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61	Clients' Service Expectations and Practitioners' Treatment Recommendations in Veterinary Oncology Stoewen, Debbie Lynn 18 May 2012 (has links) Service provision in veterinary oncology in Ontario was examined using a mixed methods approach. First, an interview-based qualitative study explored the service expectations of oncology clients at a tertiary referral centre. Next, a survey-based quantitative study established an understanding of oncology service in primary care practice and investigated the treatment recommendations of practitioners for dogs diagnosed with cancer. The first study, which involved 30 individual and dyadic interviews, identified “uncertainty” (attributable to the unpredictable nature of cancer and its treatment) as an overarching psychological feature of clients’ experience. Consequently, “the communication of information” (both content and process) was the foremost service expectation. For clients, it enabled confidence in the service, the ability to make informed patient care decisions, and preparedness for the potential outcomes of those decisions; it also contributed to creating a humanistic environment, which enhanced client resiliency. Findings suggest that services can support client efforts to manage uncertainty through strategic design and delivery of service, and incorporate intentional communication strategies to support clients’ psychological fortitude in managing the cancer journey. The second study, a vignette-based survey of primary care practitioners across Ontario (N=1071) which investigated veterinarian decision-making in relation to oncology care, determined that 56% of practitioners recommended referral as their first choice of intervention, while 28% recommended palliative care, 13% in-clinic treatment, and 3% euthanasia. Recommendations were associated with patient, client and veterinarian factors. Specifically, referral and treatment were recommended for younger dogs, healthier dogs, and dogs with lymphoma versus osteosarcoma; for strongly bonded clients, and financially secure clients; and by veterinarians who graduated from a North American college, had experience with treating cancer, felt confident in the referral centre, and believed treatment was worthwhile, with variation in relation to practitioner gender and the type of medicine practiced. The human-animal bond appeared to be the primary factor associated with practitioners’ advocacy for quality of medical care for patients. Through a blend of qualitative and quantitative methodologies, this thesis contributes to the evidence upon which best practices may be built so as to enhance the quality of patient and client care in veterinary oncology. / Ontario Veterinary College Pet Trust Fund 049406 and 049854 client expectations treatment recommendations veterinary oncology practitioner service expectations qualitative research quantitative research thematic analysis vignette-based vignette-based inquiry full factorial experiment vignette-based research specialty oncology service primary care practice veterinary client logistic regression analysis uncertainty client uncertainty interview cancer cancer care canine cancer lymphoma osteosarcoma veterinary communication communication communication skills information content and process veterinary cancer care Ontario survey questionnaire referral euthanasia in-clinic treatment palliative care quality of care quality of medical care illness uncertainty service provision oncology epidemiology tertiary referral centre social epidemilogy veterinary epidemiology client well-being human-animal bond practitioner attitude best practice information preferences preparatory information cancer journey communication process continuity of care clinical decision making decision making practice variation adaptation

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Clients' Service Expectations and Practitioners' Treatment Recommendations in Veterinary Oncology