Determining the characteristics of effective veterinary-client communication using the client’s perspective, the human-animal bond, and communication accommodation theory

Abstract This thesis is unique in its emphasis on using Communication Accommodation Theory (CAT) as the theoretical foundation to studying veterinary-client communication. It explores the client’s perspective and the human-animal bond (HAB) in determining the factors that influence effective and satisfying communication. To date there has been minimal empirical research into effective veterinary-client communication. CAT is a psychological theory of social interaction that explains communication in terms of how people adjust their style of communication in relation to others to achieve their social goals. In addition this thesis uses convergent methodologies by incorporating qualitative and quantitative approaches. Two main data collection and evaluation studies comprised this thesis. The first study employed a cross-sectional survey design and analysed veterinary clients’ (N=205) perceptions and expectations of effective and satisfying communication. Clients completed a survey that aimed to explore how HAB influenced their expectations of communication. This study revealed that clients expect veterinarians to use questions and statements to explore and acknowledge the relationship they have with their pet. They also expect veterinarians to ask for their opinion and seek their understanding of their pet’s illness. Also, highly bonded clients have significantly greater expectations for these communication strategies to occur during consultations, compared with clients who are less bonded. These findings suggest veterinarians require superior communication skills and the ability to recognise and acknowledge HAB. The second study evaluated veterinary student-client communication before and after a communication skills training workshop. These data was collected across two stages. A convenience sample of 14 veterinary students and simulated clients participated. A total of 112 consultations were audiotaped in a communication skills laboratory located at the Queensland Health Skills Development Centre, Brisbane. The first stage of this study involved a cross-sectional analysis of 56 pre-training consultations. Simulated clients completed surveys measuring CAT strategies, client satisfaction and their perception of each student’s communication skills. From the client’s point of view, appropriate use of all four CAT strategies (i.e. discourse management, emotional expression, interpersonal control and interpretability) was integral to achieving effective and satisfying veterinary-client communication. Acknowledging and managing the emotional and relational needs of clients, arising as a consequence of the relationship they have with their pet, and providing information that is easy to understand was also associated with greater client satisfaction and intention to adhere to treatment advice. Audiotapes of the pre-training consultations were then analysed using the Roter Interaction Analysis System (RIAS), a widely used reliable quantitative coding system for physician-patient communication. RIAS evaluation of the conversations revealed that greater use of emotionally supportive exchanges (i.e. emotional talk such as empathy, self-disclosure, concern, reassurance and legitimising statements), and activation and partnership statements were key communication factors associated with higher levels of client satisfaction and adherence. Also, client centred care communication strategies predicted client satisfaction. Although the above strategies were highly rated by clients, they were underutilised by veterinary students. The second stage of this study involved quasi-experimental pre-test and post-test evaluations of the effectiveness of the communication skills training workshop. Students were trained in aspects of the HAB, CAT strategies and client centred care. Veterinary students completed surveys that measured their perceptions of their acquisition of communication skills and the success of the workshop. Client satisfaction and intention to adhere to recommendations significantly improved in the post-training evaluation. Veterinary students’ communication skills, as measured by the RIAS, improved as a result of attending the workshop. In particular, students used more data gathering questions (open and closed-ended), emotional talk, positive talk, and activation and facilitation statements in the post-training evaluation. Students explored the client’s point of view to a greater degree post training by asking them about their main concerns, thoughts, and ideas about their pet’s illness. Students also used a greater number of appropriate statements and questions that explored and acknowledged the HAB. Finally, the majority of students rated the training workshop as excellent and their confidence in their communication skills improved significantly in the post-evaluation. Together these two studies provide a comprehensive evaluation of veterinary-client communication and contribute to the knowledge of effective veterinary-client communication. First, understanding and acknowledging the HAB and exploring clients’ points of view are crucial aspects of successful consultations and are associated with client satisfaction and client intention to adhere to treatment instructions and advice. Second, the current findings demonstrate that a psychological theory of social interaction (i.e. CAT) can explain effective communication strategies in veterinary-client communication. Third, for veterinarians to demonstrate genuine care and concern during consultations they should learn to recognise and question the social roles and norms associated with veterinarian and client interactions and adjust their communication appropriately to acknowledge the unique characteristics of the client and animal. Overall this thesis makes a valuable contribution to our understanding of effective communication involving the triadic relationship between veterinarian, client and anima