Even when physically healthy and pain free, dogs may have aversions to being handled in particular ways (Oxley et al, 2018) and to certain individuals (Csoltova et al, 2017), this aversion may manifest itself in fearful or aggressive behaviour (Oxley et al, 2018). Canine handling intolerances can make handling dogs within a veterinary practice environment more problematic and pose a risk for veterinary staff and owner health and safety (Dhillon et al, 2019). In particular, being bitten can cause life-changing physical and psychological injury (Dhillon et al, 2019). However, canines that are problematic to handle may also reduce job satisfaction in veterinary professionals (Roshier and McBride, 2012), or be a source of embarrassment to owners (Roshier and McBride, 2013), with the canine stress associated with it resulting in reduced owner willingness to visit the veterinary practice (Lloyd, 2017). Combined, these factors may result in lower levels of veterinary care being provided to handling intolerant dogs. Clearly, prevention of handling intolerances is an admirable goal (Ryan, 2017). However, it also seems likely that complete eradication of handling intolerances among the pet dog population is unachievable. Therefore, the veterinary professional will continue to meet dogs that have handling intolerances and be exposed to the risk that is involved in this when meeting the requirement to put patient welfare at the centre of their veterinary endeavour.
One way to potentially reduce the risk posed by canine handling intolerances, is to improve owner communication of handling intolerances. This may also facilitate early measures to work with this handling limitation to still ensure good quality veterinary provision for canine patients visiting the clinic. The owner is a potential source of valuable information (Roshier and McBride, 2013), both about their dog's more general behaviour and handling intolerances, but also in relation to the behaviour of their dog towards veterinary professionals at previous veterinary consultations. However, in several of the authors’ (Emma Campbell and Louise Buckley) veterinary experience owners seem to be reluctant to share this information, waiting until after the dog has shown behavioural signs of aversion before confirming this dislike of handling. There is currently no research that seeks to understand canine handling intolerances at the veterinary practice and owner attitudes/beliefs in relation to communicating canine handling intolerances.
The purpose of this study was to better understand canine intolerances in dogs in the UK visiting the veterinary practice. It aimed to identify apparent prevalence of canine handling intolerances, owner willingness to communicate these to veterinary professionals and beliefs as to whose responsibility it was for identifying canine handling intolerances that might put veterinary professionals at risk. Risk (to the veterinary professional) perception was also evaluated, and its association with owning a dog with handling intolerances explored. It was hypothesised that owners with dogs with handling intolerances would perceive a higher risk than those that did not. Finally, the survey aimed to identify potential sources of advice that owners would be likely to consult if they owned a dog with handling intolerances and the potential role of the veterinary practice in canine intolerance to handling prevention.
Methods
Participants and sampling
The study utilised a prospective cross-sectional survey design that convenience sampled adult dog owners and their dogs residing in the UK. By using convenience sampling, dog owners were approached through social media rather than randomly selected from the whole cohort of dog owners in the UK. The inclusion criteria for the survey included the following:
There were no breed or sex restrictions.
Survey distribution
The survey was hosted by Online Surveys (JISC, Bristol, UK) and was distributed via social media (Facebook™) during the period December 2018 – March 2019. Social media Facebook™ groups aimed at dog owners (e.g. Dog Owners Group UK) or where dog owners might be incidentally members (e.g. Edinburgh Anything For Sale Free Swap Household Phones Car Services; Walking in the national parks in the UK) were approached for permission to post the survey via their group wall, with the survey posted to 19 groups. The survey was also distributed by several Facebook pages managed by veterinary focused businesses (e.g. Independent Vet Care, People's Dispensary for Sick Animals) and animal welfare organisations/charities (e.g. Springer Rescue Scotland) so the total reach and response rate of the survey could not be determined.
Survey design
The survey was divided into:
A mixture of dichotomous, multiple choice and Likert-type questions (6-point scales) were used to address the aims of the survey. Perception of risk during each common consultation room procedure was converted to a composite scale that measured perception of risk generally during a consultation room.
