Evidence collection22 October 2025

Contextualised care

Evidence-based veterinary medicineMedicine

What is contextualised care?

The use of the term contextualised care may be relatively new to veterinary practice but the concept of adapting care to the individual circumstances of the animal and owner, as well as wider context in which care is delivered, is not, and may previously have been referred to as the “art” of veterinary practice.

This approach is also encompassed by the definition of evidence- based practice, which 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.

The term contextualised care was introduced by members of Veterinary Humanities UK as an approach “which provides a more flexible and inclusive acknowledgement that different treatment modalities may be equally valid in different contexts. The most appropriate pathway for each patient and owner should be navigated through an iterative process of shared decision making we cannot separate clinical decisions from their social contexts”.

Skipper, A. et al. (2021) ‘Gold standard care’ is an unhelpful term. Veterinary Record, 189 (8), pp. 331. https://doi.org/10.1002/vetr.1113
Skipper, A. et al. (2024) Contextualised care: faddish or foundational? Veterinary Record, 195 (3), pp.117. https://doi.org/10.1002/vetr.4567

The purpose of this evidence collection is to bring together a curated selection of published papers, and other resources, to help you understand the concept of contextualised care, and how we can apply it in practice.

Standards of care

The discussion of contextualised care in the UK has contrasted contextualised care with the concept of “gold standard care” where it is presumed that there is a single “text book” way to approach the diagnosis and treatment of a disease.

In the United States concerns about access to care, especially related to the cost of care, have led to the concept of a spectrum of care.

In both cases there is an underlying concern that advances in veterinary medicine may have led to a situation where some available diagnostic investigations and treatments are unaffordable to owners or not in the best interests of the animal.

Evason, M., Stull, J.W. and Coe, J. (2025) Spectrum of care toolkit: identifying and communicating evidence-based options. Journal of the American Veterinary Medical Association. https://doi.org/10.2460/javma.25.06.0384
Block, G. (2018) A new look at standard of care. Journal of the American Veterinary Medical Association, 252(11), pp.1343-1344. https://doi.org/10.2460/javma.252.11.1343
Englar, R.E. (2023) Recasting the gold standard – part I of II: delineating healthcare options across a continuum of care. Journal of Feline Medicine and Surgery, 25 (12). https://doi.org/10.1177/1098612X231209855
Englar, R.E. (2023) Recasting the gold standard – part II of II: communicating healthcare options along a continuum of care. Journal of Feline Medicine and Surgery, 25 (12). https://doi.org/10.1177/1098612X231215639
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
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
Futter, I. and Allen, C. (2024) Focus on contextualised care (Part 1). BSAVA Companion, 2024 (3), pp. 10-15. https://doi.org/10.22233/20412495.0324.10
Allen, C. and Futter, I. (2024) Focus on contextualised care (Part 2). BSAVA Companion, 2024 (4), pp. 20-25. https://doi.org/10.22233/20412495.0424.20

Why do we need contextualised care?

There are a number of reasons why the concept of contextualised care and spectrum of care have come to the fore at the present time. Advances in veterinary medicine have greatly increased the options for diagnosis and treatment, especially for domestic pets. This has led to increased options but also increased costs, which will not be affordable to all. However, there although costs of care are certainly an important aspect there can be many additional contextual factors which affect the decision making surrounding the care of individual animals.

Advanced veterinary care

This is perceived as one of the major drivers to increased costs and therefore lack of access. However, discussions about advanced veterinary care may also lead into discussions of overdiagnosis and / or overtreatment and whether advanced treatments are in the best interests of the animal and their impact on the quality of life of the animal both during and after treatment.

Quain, A., Ward, M.P. and Mullan, S. (2021) Ethical challenges posed by advanced veterinary care in companion animal veterinary practice. Animals, 11 (11), 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
Grimm, H. et al. (2018) Drawing the line in clinical treatment of companion animals: recommendations from an ethics working party. Veterinary Record, 182 (23), pp. 664. https://doi.org/10.1136/vr.104559
Mwacalimba, K.K. et al. (2020) Owner and veterinarian perceptions about use of a canine quality of life survey in primary care settings. Frontiers in Veterinary Science, 7. https://doi.org/10.3389/fvets.2020.00089
RCVS Knowledge (2021) Spotlight: Quality of life assessment tools [inFOCUS] [online]. Available from: https://infocus.rcvsknowledge.org/qol-spotlight-on-quality-of-life-assessment-tools/ [Accessed 30 July 2025]

