Translating the UK's contextualized care roadmap to the spectrum of care practice – part 1

By Kate Boatright, VMD

As the range of diagnostic and therapeutic options available to our patients continues to expand and veterinary costs rise, both pet owners and veterinary teams face increasing pressure to deliver the best possible care to each pet and family. This does not always mean following the traditional "gold standard" for a given condition. Pet families may want to pursue a less invasive, less intensive, or less expensive approach for a wide range of reasons, including finances, physical limitations, scheduling constraints, caregiver burden, patient cooperation, and more. In many cases, a middle-ground or a more conservative approach can have similar outcomes for the patient.

This approach to practice, where veterinary teams work with clients to identify barriers and collaboratively determine a solution that fits the needs of the pet within the constraints of the pet family has many names. The two most common terms are spectrum of care in the United States^1,2 and contextualized care in the United Kingdom.^3,4 Regardless of which term is used, this style of practice is needed to support the needs of pet families, as well as the mental health and well-being of veterinary professionals.⁵

In 2025, the Royal College of Veterinary Surgeons' (RCVS) charity partner, RCVS Knowledge, engaged in research that "investigated how contextualised care for cats and dogs is understood, experienced, and applied within the UK veterinary landscape, and to develop practical, evidence-informed recommendations to further support its implementation."⁶ The process included a literature review, in-person forums, surveys of pet owners and veterinary professionals, virtual pet owner focus groups, and interviews with veterinarians and veterinary nurses. Many of the findings of this report and the recommendations published in the accompanying roadmap⁷ are applicable in the United States as we seek to improve comfort with the spectrum of care practice.

In the RCVS Knowledge report, 54 percent of veterinarians stated they experienced very few barriers to providing contextualized care.6,7 This leaves just under half of veterinarians who feel barriers to offering contextualized care in the UK. These findings are similar to the results of a recent survey of veterinarians in the United States, where 88 percent of veterinarians stated they were familiar with the concept of spectrum of care but only 45 percent said they always offer a full range of options to clients.⁸

The Contextualised Care Roadmap summarized five target areas where the profession could focus on improving delivery of contextualized care. The remainder of this article will review the first two of these areas and how they have been or could be applied in the United States.

Professional leadership

From the Roadmap: "A culture of contextualized care should be fostered across the veterinary sector, recognizing it as the most appropriate way to deliver veterinary care."^6,7

The first suggested action step is to "debunk the notion of 'gold standard' in veterinary care."^6,7 This term is often used to refer to the "best" diagnostic and treatment plan, but its use can convey judgment and suggest there is only one right way to approach cases.

While the term is still used widely, some organizations have encouraged veterinarians to re-evaluate its use. The 2024 AAHA Community Care Guidelines state "it would benefit the profession to reclaim [the term gold-standard] and adopt a broader meaning for the gold standard that encompasses spectrum of care."⁹ Continued conversations around the terminology used in the profession to discuss and define "ideal" outcomes are needed.

A second action step is to "Ensure veterinary professionals are clear that making warranted adjustments to diagnosis and treatment routes based on the individual patient and client circumstances will not result in disciplinary action."⁷ Anecdotally, concerns about colleagues' and team members' opinions and about liability have been identified as common barriers to spectrum-of-care practice.^10,11

These concerns are supported by data from recent surveys, though they do not appear to be the most common concern around spectrum-of-care practice. In the PetSmart Charities-Gallup State of Pet Care Study, liability concerns ranked among the top three reasons, accounting for 21 percent of responses.⁸ Concerns around negative impact to license (16 percent) and fear of judgment from peers (6 percent) were also listed.⁸

An earlier survey of veterinarians on the Veterinary Information Network (VIN) showed similar results, with 14 percent of respondents agreeing or strongly disagreeing that they worried about their license when practicing a spectrum of care.¹² It is important to note this data is survey-based and may not be representative of the wider population of veterinarians in the United States.

Professional organizations are working to broaden the conversation around spectrum-of-care practice and address concerns around the potential for board discipline in the country.

The American Veterinary Medical Association's 2024 update to the Principles of Veterinary Medical Ethics (PVME) included the addition of contextual care.¹³ In December 2025, the Journal of the American Veterinary Medical Association (JAVMA) published a supplementary issue on spectrum of care. In one article, Beth Venit, VMD, MPH, DACVPM, chief veterinary officer of the American Association of Veterinary State Boards (AAVSB), writes: "If done correctly, practicing along a spectrum of care typically aligns with a regulatory board's requirements and optimizes patient care and client satisfaction."¹⁰

The articles and guidelines mentioned above show leaders in the profession see the need for spectrum of care. The challenge is ensuring all members of the profession are aware of these conversations and updates. Continued publications, continuing education, and professional dialogue are needed to improve comfort with spectrum-of-care practice. These conversations should include regulators and lawyers in addition to veterinary professionals to ensure all concerns are adequately addressed.

