How do we best care for senior pets, companion animals
with chronic or terminal illnesses? When I grew up, diagnosis of a chronic
disease was a one-way ticket to the vet. Fast forward and we now have
successful triple therapy and monitoring for patients with heart disease,
prescription diets and medications for animals with kidney disease, veterinary
oncology surgeons and chemotherapy protocols, and a suite of analgesics that
work on different pathways.
Veterinary palliative care
is not about extending quantity of life, but extending quality of life. Quality
of Life, or QoL, refers to states of comfort or discomfort, and a combination
of physical (for example disease-related) and non-physical factors, such as satisfaction,
sense of control, social relationships, extent of emotional or physical
discomfort, and management of stress(Lavan, 2013). In one study, 86
per cent of owners of companion animals with heart disease said they would
trade the animal’s longevity for their quality of life(Oyama et al., 2008).
One of the tricky issues for
vets (as it is for paediatricians and medical professionals working with
patients who cannot report their own QoL) is that we rely on proxies – the owners
– to report an animal’s QoL. While people are very in tune with animals they
live with, there is the potential for a mismatch between an animal’s actual QoL
and one’s assessment of it.
Different interventions can
impact QoL positively or negatively, which is why it is important to talk about
and assess QoL. As companion animals are living longer overall, and living
longer with disease, there is scope for our profession to learn more about
palliative care.
In 2017, the AustralianVeterinary Palliative Care Advisory Council was founded as forum for discussion of this important area. One of the founders
and a huge driver behind it is Dr Jackie Campbell. As the owner of Sunset Veterinary
Care, Jackie’s dayjob involves helping people navigate end-of-life decision
making (you can see her TED talk here. She is the first Australian vet to achieve certification in Animal Hospice
and Palliative Care (CHPV), and also holds a diploma in Canine Myotherapy. She
has an interest in degenerative joint disease and pain management.
In May, the Australian
Veterinary Palliative Care Advisory Council, of which I am a member, is holding
its inaugural conference on palliative care. The day-long conference includes,
a palliative approach to pain (Dr Jackie Campbell), palliative care in the
terminal cancer patient (Dr Kathleen O’Connell), physiotherapy of the geriatric
patient (Brooke Marsh) and supporting clients through grief and loss (Rosie
Overfield). I will be reviewing QoL assessment and ethical decision making.
If you are a veterinarian, animal physiotherapist or
allied animal health professional with an interest in improving the QoL of
patients, you can find out more and register here. www.avpcac.com/conference
References
LAVAN, R. P. 2013. Development and
validation of a survey for quality of life assessment by owners of healthy
dogs. Veterinary Journal, 197, 578-582.
OYAMA, M.
A., RUSH, J. E., O'SULLIVAN, M. L., WILLIAMS, R. M., ROZANSKI, E. A., PETRIE,
J. P., SLEEPER, M. M. & BROWN, D. C. 2008. Perceptions and priorities of
owners of dogs with heart disease regarding quality versus quantity of life for
their pets. J Am Vet Med Assoc, 233, 104-8.