Access to care and affordability

O’Connor, A. et al. (2025) Risk factors for, metrics of, and consequences of access to veterinary care for companion animals: A scoping review. PLoS One, 20 (5), no. e0325455. https://doi.org/10.1371/journal.pone.0325455
Aggarwal, A., Ramirez-Guillen, Y. and Haeder, S.F. (2025) Secret shopper survey reveals generally reasonable access to preventive veterinary appointments for dogs, with notable gaps in rural areas and for other outliers. Journal of the American Veterinary Medical Association. https://doi.org/10.2460/javma.25.05.0311
Croney, C. et al. (2025) How does access to veterinary care relate to animal welfare? Advances in Small Animal Care, 6 (1), pp. 2019-221. https://doi.org/10.1016/j.yasa.2025.06.014
Program for pet health equity [Access to Veterinary Care Coalition] [online]. Available from: https://pphe.utk.edu/access-to-veterinary-care-coalition-avcc/ [Accessed 30 July 2025]
Access to Veterinary Care Coalition (2018) Access to veterinary care: Barriers, current practices and Public Policy. [online] Knoxville : University of Tennessee. Available from: https://trace.tennessee.edu/cgi/viewcontent.cgi?article=1016&context=utk_smalpubs [Accessed 30 July 2025]
Niemiec, R. et al. (2024) Veterinary and pet owner perspectives on addressing access to veterinary care and workforce challenges. Frontiers in Veterinary Science, 11. https://doi.org/10.3389/fvets.2024.1419295
Blackwell, M. (2024) Bridging gaps in veterinary care: Equity, access, and innovation. The Veterinary Clinics of North America: Small Animal Practice, 54 (6), pp. 859-867. https://doi.org/10.1016/j.cvsm.2024.07.013
Sullivant, A.M., Mackin, A.J. and Morse, D. (2020) Strategies to improve case outcome when referral is not affordable. Journal of Veterinary Medical Education, 47 (3), pp. 356-364. https://doi.org/10.3138/jvme.0518-061r1
Strand, E.B. et al. (2024) Life with pets study: lower income veterinary clients’ perception of pets’ quality of life. Frontiers in Veterinary Science, 11. https://doi.org/10.3389/fvets.2024.1422359
Kipperman, B.S., Kass, P.H. and Rishniw, M. (2017) Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout. Journal of the American Veterinary Medical Association, 250 (7), pp. 785-794. https://doi.org/10.2460/javma.250.7.785
Benson, J. and Tincher, E.M. (2024) Cost of care, access to care, and payment options in veterinary practice. Veterinary Clinics of North America: Small Animal Practice, 54 (2), pp. 235-250. https://doi.org/10.1016/j.cvsm.2023.10.007
Egenvall, A. et al. (2024) Prices for veterinary care of dogs, cats and horses in selected countries in Europe. Frontiers in Veterinary Science, 11. https://doi.org/10.3389/fvets.2024.1403483
Williams, R. (2024) How the cost of veterinary care impacts the wellbeing, learning and practice of early career vets. Veterinary Record, e4597. https://doi.org/10.1002/vetr.4597
Rausch, Q. et al. (2025) Access to veterinary care in Canada: a cross-sectional survey of animal healthcare organizations and interventions. Frontiers in Veterinary Science, 12, 1581316. https://doi.org/10.3389/fvets.2025.1581316

How to deliver contextualised care in practice?

Although there is not yet any detailed evidence about how to deliver contextualised care the need to adapt care to the individual circumstances of the animal and owner will involve communication skills and bringing the owner into the decision-making process

The owner perspective

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
Wallis, L.J. et al. (2024) Cross-sectional United Kingdom surveys demonstrate that owners and veterinary professionals differ in their perceptions of preventive and treatment healthcare needs in ageing dogs. Frontiers in Veterinary Science, 11. https://doi.org/10.3389/fvets.2024.1358480
Piazza, C., Dominguez Cots, L. and Dye, C. (2025) Assessing pet owners’ knowledge and comprehension of veterinary medical terminology. Veterinary Record, 196 (9), p.e5163. https://doi.org/10.1002/vetr.5163
RCVS Knowledge (2022) Spotlight: Caregiver burden and the client perspective on veterinary care [inFOCUS] [online]. Available from: https://infocus.rcvsknowledge.org/cgb-spotlight-on-caregiver-burden-and-the-client-perspective-on-veterinary-care/ [Accessed 30 July 2025]

