Let s Talk About. Obesity. A relationship-centered care approach to promoting canine health

Transcription

1 Let s Talk About Obesity A relationship-centered care approach to promoting canine health

2 introduction Among the issues facing veterinary professionals today is the wide prevalence of canine obesity 25% to 40% of dogs in the United States are overweight obese. 1,2 And while veterinary professionals understand that obesity is an imptant medical condition with serious health implications, 3,4 dog owners are not necessarily as well infmed. Owners are often not even aware that their pets are carrying excess weight. In one market research study, veterinarians estimated that 47% of their patients were overweight obese while only 17% of owners held a similar perception about their dogs. 5,6 Research among veterinary practices has shown that there is inherent difficulty in discussing obesity with clients, particularly when the client may also have a weight problem. When the client is overweight, a full two thirds of veterinarians rept hesitation in beginning the conversation. 5 Addressing such a sensitive topic presents many challenges. The veterinary professional has to: Raise the topic of obesity Explain the risk facts and consequences Gain commitment to a weight-management program and follow-through plan The purpose of this booklet is to help you to communicate me effectively with clients about canine obesity. The ideas in this guide will help you establish a dialogue and create a partnership between the veterinary team and the client, with the goal of reaching a successful treatment outcome. The partnership between veterinary professional and client is central to relationship-centered care. 7,8 In relationship-centered care, interactions between the entire veterinary team and the client are characterized as collabations between partners, resulting in the creation of a joint venture dedicated to the health of the animal.

3 Creating a relationship-based culture When the veterinary visit focuses on communication between caregivers that is, every member of the healthcare team, including veterinarians, technicians, receptionists, other staff members, and clients a me effective result becomes possible. Effective communication in human medicine has been found to favably affect clinical outcomes, 9 and it is a fair deduction that these findings may also be relevant in the veterinary setting. Benefits of effective communication could include: A healthier canine patient Greater client participation, compliance, and follow-through Enhanced satisfaction f both veterinary professional and client Improved relationships between client and the entire veterinary team Better codination of care Shared decision-making is a key component of relationship-centered care. Taking the client s perspective into account and establishing mutual understanding and agreement encourages the client to fully participate in the discussion and commit to treatment plans. This approach is effective not only in the management of canine obesity, it is equally applicable to enhancing compliance with all veterinary treatment plans.

4 a change in approach Compliance has been viewed as the client s responsibility to follow through with the recommendations given by the veterinary professional. What is different about the relationship-centered care approach? Less emphasis goes into telling someone what to do; me focus is placed on developing a positive relationship through mutual respectful communication and making space f client participation. An evolution in client conversation While the veterinary professional s recommendations retain imptance, the relationship-centered care approach creates a true dialogue with the client. By listening to the client, eliciting and acknowledging the client s point of view, establishing mutual understanding and agreement, and inviting feedback, the veterinary professional communicates a true partnership. The sincere relationship and trust that result are essential elements of this approach. Establishing a relationship-centered partnership from the beginning lays the foundation f discussing the topic of obesity. If the ensuing commitment is both generated by and agreed upon by both parties, it is far me likely to lead to a positive outcome. So, what can you do to make all this happen? Divide the clinical interview into its component tasks and associated skills to enhance communication. The examples that follow are guidelines to engage in obesity conversations using the relationship-centered care approach.

5 goal: initiate the topic by creating a shared agenda The first guideline is to establish a relationship pri to raising the topic of obesity. Mrs. Wilson, I understand that you are concerned about the inflamed area on Molly s leg. We ll take a close look at that... Is there anything else you would like to discuss today? If it is all right with you, I d also like to discuss her weight. You are doing a great job caring f Murphy. Looking at his recd, I see that he has put on weight; how are you feeling about Murphy s weight? Mrs. Jones, during Sam s examination today we will also be scing his body condition. As we compare Sam s body condition to the pictures on the scale, which sce do you think best describes him? You ll note that the conversation includes eliciting and acknowledging the client s perspective, listening to the client s sty, reinfcing the client s care of the pet, asking open-ended questions that promote discussion, and providing plenty of opptunity f client participation. These skills are integral to relationship-centered care. By collabating with the client to fm an active partnership in the care of the dog, you establish a rappt that helps diffuse sensitivity that may arise when broaching a delicate subject, such as obesity. Doing so allows you to develop an initial understanding of the client s perception of their dog s weight and their readiness f change. Developing trust is essential to both the veterinary professional and the client. These skills contribute to mutual understanding and the likelihood of follow-through.

