Table 2 Themes emerged from the included studies

(1) Client-veterinarian communication

The facilitation of utterances that address the animals directly or on behalf them can promote a healthy client-veterinarian relationship.

[29]

Gaining a better understanding of the pets’ dietary histories through routine communication allows veterinarians to offer more effective health care recommendations to the clients.

[1]

Although poor client-veterinarian relationship is one of the sources of occupational stress in veterinary practices, veterinarians still find themselves enjoying the career because of the human-animal bond and the satisfaction of improving animal welfare.

[30]

To ease the process of delivering bad news, it is important to deliver information little by little, keep the language simple and clear, provide every possible treatment with related information and give sympathy to the clients.

[7]

Nigel Hough received several charges due to inadequate overnight care for a Staffordshire bull terrier, miscommunication with the clients and using disparaging language to the clients.

[31]

In both cases of small animal practices and large animal production, thinking in the clients’ perspectives and understanding their own situations and constraints is a key to build a healthy relationship.

[32]

The VR-CoDES model for analyzing clients’ negative emotions in human medicine is applicable in veterinary medicine, although limitations exist since there are extra considerations in veterinary medicine such as guilt, reassurance and cost discussion.

[33]

The stressor of client-veterinarian relationship is usually the time when euthanasia is the most suitable decision for the animals or the sudden loss of the animal.

[34]

The communication models SPIKES and COMFORT in human medicine are largely applicable in veterinary medicine. However, both models do not fully accounted every strategy reported by veterinarians. Currently, COMFORT would be a more preferable model to use in veterinary medicine.

[21]

Effective communication can build a close client-veterinarian relationship, which further improves animal care.

[6]

Veterinarians rated delivering bad news as moderately stressful and the stress level usually declines gradually when they experience more bad situations.

[35]

Majority of veterinary students believe there should be more emphasis on end-of-life issues in order to fully prepare them to face terminally-ill animals.

[36]

In terms of emerging zoonosis risks in large animals workplace, veterinarians should receive more training on discussing risks and management strategies with farmers in order to ensure public health and human safety.

[3]

Veterinary students feel unprepared to bring bad news to clients and therefore they seek for more communication skill training with stimulated pet owners.

[37]

Reassuring clients with empathetic communication gives clients a higher satisfaction in the clinic visit experiences.

[38]

Majority of veterinarians in United Kingdom think that clients obtain online information about pet health and most of them cannot fully understand the information given, therefore resulting in a negative impact on animal health, as well as on the client-veterinarian relationship.

[12]

There are misunderstanding and misconceptions about the use of antibiotics between clients and veterinarians, therefore leading to antimicrobial resistance.

[39]

A mutualistic and paternalistic approach in client-veterinarian relationship is more preferable in the large animal production context.

[16]

The mnemonic tool ADOBE is useful for veterinarians to bring the clients from the challenge zone to the comfort zone in order to create a comfortable environment and to facilitate client-veterinarian communication.

[14]

Nonverbal behavior can help create a safe space for the clients to share information about their pets and to show their emotions. This set of skill can be applied everywhere and can most definitely create a satisfied partnership for the client and veterinarian.

[40]

Improved communication with pet owners is proved to be associated with fewer complaints and higher level of satisfaction. The emerging acknowledgement of the importance of communication and relationship building contributes to the growing recognition of the skills; significance.

[4]

Veterinarians may face different opinions with clients due to ethical dilemma but they should be comfortable in drawing boundaries and explaining the underlying values with their clients. Ethical issues and morally problematic situations should be acknowledged in order to improve veterinarians’ practice and to provide a high level of care for pets.

[41]

Both clients and veterinarians should accept the inherent risks in diagnostic and treatment decisions. Situations that deal with client disappointment have to manage carefully. Responsibility should be accepted, while acting ethically, sensitively and trying to reach the best solution possible. The effort of addressing disappointment and maximizing client satisfaction can help build rapport and loyalty among customers.

[42]

Skillful end-of-life discussions are important for veterinarians and it is seen as a core clinical skill, as well as an integral part of the job. Facilitating a good discussion can help ease the emotional distress of the clients and maintain a long term relationship and enhance veterinarian and client satisfaction.

[8]

Treating clients in a respectable manner and acknowledging the information as well as animals’ diagnosis is about them can help veterinarians preserve relationship with their clients.

[43]

The stress level of veterinarians and their clients when breaking bad news is significantly different. There is no evidence that following suggestions of how to deliver bad news have effectively lower the stress experienced by the receiver. Giving bad news gets easier with practice as veterinarians will be less likely to get caught off guard by a client’s response.