Relationship centred care

McDermott, M. et al. (2021) Preliminary assessment of a tool for measuring relationship-centred communication in veterinary consultations (adapted VR-COPE). MedEdPublish, 10, p.134. https://doi.org/10.15694/mep.2021.000134.1
Küper, A.M. and Merle, R. (2019). Being nice is not enough-exploring relationship-centered veterinary care with structural equation modeling. A quantitative study on German pet owners’ perception. Frontiers in Veterinary Science, 6. https://doi.org/10.3389/fvets.2019.00056
Adams, C.L. and Frankel, R.M. (2007) It may be a dog’s life but the relationship with her owners is also key to her health and well being: Communication in veterinary medicine. Veterinary Clinics of North America: Small Animal Practice, 37(1), pp.1-17. https://doi.org/10.1016/j.cvsm.2006.10.003
Lue, T.W., Pantenburg, D.P. and Crawford, P.M. (2008) Impact of the owner-pet and client-veterinarian bond on the care that pets receive. Journal of the American Veterinary Medical Association, 232(4), pp.531-540. https://doi.org/10.2460/javma.232.4.531

Shared decision making

Coe, J.B. et al. (2025) Clinical communication tools for contextualizing spectrum of care. Advances in Small Animal Care, 6 (1), pp. 191-208. https://doi.org/10.1016/j.yasa.2025.06.013
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
Christiansen, S.B. et al. (2016) Veterinarians’ role in clients’ decision-making regarding seriously ill companion animal patients. Acta Veterinaria Scandinavica, 58, 30. https://doi.org/10.1186/s13028-016-0211-x
Pyatt, A.Z. et al. (2020) Co-produced care in veterinary services: a qualitative study of UK stakeholders’ perspectives. Veterinary Sciences, 7 (4),149. https://doi.org/10.3390/vetsci7040149
Cary, J. (2021) Implementing shared decision making in veterinary medicine. Veterinary Record, 189 (8), pp. 320-322. https://doi.org/10.1002/vetr.1104
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. et al. (2021) Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice. PLoS ONE, 16 (2): e0245632. https://doi.org/10.1371/journal.pone.0245632
Janke, N., Shaw, J.R. and Coe, J.B. (2024) A need for targeted teaching of shared decision-making as identified from an assessment of client-centered communication skills training with companion animal veterinarians. Journal of Veterinary Medical Education, e20240016. https://doi.org/10.3138/jvme-2024-0016
Seitz, H.H. and Grady, J.G. (2021) Measuring veterinary client preferences for autonomy and information when making medical decisions for their pets. Journal of the American Veterinary Medical Association, 259 (12), pp. 1471-1480. https://doi.org/10.2460/javma.19.12.0630
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://doi.org/10.3389/fvets.2021.692452
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, no. 296. https://doi.org/10.1186/s12917-022-03401-6
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
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
Groves, C. N. H. et al. (2024) Clients prefer collaborative decision-making with veterinarians regardless of appointment type. Journal of the American Veterinary Medical Association, 263 (1), pp 1-11. https://doi.org/10.2460/javma.24.06.0421
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

Informed consent

Gaining informed consent is considered an essential part of veterinary practice and the client should have the opportunity to consider a range of reasonable treatment options (including euthanasia and the option to monitor the animals without further tests or treatment. See RCVS Guidance 11. Communication and consent – Professionals (11.2).

