Making client communication appetising: talking with clients about nutrition

Open-ended questions

Open-ended questions provide clients with the opportunity to describe their perception of their pets' health concerns. Although specific, closed-ended questions may seem like an efficient method of obtaining data, open-ended questions enable veterinary nurses to gain information more effectively while building understanding of their clients' concerns and needs. There is often temptation to cut an owner's answer short with additional questions; in a study by Dysart et al (2011), veterinary clients were only able to speak for a median of 11 seconds before they were interrupted. Client interruption results in potential loss of relevant information (Beckman and Frankel, 1984). In addition, clients may feel disappointed if they feel that they are unheard, which may lead to distrust and misconception that the veterinary team does not care about their opinions. Well-phrased open-ended questions invite the client to explain what most concerns them and allows veterinary nurses to respond with open-ended follow-up questions to further guide their responses.

Reflective listening

After asking an open-ended question, summarising owners' responses shows that the veterinary nurse understands and is devoting appropriate consideration to their statements. When owners feel that their input is received and valued, they are more likely to have a positive experience (Coe et al, 2008). Acknowledgement of owners' concerns and repeating key points demonstrates understanding of their perspective. At the end of a client interaction, reflective listening is best achieved by summarising their statements in a concise way and highlighting any areas of particular concern for the owner. These steps demonstrate engagement with the owner and mutual concern about the information they have shared.

Non-verbal communication

While phrasing of questions and discussion are important, 80% of communication is non-verbal, including facial expressions and body posture. Nonverbal communication is important for veterinary nurses, not only in how they portray themselves, but also to help understand a pet owner's perspective. For example, if an owner verbally agrees to a procedure while frowning and crossing his arms, this non-verbal communication suggests that he actually has deeper misgivings about the treatment plan. Paying close attention to these non-verbal cues can uncover an owner's true feelings, and help to predict how he will respond to your recommendations (Carson, 2007). Likewise, veterinary nurses should also be conscious of their own non-verbal cues to ensure that their actions are consistent with their verbal messages. In fact, a human study (Verheul et al, 2010) showed that empathic communication, such as a warm, friendly tone of voice and smile, had the most favorable effects on patient anxiety and expectations for success.

Empathy

Pets are increasingly considered to be a part of the family; with this trend of growing emotional investment, there is increasing potential to encounter sensitivity when discussing medical matters. Shaw et al (2004) found that empathy was expressed in only 7% of 300 veterinary visits studied. A pet owner that brings his pet to a veterinary clinic has already demonstrated care and concern for his pet. To express empathy, the veterinary healthcare team should provide positive feedback and affirmation of these good intentions, as well as normalising and addressing pet owners' concerns. Regardless of the level of urgency, owners' concerns about their pets' health cannot be dismissed. In addition, it is important to focus on education, rather than judgment, if an owner has made a decision that adversely affected their pet's health. Conscientious use of empathy builds trust between an owner and the veterinary team, leading to greater likelihood of positive outcomes (Adams and Frankel, 2007).

Nutrition resources for pet owners and the veterinary healthcare team

By employing the four communication strategies descibed in Table 1, veterinary nurses can make owners feel valued, respected, heard, and validated; this connection leads to increased trust in the veterinary healthcare team and improved client satisfaction.

Getting information: knowing your patient

It is important to obtain an accurate, detailed diet history at the start of every veterinary visit. A complete diet history serves as an essential component of a patient's medical record and helps to guide further diagnostics and treatment; for example, in a dog presenting for vomiting and lethargy, a diet history of chicken jerky treats that may be a cause of proximal renal tubulopathy (Thompson et al, 2013) or ‘bully’ sticks (animal by-products (bull penis) made into chews) that can carry bacterial contamination (Freeman et al, 2013) may reveal possible causes for the pet's illness. Open-ended questions are especially helpful since many owners do not remember to disclose important components of their pet's diet history. For example, pet owners may not realise that chews or bones are sources of calories, or that some human foods can be toxic to pets. Open-ended questions help to guide the conversation and yield more useful information. For example, asking ‘Do you feed treats?’ may put owners on the defensive, especially if they perceive that treats are frowned on. Instead, asking ‘What treats does your pet enjoy?’ suggests a more positive approach and is more likely to yield a detailed response.

