title: Factors influencing veterinarian referral to oncology specialists for treatment of dogs with lymphoma and osteosarcoma in Ontario, Canada.
abstract: OBJECTIVE
  To elucidate factors influencing practitioner decisions to refer dogs with cancer to veterinary oncology specialists.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  2,724 Ontario primary care companion animal veterinarians.
  
  
  METHODS
  Practitioners were invited to participate in a survey involving clinical scenarios of canine cancer patients, offered online and in paper format from October 2010 through January 2011. Analyses identified factors associated with the decision to refer patients to veterinary oncology specialists.
  
  
  RESULTS
  1,071 (39.3%) veterinarians responded, of which 603 (56.3%) recommended referral for dogs with multicentric lymphoma and appendicular osteosarcoma. Most (893/1,059 [84.3%]) practiced within < 2 hours' drive of a specialty referral center, and most (981/1,047 [93.7%]) were completely confident in the oncology service. Few (230/1,056 [21.8%] to 349/1,056 [33.0%]) were experienced with use of chemotherapeutics, whereas more (627/1,051 [59.7%]) were experienced with amputation. Referral was associated with practitioner perception of patient health status (OR, 1.54; 95% confidence interval [CI], 1.15 to 2.07), the interaction between the client's bond with the dog and the client's financial status, practitioner experience with treating cancer (OR, 2.79; 95% CI, 1.63 to 4.77), how worthwhile practitioners considered treatment to be (OR, 1.66 to 3.09; 95% CI, 1.08 to 4.72), and confidence in the referral center (OR, 2.20; 95% CI, 1. 11 to 4.34).
  
  
  CONCLUSIONS
  Several factors influenced practitioner decisions to refer dogs with lymphoma or osteosarcoma for specialty care. Understanding factors that influence these decisions may enable practitioners to appraise their referral decisions and ensure they act in the best interests of patients, clients, and the veterinary profession.
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Stoewen
authors.forename: Jason B
authors.initials: JB
authors.lastname: Coe
authors.forename: Clare
authors.initials: C
authors.lastname: MacMartin
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stone
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Dewey
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004283:Dog Diseases / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D004285:Dogs; D005260:Female; D008223:Lymphoma / Q000473:pathology / Q000628:therapy / Q000662:veterinary*; D008297:Male; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D012516:Osteosarcoma / Q000473:pathology / Q000628:therapy / Q000662:veterinary*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013038:Specialization; D018634:Veterinarians; D014730:Veterinary Medicine
chemical_list: D000970:Antineoplastic Agents