Contextualised care: why now and what next?

Katie Mantell

Hello and welcome to the RCVS Knowledge podcast. My name is Katie Mantell and I’m CEO of RCVS Knowledge. And this podcast is the first in a new series, exploring Contextualised Care in Veterinary Practice. In this podcast, we’ll be stepping back and looking at the big picture. We’ll be talking about what contextualised care is, why it’s so important to focus on right now, and a bit about what we’ve learnt from some research we carried out last year, before looking ahead to what we think needs to happen next.

I’m really delighted to be joined by three guests today, each of whom has quite a lot to say about contextualised care, so we might need to rein ourselves in at some point. To get things going, I’d like to ask each of my guests to introduce yourselves and say in a sentence or two why contextualised care is important to you. So Sally Everitt, would you like to kick things off?

Sally Everitt

Okay, yes. I’m Sally. I’m the clinical lead for evidence at RCVS Knowledge, and I was also the clinical lead on the contextualized care project that RCBS Knowledge carried out with Kaleidoscope Health and Care. I’ve been a vet in practice for a long time and have always been interested in how we make decisions with our clients. I did a PhD looking at the factors that influence our decision making.

So this led very well into all the work we’ve done with contextualised care.

Katie 

Thank you, Andrea.

Andrea Taylor

Yes, I’m Andrea Taylor. I work for Kaleidoscope Health and Care, and I’m a social researcher and have led I primarily work in social research in health and care for humans, and have led research projects all over the world that are focused primarily on human health and care. So this was a really fun project for me to get to apply a lot of the the work and the methods that we use in human health care but apply that to veterinary care.

Katie

Okay, and Sue.

Sue Paterson

Hi Katie, thank you so much for inviting me to be involved in this. Really looking forward to some great conversation. I have several hats that I’m wearing really. I suppose the most relevant of which is I’m a trustee of RCVS knowledge. So I’ve been involved with a lot of this work. I also have other charity involvement. So I’m also a trustee of the animal charity Pharmacy and I’m also vice chair of trustees at Battersea Dogs and Cats Home. So a lot of rescue work and that’s certainly one of the things that’s really important for me because certainly with my rescue hat on, I think there’s real inequity when it comes to owner’s ability to access veterinary care, to access it, to afford it, to receive it. And I think one thing that we really need to do, and we’re going to talk a lot about it, I know, is breaking down those barriers so that owners feel empowered to go to the vets because they know their vet is going to offer them that spectrum of care. And it takes away that fear factor so they know they can seek veterinary advice and veterinary care and therefore helps reduce pet relinquishment because we know from a rescue point of view that a lot of animals are released into rescues because owners cannot afford veterinary care. So I think embracing contextualised care for the professions is absolutely crucially important for animal welfare.

Katie

Thank you and great to have you here today. So before we start getting into contextualised care in more detail, let’s just be sure that we’re all talking about the same thing and just talk definitions for a second.

There are several different definitions of contextualised care and you can kind of get bogged down in some of the wording, but essentially we understand it as care that is adapted to the individual needs and circumstances of each animal, its owner and the wider context. But I think like lots of these kind of terms that just get bandied around, there can sometimes be some… misunderstandings or some myths associated with it. So I wondered if I could kind of throw it open to you. What do you think are some of the myths and misunderstandings about contextualised care?

Sally

Yeah, a big one for me is the idea that when we do contextualised care, we’re somehow not giving the best care that we can be giving. And I think this is comes from an idea that somehow there’s a single best ideal way that we should be approaching these cases and diagnosing and treating an individual animal. We definitely need to be using evidence to inform our discussions with owners about the options, but I spend a lot of my time reading the veterinary evidence.

And there are very few areas where the evidence base is strong enough to support a single best approach. Even where there is strong evidence for a particular approach, there may be individual factors that mean it’s not appropriate for a particular animal, for example, with comorbidities or due to its temperament, for that particular owner due to financial or other constraints, or the context in which the care is delivered, which may relate to the skills and resources available at the time to treat that animal.

We also have to remember that extensive invasive diagnostic and treatment can have a negative impact on the quality of life for the animal. And one of the things that came out really strongly in our research was that quality of life, both during and after treatment, came out as a top consideration for owners.

Katie

Do you think that the term evidence-based veterinary medicine has sometimes been unhelpful in that it’s not fully of understood?