Statistical analysis
All statistical analyses were performed using SPSS® version 26 ((IBM Corp., Armont, New York), with graphics produced using Microsoft® Excel® (Microsoft 365®, Microsoft®, Washington, USA). A composite summative scale for the risk to the veterinary professional of not being warned of canine handling intolerances/preferences prior to under-taking common consultation procedures was generated by undertaking a Cronbach alpha analysis, with stepwise removal of items (n = 1) until the Cronbach alpha value was maximised at 0.967. Scale data (using a summative score over all scale items) were analysed using the Median Test to compare medians as transformations did not normalise the distribution of residuals and reported using medians and interquartile range. Chi-square analyses were undertaken to examine associations between handling intolerances and veterinary practice avoidance, and to assess responsibilities for ensuring veterinary professionals were aware of canine handling intolerances. For responsibilities data, due to low frequencies in some categories, ordinal categories were merged to produce binary outcomes (completely or strongly agree versus all other options). For sources of assistance, the 6-point likert type scale was reduced (by merging points 2 & 3 and 4 & 5) to a 4-point scale (definitely/somewhat likely/somewhat unlikely/definitely not) to facilitate data handling.
Ethical considerations
The University of Edinburgh (Royal (Dick) School of Veterinary Studies) Human Ethical Review Committee approved this survey for dissemination (HERC: 292 – 18). The survey was approved in December 2018.
Results
Respondent demographics
Of 501 completed surveys, 471 usable responses were obtained. Twenty-eight were excluded because the owner completed the survey in a way that made it difficult to be certain which dog, or whether one dog, was the focal dog during completion. Two further responses were excluded because the owner indicated that the dog was deceased and therefore not relevant to the current study. Tables 1 and 2 show the demographic information of the dog owner and detailed information of the corresponding dog.
| Demographic | Number | % | |
|---|---|---|---|
| Age (years) | 18–30 | 78 | 16.6 |
| 31–45 | 145 | 30.8 | |
| 46–60 | 191 | 40.6 | |
| 60+ | 57 | 12.1 | |
| Gender | Male | 35 | 7.4 |
| Female | 436 | 92.6 | |
| Education | Primary/secondary | 97 | 20.6 |
| Further/higher | 364 | 77.3 | |
| Other | 10 | 2.1 | |
| Dog ownership experience | First time | 110 | 23.4 |
| Experienced | 360 | 76.4 | |
| Breeder | 1 | 0.2 | |
| Number of dogs currently owned | 1 | 299 | 63.5 |
| 2 | 119 | 25.3 | |
| 3+ | 53 | 11.3 | |
| Currently registered with vet practice | Yes | 463 | 98.3 |
| No | 8 | 1.7 | |
| Demographic | Number | % | |
|---|---|---|---|
| Gender | Male | 55 | 11.7 |
| Male neutered | 208 | 44.2 | |
| Female | 35 | 7.4 | |
| Female neutered | 173 | 36.7 | |
| Age (years) | <1 | 17 | 3.6 |
| 1–4 | 170 | 36.1 | |
| 4–8 | 162 | 34.4 | |
| 8+ | 122 | 25.9 | |
| KC breed classification | Working | 21 | 4.5 |
| Utility | 20 | 4.2 | |
| Terrier | 41 | 8.7 | |
| Pastoral | 42 | 8.9 | |
| Toy | 16 | 3.4 | |
| Gundog | 150 | 31.8 | |
| Hound | 48 | 10.2 | |
| Other | 133 | 28.2 | |
| Status within household | Family pet | 460 | 97.7 |
| Other | 11 | 2.3 | |
Canine handling intolerances and owner willingness to disclose these
Eighty-nine (18.9%) respondents reported that their dog's behaviour during handling at the veterinary clinic had been a reason to avoid or delay going to a veterinary practice. This behaviour was significantly (χ21 = 48.707, p<0.001) associated with the owner reporting that their dog (when physically healthy) had handling intolerances to at least one body part, with 286 owners (60.7%) reporting handling intolerances present. Where handling intolerances were reported, the most commonly selected body parts were gums/teeth, followed by front and back paws (Figure 1).