6 goal: gather infmation by expling the client s perspective Once a collabative discussion is under way, veterinary professionals have the opptunity to elicit and incpate the client s perspective. An open and inviting tone and manner help impart the concern you feel f the animal s welfare. Pet owners want the best care f their pets, and will engage enthusiastically when questions are posed in a nonjudgmental way: I see that Molly s weight has increased since her last visit. What are your ideas about what might be causing this? Earlier you said that Murphy no longer likes to run and play outdos. It would help me to understand what you think might be causing this change in behavi. It looks like Sam has gained weight. How do you feel that Sam s weight is impacting his general health? Acknowledging and encouraging client input helps create a dialogue focused on the health of the patient and perspective of the client. This is best accomplished by bringing some ce skills into play. F example: Encouraging clients to express their feelings, ideas, and expectations Listening closely to the client Picking up on the client s verbal and nonverbal cues and responding to them Asking open-ended questions to elicit the client s sty and point of view Collabative partnership takes into account the client s intrinsic values and goals. The greatest catalyst f change comes from within.

7 goal: build the relationship and ensure accuracy The ce skills of effective communication contribute to building the relationship. Building the relationship is imptant and is a critical element in the ongoing development of trust. It is also essential to the exchange of infmation and the accuracy with which that infmation is received and perceived. Reflective listening, picking up on clients verbal and nonverbal cues, and empathy are 3 additional skills that foster building a relationship and ensuring accuracy. Reflective listening Reflective listening means reflecting back to the client what you heard in your own wds. It allows you to check on your own interpretation, and it allows the client to confirm, clarify, crect, add, ask questions. F example: I hear your concern about Molly s difficulty going up and down the stairs and getting around. If I understand you crectly, the changes we have been discussing about Murphy s exercise routine will conflict with your wk schedule. Do I have that right? You ve told me that Sam loves table scraps and you feel that is a contributing fact to his weight gain. Tell me me.

8 Picking up on clients verbal and nonverbal cues Clients verbal and nonverbal cues, just like our own, might indicate several things; f example, a moment of indecision, a need to say something, a wry concern, a question. Client cues may also signal their understanding, agreement, readiness f change. It is imptant to watch f and respond to the client s: Nonverbal cues and behavi, such as posture, facial expression, eye contact, gestures Vocal cues, such as rate, volume, tone of voice Raising additional issues, deflections, and/ denial Interjecting affirmative comments such as, I understand and Uh-huh, negative comments such as Yes, but and Hold on As you develop these skills through frequent use, you may find yourself employing them in a wide range of clinical settings. You may also find that you are building stronger relationships with pet owners. Empathy Empathy is an imptant foundation f relationship building. We all want to have our feelings, thoughts, and concerns acknowledged. Acknowledgment means reflecting back to the person what you heard observed. In other wds, you recognize and accept the legitimacy of their point of view regardless of whether you agree with it not. It is imptant to pause after making an acknowledgment to let the feeling of acceptance sink in to allow the client to explain further. I see how much you care f Molly, and I know this is a sensitive subject. We both want what s best f Murphy; I know how hard it is to resist it when he begs. Like you, clients have the best interests of their dogs at heart. Reinfcing that your goals are the same enables you and the client to devise a plan collabatively.

9 goal: explain, plan, and determine acceptance Assess the client s starting point Befe beginning an explanation, find out the client s level of understanding of obesity. F example, determine the client s level of awareness, knowledge of the medical condition, and interest in participating in a weight-management plan. I know Molly s weight can be frustrating to manage, and there are options we can discuss to best meet your needs. How do you feel about considering some options to manage her weight? What do you know about the risks Murphy might face as a result of being overweight? Determining the client s starting point, knowledge, and level of concern can facilitate the development process of an effective treatment plan. Check f understanding Once you establish that the client wishes to help the dog lose weight, discuss the available options. Checking f understanding helps to address any miscommunication, misperceptions, gaps in communication. Probe f questions about implementing the weight-loss plan you are mutually devising What will be the easiest piece of our plan to put into action? What will be most difficult f you? Client resistance is often a signal that you may need to modify your approach and go back to exple the client s perceptions, that you may need to provide additional infmation Ask the client if they have any questions need additional infmation