Venit, E.L. (2025) Informed consent plays an important role when practicing veterinary medicine along the spectrum of care. Journal of the American Veterinary Medical Association. https://doi.org/10.2460/javma.25.05.0340
Whiting, M. et al. (2016) A survey of veterinary clients’ perceptions of informed consent at a referral hospital. Veterinary Record, 180 (1), pp. 20. https://doi.org/10.1136/vr.104039
Ashall, V., Millar, K.M. and Hobson-West, P. (2018) Informed consent in veterinary medicine: ethical implications for the profession and the animal ‘patient’. Food Ethics, 1, pp. 247-258. https://doi.org/10.1007/s41055-017-0016-2
Gray, C. (2020) Role of the consent form in UK veterinary practice. Veterinary Record, 187 (8), pp. 318. https://doi.org/10.1136/vr.105762
Gray, C.A. (2020) Researching consent in veterinary practice: The use of interpretive description as a multidisciplinary methodology. Methodological Innovations, 13 (3). https://doi.org/10.1177/2059799120961614

Contextualised care in practice

This section includes references to examples of contextualised care/ spectrum of care delivery, as well as resources to help in the delivery of contextualised care.

Jankowski, K. et al. (2025) One Health clinic challenges and evolution: increasing access to care for people and pets in a rural community in Northern California. Frontiers in Veterinary Science, 12, 1599422. https://doi.org/10.3389/fvets.2025.1599422
Alvarez, E.E. et al. (2025) A unique approach to fostering student wellbeing while supporting community needs through an interprofessional, One Health, access to care veterinary clinic: WisCARES. Frontiers in Veterinary Science, 12, 1602028. https://doi.org/10.3389/fvets.2025.1602028
Wilcox, Z. et al. (2025) Emergency clinicians need more information about offering spectrum of care and solutions for clients with financial limitations. Journal of the American Veterinary Medical Association. https://doi.org/10.2460/javma.25.01.0034
Miller, J. et al. (2023) 2023 AAHA management of allergic skin diseases in dogs and cats guidelines. Journal of the American Animal Hospital Association, 59 (6), pp. 255–284. https://doi.org/10.5326/JAAHA-MS-7396 contains section on Spectrum of care approach
Hohenhaus, A.E. and Provost, D.C. (2024) A unique spectrum of care tool provides a self-regulated learning opportunity and facilitates client communication. Journal of Veterinary Medical Education, e20230144. https://doi.org/10.3138/jvme-2023-0144
Wright, A. et al. (2025) Exploring pet owner preferences in order to assess the role of cost and quality of life in anti-pruritic treatment plan selection for dog owners. Animals, 15 (4), 509. https://doi.org/10.3390/ani15040509
2025 AAHA Referral Guidelines [AAHA] [online]. Available from: https://www.aaha.org/resources/2025-aaha-referral-guidelines/ [Accessed 30 July 2025]
2024 AAHA Community Care Guidelines for Small Animal Practice [AAHA] [online] Available from: https://www.aaha.org/resources/2024-aaha-community-care-guidelines-for-small-animal-practice/ [Accessed 30 July 2025]

Education for contextualised care

The concept of a spectrum of care is being incorporated into veterinary education in the US through the AAVMC Spectrum of care initiative.

Arnold, E. and Warman, S. (2025) Distributed veterinary education: how can veterinary practices and veterinary schools work together to improve spectrum of care training? Journal of the American Veterinary Medical Association. https://doi.org/10.2460/javma.25.07.0451
Read, E.K. et al. (2025) Development and implementation of a veterinary spectrum of care clinical rotation aligned with the CBVE model. Journal of Veterinary Medical Education, 52 (4), pp. 518-532. https://doi.org/10.3138/jvme-2024-0020
Boatright, K.M. (2025) Mentorship supports early-career veterinarians in developing the skills necessary for successful spectrum-of-care practice. Journal of the American Veterinary Medical Association. https://doi.org/10.2460/javma.25.06.0362
Vet spectrum of care: What it is and why now? [Vet Spectrum of Care] [online]. Available from: https://vetspectrumofcare.com/ [Accessed 30 July 2025]
The Spectrum of Care Initiative [AAVMC] [online]. Available from: https://www.aavmc.org/the-spectrum-of-care-initiative/ [Accessed 30 July 2025]
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
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
Read, E.K. et al. (2024) Development and implementation of a veterinary spectrum of care clinical rotation aligned with the CBVE model. Journal of Veterinary Medical Education. https://doi.org/10.3138/jvme-2024-0020

About evidence collections

Evidence collections bring together collections of published papers on topics of interest and importance to the veterinary professions. Papers are chosen for relevance and accessibility, with the full text of articles either being available through the RCVS Knowledge library, on open access or from other publications to which a significant number of veterinary professionals are likely to have access. This means that there may be relevant evidence that is not included.

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