Most owners (78.3%) reported that they would definitely tell veterinary professionals about their dog's handling intolerances, and this was not significantly associated with owning a dog that currently had handling intolerances (χ21 = 0.492, p=0.483). No owners reported that they would definitely not tell veterinary professionals about their dog's handling intolerances. The majority of owners felt that behaviour-related aspects were of similar importance to the veterinary consultation as the veterinary surgeon having access to their dog's clinical history (Figure 2).
Ninety owners (19.1%) reported that their dog wore a muzzle during at least some veterinary consultations, with approximately 1 in 5 owners (22.9%) reporting that it was sometimes necessary to have more than one veterinary professional to handle their dog during a veterinary examination. Where a muzzle was used, 52% of owners (n=47) reported that it was always them that suggested to the veterinary professional that a muzzle be used, a further 34% reported shared decision-making with both parties suggesting muzzle use. The remaining 11 owners reported that the veterinary professional was always the individual to suggest a muzzle should be used during handling in the consultation.
Attitudes regarding risk to veterinary professionals of not disclosing canine handling intolerances
The majority of owners perceived that there was a high risk if veterinary professionals were not informed of dogs’ handling intolerances/handling preferences prior to common procedures undertaken during a veterinary consultation. The median risk perceived was 5.9 (5–6). There was no significant effect of age, gender, qualification, dog owning experience, or ownership of a dog with handling intolerances or from a particular Kennel Club grouping.
Beliefs as to whose responsibility it is to ensure veterinary professionals are aware of handling intolerances
Respondents believed that it was primarily the role of the owner to ensure that veterinary professionals were informed of any handling intolerances that their dog may have. Significantly (χ21 = 12.133, p<0.001) more respondents (90.5%) completely agreed with the statement ‘It is the responsibility of the dog owner to alert veterinary staff where their dog does not like being touched’ than completely agreed with the statement ‘The veterinary staff should ask before each consult if there are areas a dog (patient) does not like being handled’ (only 58.2% of respondents). Furthermore, 72% of respondents completely or somewhat disagreed with the statement ‘Dog owners need only alert veterinary staff if the dog is likely to bite the veterinary professional when being handled’. However, approximately 1 in 5 respondents (20.7%) completely agreed with this statement.
When asked about acceptability of approaches that a veterinary practice may take to ensuring that the veterinary professionals know about a dog's handling intolerances before clinically examining the dog, most respondents strongly agreed with all four common approaches suggested. The option with the strongest agreement was for the owner to ensure that the veterinary professional was informed (90.1% of respondents), and the option with the fewest respondents strongly agreeing was for veterinary professionals to verbally inform each other (59.7%) (Figure 3).
Prevention and treatment of canine handling intolerances
The majority of respondents (62.9%) believed that veterinary practices could do more to educate owners on how to prevent or minimise the risk of their dog developing handling intolerances, with 82.9% believing that being educated generally when adopting their new dog on reading canine body language would be useful. Seventy one percent of respondents said they would have potentially attended a free puppy class at their local veterinary practice that focused on how to help puppies desensitise to veterinary handling.
When asked who the respondent would approach for help if their dog had handling intolerances while at the veterinary practice, 74.9% and 68% of respondents would either definitely or be somewhat likely to approach the veterinarian or veterinary nurse respectively for assistance. A similar percentage would approach a dog trainer (72.6%) or behaviourist (69.7%) for advice. Breeders, friends and books were less likely to be consulted (21.3%, 22.8% and 48.8% respectively). Just 5.3% of respondents said that they would ‘definitely not’ or ‘would be somewhat unlikely’ to consult anyone about their dog's handling intolerances.
Discussion
To the authors’ knowledge, this is the first study to examine the owner perspective on factors associated with a dog's intolerance of being handled by veterinary professionals. Thus, the study provides a valuable contribution to understanding reported prevalence of handling intolerances, as well as improves veterinary professional understanding of client beliefs and reported behaviour in this under-researched but important topic.