Sally

I think the problem is that the term evidence based veterinary medicine, where it came from, related to not just the published evidence, but also the individual owner circumstances, when in human medicine, the patient circumstances, the animal circumstances and the vet’s clinical judgment. But somewhere along the line the the emphasis on the published evidence has slightly taken over those other areas and become the dominant thing that we think about.

Katie

It’s interesting how the language is so important, isn’t it, in terms of what it just focuses the attention on. Any other myths? Sue, do you have any you’d like to share?

Sue

Yeah, I suppose. And I think the thing that we perhaps forget a little bit about is that contextualised care is not just about finances, although finances are hugely important when we’re looking at putting together a package of contextualised support for an animal. I think we need to look really an awful lot at the owner circumstances. And there are so many other factors that we need to take into account. And it may be something as simple as, for example, the owner hasn’t got access to transport, so can’t get back to the clinic and we therefore have to tailor our treatment to deal with that. It may be we have an owner with a disability, it may be that’s a physical disability, it may be for example that they have problems with their hearing. It may be that people have, you know, so many people nowadays don’t have a nine to five job.

And if you don’t have a nine to five job, it’s very difficult to give medication three times a day. So it may be that that person work shifts, it may be they’re away from home, it may be they’ve got a dog sitter. So looking at someone’s lifestyle, I think is really important. And of course, language barriers are important too.

We’ve talked about people with impairment of hearing, but people who don’t have English as their first language, for example, perhaps someone who’s elderly, where it becomes really important to look at your communication skills talking really simple language. One of the things that vets are sometimes not very good at is talking in simple language. We use acronyms, we use long medical terms, and we forget that many people don’t understand that sort of thing. The other thing too is I think we need to think about the emotional effect it has on our pets. I know what I’m like with my dogs. I forget my veterinary hat when there’s something wrong with my dogs. I become completely irrational.

So breaking bad news to someone that their dog has got some form of terminal disease, the dog has got diabetes, the cat has got thyroid disease, there’s the emotional component of it that we need to take into account to actually allow for the fact that that will affect owner’s decision making. So it’s so complex. And when we’re putting together treatment protocols, you we may have the protocol in the book that says you will give this tablet three times a day, but if an owner can’t do that, you need to compromise, need to adjust your treatment.

And what you need to do is put together a protocol that’s going to still maintain animal health and welfare, but is something that the owner can actually do. And that is where I think specialists are particularly good at it. Not because they’re more clever than primary care vets, they’ve just had more experience. And I think as you gain experience and you start to manage these cases away from what the textbook dictates to you, I think you start to get a feel for what you can do.

I think the other thing that’s really important as well is that vets are terrified of litigation. And I think that’s something that came out in the research. And I have it written down in front of me, because I knew I would forget it, but under our code of professional conduct, it actually says, we should make decisions on treatment based first and foremost on animal health and welfare considerations, while providing contextualised care and exercising professional judgment about what is best for the animal in each individual case taking into account the needs and circumstances of the animal.

So we should be as veterinary surgeons, as veterinary nurses, and as veterinary professionals thinking about not just, as Sally said, that ‘gold standard’. We need to think about what that individualised treatment needs to be for that particular person.

Katie

Thanks Sue. As you were speaking, it made me think about, I think, a myth around contextualised care when you mentioned the role of specialists, which is I think there’s sometimes a myth or sometimes a misunderstanding that contextualised care only means basic or pragmatic care, but of course specialists have a really crucial role within contextualised care and it’s about all ends of the spectrum of different treatments, it’s not just around just focusing at one particular area of the spectrum.

The other thing it made me think about when you were talking about veterinary professionals using lots of acronyms and long words was the word contextualised care itself, which is a bit of a mouthful and not and why should it be well kind of understood or used outside of veterinary circles. So Andrea, you’re not, you know, you don’t normally work in veterinary but you joined us to work together with us on the contextualised care report last year that RCVS Knowledge produced. So I wanted to ask you, you know, if you’re talking with your colleagues in human health care or friends about this piece of work that you’ve done with RCVS Knowledge on contextualised care, how would you describe contextualised care to them?

Andrea

Yeah, we did have to describe it quite a lot to explain what we were doing. and as a dog owner, I also had to think about it from a from a pet owner’s perspective. And really it’s about common sense veterinary care. So it’s really about taking an approach that pays attention to the needs and preferences of the owner and the animal. And that sounds quite simple, but when you dig into it a little bit, it, it means slightly different things for vets than for pet owners, as we discovered.

