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The veterinary literature on end-of-life care, animal hospice care, and hospice care is growing as these areas of practice become more common. The goal of this type of research is to support the “human-animal bond by providing the best medicines and leading the industry,” according to DACAW resident Kathleen Cooney, DVM, CHPV, of the Companion Animal Euthanasia Training Academy. During a session at the recent Fetch dvm360® conference in Charlotte, North Carolina, Cooney reviewed some of the latest research on pet end-of-life care and key takeaways that can be used by veterinarians and their teams when engaging in end-of-life care. care.1
Use of quality of life scales
Quality of life (QOL) scales are commonly used by hospice and palliative care veterinarians to provide pet families with a more objective way to monitor a pet’s quality of life.2 Cooney shared that only one scale has been validated (Vetmetrica, which is a paid system). However, the Lap of Love and H5M2 scales are commonly used and take into account some social and emotional aspects as well as physical measures of quality of life. Cooney suggests adding the BEAP scale for assessing pain to existing quality of life scales. These assessments are most beneficial when completed by multiple family members.
Communication on euthanasia
A 2019 article by Matte et al. explored the impacts of euthanasia and end-of-life conversations on veterinarians.3 This survey-based study found that veterinarians understand the importance of providing a “good death” for their patients. In fact, the ability to provide a good death is directly linked to well-being, with those who are able to provide “humane, peaceful, gentle and speedy” euthanasia having a great sense of accomplishment. However, when euthanasia goes poorly, the feeling of well-being and job satisfaction decreases.
Additionally, this study found that one of the most difficult parts of the euthanasia process was making complex decisions with clients. Veterinarians often report feeling exhausted when multiple, lengthy conversations are required before a euthanasia decision is made. Overall, these conversations are more exhausting than euthanasia. Cooney notes that these types of conversations are an opportunity to involve veterinary social workers to help support both the client and members of the veterinary team in these difficult decisions.
Defining a good death
A Study 2022 explored pet owners’ opinions on what defines a “good death.”4 The top 5 characteristics of a good death from a pet owner’s perspective are:
- Never separated from the animal and allowed to be with them throughout the process.
- Assistance with pre-planning, which includes the ability to set expectations and minimize regret by determining who will be present, where euthanasia will take place, and what aftercare will be.
- The animal sleeps and is comfortable, even if it takes time.
- The animal is anxiety and pain free.
- The client is offered euthanasia at home.
Although some of these elements, such as advance planning and home euthanasia, are not feasible in an emergency situation, many others could be achieved, including through the use of pharmaceuticals to reduce the pain and anxiety and provide significant sedation. The results of this pet owner survey should be considered when determining how euthanasia is handled in the clinic.
Documentation of customer conversations
Cooney noted that documenting the details of conversations leading to euthanasia is essential to protect veterinarians in the event of a client complaint.5.6 Detailed records also hold the team accountable. Cooney recommended clinics create practical guidelines for how euthanasia is handled, which will increase efficiency and ensure all appropriate documentation is available. Additionally, when euthanasia is denied or delayed, it is important to provide documented recommendations for palliative care, pain management, and emotional support to pet families.
Considerations for monitoring
Pet owners turn to veterinarians and their teams not only for assistance in the decision to euthanize an animal, but also to make decisions regarding aftercare.7 Although pet memorial experts work at crematoriums, they were low on the list of sources of pet aftercare information. Cooney recommended veterinarians visit crematory facilities annually and discuss options they can offer their clients. Connecting clients with the crematory to discuss all pet memorialization options can improve the client’s perception of the aftercare process.
This study also found that owners have very strong feelings about how their pet’s body is preserved after death. Trash bags are unacceptable. Blankets/shrouds, designated cadaver bags, and coffins were acceptable ways to store pet bodies. Most owners expect their pet’s body to be transferred from the veterinary office to the crematory or burial site within 24 hours of death.
Emerging problem: pentobarbital and animal remains
Cooney concluded his lecture with a warning regarding the use of pentobarbital. Although commonly used for euthanasia, pentobarbital poses an environmental risk, particularly in secondary poisoning of animal carcasses. In fact, there are federal fines for improper burial leading to relay toxicosis. Large animal practitioners are more likely to be aware of and discuss these risks with their clients than small animal practitioners.8 However, it is essential that veterinarians provide their clients with safe burial guidelines. To protect access to pentobarbital, Cooney said the American Veterinary Medical Association is exploring ways to help improve awareness of this issue and the need to educate clients.8
The future of end-of-life research
End-of-life care continues to be an evolving area of veterinary practice and research continues in this area. Cooney encouraged veterinarians interested in exploring research in this area of medicine to contact her or the International Animal Hospice and Palliative Care Association.
Dr. Boatright, a 2013 graduate of the University of Pennsylvania, is a practicing veterinarian, speaker, and freelance author in western Pennsylvania. She is passionate about mentoring, educating, and addressing common sources of stress for veterinary teams and recent graduates. Outside of clinical practice, Dr. Boatright is actively involved in organized veterinary medicine at the local, state, and national levels.
The references
- Cooney K. Updates on new research on end-of-life topics. Presented at: Fetch dvm360 Conference; Charlotte, North Carolina. March 25, 2023
- Flavell S. The use of quality of life scales for palliative care and end-of-life patients. The veterinary nurse. December 2019/January 2020. Vol 10, number 10. P 534-537
- Matte A, Coe J, Khosa D et al. Impacts of decision-making regarding pet euthanasia on veterinary welfare. Veterinary file. 2019-10, Vol.185 (15), p.480-480
- Cooney, K., Kogan, L. “How Pet Owners Define a ‘Good Death’: New Study Reveals Surprising Facts.” » DVM360 Review 2022. 53.8:12 https://www.dvm360.com/view/how-pet-owners-define-a-good-death-
- Gray C and Radford A. Using electronic health records to explore negotiations around euthanasia decision-making for dogs and cats in the UK. Veterinary file. 2022-02, Vol. 190(9):https://doi.org/10.1002/vetr.1379.
- Cooney KA. The importance of documenting euthanasia decision-making processes in patient medical records. Veterinary file. 2022-05, Vol 190(9):364-366. https://doi.org/10.1002/vetr.1759
- Cooney K, Kogan L, Brooks S, Ellis C. Pet owners’ expectations regarding end-of-life support for pets and body care after death: exploration and practical applications. Topics in Companion Animal Medicine. Volume 43. 2021
- Kollias NS, Hess WJ, Johnson CL, et al. A literature review of current practices, knowledge, and views on pentobarbital euthanasia by veterinarians and the disposal of animal remains in the United States. JAVMA 2023;261(5):733-738. DO I: 10.2460/javma.22.08.0373