Journal Scan: Pet owner perceptions of small animal surgery, anesthesia and pain management

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Why they did it

Effective client communication and education are vital components of a successful veterinary practice. Small animal pet owners' perceptions of veterinary procedures have been reported in Canada and Finland, revealing that many owners believe they receive insufficient information from their veterinary service providers.^1,2 Until recently, however, an equivalent study had not been performed in the United States.

What they did

Researchers at Texas A&M University conducted a survey to gauge the opinions and perceptions of small animal pet owners in the U.S. about surgical procedures, anesthesia, pain management and client communication during the perioperative period. The study's purpose was to identify knowledge gaps that would help veterinarians provide “education on perioperative pain management during a client visit” to “improve compliance, [the] veterinarian-client relationship, client satisfaction, and patient wellbeing.”³

The authors generated a survey adapted from similar studies conducted in Canada and Finland.^1,2 Eight privately owned, small animal referral hospitals in Alaska, Florida, Hawaii, Massachusetts, Ohio, Oregon, Texas and Washington, DC agreed to participate in the study. The participating hospitals met all the inclusion criteria, which included a sufficient caseload and current employment of at least one board-certified veterinary specialist.

Each practice distributed 200 paper surveys to adult dog- and cat-owning clients on a voluntary basis from March to June 2016. The study's principal investigator also assigned one employee at each practice as a survey leader to collect and return the completed surveys, which clients sealed in envelopes to maintain anonymity.

The survey, which was designed to be completed within 5 minutes, consisted of 34 questions that were each answered by checking a box best representing the pet owner's beliefs. In addition to collecting owner demographics, the survey questioned owners on their perceptions regarding the following categories:

• The need for analgesia for specific surgical procedures and medical conditions
• The importance of perioperative client communication and having a board-certified anesthesiologist perform anesthesia
• The understanding of pain and pain management in veterinary medicine

The authors performed statistical analyses to examine relationships between client demographics and survey responses. Client age was divided into two categories based around the median age of 46 years, and education level was classified as either at or below high school level or at college level and above.

What they found

Of the 1,600 questionnaires distributed, 948 (59.3%) were completed. Seventy-four percent of respondents were male, and 89% indicated a college-level or higher education. Approximately one-quarter of respondents were health care professionals. Pet ownership was classified as 61.8% dog owners, 13.7% cat owners and 24.5% both cat and dog owners.

Pain management. Between 50% and 75% of all respondents indicated that pain medication should always be provided for small animal patients undergoing specific surgeries, such as fracture repair, mass removal, dental extraction and onychectomy. These percentages were lower than those indicated in the Finnish pet owner survey.1 The authors noted that these figures suggest client education on the subject of pain management should generally be increased by small animal practitioners.

Less than 20% of all respondents felt pain medication was important while treating lameness and ear infection, suggesting that owners do not recognize lameness as an indicator of pain and that, likewise, they do not consider otitis a painful condition. While 76% of respondents at least partially agreed that pain medication helps accelerate surgical recovery, 38% also considered postoperative pain to be beneficial during the recovery process as it limits a recovering animal's activity. Approximately half of respondents also indicated concern for possible negative side effects associated with analgesic drugs.

Detailed analysis of pet owner demographics revealed that college-educated individuals, health care professionals, or respondents who had undergone surgery themselves or owned pets with previous surgery all generally considered pain medication for surgical procedures to be of higher importance than did other respondents. Health care professionals were also more likely to agree that the use of postoperative pain medications speeds recovery.

Perception of feline declawing procedures. Overall, 59% of respondents agreed that declawing is a painful procedure, and 32% believed the practice should be banned in the U.S. Compared with other respondents, those who were female, cat owners, health care providers, or owners of pets that had had previous surgery were more likely to want a declaw ban.

Anesthesia. The majority of respondents (93.6%) reported that having a board-certified anesthesiologist perform anesthesia on patients was important, a response that was higher in women than in men. 

Preoperative communication, education and client expectations. Women were also more likely than men to place emphasis on knowing what to expect during surgery and how to manage postoperative pain. The cost of pain medication and the risk of side effects from pain medication were not as much of a concern for respondents who were college educated or owned pets that had undergone surgery previously.

Take-home points

These survey results revealed that client education is an important component of effective veterinary care. Most survey respondents stated that receiving detailed information regarding surgical procedures, cost of services, and expectations for recovery was very important, thus indicating that pet owners value honesty and inclusion from their veterinarian. Similarly, previous studies have shown that veterinary clients who receive a greater amount of communication are more satisfied with the level of patient care.⁴

Furthermore, pet owner demographics and education level appeared to affect how owners felt about the subject of pain management. The authors cited human medical studies that revealed patient compliance increased with a greater level of communication and education from health care providers.^5,6 They also emphasized that clients should be informed during preoperative discussion about current American Animal Hospital Association and American College of Veterinary Anesthesia and Analgesia guidelines, which describe pain management as a necessary component of all surgical cases.^7,8 Finally, in fulfillment of the veterinarian's oath to “do no harm,” practitioners should always make sure that clients fully understand the negative consequences of pain on their pets' health and welfare.

References

1. Vaisanen MA, Tuomikoski-Alin SK, Brodbelt DC, t al. Opinions of Finnish small animal owners about surgery and pain management in small animals. J Small Anim Pract 2008;49:626-632.
2. Steagall PB, Monteiro BP, Ruel HLM, et al. Perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals. J Small Anim Pract 2017;58:380-388.
3. Simon BT, Scallan EM, Von Pfeil DJF, et al. Perceptions and opinions of pet owners in the United States about surgery, pain management, and anesthesia in dogs and cats. Vet Surg 2018;47:277-284.
4. Shaw JR, Barley GE, Broadfoot K, et al. Outcomes assessment of on-site communication skills education in a companion animal practice. J Am Vet Med Assoc 2016;249:419-432.
5. Butow P, Sharpe L. The impact of communication on adherence in pain management. Pain 2013;154(Suppl 1):S101-S107.
6. Majid N, Lee S, Plummer V. The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol. JBI Database System Rev Implement Rep 2015;13:122-133.
7. American College of Veterinary Anesthesiologists' position paper on the treatment of pain in animals. J Am Vet Med Assoc 1998;213:628-630.
8. Epstein ME, Rodanm I, Griffenhagen G, et al. 2015 AAHA/ AAFP pain management guidelines for dogs and cats. J Feline Med Surg 2015;17:251-272.

Dr. Natalie Stilwell provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting. In addition to her DVM obtained from Auburn University, she holds a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida.