Conversation Analysis of Clients' Active Resistance to Veterinarians' Proposals for Long-Term Dietary Change in Companion Animal Practice in Ontario, Canada.

The impact of nutrition on animal health requires effective diet-related treatment recommendations in veterinary medicine. Despite low reported rates of veterinary clients' adherence with dietary recommendations, little is known about how clients' resistance to nutritional proposals is managed in the talk of veterinary consultations. This conversation-analytic study investigated clients' active resistance to veterinarians' proposals for long-term changes to cats' and dogs' diets in 23 segments from 21 videotaped appointments in Ontario, Canada. Clients' accounts suggested the proposals themselves or nutritional modifications were unnecessary, inappropriate, or unfeasible, most often based on patients' food preferences, multi-pet feeding issues, current use of equivalent strategies, or current enactment of the proposed changes. Resistance arose when veterinarians constructed proposals without first gathering relevant diet- and patient-related information, soliciting clients' perspectives, or educating them about the benefits of recommended changes. Veterinarians subsequently accommodated clients' concerns more often when resistance involved patient- or client-related issues rather than clients' lack of medical knowledge. The design of subsequent proposals accepted by clients frequently replaced dietary changes in the initial proposals with nutritional or non-nutritional alternatives and oriented to uncertainty about adherence. This study provides evidence-based findings for developing effective communication training and practice guidelines in nutritional assessment and shared decision-making.

Authority in therapeutic interaction: A conversation analytic study.

A paradigmatic shift toward postmodern, collaborative practice in family therapy raises questions about how therapists can use professional authority to facilitate change and how clients can assert their knowledge and agency. We used conversation analysis to investigate how the authority to know and to determine here-and-now action (i.e., who does what, and how, in therapy) was negotiated and accomplished in 10 sessions of emotion-focused therapy involving chair work. Therapists were observed to rely on a particular interactional sequence structure: stepwise entry into a directive, in which directives were preceded by a question-answer sequence. We show how instances where clients' views were elicited prior to the delivery of a directive resulted in different interactional consequences from instances where therapists straightforwardly directed clients to perform some action. The study offers evidence concerning how therapists can facilitate chair work collaboratively and responsively.

Effects of three diet history questions on the amount of information gained from a sample of pet owners in Ontario, Canada.

OBJECTIVE: To examine the effect of 3 diet history questions on the amount and type of diet-related information gathered from pet owners and to assess whether diet-related information obtained with each question in person differed from information obtained with a diet history survey. SAMPLE: 99 pet owners. PROCEDURES: Participants' responses to 1 of 3 randomly selected diet history questions ("Tell me everything he [or she] eats throughout a day, starting first thing in the morning right through to the end of the day"; "What kind of food does she [or he] eat?"; or "What kind of foods does he [or she] eat?") were recorded and coded for analysis. Participants completed a postinteraction diet history survey. Amount and type of diet-related information obtained were compared among responses to the 3 diet history questions and between the response to each question and the diet history survey. RESULTS: The "Tell me…" question elicited a significantly higher total number of diet-related items (combined number of main diet, treat, human food, medication, and dietary supplement items) than did the "What kind of food…" or "What kind of foods…" questions. The diet history survey captured significantly more information than did the "What kind of food…" or "What kind of foods…" questions; there was little difference between results of the diet history survey and the "Tell me…" question, except that treats were more frequently disclosed on the survey. CONCLUSIONS AND CLINICAL RELEVANCE: Findings reinforced the value of using broad, open questions or requests that invite expansion from clients for gathering diet-related information.

Patient Simulations Improve Dietetics Students' and Interns' Communication and Nutrition-Care Competence.

OBJECTIVE: To investigate the impact of simulated patients on dietetics students' and interns' communication and nutrition-care competence. DESIGN: Pre-post observational study in which students' communication and nutrition-care competence was evaluated during the first and final clinical nutrition simulations in winter, 2017. SETTING: University of Guelph, Canada. PARTICIPANTS: Seventeen undergraduate students enrolled in Applied Clinical Skills (NUTR*4120) and 15 graduate students/interns enrolled in Practicum in Applied Nutrition II (FRAN*6720). VARIABLES MEASURED: Selected communication and nutrition-care performance indicators (PI) (undergraduates = 18; graduate = 33) included in the Canadian Integrated Competencies for Dietetic Education and Practice, each measured out of a maximum of 3 points. ANALYSIS: Grand means of communication and nutrition-care PI scores were compared across 2 time points using paired t tests, at a significance level of .05. RESULTS: Undergraduates' (n = 15) communication and nutrition-care PI scores increased by 0.9 ± 0.35 (49.7%) and 0.8 ± 0.22 (45.8%) points, respectively (both P < .001). Graduate students' communication and nutrition-care PI scores increased by 0.4 ± 0.45 (18.5%) and 0.7 ± 0.59 (37.9%) points, respectively (both P < .01). CONCLUSIONS AND IMPLICATIONS: Simulated patients incorporated into clinical nutrition courses increase dietetics students' and interns' communication and nutrition-care competence. More research using comprehensive practice-based competency assessment tools is needed in larger samples of students and interns.