10 Check to see that the client accepts the plan Keep in mind that you are seeking shared decision-making. Set appropriate expectations with the client and agree upon a definition of success What results would you expect to see from the plan we set up f Murphy? Determine the client s acceptance level of the plan and willingness to implement it What small change might you start with? Ask the client f feedback on their ability to follow through with the weight-loss plan How will implementing this plan fit in with your daily schedule? At the next visit, reinfce the client s commitment to the program you ve agreed upon. Whether it is a simple comment about the care already being provided praise f the client s enthusiasm f the new weight-loss program, verbal suppt adds to the sense that you are in this together as full partners in the dog s health care. You are doing a great job of increasing Sam s activity. What has been the most challenging f you? How have you overcome those challenges? Thanks to your hard wk, she has lost one pound in the past month. This partnership signifies that all parties are invested; both the plan and the follow-through will be a mutual responsibility. 10

11 A paradigm shift is under way In both human and veterinary medicine, we have moved from a guardianship to a partnership. The traditional approach relies on the veterinary staff providing infmation: Offering directives and recommendations f behavial changes Delineating predetermined plans Maintaining a relatively passive role f the client during the interaction The relationship-centered approach is based on collecting and sharing infmation, receiving client feedback, and responding to it: Facilitating the conversation and wking with the client Customizing the care to the specific needs of each pet and client Creating a plan together Verifying understanding and asking f the client s point of view Reassuring the client appropriately Encouraging the client to be an active participant throughout the process Time well spent This relationship-centered care approach may take a little longer than the traditional method. In the beginning, it may feel uncomftable awkward and take longer because it may interrupt communication approaches that have become routine. In the end, the benefits of me effective communication will save time, improve follow-through, enhance outcomes of patient care, and help the veterinary professional build stronger, me partner-based relationships. Patience, perseverance, and these communication initiatives will help you address the growing problem of canine obesity, thereby improving the health of a huge subset of the canine population. 11

12 keys to successful partnering: a checklist Initiate the conversation effectively broach the topic of canine obesity Gather infmation and exple the client s perspective Build the relationship and ensure accuracy Collabate with the client to develop a plan Explain, plan, and determine the client s acceptance Be flexible and tail your approach on a case-by-case basis Encourage questions and mutual understanding throughout Co-authed by: Jane R. Shaw, DVM, PhD; Suzanne Kurtz, PhD; and Sue Berryhill, BS, RVT, VTS (Dentistry) Concepts and other material in this guide are based on the following resources: Kurtz S, Silverman J, Draper J. Teaching and Learning Communication Skills in Medicine. 2nd ed. Oxfd, England: Radcliffe Medical Press; 2005: Silverman J, Kurtz S, Draper J. Skills f Communicating with Patients. 2nd ed. Oxfd, England: Radcliffe Medical Press; Calgary-Cambridge Guides: Communication Process Skills Shaw JR. Four ce communication skills of highly effective practitioners. Vet Clin Nth Am Small Anim Pract. 2006;36(2): References: 1. Wolfsheimer KJ. Obesity. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine: Diseases of the Dog and Cat. Vol. 1. 5th ed. Philadelphia, PA: W. B. Saunders Company; 2000: Hand MS, Armstrong PJ, Allen TA. Obesity: occurrence, treatment, and prevention. Vet Clin Nth Am Small Anim Pract. 1989;19: Burkholder WJ, Toll PW. Obesity. In: Hand MS, Thatcher CD, Remillard RL, Rhoudebush P, Lewis LD, eds. Small Animal Clinical Nutrition. 4th ed. Topeka, KS: Mark Mris Institute; 1997: Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk facts f obesity in adult dogs from private US veterinary practices. Intern J Appl Res Vet Med. 2006;2: Data on file. Pfizer market research SL1206. Pfizer Inc, New Yk, NY. 6. Data on file. Pfizer market research SL1106. Pfizer Inc, New Yk, NY. 7. Beach MC, Inui T, with the Relationship-Centered Care Research Netwk. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21(suppl 1): Tresolini CP and the Pew-Fetzer Task Fce. Health professions education and relationship-centered care. San Francisco, CA: Pew Health Professions Commission; Simpson M, Buckman R, Stewart M, et al. Doct-patient communication: the Tonto consensus statement. BMJ. 1991;303: Brought to you by SLE Pfizer Inc. All rights reserved Printed in USA/April 2007