MacMartin Clare, Wheat Hannah C, Coe Jason B, Adams Cindy L
Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1 Canada. E-mail:
UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
J Vet Med Educ. 2018 Winter;45(4):514-533. doi: 10.3138/jvme.0317-034r. Epub 2018 Feb 2.
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.
兽医向客户推荐的营养方面的改变对动物患者的健康可能起着重要作用。尽管有关于最佳实践的文献可为兽医沟通培训提供参考，但对于兽医在现实生活互动中如何向客户传达其建议，具体情况却知之甚少。本研究采用会话分析这一定性研究方法，调查兽医针对犬猫患者长期饮食改变提出建议的形式和内容，以进一步为兽医沟通培训提供信息。我们从加拿大安大略省东部35次伴侣动物诊疗预约的录像片段中抽取了42个片段作为子样本，分析了兽医提出的长期营养调整建议的特点和设计，以及这些建议出现的诊疗阶段。分析表明，兽医在诊疗过程中的不同时间点提出建议，而不是作为治疗计划最后可预测的一部分。虽然有些建议措辞强硬（例如，“她应该吃……”），但大多数建议避免假定饮食改变必然会发生。这些建议将饮食项目描述为选项（例如，“也有特殊的饮食……”）或使用缓和性语言（例如，“你可能想试试……”）。这些发现似乎反映了兽医与客户在提供饮食建议方面微妙的动态关系，这可能会影响依从性并限制共同决策。我们的分析为兽医教育中与饮食治疗决策相关的沟通培训提供了指导。