Identification of Illness Uncertainty in Veterinary Oncology: Implications for Service.

Uncertainty has been identified as the central psychological feature of illness experiences, necessitating a variety of coping strategies to effectively manage it and successfully adapt. The purpose of this qualitative study was to determine the expectations of veterinary clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer. The study consisted of 43 dog owners participating in 30 independent in-person single and dyadic interviews conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis (supplemented with content analysis) was performed on transcripts of the interview discussions. Uncertainty was inadvertently identified as a central theme of the clients' experience. The diagnosis of a serious, life-limiting cancer and its treatment appeared to move clients into a world of uncertainty, which affected their feelings, thoughts, behaviors, attitudes, and personal expectations in relation to their dog, and their expectations of the oncology service. With uncertainty appraised mostly as a danger, clients appeared to employ multiple coping strategies to reduce uncertainty in the effort to adapt to the new reality of living with and caring for a dog with cancer. The need to manage uncertainty influenced their expectations of the service, specifically for information, ongoing relationships, 24-h access, and timely care. Our findings have implications for the delivery of specialty oncology services and for client welfare. When working with owners of dogs with life-limiting cancer, results suggest health care providers can facilitate the management of uncertainty to enhance clients' psychological well-being, thereby supporting clients' successful adaptation to the cancer experience.

Conversation Analysis of Veterinarians' Proposals for Long-Term Dietary Change in Companion Animal Practice in Ontario, Canada.

Nutritional changes recommended by veterinarians to clients can have a major role in animal-patient health. Although there is literature on best practices that can inform veterinary communication training, little is known specifically about how veterinarians communicate their recommendations to clients in real-life interactions. This study used the qualitative research method of conversation analysis to investigate the form and content of veterinarian-initiated proposals for long-term dietary change in canine and feline patients to further inform veterinary communication training. We analyzed the characteristics and design of veterinarian-initiated proposals for long-term nutritional modification as well as the appointment phases during which they occurred, in a subsample of 42 videotaped segments drawn from 35 companion animal appointments in eastern Ontario, Canada. Analyses indicated that veterinarians initiated proposals at various points during the consultations rather than as a predictable part of treatment planning at the end. While some proposals were worded strongly (e.g., "She should be on…"), most proposals avoided the presumption that dietary change would inevitably occur. Such proposals described dietary items as options (e.g., "There are also special diets…") or used mitigating language (e.g., "you may want to try…"). These findings seem to reflect delicate veterinarian-client dynamics associated with dietary advice-giving in veterinary medicine that can impact adherence and limit shared decision-making. Our analyses offer guidance for communication training in veterinary education related to dietary treatment decision-making.

Effect of question design on dietary information solicited during veterinarian-client interactions in companion animal practice in Ontario, Canada.

OBJECTIVE: To establish the types of initial questions used by veterinarians in companion animal practice to solicit nutritional history information from owners of dogs and cats, the dietary information elicited, and the relationship between initial question-answer sequences and later nutrition-related questions. DESIGN: Cross-sectional qualitative conversation analytic study. SAMPLE: 98 appointments featuring 15 veterinarians drawn from an observational study of 284 videotaped veterinarian-client-patient visits involving 17 veterinarians in companion animal practices in eastern Ontario, Canada. PROCEDURES: Veterinarian and client talk related to patient nutrition was identified and transcribed; conversation analysis was then used to examine the orderly design and details of talk within and across turns. Nutrition-related discussions occurred in 172 visits, 98 of which contained veterinarian-initiated question-answer sequences about patient nutritional history (99 sequences in total, with 2 sequences in 1 visit). RESULTS: The predominant question format used by veterinarians was a what-prefaced question asking about the current content of the patient's diet (75/99). Overall, 63 appointments involved a single what-prefaced question in the first turn of nutrition talk by the veterinarian (64 sequences in total). Dietary information in client responses was typically restricted to the brand name, the subtype (eg, kitten), or the brand name and subtype of a single food item. When additional diet questions were subsequently posed, they typically sought only clarification about the food item previously mentioned by the client. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that question design can influence the accuracy and completeness of a nutritional history. These findings can potentially provide important evidence-based guidance for communication training in nutritional assessment techniques.