Getting information: knowing your audience

Throughout the pet's visit, actively seeking out information will help to better understand the client's perspective and level of knowledge. These details will help tailor future recommendations in a way that is most likely to be well received and understood. For example, questions like ‘How can we best communicate information?’ can help to determine whether drawn diagrams, written pamphlets, or demonstrations will be the most effective means of education. Pet owners with low health literacy or language barriers may misunderstand recommendations and be considered non compliant (Easton et al, 2013). Since some of these clients may not be willing to disclose their challenges, good general guidelines are to simplify explanations, avoid use of jargon, and speak clearly at a measured pace. Assessment of non-verbal cues may indicate an owner does not understand and that a point may need rephrasing or reiteration. In addition, actively soliciting concerns at the start of the pet's visit can help to avoid last minute questions at the end of the visit that may require extending the appointment or leaving the client unsatisfied (Dysart et al, 2011). Making a checklist including questions asked by the owner as well as any issues raised during discussion ensures all matters are addressed by the end of the visit.

Giving information: providing clear and specific recommendations

After obtaining important information and assessing the client's needs, the veterinary healthcare team should provide clear and specific nutritional recommendations. In the Bayer Veterinary Care Usage Study, only 57% of pet owners agreed that their veterinarian communicates in language they understood (Felsted, 2011). Members of the veterinary healthcare team must avoid using jargon or assuming owners' understanding of medical details. For example, some clients may not understand body condition scoring, and are more likely to comprehend that their pet is underweight or overweight.

Additionally, vague or tentative statements like ‘Your cat could lose some weight’ do not reflect confidence in the recommendation to the owner and may be interpreted differently than intended. A more compelling approach could be, ‘Your cat is 4 kg overweight, which increases her risk for joint disease and other serious health conditions. It is important for us to develop a weight loss plan to help keep her healthy and happy for as long as possible’. This statement combines a specific assessment of a medical problem, describes consequences, and sets up for a team-based plan to achieve a shared goal. Further discussion with the owner would include selecting a specific diet together, recommending explicit daily feeding amounts, and setting a timeline for future weigh-ins.

After learning their audience's communication preferences, veterinary nurses can deliver recommendations using a jargon-free, multi-modal approach tailored to each pet owner. If recommendations are complicated, comprehension can be improved by breaking ideas into smaller sections and periodically verifying that owners can summarise what has been reviewed (Coe et al, 2008). Finally, referring to the checklist of owner and veterinary team concerns will help to ensure that nothing has been forgotten.

Giving information: providing additional references

Providing additional resources for credible information can help owners understand the reasoning and evidence behind recommendations. For example, a pet owner who mentions frequently turning to the internet for health information can benefit from recommendations for reputable, reliable resources online (McMullan, 2006). Additionally, a ‘Frequently Asked Questions’ handout can be given to owners or made available on the clinic's website. This not only increases efficiency during pet visits, but reinforces the veterinary healthcare team as a trusted source of factual information on pet health and nutrition. See Box 1 for additional nutrition resources for pet owners and the veterinary healthcare team.

Moving forward: working together to create a plan

As essential part of making recommendations is encouraging the pet owner to work with the veterinary healthcare team to create a plan based on shared knowledge and common goals. After discussing initial recommendations, asking, ‘What are your thoughts on this plan?’ or ‘What steps would you like to include in our plan?’ allows owners to take an active role, as well as discuss hesitations that could lead to non compliance in the future. Some hesitation may involve financial constraints, or a particular preference of the client that may contradict nutritional recommendations. In these situations, discussing alternative options or compromising on a mutual agreement will ensure higher compliance than an inflexible plan that may be completely rejected (Box 2). Structuring creation of a treatment plan as a dialogue, rather than a lecture, helps the owner to take an active role in their pet's health. Continued use of reflective listening and empathy will help to create a treatment plan that promotes owner commitment and facilitates compliance.

Spotlight on discussion of alternative diets

Key points

Follow up: encouraging compliance

All members of the veterinary healthcare team can help to reinforce the nutritional plan once it is created. For example, if a veterinarian recommends a therapeutic diet for a patient and an owner agrees, veterinary nurses can help answer any questions and discuss any concerns about the diet, and front desk staff can help to set up delivery of the diet. Making a plan for maintained contact will improve accountability and address any questions or problems after the pet's visit. As clients are checking out at the front desk at the end of the appointment, offer to schedule in a specific date and time for a recheck weigh-in for patients on a weight-loss plan, or add a client reminder for refills on a prescription diet. Designating a specific team member to be responsible for contacting the client a few days after every appointment will elicit client questions or concerns. These active efforts to reach out to clients will help to reinforce recommendations and encourage compliance while strengthening the bond between the client and veterinary healthcare team.