Wednesday, March 14, 2018

Veterinary palliative care


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.

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