For better veterinary feeding information, change your question

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Disease prevention and management in individual veterinary patients rely on the veterinarian’s understanding of what that pet eats. A thorough nutrition history includes information about the pet’s main diet, treats and supplements, feeding schedule and practices, and environment and exercise.¹ Studies show that capturing this information from clients and enacting nutritional modifications is not so easy, and hinges on the nuances of communication between veterinarian and pet owner.^2,3

In the exam room,⁴ conversations about diet typically begin with the word “what,” as in “What kind of food do you feed your cat?” But questions phrased this way may glean little information. One study found that this style of questioning unmasked a mere one or two food items in 89% of interactions.² And in most of these situations, veterinarians failed to ask follow-up questions to round out the narrow nutrient picture painted.

But open-ended questions—such as “Tell me about…”—were found to produce more comprehensive responses because they encourage people to talk more freely and expand their answers.^2,4

Study details

A study recently published in the Journal of the American Veterinary Medical Association was performed to investigate the effect of question design on breadth of response in veterinary diet history-taking.⁵ During the summer of 2015, researchers from Ontario Veterinary College and the University of Guelph invited clients with scheduled appointments for their dog or cat at four Ontario veterinary clinics to participate.

An investigator asked each owner one of three standardized diet history questions and one question about physical activity. The nutrition questions were:

• “Tell me about everything your pet eats throughout a day, starting first thing in the morning right through to the end of the day.”
• What kind of food does your pet eat?”
• What kind of foods does your pet eat?”

In videotaped data collection sessions held in the exam room, the investigator posed one of the variably worded diet questions, randomly assigned to each participant, followed by the physical activity question.

The answers were then measured against information yielded in a comprehensive diet history survey (paper or online) directly following the visits. Survey questions sought specifics about a pet’s:

• Main diet (e.g. food type [brand, ingredients, wet/dry…], amounts, frequency)
• Pet treats
• Human foods
• Medications/supplements

The survey also included an open-ended query regarding anything else the pet regularly ate, and sought the pet’s weight, (owner-reported) body condition, eating behaviors and exercise, as well as the owner’s feeding habits (who feeds, food availability, food measurement, etc.).

Responses were coded using standardized definitions. Quantified variables included main diet items, pet treats, human food items and medications/supplements, as well as a comprehensive total. The duration of clients’ verbal responses to diet questions was also recorded.

Statistical analyses were performed to:

• Determine associations between the diet question posed and the frequency of participants’ reporting specifics (brand name, diet form, feeding quantity/frequency) for main diet items
• Compare numbers for main diet items, treats, human foods, medications/supplements, plus total number of diet-related items reported and the duration of participants’ responses among the three diet history questions
• Measure information harvested through the written dietary history surveys against that gained through each of the three verbal questions

A total of 99 participants were recruited for the study; each recruit addressed the diet of a single pet. For 76 of the videorecorded interactions, the pet was a dog; for the remaining 23, a cat. Thirty-three participants were assigned to the “Tell me…” group, 40 to the “What kind of food…” (singular question) group and 26 to the “What kind of foods…” (plural question) group.

What they found

For the “Tell me…” question, feeding frequency (for the main diet) was the most commonly reported variable. But for the two “What kind of…” questions, it was brand name. Yet brand name reporting frequency did not vary significantly among the three diet questions. By contrast, reporting of diet form (wet/dry…) was significantly greater for the “tell” question than for the “what” questions; for the “what” questions, “What kind of food…” elicited more detail about diet form than did the “What kind of foods…” question. Feeding quantity (for main diet) was more likely to be reported with the “tell” question than with the “what” questions.

While the diet question phrasing did not impact whether an owner reported medications and dietary supplements, the detail with which an owner described their selections and feeding regimens for main food items, treats, humans foods and medications/supplements did: “Tell” phrasing generally teased out the most complete picture, including the greatest quantities of diet-related items reported, with reported quantities for the two “what…” questions running neck-in-neck.

How a nutrition question was posed to pet owners determined how much time they spent answering it. Individuals asked the “tell” question spoke for some 43 seconds in response, compared with about 11 seconds in reply to “what…food?” and about 27 seconds answering “what…foods?”

When compared with results for the dietary history survey—deemed closer to the gold standard for accuracy because of administration without time constraints and pressures inherent in verbal questioning—the “tell” question produced no differences in the breadth of dietary data offered up, but owners copped to fewer treat items verbally than in the written survey.

The “what” questions elicited lower total reports of diet-related items than did the dietary history surveys. The “what…food” question also produced lower numbers for main diet items, treats and human foods than did the written survey; likewise, respondents to the “what…foods” question disclosed fewer treat items and medications/supplements in their videotaped verbal responses than in the written survey.

What’s the take-home?

This study found that nuances of wording can impact the quality of communication between veterinarian and pet owner. Open-ended “tell” questions about pet feeding practices elicited more comprehensive responses than did targeted questions, and approximated the results produced by written diet surveys. For “what” questions, minimizing specificity by inquiring about the plural “foods” versus the singular “food” did not broaden overall results, with the exception of more human food items being disclosed.

Open-ended questions can be followed by a coned-down approach to specific variables, particularly those that are patient-specific, embarrassing to reveal or perhaps deemed irrelevant. Transparency during the veterinary visit sets the stage for shared decision-making between owner and doctor, particularly where feeding habits are concerned. Full disclosure enables an open forum for meeting those factors that can deter optimal nutrition choices once the owner leaves the office.

Dr. Capuzzi, who earned her BS and VMD degrees from the University of Pennsylvania, works in small animal practice in the Philadelphia area and is a published author. She has written for The Philadelphia Inquirer, Time, Business Philadelphia, Dog Fancy and Dog World, among others. She is especially interested in public health and animal welfare, and is involved with several organizations whose missions are to improve the lives of domesticated and wild animals.

References

1. Michel KE. Using a diet history to improve adherence to dietary recommendations. Compend Contin Educ Vet 2009;31:22-24.
2. MacMartin C, Wheat HC, Coe JB, et al. Effect of question design on dietary information solicited during veterinarian-client interactions in companion animal practice in Ontario, Canada. J Am Vet Med Assoc 2015;246:1203-1214.
3. MacMartin C, Wheat HC, Coe JB, et al. Conversation analysis of veterinarians’ proposals for long-term dietary change in companion animal practice in Ontario, Canada. J Vet Med Educ 2018;45:1-20.
4. Adams CI, Kurtz SA. Skills for communicating in veterinary medicine. Parsippany, NJ: Dewpoint Publishing; 2017:90-100.
5. Coe JB, O’Connor RE, MacMartin C, et al. Effects of three diet history questions on the amount of information gained from a sample of pet owners in Ontario, Canada. J Am Vet Med Assoc 2020;256(4):469-478.