So pulling on some of the themes that that have already, Sally and Sue have already mentioned, for vets it’s really about taking a holistic view of the animal’s circumstances. So when we were trying to describe it to people outside of of the world of veterinary care, it’s really for vets, about thinking about the age, the comorbidities, the quality of life of the animal, and also thinking about the owner’s preferences. So not just pursuing top-shelf care options at any cost, but rather recognizing that there may be valid and good reasons to choose a different care plan. And for pet owners, it was really mostly about the quality of life for their pets, which as a dog owner I can really resonate with.

So wanting the opportunity to make care decisions for your pet based on the value that care decision is going to have for the pet’s well-being, rather than just pursuing every diagnostic and treatment option available. And as Sue noted, also importantly, this really extends beyond care decisions. So one of the things we saw in the research was that for pet owners, contextualized care also meant the experience of the vet appointments, whether the clinic was accessible, whether it was on public transport, if it was set up, the clinic structure was physically set up in a way that could minimise stress for their animals. All those things were a part of contextualised care for pet owners.

Katie

Sorry Sue, do you want to come in?

Sue

It’s just an observation really. think in human medicine, they use nurses a lot. And I think nurses are really great at delivering contextualised messages and talking to clients because nurses are great communicators. And also I think there isn’t perhaps the fear, perhaps that’s the wrong word, but the fear that there is perhaps of the consultant or the doctor or the specialist or the vet. And I do think, you know, when we’re talking about an approach to contextualised care, the whole veterinary team is really important.

I know we’re going to come onto this a little bit later on when we look at the recommendations, but I do think [human]  medicine does that very well. And I do think we could learn that in veterinary medicine by using our nurses and empowering our nurses because they are without exception, fantastic communicators.

Katie

There’s a lovely quote in the research that we’ll talk about a bit more in a moment, which is from a veterinary nurse. very short. I’ll just read it to you now. It’s contextualised care shouldn’t be considered as something new. It’s what we should have been doing all along. Unfortunately, we lost our way. And I think that sums up quite a lot of comments we’ve heard over the last few months. So just wanted to explore that a bit more with you.

Why do we need to focus on it now and have we really lost our way? Sally, would you like to come in first?

Sally

Yeah, as a… someone who graduated forty five years ago, I’m definitely of the generation who thinks that contextualised care is what we were always doing. But I also understand that there are reasons why it can seem much more difficult to do it now than it did when I graduated or from many parts of my career. The first is that, you know, there have been amazing advances in our scientific knowledge and the technology we have available.

Which now means we are actually able to offer a much greater range of diagnostic and treatment options. And this has enabled us to successfully diagnose and treat far more animals, but it has brought with it issues around the affordability and the accessibility of veterinary care.

There have also been changes in the expectations of veterinary care, and we’re talking really about pets here primarily, because that was where our research was, but in other areas as well. Because pets are being seen increasingly as family members. And, you know, part of our research, but also other research has shown that increasingly families are treating them as family members and expect to have access to similar levels of care as they would for human members of their family.

And then alongside this, there have been enormous changes in the way that veterinary services are delivered. Many of these have been very good for the veterinary profession. We’ve moved away from individual practices, individual vets providing 24/7 care. We now have far more referral practices providing advanced care and lots more opportunities for out of hour service provision. But these things have had a sometimes a detrimental effect for the pet owners and their animals in that it’s much harder to deliver continuity of care. They’re not seeing the same vet or same practice members every time they go. they’re often sometimes visiting more than one practice, an out of hours service provider or a referral practice during the treatment of a single condition.

And the final thing that’s caused problems is the scrutiny that the veterinary profession has been under from the Competition and Markets Authority. They’ve been undertaking a review of the veterinary services for household pets, and while lots of this has been focused on the regulation of veterinary businesses, and they’ve acknowledged the professionalism and commitment of the vets and nurses delivering care. I think there’s a feeling that this, along with the media coverage, has damaged the trust between clients and veterinary practices and this again has an impact on the care that we can deliver.

Katie

Sue is there anything you’d add to that about why we really need to focus on contextualised care right now?