Handling intolerances
Alarmingly, almost 1 in 5 owners had delayed taking their dog to the veterinary practice because of the dog's behaviour, and over 60% of owners reported handling intolerances to one or more body parts and handling intolerances associated with increased likelihood of delaying visits. This suggests far reaching effects on the welfare of all parties as the dogs often had concurrent aversions to being handled in more than one area of the body. An important consideration is whether these wider handling intolerances could have been mitigated by increased involvement of the veterinary professional at an earlier stage to prevent or reverse issues developing. Westlund (2015) identified positive effects of using treats during desensitisation sessions. Benefits included reduced stress for the canines involved, reduced fear anticipation of veterinary visits and therefore less risk to staff of injury during handling. Factors such as aggression or handling issues can stem from early socialisation experiences or from previous negative experiences and associations with unpleasant stimuli, such as veterinary buildings, or uniforms, and the feeling of fear (Howell et al, 2015; Csoltova et al (2017) or poor reading of canine body language by veterinary professionals (Ryan, 2017). Thus it is important that the veterinary professional can work collaboratively with owners to produce canines habituated to veterinary visits and examinations. It also indicates a need to identify those clients that may be avoiding veterinary care because of handling intolerances and to look at ways the practice can implement measures to reduce the percentage of clients affected. A starting point for this would be a clinical audit to establish baseline attendance issues within the reader's practice.
It was interesting to note that the most commonly reported handling intolerances in healthy dogs were the teeth/gums area. While we cannot discount the possibility that this is partially due to undiagnosed periodontal disease that made mouth handling uncomfortable/painful, this does suggest a particular need to proactively teach a dog to be comfortable with oral examinations. Periodontal disease is common in canines (Kyllar and Witter, 2005; Wallis et al, 2019), and clinical signs often develop in young adult dogs (Hoffmann and Gaengler, 1996; Wallis et al, 2019) therefore measures to make regular oral examinations easier to undertake and less aversive to canine patients are recommended (Summers et al, 2019). Veterinary nurses could consider placing increased emphasis on this as part of puppy training and developmental checks in order to allow plenty of oral handling training and positive associative efforts before any risk of periodontal disease complicating efforts to do so.
It was encouraging to note that 78% of respondents said that they would definitely ensure that they informed the veterinary professional if their dog had handling intolerances, but this still meant that 22% were not certain that they would always do so. It is unclear why this was the case. This response was not associated with not owning a handling intolerant dog, so lack of experience of handling issues at the veterinary practice could not explain the findings. A weakness of the current study is that we did not specifically ask respondents why they would not ‘definitely report’ handling intolerances, and so we cannot be certain how much of this response is due to other factors like ‘I might forget, get distracted, etc’, rather than a conscious decision not to alert the veterinary professional in that particular circumstance. If it is assumed that at least some clients just ‘forgot’ then the introduction of a canine ‘Question Prompt List (QPL)’ could be beneficial that covers behaviour topics (including intolerances). QPLs have been shown to be beneficial in human healthcare consultations as they increased communication in multi-department human hospitals and therefore increased health and safety (Sansoni et al, 2015). QPLs could also have wider benefits by raising awareness of behaviour and its importance, increasing likelihood of discussions between veterinary professionals and owners (and at an earlier stage), and potentially improving both staff, client and patient welfare.
