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Contextualised Care

To support veterinary teams to navigate discussions around the topic of contextualised care, we have curated a collection of resources from a variety of sources. Please email [email protected] to suggest other materials for inclusion in this collection.

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What is contextualised care?       

Contextualised care is a way of delivering veterinary care that acknowledges that there are different ways to approach the diagnosis and treatment of an animal, depending on the circumstances of the individual animal and their caregivers, and the context in which the care is delivered.  

This requires a partnership between caregivers/owners, and the veterinary team, all working together for the best quality of life for the patient. 

It builds on evidence-based veterinary practice, which combines clinical expertise with the most relevant and best available scientific evidence, patient circumstances, and caregiver/owner circumstances and acknowledges that it is appropriate to offer different pathways of care in different circumstances.  

Although the term ‘contextualised care’ is relatively new, the idea of adapting veterinary care to the individual circumstances of the animal and their owner is not and has been described in a number of ways: 

  • evidence-based decision making
  • patient-centred care
  • spectrum of care
  • art and science of veterinary medicine
  • shared decision-making
  • value-based care

Whatever terminology is used, this is all about veterinary teams taking a holistic approach to providing quality veterinary care and making decisions that take all domains of quality into consideration.

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Domains of quality veterinary healthcare

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Contextualised care in practice

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Veterinary support and tools

  • RCVS Knowledge (2022) Dogs Trust Complex Case Management - Framework - This tool can help the caregiver team record and assess different aspects of care, what further support might be required for the team, and how any treatment might impact the patient.
  • RCVS Knowledge (2022) Conversation guide for discussing contextualised care - This tool, to be used when the patient has a diagnosis, can be used to discuss treatment options with the owner, allowing for an in-depth discussion on what treatment will entail, and how this might impact both the owner and the patient. This can help the team make more informed decisions on the most appropriate care plan.
  • Pre-consultation conversation guide for owners: This guide is designed to help pet owners prepare for a veterinary consultation and help the veterinary team identify any support areas they may need. It is not to replace the conversations that will occur during the consultation but rather to aid them by helping owners make a note of the things that are most important to them and their pet. This form can be sent digitally to the owner after they booked their appointment, or the URL be made available on your practice website for the owner to access. 
  • Your pets wellbeing during treatment: This guide will help pet owners and the veterinary team identify how pets may react to certain treatments, and it will guide overall decisions on treatment plans. This can be filled out by the owner, or during a consultation with the owner and veterinary team. This form can be sent digitally to the owner, or the URL be made available on your practice website for the owner to access. 
  • RCVS Knowledge (2022) Boxset Series 4 Guidelines - This Series in the QI Boxset will show you how you can use guidelines in practice, and how they can be beneficial to teams, patients and clients. Learn how to structure your own guidelines in practice. Guidelines should be used in conjunction with your clinical expertise and each patient and owner's circumstances to provide contextualised care. Please create a free account to log in. 
  • RCVS Knowledge (2021) Spotlight: Quality of Life assessment tools 
  • RCVS Knowledge (2022) Spotlight: Caregiver burden and the client perspective on veterinary care
  • British Veterinary Association (2024) Transparency and client choice guidance [BVA] [online]. Available from: https://www.bva.co.uk/resources-support/practice-management/transparency-and-client-choice-guidance/ [Accessed 4 June 2024]

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Evidence from research  

1. Contextualised care

 

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2. Standard of care

 

Examples of different standards

  • Colmery, B. (2005) The Gold Standard of veterinary oral health care. Veterinary Clinics of North America: Small Animal Practice, 35 (4), pp. 781-787. https://doi.org/10.1016/j.cvsm.2005.02.005
  • Englar, R.E. and Dial, S.M. (2022) Low-cost veterinary clinical diagnostics. [Oxford]: Wiley-Blackwell

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3. Spectrum of care

 

  • Brown, C.R. et al. (2021) Spectrum of care: more than treatment options. Journal of the American Veterinary Medical Association, 259 (7), pp. 712-717. https://doi.org/10.2460/javma.259.7.712
  • Evason, M.D., Stein, M.R. and Stull, J.W. (2023) Impact of a spectrum of care elective course on third-year veterinary students’ self-reported knowledge, attitudes, and competencies. Journal of Veterinary Medical Education, 50 (5), pp. 590-598. https://doi.org/10.3138/jvme-2022-0010
  • Fingland, R.B. et al. (2021) Preparing veterinary students for excellence in general practice: building confidence and competence by focusing on spectrum of care. Journal of the American Veterinary Medical Association, 259 (5), pp. 463-470. https://doi.org/10.2460/javma.259.5.463  
  • Mace, J.L. and Knight, A. (2024) From the backyard to our beds: The spectrum of care, attitudes, relationship types, and welfare in non-commercial chicken care. Animals, 14 (2), no. 288. https://doi.org/10.3390/ani14020288

  • Moore, R.M. et al. (2023) A new dimension in learning: implementing an outcomes-based veterinary curriculum with a focus on spectrum of care. Journal of the American Veterinary Medical Association, 261 (9), pp. 1401. https://doi.org/10.2460/javma.23.07.0383  

  • Stull, J.W. et al. (2018) Barriers and next steps to providing a spectrum of effective health care to companion animals. Journal of the American Veterinary Medical Association, 253 (11), pp. 1386-1389. https://doi.org/10.2460/javma.253.11.1386

  • The Spectrum of Care Initiative [AAVMC] [online] Available from: https://www.aavmc.org/the-spectrum-of-care-initiative/ [Accessed 3 June 2024]

  • Warman, S. M. et al. (2023) Preparing veterinarians to practice across the spectrum of care. Advances in Small Animal Care, 4 (1), pp. 171–183. https://doi.org/10.1016/j.yasa.2023.04.004

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4. Evidenced-based veterinary medicine

 

Evidence-based practice involves applying the best and most relevant scientific evidence, integrated with clinical expertise, whilst taking into account each patient and owner's individual circumstances, when making clinical decisions.