Sue

Yeah, I think one of the things that we need to think about is that we’ve got more dogs and cats as pets than we’ve ever had before in the UK. And part of that, I think, is due to Covid. People sought out companionship during Covid and there’s been a lot of work done looking at, for example, pandemic puppies. So we know animals were bought during Covid when people’s circumstances were very different, when we all went back to work and got some degree of normality back and people started to reassess whether they really wanted an animal, whether they could really afford an animal.

And we know if we look at the animals that are now being released into rescues, we’re seeing animals with really complex medical problems because they were dogs that were bought probably from the back of a car in a pub car park without any papers with perhaps slightly doubtful breeding. So we’re seeing animals with really severe medical problems, particularly some of our brachycephalics with really bad, you know, breathing problems.

We’re also seeing going into rescue animals with very complex behavioral problems too, where they’ve not been properly socialised, where their lifestyle has changed. So the dog’s been the center of attention for a period of time, and then the owner’s gone back to work and then they’ve been dumped and left in the house. And that’s perhaps being unkind to some people, but we certainly know that happens in other situations. So while we’ve got animals like that, they really need to be able to reach out to their vets, those owners of those animals to actually get help and support.

And if that support is coming at a cost, then obviously they’re not going to go and reach out and get that support. And those animals therefore end up in rescue centers. And the sad thing is that some of these animals probably should be euthanised. And I think when we talk about contextualised care, one of the things that we do have to think about is that euthanasia is a form of contextualised care.

Sometimes the quality of life for the animal is something that we haven’t taken into account and need to, or sometimes the animal is a danger. Sometimes we’ve seen the behavioural problems that we see coming into rescues where the animal hasn’t been socialised, they’re actually dangerous. And where behavioural therapy can’t put that right, euthanasia is the absolutely the right option. So I think Covid’s got an awful lot to do with it, people’s financial capabilities, but also the sorts of animals that are coming through the system because they’ve come through that whole Covid period, which hasn’t helped us at all.

Katie

So yeah, it’s really interesting as it’s like such a cauldron of kind of social and financial and kind of medical advancement reasons that make this such an important topic. Now, for anyone listening, you can hear the little jangling in the background with Sue. No veterinary podcast would be complete without a pet cameo. That’s your wonderful brown lab behind you, isn’t it Sue?

Sue

I’m sorry, it is my wonderful brown lab who is getting less attention than he’d like. So, oops, he keeps sneaking in in the background. Yes, he’s walking about and the yellow one is sitting on my legs and making a nuisance of herself as well. So, I apologize.

Katie

They are welcome to join the podcast at any point. And Andrea, kind of coming in kind of fresh, can I call you fresh from human health care with kind of fresh eyes on this. What was the sense you got about the importance and relevance of contextualised care kind of now from the conversations that you had as part of this work? And are there any kind of parallels with any concepts or kind of discussions going on in human healthcare around access to care there.

Andrea

Yeah, absolutely. So, really in line with what Sally and Sue have already said, the sense that we got as the as part of the research team was that pet owner expectations are really going up at the same time that veterinary practices are feeling financially squeezed. And while we have more clinical options than ever before, that doesn’t necessarily mean that they are going to be the right choice or even an affordable choice for everyone in every circumstance and then at the same time there is really concern amongst both vets and pet owners that corporate structures are potentially prioritising revenue over owner and pet well-being, and and the owners really wanted to be heard by their vet team and to have their own knowledge of their pet respected and included and feel that sometimes this isn’t happening, feeling a bit rushed and so it it’s kind of culminating in a in a bit of a perfect storm.

So contextualised care is a very important part of this conversation. And I think there are really a lot of parallels with human health care. Actually, we see we have diagnostic and treatment options that are expanding all the time in human health care, but so is the cost of care. And cost-saving measures to address this can often lead to rushed appointments, lack of continuity of care, a perception for patients that they’re not being heard.

And we’re seeing significant movements in the NHS, but also in other parts of the world. We’re seeing around the world a real push to integrate care more across primary and acute care and to push more care into communities and neighborhoods. And that is really working to address many of the same issues that we saw come through in the contextualised care research. So I think we’re a lot of there’s just a lot of parallels across veterinary and human health care right now.

Katie

Thank you. It’s something I reflect on as well, because my background, as you know, is also in human health care. And there are obviously some key differences, but actually a lot of parallels between some of the issues that both kind of sets of clinical professions are facing. Shall we move on and talk in a bit more detail around the research that we carried out at RCVS Knowledge with Kaleidoscope Health and Care last year and delve a bit more into what that work involved and kind of what we learnt from it. Andrea, do you want to start this off and maybe talk about a bit about the research process and what we did?

Andrea

So we kicked it off with a stakeholder event. So we had a national forum on contextualised care that brought together more than 70 stakeholders, and they really represented a wide range across the veterinary care spectrum. So we brought it together veterinary surgeons and RVNs, receptionists, educators, regulators, leaders of veterinary associations, leaders from charity and rescue settings, recent graduates, and we also had some pet owner representation as well.

And so we brought this fantastic group of people with a diverse range of perspectives together for one day to have this summit that really helped us shape the direction of the research and helped us inform the framework design for the research and the tools, including the surveys and the interview guides. Then we had two surveys. We had a survey for veterinary professionals and one for dog and cat owners.

And the surveys achieved we went beyond our goals actually in terms of recruitment and the final samples, which was really exciting. So the final sample for the veterinary professional survey was 417, and that was about 75% veterinary surgeons and 25% RVNs. And then for the pet owner survey, our sample was 763 pet owners and the majority of those had owned a cat or dog for more than six years.

And then once we had the surveys, we also did interviews with veterinary professionals and we ran focus groups with pet owners as well to collect some qualitative data to help us understand the nuances behind the quantitative data that we had.

Then we held a final stakeholder event after we had the data in. And so we had another summit which brought back a lot of the same people who’d been in the first summit, and we were able to share the initial findings and reflect on those and talk through kind of what resonated, what was missing, what needed further context, what didn’t quite seem right. And that really allowed us to develop the final recommendations and and and who test those findings, make sure that we were providing the nuance that was needed.

Katie

That was a huge amount of work done at quite some pace actually, wasn’t it, last year. Sally, what, I know there are lots of findings in there. We could have a whole podcast just talking about that, but Sally, what are some of the headline findings from the research that you’d like to share?

Sally

The most rewarding thing, because we didn’t know this when we set out, was the really strong agreement between pet owners and veterinary professionals that applying contextualised care would bring benefits to animals, pet owners, and veterinary teams. There was enormously high agreement that contextualised care could improve the trust between pet owners and veterinary teams. And as we said earlier, that may have been under a bit of pressure at the moment, with 96% of veterinary professionals and 85% of pet owners agreeing with that.

There was also a really high agreement that adapting a context adopting a contextualised care approach will improve the quality of care. And as Sue said earlier, has the potential to reduce the rehoming of pets.

But there’s also some things within the veterinary team, because I know sometimes the veterinary profession is feeling a bit under pressure at the moment, that they feel that contextualised care can foster openness and supportive working within teams. It can be sustainable and it can improve satisfaction for people working in veterinary practice.

However, all of that really positive news was followed up with a concern that fifty-five percent of veterinary professionals are reporting barriers to the delivery of contextualised care. And a similar percentage of pet owners reported problems obtaining veterinary care that they feel had been adapted to them and their pet.

The most frequently reported barriers were lack of continuity of care, which we’ve mentioned earlier, and financial constraints, particularly barriers around discussing the costs of care, which seems to be a bit of a taboo subject for us in this country. Another striking finding, as Sue referred to earlier, was the emotional nature of veterinary consultations, with veterinary professionals reporting fear of regulatory scrutiny, missed or incorrect diagnosis and client complaints, which was adapted acts as a barrier and they they want to do more tests to be in a rather sort of defensive medicine approach.

And owners feel emotional when their pets are unwell and also guilty if they don’t feel they’re able to afford all the treatment options that are on offer. So this was sort of these were the the sort of absolutely headline findings that there’s a huge amount more and there’s a whole report people can look at if they want to look at it in more detail. But I think those are the ones that stood out for me.

Katie

Thank you. Andrea and Sue, we were all at the summit and really familiar with the research. Is there anything else you would pull out as one of the key findings or anything that particularly interested you from the results?

Sue

I suppose for me, it is all about breaking down barriers. And I think one of the biggest problems is that people are frightened to go to their vets because they are worried about the cost. And also I think we all know as a nation that we love our pets, they’re members of the family. And where you’re only offered potentially one solution to a problem and that problem is something that is beyond your means, whether you physically can’t do it, the time. the cost of it, then you get this tremendous feeling of guilt that you’re not doing the very best that you can for that family member.

And so I think that was one thing that came across really strongly for me. We need to empower owners. We need to empower owners to be able to have those open and transparent conversations with their veterinary team. It’s not just the vet, it’s the nurses, it’s everybody at the practice, even the receptionist where that conversation starts so that we can actually get animals care that they need, but also perhaps get animals to vets more quickly, because I think potentially sometimes people wait before they go to their veterinary surgery because they’re worried about those different factors.

So for me, think empowering owners is the single most important thing that came out of it for me. And the fact there’s that fear factor that we need to break down.

Andrea

Yeah, I would just really agree and underscore what Sue just said. I think the key thing that really came through and stuck with me was that pet owners want to be heard and respected, and they want clear communication from vets about the options and the pros and cons of each option. And they also really wanted clear communication about costs before decisions are made. So a lot of pet owners told us that they found it was really difficult to discuss costs with their vet and the vet often would just rush over that or skip it altogether.

And they really wanted a clear conversation about what things would cost and what  the cost of different options were so that they could take that away and make a decision. But I think also to underscore something Sally said, the good news is that nearly half of the pet owners we surveyed felt that they were already getting contextualised care and thought that there wasn’t anything actually that needed improvement.

They were really, really happy with their care. So I think that’s an important thing to bear in mind as well, where there is there is a lot of room for improvement and there’s a lot of really important lessons that can and come through the findings of this research. It’s also important to remember that a lot of pet owners are feeling that they are already getting it in a lot of places.

Sue

So I think one of the biggest problems, and I know that I am not very good at this, is actually vets are not great at discussing money at all. We are clinicians. When we signed up, we signed up to help improve animal health and welfare. So I think a lot of it is to give vets that confidence. And I know that our veterinary schools are working really hard at it. They’re working hard on communication skills. And also one of the great things that happened a few years ago was that the Royal College changed the accreditation standards so that our students need to get their clinical experience in a primary care context.

So I do think that owners need to be empowered, but I also think vets need to be given the confidence to be able to discuss money as well, because it is really, really difficult. For some reason, solicitors and lawyers and even hairdressers are very confident talking about the cost of their services.

But as professionals, I think we’re really bad at it. And I think we need to be a lot more relaxed about the fact that, you know, we’ve done a lot of training. I would hope we all know what we’re doing so people should pay for our veterinary services because they shouldn’t be something that we give away for nothing.

Sally

I think it’s been difficult in all countries to discuss finances, but in some of the conversations I’ve had since our research, it does seem to be more difficult in the UK. And some of that may be that the nearest parallel that people think about is their own medical care. And they don’t have to discuss costs at point of delivery in human medicine, which I think makes it a little bit harder than in those countries where they’re used to having that conversation about medical care and therefore, perhaps they’ve got something to pitch it against with veterinary care, because very few people would have any idea what human medical care is actually costing to deliver.

Katie

I think there is something there, about how vet teams can talk about finances, but as you said, how pet owners can be supported. Because I just know as a pet owner myself, I’m thinking about a couple of times when I’ve taken some of my pets to the vet, and it’s really, there’s a lot of guilt there, isn’t there? As soon as you start asking about costs, you kind of feel like a bad owner for asking about costs. That’s how I feel, even as a very informed pet owner. That’s how it makes me feel. It makes me feel a bad pet owner.

Sue

And it’s true, isn’t it? Unless you’re prepared to pay anything, you don’t love your pet and we need to destroy that completely. That’s something that needs to go.

Katie

I couldn’t agree more. So I think there is something around vet teams thinking but also a kind of public conversation or public understanding of what it’s it’s okay to make choices and paying everything doesn’t necessarily mean that’s the only way to express love for your pet it may not indeed be what’s best for your pet depending on the circumstances.

If we can overcome some of these barriers to delivery of contextualised care, what, if we just have a talk about what our future might look like, what would you see as some of the benefits that we would have if we could achieve contextualised care kind of across the board?

Sue

I think one of the things that particularly young vets talk to me about is job satisfaction. And I think we all come into the profession, whether we’re nurses or vets, to make animals better. And I think if we have this spectrum, this contextualised approach, I think we’re going to get much better job satisfaction because we’re going to be able to offer treatment to a much wider range of animals. And that will give you the real buzz. I can remember when I first qualified hundreds of years ago how excited I got when I made my first animal well.