Veterinary education

From the Roadmap: "The knowledge and skills needed to practise contextualised care should be more explicitly embedded in education and training for all team members, in both academic and workplace-based learning environments."^6,7

The UK data show a notable difference in opinions of early-career veterinarians and those with more experience around barriers to contextualized care.⁶ Only 21 percent of veterinarians graduating since 2020 reported few barriers to providing contextualized care, compared to 77 percent of those graduating in the 1980s.⁶

Additionally, compared to more experienced veterinarians, those graduating since 2020 had lower confidence providing care without a definitive diagnosis relied more on testing due to fear of complaints, and had less confidence adapting care to the individual needs of the pet and owner.⁶

While the PetSmart Charities-Gallup data did not divide responses by career stage, 48 percent of respondents said their veterinary education did not prepare them to discuss financial limitations, and 32 percent said their education prepared them "a little."⁸ This is consistent with previous research that found ethical dilemmas, such as needing to adapt care plans to client finances or other limitations, to be one of the top stressors for early-career veterinarians in the U.S.¹⁴

The American Association of Veterinary Medical Colleges (AAVMC) has recognized the need for more spectrum-of-care training in veterinary schools. With support from the Stanton Foundation, they launched the Spectrum of Care Initiative in 2021 to assist veterinary colleges in making changes to their curricula.¹⁵ In 2025, an implementation guide was published to further support veterinary colleges in spectrum of care education.¹⁵

Individual colleges and schools of veterinary medicine have incorporated spectrum of care into their curriculum in a variety of ways, including elective courses, clinical rotations, adding primary care educators, and more.^1,16–19

Additional action areas

The Contextualised Care Roadmap includes three additional action areas that will be explored in part 2 of this article: Practice Support, Research and Education, and Pet Owner Empowerment.

Kate Boatright, VMD, is a small animal veterinarian, speaker, and author in Western Pennsylvania. Dr. Boatright enjoys discussing mentorship, the spectrum of care, well-being, communication, and professional collaboration. In March 2023, Boatright published the Veterinary Mentorship Manual, a resource for practices to help guide them in developing solid mentorship programs to support new graduates.

References

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2. Brown CR, Garrett LD, Gilles WK, et al. Spectrum of care: More than treatment options. J Am Vet Med Assoc. 2021;259(7). doi:10.2460/javma.259.7.712
3. Skipper A, Gray C, Serlin R, O'Neill D, Elwood C, Davidson J. 'Gold standard care' is an unhelpful term. Vet Rec. 2021;189(8). doi:10.1002/vetr.1113
4. Skipper A, O'Neill D, Serlin R, Davidson J, Elwood C, Gray C. Contextualised care: faddish or foundational? Vet Rec. 2024;195(3):117. doi:10.1002/vetr.4567
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6. RCVS Knowledge. RCVS Knowledge Report: How to Achieve Contextualised Care. Published online November 6, 2025. Accessed February 25, 2026. https://www.rcvsknowledge.org/resource/report-how-to-achieve-contextualised-care/
7. RCVS Knowledge. Contextualised care: a roadmap. Published online November 6, 2025. Accessed February 22, 2026. https://www.rcvsknowledge.org/resource/contextualised-care-a-roadmap/
8. PetSmart Charities, Gallup. State of Pet Care Study: Veterinarian Perspectives on American Veterinary Care. Published online January 13, 2026. Accessed February 15, 2026. https://petsmartcharities.org/press-releases/cost-of-care-continues-to-strain-veterinary-care-access
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15. AAVMC Spectrum of Care Initiative Task Force. Enhancing spectrum of care preparation in veterinary education programs: Implementation strategies guide. Fedesco HN, Brodsky J, eds. Published online 2025. doi:10.17605/OSF.IO/AHWQE
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18. Evason MD, Stein MR, Stull JW. Impact of a Spectrum of Care Elective Course on Third-Year Veterinary Students' Self-Reported Knowledge, Attitudes, and Competencies. J Vet Med Educ. 2023;50(5). doi:10.3138/jvme-2022-0010
19. Warman SM, Armitage-Chan E, Banse H, Khosa DK, Noyes JA, Read EK. Preparing Veterinarians to Practice Across the Spectrum of Care. Adv Small Anim Care. 2023;4(1):171-183. doi:10.1016/j.yasa.2023.04.004
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