  • Larson, R.L. and White, B.J. (2015) Importance of the role of the scientific literature in clinical decision making. Journal of the American Veterinary Medical Association, 247 (1), pp. 58-64. https://doi.org/10.2460/javma.247.1.58

  • White, B. J. and Larson, R. L. (2015) Systematic evaluation of scientific research for clinical relevance and control of bias to improve clinical decision making. Journal of the American Veterinary Medical Association, 247 (5), pp. 496-500. https://doi.org/10.2460/javma.247.5.496

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5. Access to care

 

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6. Advanced veterinary care

 

  • Brockman, B.K., Taylor, V.A. and Brockman, C.M. (2008) The price of unconditional love: Consumer decision making for high-dollar veterinary care. Journal of Business Research, 61 (5), pp. 397-405. https://doi.org/10.1016/j.jbusres.2006.09.033
  • Corr, S.A. et al. (2024) Cat and dog owners’ expectations and attitudes towards advanced veterinary care (AVC) in the UK, Austria and Denmark. PLOS ONE, 19 (3), e0299315. https://doi.org/10.1371/journal.pone.0299315
  • Quain, A., Ward, M.P. and Mullan, S. (2021) Ethical challenges posed by advanced veterinary care in companion animal veterinary practice. Animals, 11 (11), no. 3010.  https://doi.org/10.3390/ani11113010
  • Taylor, P.M. (2022) Just because we can – Doesn’t mean we should. Equine Veterinary Education, 34 (4), pp. 172-174. https://doi.org/10.1111/eve.13474 
  • Taylor, N. (2021) Just because we can, should we? Veterinary Record, 189 (7), pp. 294. https://doi.org/10.1002/vetr.1047

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7. Shared decision-making

 

  • Cary, J. (2021) Implementing shared decision making in veterinary medicine. Veterinary Record, 189 (8), pp. 320-322. https://doi.org/10.1002/vetr.1104
  • Christiansen, S.B. et al. (2015) Veterinarians’ role in clients’ decision-making regarding seriously ill companion animal patients. Acta Veterinaria Scandinavica, 58, no. 30. https://doi.org/10.1186/s13028-016-0211-x
  • Cornell, K.K. and Kopcha, M. (2007) Client-veterinarian communication: skills for client centered dialogue and shared decision making. Veterinary Clinics of North America: Small Animal Practice, 37 (1), pp. 37-47. https://doi.org/10.1016/j.cvsm.2006.10.005
  • DeGroot, A., Coe, J.B. and Duffield, T. (2023) Veterinarians’ use of shared decision making during on‐farm interactions with dairy and beef producers. Veterinary Record, 192 (1), e2384. https://doi.org/10.1002/vetr.2384
  • Ito, Y. et al. (2022) The relationship between evaluation of shared decision-making by pet owners and veterinarians and satisfaction with veterinary consultations. BMC Veterinary Research, 18 (1), no. 296. https://doi.org/10.1186/s12917-022-03401-6 
  • Janke, N. et al. (2021) Evaluating shared decision-making between companion animal veterinarians and their clients using the Observer OPTION instrument. Veterinary Record, 189 (8), e778. https://doi.org/10.1002/vetr.778
  • Janke, N., Shaw, J. R., and Coe, J. B. (2022) Veterinary technicians contribute to shared decision-making during companion animal veterinary appointments. Journal of the American Veterinary Medical Association, 260 (15), pp. 1993-2000. https://doi.org/10.2460/javma.22.08.0380
  • Kanji, N. et al. (2012) Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice. Journal of the American Veterinary Medical Association, 240 (4), pp. 427-436. https://doi.org/10.2460/javma.240.4.427
  • Merle, R. and Küper, A.M. (2021) Attitude of veterinarians toward self-informed animal owners affects shared decision making. Frontiers in Veterinary Science, 8. https://www.frontiersin.org/articles/10.3389/fvets.2021.692452     
  • Pyatt, A.Z. et al. (2020) Co-produced care in veterinary services: a qualitative study of UK stakeholders’ perspectives. Veterinary Sciences, 7 (4), no.149. https://doi.org/10.3390/vetsci7040149
  • Shaw, J.R. et al. (2006) Veterinarian-client-patient communication patterns used during clinical appointments in companion animal practice. Journal of the American Veterinary Medical Association, 228 (5), pp. 714-721. https://doi.org/10.2460/javma.228.5.714
  • Shay, L.A. and Lafata, J.E. (2015) Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision Making, 35 (1), pp. 114-131. https://doi.org/10.1177/0272989X14551638
  • Shortall, O. (2021) Veterinary expertise meets farming culture: The challenges of shared decision making in production animal healthcare. Veterinary Record, 189 (10), pp. 399-400. https://doi.org/10.1002/vetr.1197

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