The truth is it probably got better despite what I was actually doing. But I think we get huge satisfaction from making animals better and actually giving owners that sort of relief that their pet is better. So I think job satisfaction for me is a really big thing that will come from this contextualised approach.

Sally

I think that’s absolutely true. And I think one of the things we need to think about is, you know, owners come to us, okay, they’ve got a sick pet, but they’re coming to us with a problem. And it’s the problem solving part of what we’re doing. And that certainly will include elements of diagnosing and treating the animal. Might there might be all sorts of other things around that as well. So listening to the the owners about what this particular problem means for them and what are the most important things for us to work with them towards improving quality of life for the animal, but also something that is sustainable and manageable for them, rather than, as you say, you know, taking this thing off the shelf and saying, this is how you treat an animal with this particular condition. That we’re we’re doing something a little bit more complex.

And it is difficult and it’s scary to start with. And I think that’s why those of us who qualified quite a long time ago, because we had fewer things in the textbook to draw on and were often sort of, you know, I can remember pinning a budgie’s leg using a hypodermic needle because we didn’t have anything else in the practice and there was there was nowhere to refer them to suitably at that time.

But we’ve got this idea that if we can’t do it perfectly, we should refer it on to somebody else. And sometimes that I mean obviously we we must work within our areas of competence, but we can push our areas of competence a little bit and learn to do new things and approach all of these issues with how can we best look after the quality of life of the animal.

Sue

I think the other thing that’s really important for me is that euthanasia isn’t failure. So often people think that if you’re euthanising an animal it’s because you’re not able to treat it. So often that is the right decision to make and prolonging life where there is no quality of life in my opinion is completely wrong. So I think empowering vets to have that euthanasia conversation is really, really important.

Katie

Research is kind of all very well, but I suppose the key thing is what happens next. Sally, would you like to maybe tell us a bit more around the roadmap, how it was developed and at a very high level what it says?

Sally

Yeah, thanks, Katie. Yeah, we carried out the research, but the we wanted to develop a tangible plan to look at the implementation of contextualised care going forwards. And as Andrea mentioned, we in as part of our research process, we had these stakeholder meetings, but we not only had a forum at the beginning, we had a summit at the end where we brought the stakeholders back together to talk about the preliminary findings and how they could be taken forward.

So at the end of the research, we had an enormous amount of data, both the data from the questionnaires and the interviews and focus groups, but also all this feedback from the stakeholders about what they thought needed to be done, which involved a lot of work and many iterations and a lot of post-it notes, trying to come up with what were the main points we needed to talk about. But we eventually came up with five broad themes.

The first is around professional leadership and recognising that contextualised care is the most appropriate way to deliver veterinary care. As Sue’s already mentioned, it’s already in the guidance for our code of practice. The RCVS does recognise it, but this message hasn’t fully got through to the veterinary professionals and there’s still quite a feeling of defensive medicine and that somehow if they’re not doing everything, they’re not being good vets. So there’s definitely more work to do there.

There’s also a theme around veterinary education for all team members. This is both while there are students and postgraduate, and including all team members, not only vets and nurses, but veterinary receptionists and everyone else who’s involved. And this is about ensuring that they’ve all got the knowledge and skills to practice contextualised care. It’s not just about teaching the spectrum of options that are available, which I think certainly the vet schools are quite good at now but also the skills to communicate and work with the animal’s owners to help them find the care that’s most appropriate for them and their animal.

Then we get down to what’s going on at the practice level and what support is needed there. And we’ve got recommendations around ensuring that there is system support and team culture in place to enable contextualised care, and perhaps just as importantly, making certain that none of these systems are actually inadvertently getting in the way of the veterinary team delivering contextualised care. We need better data and research on outcomes so that both veterinary teams and pet owners have got the knowledge they need to make informed decisions.

And as Sue has mentioned several times, we need to have that independent trusted information to empower pet owners to be actual partners in making the decisions about what’s best for them and to enable them to make guilt free decisions about their animals’ care.

Katie

Thanks Sally. Sue, I know that final area of the road map that Sally talked about, which is around PETA-Normo-Empowerment is particularly close to your heart. Is there anything else you’d like to add about that that really resonated for you?

