Table 4 Coding list

AAT practice and environmental factors

Intervention site

▪ “Comes into the multifunction room, is sitting in a wheelchair.” (P27)

Discontinuation of intervention

▪ “Patient discontinues the AAT session due to pain. Patient requests another appointment.” (P10)

Second contact

▪ “She would like another visit on Thursday “if she is still there”.” (P36)

Integration of relatives

▪ “While playing with their grand-father who provides instruction and acts as an “expert” for Lotti, they try out numerous things and are impressed by what “Grandpa” is able to do and what he already knows after only 2 meetings with Lotti.” (P25)

Content of AAT session

Stroking of dog

▪ “Patient was relaxed, permitted manual guidance, stroked Lotti like that, felt dog’s heartbeat and breathing, stroking with manual guidance.” (P20)

Exercises with therapy dog

▪ “She gave visual signals like Sit and Give Paw, rewarded the dog with treats from a spoon while commanding Lotti to wait or to come to her and acted with self-assurance.” (P16)

Positioning of the dog

▪ “Lotti is led to the bedside. I take the patient’s hand and forearm to extend it towards the dog, there is skin contact and his fingers stroke the fur.” (P30)

Patient centred session

▪ “After greeting her and a bit of caressing the dog I ask her indirectly if stroking the dog is enough for her or whether she wants to get a bit more active with the dog. Upon which she asks which material we used the last time.” (P46)

▪ “Right from the start it is very important for him to take a photo.” (P25)

Addressing disease, dying, death\disease and hospital stay

▪ “Talks about illness, about humans and animals, wishes related to animals, emotions evoked by them. Starts to swallow hard when talking about last diagnosis, eyes full of tears, then concentrates on Lotti and is able to enjoy some moments with her in the bed.” (P44)

Effect of AAT

Emotions

▪ “She verbally reflected on Lotti’s behaviour, made some jokes, laughed several times a bit cautiously - but sincerely - about her thoughts.” (P51)

▪ “Observes her closely while trying to analyse whether she is tired or if she wants to go outside. I mirror Lotti’s behaviour for her and show her that she is actually completely relaxed and that Lotti adapts to her mood.” (P51)

Catalyst for communication

▪ “Lotti is a facilitator for communication.” (P28)

▪ “Patient opens up emotionally during the conversation.” (P5)

Activation

▪ “Patient speaks of tiredness but becomes more active again during the ball game.” (P13)

Relaxation

▪ “She seems relaxed and calm again. Says Lotti is looking for her calmness and makes her calm.” (P45)

▪ “Appears visibly weaker and tired to me; Lotti repeatedly lies down in front of her bed, too, adopts her calmness; Patient realises that also and is able to accept it.” (P18)

Self-efficacy

▪ “She seems to feel a connection to Lotti, realizes that she can make her come to her, even control her through hand commands like Sit, Down, Give Paw, and realizes the effects of her own actions.” (P46)

Intimacy and trust

▪ “He notes being aware of the fact that his manner makes Lotti accept this kind of trust.” (P42)

▪ “He becks Lotti to him, purposefully seeking to establish physical contact. He strokes and cuddles her very intensively. He wants her to lie in his bed. Lotti lies down next to him and allows every degree of closeness he is seeking.” (P42)

Distraction

▪ “Towards the end, she speaks, for the first time, about her disease, her thoughts about dying, her life, her values. At the same time, her voice becomes weaker. But then she turns to Lotti again, is able to find pleasure in the interaction and decides herself to try a trick as a farewell.” (P36)

Aversion

▪ “Patient refuses dog therapy. Reacts negatively, wishes to be left alone/ in peace.” (P41)

General effects of contact with animals

▪ “He speaks about his experiences with dogs and animals, how beneficial these were for him, occasionally about the relationships one has with animals. This causes him to think about his children, he talks about them, his suicide attempt and his other thoughts.” (P32)

Behavioural activation through AAT

Motivation available

▪ “Adopts this motivation for herself.” (P52)

No motivation

▪ “But shows no motivation or ideas to become active herself.” (P46)