Perception of risk, information provided and responsibilities
A high frequency of reported adult dog bites occur to the hands or arms and often require medical attention (Drobatz and Smith, 2003), with the risk to veterinary staff increased during clinical examination (Guy et al, 2001) so awareness of handling risks during examinations is important. It was encouraging to note that respondents perceived a high risk to the veterinary professional if they undertook veterinary procedures commonly undertaken in a consultation but were not informed about any canine handling intolerances. This perception of risk was not affected by any factors studied, including, crucially, ownership of a dog with handling intolerances. We cannot say whether this risk perception would be altered by other unstudied factors, but it was particularly valuable to note that respondents did not need experience of handling intolerant dogs to appreciate potential risks to veterinary professionals. Furthermore, respondents appeared to rate behaviour-related factors as important to a successful veterinary consultation as the veterinary professional being provided with a clinical/health history. As the behavioural information provision is heavily under the control of the client volunteering this information, this is encouraging and was reflected also in respondents' attitudes to the responsibilities of each party (veterinary professional and client) to ensure that the veterinary professional is given prior warning of handling intolerances. Client responsibility for imparting this information was most strongly agreed with, with the intra-professional communication responsibility the least strongly agreed with. This seemed to be reflected in muzzle use, with half of respondents indicating that they were responsible for their dog being muzzled, which indicated prior warning of potential handling issues and potentially a desire to ensure the welfare of the veterinary professional. However, we cannot discount the potential that people motivated to complete our survey might be a particularly informed or dog-responsible cohort. Compared with topics such as medical conditions, husbandry and cost, behaviour was found to be the least discussed welfare topic (Roshier and McBride, 2013), which seems at odds with our respondents placing similar priority on behaviour aspects as on health history. Nonetheless, these findings are encouraging and it would be interesting to identify practical barriers that might affect what influences information actually imparted in the consultation.
Respondents also indicated that veterinary professionals had a key role in facilitating the client to help the veterinary professional by ensuring a lower risk of exposure to and handling of, handling-intolerant dogs. This was by both reducing the risk of intolerances developing, increasing the ability of clients to potentially recognise developing handling intolerances, and in providing assistance if handling tolerances were being displayed. Regarding seeking information on handling intolerances, 74.9% of respondents would approach a veterinarian for advice. Roshier and McBride (2013) report a similar finding, with 70.5% respondents agreeing to seek veterinary advice for behavioural problems. It is encouraging that the majority of respondents would seek assistance from someone if handling issues arose, which opens avenues of exploration into ensuring owners seek information from reliable sources. Veterinary professionals must be aware of basic behavioural knowledge for health and safety and patient care (Hubbard and Hedges, 2017) and to garner client respect and willingness to preferentially seek advice from them. With the rise in use of the internet for self-diagnosis in both human and veterinary medicine alike, the British Veterinary Association (BVA) warned that their recent ‘Voice of Veterinary Profession’ survey revealed 82% of veterinarians have had clients challenge their diagnosis or recommendations with internet found data (BVA, 2019). By increasing education options within veterinary practices and raising awareness of canine behaviour, clients may feel more open to discussing behaviour on a regular basis which could reduce incidences and severity of handling intolerances.
Respondents believed both that veterinary practices could do more in the area of canine handling intolerances to assist clients, with high interest demonstrated in both puppy classes, and in general education in canine body language at an early stage in dog ownership (before onset of any issues). Similarly, in a canine aggression focused study, Campbell (2016) found owners felt veterinary practices could do more to educate on canine body language. This suggests that veterinary practices have a key role in client education to prevent handling intolerances developing, and this survey demonstrated that there is a potential client willingness to engage with this process. Meints et al (2018) emphasised the importance of education for both children and adults on canine signalment and body language (something that practices could be an integral part of this educational process), but the prevalence of companion animal behaviour literature in UK veterinary practices is currently relatively poor (Feilberg et al, 2019). Using leaflets and client education events to increase owners’ comprehension of body language (e.g. through the ‘ladder of aggression’, Shepherd, 2012) could aid in understanding of the correct time to give canines space when early warning signs are displayed.
Conclusion
To conclude, most respondents were very willing to disclose their dog's handling intolerances, felt it was primarily their responsibility to ensure the veterinary professional had prior knowledge and that in not doing so put the veterinary professional at high risk. They also showed a willingness to seek out veterinary professional advice when owning a dog with handling intolerances and would utilise preventative measures offered by the veterinary practice. The veterinary practice keen to support clients in this area is recommended to review its provision of services to identify where provision could be improved or further developed, and to identify clients and dogs that might be at risk of lack of/delayed attendance. Further research should focus on identifying those clients who would not definitely disclose handling intolerances in order to understand the motivations for, and barriers to, lack of guaranteed disclosure of this information.