Sue

RCVS Knowledge is doing a huge amount of work in this and I absolutely applaud it. I think it’s fantastic that knowledge is leading in this particular respect, but I think we need partnerships because I think knowledge is very much a veterinary facing, veterinary nurse, veterinary professional facing charity. And I do think we need to work with other stakeholders as well. So I think wide stakeholder engagement is going to be really important. and talking to some of the people who have got access to pet owners, I think is going to be absolutely really key.

And also I think when we’re looking at providing resource for owners, it’s got to be in simple language. I think the resources that we have for vets and nurses and other professionals is going to be entirely different to the resources that we have for pet owners. So I think that is a really, really important part of this overall work.

And I think creating the resource and giving access to that resources is really, really important. The other thing that I also feel very strongly about is I think going back to the educational bit that Sally was talking about, I think so often as specialists, and I’m probably as guilty as this as anybody is, specialists who deliver most of the CPD that we have in the veterinary sector are very keen to show people their shiny toys and their new treatment. protocols and all the clever things that they can do.

But actually, think specialists need to rise to this as well as specialists need to talk to primary care practitioners and go, okay, well, okay, I’ve got all these fabulous things, but this is how you would do it in primary care practice. So I think in every single lecture that we deliver, there needs to be that primary care context as part of that educational resource that’s actually there.

And I think as we start to do that, then we’re actually going to give that spectrum to our primary care vets where they know what they can do in practice that’s within their capability and is within their own resources, but also where they can go to that specialist if that owner has got the, has the need, the want, the financial capability to go and look at that more advanced type of treatment. So I think specialists, experts in the fields are really, really important as part of that educational piece.

Katie

Thanks, Sue. Andrea, what was it that particularly stood out to you from the roadmap process or recommendations?

Andrea

Yeah, so I think for me coming again from a background in human healthcare, I I felt really optimistic actually about this the roadmap and the research that it was based on. And I felt it was a really special project to be a part of. and there were so many parallels again with human healthcare. So I think one thing that did really stand out through the whole process, was that the commitment and the passion from the veterinary professionals across a whole range of roles was really clear.

There was such a strong desire to do the best for animals, and that was so central to all the discussions we had in the stakeholder events, to all the interviews that we had, to what came through in the surveys. And what that meant was that everyone was coming to this conversation with a common goal.

So even though there was a really wide range of perspectives and experiences, there was this common thread that everyone could sort of hold on to and agree on. And we see that also in human healthcare as well. That although there are so many challenges and so many difficulties, it’s I always find it quite hopeful that actually at the end of the day, everyone does really want the same thing and is motivated by sort of doing, doing the best for their patients.

And the other thing that really stood out for me was that when we get it right, it’s so impactful. And we talked to a lot of pet owners who recounted previous experiences where contextualised care had been given, they’d really experienced contextualised care. And they were so grateful, and the experience had of being listened to and empowered had been so meaningful to them.

That it really underscored to me the importance of of how important this is to to get it right and what that means for pet owners and for pets when we do, as well as for vets, actually as well. So we heard also some really incredible stories from vets where they had felt empowered to use clinical judgment, to work with owners to empower owners and to use contextualised care and really felt that that was it was such an important part of their own job satisfaction and again feeling like they were able to do what was right for the animal.

Katie

Andrea, that’s a really nice point to kind of dwell on I think as we come to the end of our chat today. So maybe I could talk a little bit about what we’re looking to do next at RCVS Knowledge. So we have been so quite overwhelmed by some of the response to the research and the roadmap from within the UK and actually from abroad as well because there are lots of similar challenges and issues being being felt by many veterinary sectors and pet owners, animal owners in many different countries. So what we’re looking to do next is to really, as Sue was saying, bringing on that kind of partnership and working with others. So looking to bring together individuals and organisations from across the veterinary sector to drive and map progress towards implementing some of those actions that are laid out in the contextualised care roadmap.

We really would love to explore and work with others around what resources and tools could help veterinary teams and animal owners to achieve contextualised care. And we know this is an area that’s really important to many people who are doing great work in this area. So we want to do what we can to celebrate that and to help raise visibility and share learning across the sector and with pet owners around how to achieve good contextualised care and what that looks like. So I think it just remains for me to say thank you so much to our three fantastic guests, Andrea Taylor, Sally Everitt and Sue Paterson. Thank you so much for joining us today.

Please do everyone look out for more podcasts in this series when we’ll be delving a bit more into some different aspects of the practicalities of contextualised care. So from me and three guests today, goodbye.