[35]

There is a lack of training in veterinary school on how to communicate social support to grieving clients. Most veterinarians learned through experiences and they believe such training will be beneficial as these are stressful situations that are highly common during practice.

[18]

The potential benefits of introducing an interdisciplinary field of veterinary health psychology is highly promising as it can help veterinarians deal with cope, decision making and end-of-life matters. A program should be devoted to understand how psychology affects and benefit veterinary medicine.

[17]

There is a need for more research on low-cost and community-based veterinary medicine. More research is needed to improve animal care and animal welfare in low-income communities, and provide low-cost clinics training in school curriculums for the underserved populations.

[22]

Veterinarians cannot avoid encountering clients of all phases of life span and it is essential to communicate with them in a compassionate, respectful and honest communication. It can help improve clients veterinarians relationship and advance the field of veterinary medicine.

[44]

Bad news should be delivered skillfully by using various strategies to ensure a better experience for the clients and be more acceptable to the outcomes. Veterinarians can benefit from learning the skills and techniques used in emergency settings to make clients more comfortable when receiving bad news.

[45]

(2) Cross-disciplinary communication in a veterinarian professional team

Under the high pressure and high workload working environment in the veterinary clinic, verbal and written communication become critical to reduce communication errors that are usually evitable with effective communication between receptionists, veterinary nurses and veterinary surgeons.

[5]

Social media acts as an important platform for international knowledge sharing in order to exchange experiences between geographically different veterinarians in the context of veterinary practices.

[46]

Veterinarians, technicians and shelter workers are highly at risks of having compassion fatigue as they care very deeply for animals that they often fail to care for themselves. Self-care and overcoming compassion fatigue can be rewarding and can lead to a healthier balance between life and work.

[47]

Teamwork is highly significant in the practice of veterinary medicine. Though there are challenges in creating a good relationship among the members, but efforts like weekly meetings, committing to their jobs and showcasing trust can come a long way in creating a better environment for the practice.

[48]

(3) training of veterinary communication skills

The expected outcomes through communication training with real life interpersonal challenges are developing empathy and ethical awareness.

[49]

Problem-based communication training approach prepares veterinary students to develop a client-centered communication skill in order to enhance client-veterinarian relationship.

[11]

Addressing veterinary students’ understanding of euthanasia, death and illness in earlier stage of the veterinary school curriculum can better prepare them for facing emotionally difficult situations in the clinical placements, as well as future practices.

[50]

Veterinary students appreciate learning communication skills through experimental learning experiences, where they observe real life cases during clinical rotations.

[51]

There are increasing emphasis on communication skill training in veterinary schools in United Kingdom, where different approaches are planned throughout the curricula.

[10]

Most of the communication related encounters are the same for both veterinary medicine and human medicine, but the major differences between two are the additional communication requirements in veterinary medicine, where veterinarians need to deal with discussing financial issues, treatment options and euthanasia.

[20]

Workshops based on translational research that focuses on the flow of communication between farmers and veterinarians can ease the communication and therefore leading to a better dairy farm management.

[36]

The concept of ‘One Communication’ should be implemented in the curricula of veterinary medicine in order to facilitate communication between different stakeholders in the perspectives of small animal practices, farm animal production, infectious disease, public health and pharmaceuticals.

[52]

Web-based learning teaching in communication skills has shown its reliability and validity in human medicine and therefore similarly, it can be a future direction for communication education in veterinary medicine.

[53]

Kolb’s Experiential Learning Theory (ELT) was tested to be a useful framework in communication education in veterinary medicine.

[54]

Veterinary communication skill is one of the core competencies and should be prioritized from the early veterinary school curriculum.

[55]

Web-based learning is considered effective for communication education especially to access communication skills in human medicine and it will be a possible approach in veterinary medicine.

[2]

Nearly 100% of the respondents believe that communication skills are as important as or more important than clinical skills and 40% are interested in further simulated online training.

[13]

Veterinarians have strong desire to help and bring comfort to the clients when euthanizing animals, they need to show understanding and personal treatment during the procedures. They recognize client-present euthanasia is power and a grief-intervention tool, it can effectively build client veterinarian relationship. With experience, veterinarians develop the ability to serve as grief counselors though they are not trained as one. The majority of the respondents think veterinarian training had not prepared them well enough to handle and communicate with owners of terminally ill animals. An overwhelmingly large amount agree that schools should place more emphasis on communication skills with owners of animals that had to go through euthanasia.

[19]