On-site communication skills education increases client-centered communication in four companion animal practices.

OBJECTIVE: To evaluate veterinarian-client communication before and after a 15-month on-site communication skills training intervention. PROCEDURES: Multipractice, pretest-posttest intervention study. SAMPLE: A convenience sample of 4 companion animal practices owned by a single practice group in Austin, Texas (n = 9 veterinarians; 170 audio recordings). RESULTS: After intervention, visits were 8 minutes longer (P = .005), and veterinarians' client-centered scores increased significantly (2.30 vs 2.72; P = .006). Veterinarians' biomedical questions decreased by nearly a third (P = .0007), while veterinarians' facilitation (ie, partnership-building) statements were 1.15 times as great (P = .04) after intervention due to an increase in asking for the client's opinion (P = .03) and use of back-channel statements (P = .01). Agenda-setting skills, including agenda-setting questions (P = .009), summary of the client's agenda (P = < .0001), and a check for remaining concerns (P = .013), increased significantly after intervention. Clients asked 1.9 times as many lifestyle-social related questions (P = .02) and provided 1.3 times as much lifestyle-social information (P = .0004) after the intervention. Additionally, clients offered 1.4 times as many emotion-handling statements (P = .0001), including showing concern (P = .03) and optimism, reassurance, or encouragement (P < .0001), after intervention. Paraverbally, clients presented as more anxious/nervous (P = .03) and emotionally distressed/upset (P = .02) after the intervention. CLINICAL RELEVANCE: Results suggest that client-centered communication skills increased after intervention. This study builds upon previous case-based studies examining practice-based communication training, emphasizing that long-term interventions positively enhance veterinarian-client communication, which is likely to have a positive impact on client and patient care.

Veterinary technicians contribute to shared decision-making during companion animal veterinary appointments.

OBJECTIVE: To describe and compare veterinary professionals' use of shared decision-making during companion animal appointments. DESIGN: Multi-practice cross-sectional study. SAMPLE: A purposive sample of 4 companion animal veterinary clinics in a group practice in Texas. PROCEDURES: A convenience sample of veterinary appointments were recorded January to March 2018 and audio-recordings were analyzed using the Observer OPTION5 instrument to assess shared decision-making. Each decision was categorized by veterinary professional involvement. RESULTS: A total of 76/85 (89%) appointments included at least 1 decision between the client and veterinary professional(s), with a total of 129 shared decisions. Decisions that involved both a veterinary technician and veterinarian scored significantly higher for elements of shared decision-making (OPTION5 = 29.5 ± 8.4; n = 46), than veterinarian-only decisions (OPTION5 = 25.4 ± 11.50; P = .040; n = 63), and veterinary technician-only decisions (OPTION5 = 22.5 ± 7.15; P = .001; n = 20). Specific elements of shared decision-making that differed significantly based on veterinary professional involvement included educating the client about options (OPTION5 Item 3; P = .0041) and integrating the client's preference (OPTION5 Item 5; P = .0010). CLINICAL RELEVANCE: Findings suggest that clients are more involved in decision making related to their pet's health care when both the veterinary technician and veterinarian communicate with the client. Veterinary technicians' communication significantly enhanced client engagement in decision-making when working collaboratively with the veterinarian.

On-site communication skills education increases appointment-specific client satisfaction in four companion animal practices in Texas.

Objective: To assess the impact of a 15-month, in-practice communication skills intervention on client visit satisfaction. Sample: 4 purposely selected veterinary clinics, 9 veterinarians, and 930 appointment-specific client satisfaction surveys. Procedures: The study was designed as a multipractice, preintervention-postintervention study. Practice teams participated in a 15-month communication skills intervention that included interactive group workshops and one-on-one communication coaching with the entire practice. Client Satisfaction Questionnaires were completed 3 months before (mean, 55 questionnaires/veterinarian) and after (mean, 48 questionnaires/veterinarian) the intervention. The impact of the intervention and factors associated with client visit satisfaction were evaluated with mixed logistic regression. Results: Client satisfaction scores were dichotomized owing to extreme negative skewness. In total, 57% (284/496) of clients were completely satisfied on pretest questionnaires, and 67% (290/434) were completely satisfied on postintervention questionnaires. The odds of clients being completely satisfied were significantly higher after the communication skills intervention (OR = 1.56; P = .002). When controlling for the intervention, predictors of client visit satisfaction included appointment type (odds of being completely satisfied were significantly higher for recheck appointments than for preventative care appointments [OR = 1.71; P = .02] and health problem appointments [OR = 1.99; P = .003]) and duration of the veterinarian-client relationship (probability increased by 0.52 with each 1-year increase in relationship duration; P = .008). Clinical Relevance: Results suggested that the client-centered, skills-based communication intervention resulted in increased client visit satisfaction. Findings contribute to current evidence that client-centered communication and duration of the veterinarian-client relationship promote client satisfaction during veterinary visits.

Evaluating third- and fourth-year veterinary students' communication skills knowledge and performance at Colorado State University.

OBJECTIVE: To assess the impact of a communication program on a cohort of veterinary students' knowledge and performance of communication skills. SAMPLE: Class cohort of veterinary students at Colorado State University. PROCEDURES: Year 3 students' knowledge of communication skills was evaluated using quizzes, administered before and after the fall 2016 and spring 2017 Clinical Communication Skills-I and II junior practicum. In year 4, student performance of 22 Calgary-Cambridge Guide communication skills was assessed by coding video-recordings of student-client interactions collected during their second and fourth weeks of the Community Practice rotation in the summer and fall of 2017 and spring of 2018. The impact of training, association with demographic factors, and correlation between knowledge and performance of communication skills were investigated. RESULTS: In year 3, 136 students completed both fall and spring quizzes; in year 4, 65 week-2 and 29 week-4 appointments were video-recorded during Community Practice rotation. Students' knowledge assessed via quizzes containing skill spotting and skill demonstrating questions increased significantly after the fall and spring junior practicums; however, knowledge of communication skills was not associated with performance during year 4 Community Practice rotations. Communication skills most frequently demonstrated by students during the fourth year Community Practice rotation were open-ended questions, closed-ended questions, empathy toward the client and patient, providing "chunks" of information, and signposting. Students received high quality scores for non-verbal behaviors and logical clinical interview structure. CLINICAL RELEVANCE: Results suggest that experiential learning techniques, including a flipped classroom approach, role-play, and communication laboratories contributed to increased student knowledge of communication skills.