Qualitative study of the information expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer.

OBJECTIVE: To evaluate the content aspects of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer. DESIGN: Qualitative analysis of data acquired during in-person single and dyadic interviews. Sample-43 dog owners participating in 30 interviews. PROCEDURES: Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions. RESULTS: For the clients, the central qualification was that the information given had to be the truth. Information was expected about all aspects of their dog's cancer and its treatment, varying in relation to clients' basic understanding of cancer, their previous experience with cancer, and their information preferences. Provision of information generated the trust and confidence necessary to engage in treatment, the ability to make informed decisions, and the ability to be prepared for the future. Provision of information also engendered a sense of control and capability and fostered hope. CONCLUSIONS AND CLINICAL RELEVANCE: When dealing with owners of dogs with life-limiting cancer, results indicated that in addition to abiding by the principle of truth-telling, it is important for health-care service providers to ascertain clients' understanding of and experiences with cancer as well as their information preferences and thereby adopt a tailored approach to information giving. Provision of information enabled client action and patient intervention but also enhanced clients' psychosocial well-being. Veterinary healthcare service providers can purposely provide information to build and sustain clients' ability to successfully cope with their pet's condition.

Qualitative study of the communication expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer.

OBJECTIVE: To describe the process aspects (communication) of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer. DESIGN: Qualitative analysis of data acquired during in-person single and dyadic interviews. SAMPLE: 43 dog owners participating in 30 interviews. PROCEDURES: Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions. RESULTS: The participants expected information to be communicated in a forthright manner; in multiple formats; with understandable language; in an unrushed environment wherein staff took the time to listen, answer all questions, and repeat information when necessary; on a continuous basis, with 24-hour access to address questions or concerns; in a timely manner; with positivity; with compassion and empathy; with a nonjudgmental attitude; and through staff with whom they had established relationships. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the manner in which information is communicated is vitally important to clients of dogs with life-limiting cancer in that it not only facilitates comprehension but also creates a humanistic environment from which clients derive the psychosocial support needed to successfully cope with their pet's condition.

Factors influencing veterinarian referral to oncology specialists for treatment of dogs with lymphoma and osteosarcoma in Ontario, Canada.

OBJECTIVE: To elucidate factors influencing practitioner decisions to refer dogs with cancer to veterinary oncology specialists. DESIGN: Cross-sectional study. SAMPLE: 2,724 Ontario primary care companion animal veterinarians. PROCEDURES: Practitioners were invited to participate in a survey involving clinical scenarios of canine cancer patients, offered online and in paper format from October 2010 through January 2011. Analyses identified factors associated with the decision to refer patients to veterinary oncology specialists. RESULTS: 1,071 (39.3%) veterinarians responded, of which 603 (56.3%) recommended referral for dogs with multicentric lymphoma and appendicular osteosarcoma. Most (893/1,059 [84.3%]) practiced within < 2 hours' drive of a specialty referral center, and most (981/1,047 [93.7%]) were completely confident in the oncology service. Few (230/1,056 [21.8%] to 349/1,056 [33.0%]) were experienced with use of chemotherapeutics, whereas more (627/1,051 [59.7%]) were experienced with amputation. Referral was associated with practitioner perception of patient health status (OR, 1.54; 95% confidence interval [CI], 1.15 to 2.07), the interaction between the client's bond with the dog and the client's financial status, practitioner experience with treating cancer (OR, 2.79; 95% CI, 1.63 to 4.77), how worthwhile practitioners considered treatment to be (OR, 1.66 to 3.09; 95% CI, 1.08 to 4.72), and confidence in the referral center (OR, 2.20; 95% CI, 1. 11 to 4.34). CONCLUSIONS AND CLINICAL RELEVANCE: Several factors influenced practitioner decisions to refer dogs with lymphoma or osteosarcoma for specialty care. Understanding factors that influence these decisions may enable practitioners to appraise their referral decisions and ensure they act in the best interests of patients, clients, and the veterinary profession.