In the last 10 years I have found an increasing interest in veterinary end of life care. Many of my pet rescues have been seniors with all the issues that ageing brings.
I was over two decades in to my career at this point. I started reading around the subject of end of life care.Ā I addressed individual medical issues. I was not addressing the overall comfort of my pets or my own comfort as their caregiver.
I felt that in veterinary end-of-life care there was the āgold standard” approach. Appropriate diagnosis and perhaps intensive treatment. The alternative was doing little. The risk of a gap in care between the onset of ill health and saying our goodbyes seemed real.
I now see contextualised care increasingly recognized in all veterinary disciplines. Contextualised care is appropriate and proportionate care tailored to the needs of both the client and the animal.
I discovered that there was a growing community of veterinary colleagues who were one step ahead already. They were researching and practicing veterinary palliative care. They were mainly in the US, in Canada & in Australia, with a handful of pioneer vets here in the UKĀ (Dignipets).
Veterinary palliative care researchers often extrapolated findings from the human palliative care field.
Both human and veterinary palliative care are still in their infancy. The UK established the first human medicine speciality in palliative care in 1986. There is not yet an equivalent in veterinary medicine. The certified hospice and palliative care qualification is the only veterinary post graduate training available currently worldwide.Ā
We need an improved understanding of veterinary palliative care as a new discipline. I see common misconceptions surrounding its introduction.
One is that we are already offering it fully in veterinary practice. Some believe that it is there only for the benefit of the owner. That it may extend a petās life but to the detriment of that lifeās quality.
As all of us working in veterinary end of life say, this needs a paradigm shift. Or as Maya Angelou says, āDo the best you can until you know better. Then when you know better, do betterā.
I posted a few weeks ago about new learnings in when to choose euthanasia for your pet. When to say goodbye? We already look at quality of life scores. But some are medically skewed, non are scientifically validated, and with newer thinking we should be considering pain scales and animal advanced directives also.
Someone criticised me for making it too complicated.
I have worked in in-home euthanasia for 16 years, 4 as a dedicated practitioner. I practice what some perceive as new ways. I am quite used to this.
In home euthanasia (IHE) is not new to veterinary practice. Euthanasia techniques have advanced significantly and there are increasingly more in home providers so families are more aware of it as an option.
In some ways veterinary medicine is coming full circle with a return to its ambulatory roots.
Palliative care IS new.
Palliative careās goal is to provide comfort. It is symptom and pain management to improve quality of life without trying to cure the patient.
In human medicine palliative care can apply to any advanced, progressive chronic disease not just terminal illness. It can be ongoing for months, even sometimes for years, supporting current medical treatments.
Think about osteoarthritis in dogs-surprisingly a disease of the young. We have access to amazing veterinary pain specialists and brilliant physical therapists. I see that as a small and effective multidisciplinary palliative care team. That is an accepted team in the veterinary field.
We have to apply that thinking to other chronic, end of life or terminal cases. Understand how a trained palliative care vet can work with other veterinary professionals to provide care.
Doctors use the term hospice to describe terminal illnesses in human medicine. This is often when the patient is no longer seeking medical care outside palliative care. Usually where someone has 6 months or less life expectancy. People view hospice more negatively, likely because of fear of the dying process.
(Interestingly, and perhaps unsurprisingly, insurance companies have influenced the definition of hospice and palliative care in the US medical system).
In human medicine early onset palliative care can have a significant impact on the patientās life. Not just better quality of life but enabling the patient to live longer too (the landmark TemelĀ study). It also has a positive impact on the caregiverās quality of life.Ā
I see a veterinarianās focus in palliative care in achieving two goals . The palliative care vet has the medical knowledge to try to achieve symptom and pain relief for the patient for as long as that is possible. As importantly, they offer the space to listen to what a family wants and needs-for both their pet and for the family themselves.
Being mindful of the latter the palliative care vet can work towards facilitating a treatment plan. This supports primary care already in place.
Caregivers may feel lost at this critical time in their petās lives. External support to the family is hugely beneficial.
Access to palliative care gives the family back a sense of agency. It can help to unstick fear paralysis in decision making. It can allow for informed decision making to advocate for their pet. It can gift a family the time needed to come to terms with a bombshell diagnosis.
Helping families to be in a better place to say their goodbyes.
Veterinary palliative care honours the human-animal bond. Like in home euthanasia, it is an entirely rewarding area of veterinary practice. At its centre is open and honest communication and connection. I find that as interesting and holding as much to learn as the technical aspects.
In my euthanasia service I see families who have disconnected from primary care for their pet. This is mainly because of fear.
Provision of palliativeĀ care makes that a less likely scenario. It enables families to re-engage in veterinary end of life care. In doing so it offers families a more substantial end-of-life experience with their pet.