Patient-Centered Communication – a barometer frequently utilized in human medicine – to analyze interactions between simulated clients and private practitioners, whose clinics are located close to the aforementioned university. Simulated clients made two undisclosed visits to veterinarians over a nine-month period between October 2005 and April 2006 and used hidden recorders to document their experiences. Veterinarians had previously agreed to participate in the study and knew that simulated clients would make appointments, but they did not know when those appointments would take place or who the clients were.

“End-of-life communication and euthanasia decision-making are unique to the veterinary profession and present considerable challenges to both veterinarians and clients,” Nogueira said. “I saw this as an area where research could have a tremendous impact, benefiting veterinarians, clients, and pets.”

After listening to audiotapes of clinic visits, researchers determined that the weakest part of the client/doctor interaction was explanation of the disease/illness while the strongest element was the veterinarian’s attempt to reach common ground.

Speaking to colleagues during the conference, Adams emphasized the importance of adopting effective end-of-life discussions to ensure that euthanasia is a mutually agreed upon decision and a byproduct of patient health and well-being. In 2000, when Adams conducted her research, she discovered that 30 percent of the pet owners who euthanized their pets experienced severe grief, 50 percent felt guilty about their decisions, and 16 percent said they felt like murderers. “Are we truly grasping [the magnitude] of this?” she asked.

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