The Initial Appointment
The initial palliative appointment should occur early in the course of the disease. There is research on the human side of palliative care that indicates starting early increases the quality and the quantity of life.73 Palliative care may be basic, such as symptom management, to advanced level care, including multiple comorbidities and more advanced pain and symptom management. The introductory end-of-life appointments may be longer than the average appointment, with some palliative practitioners using up to 3 hr for a single appointment. Listening to clients about their goals, fears, and worries and then educating them about end-of-life care takes time. It is key to defining the client’s goals of care and maximizing the QOL of the patient. Compassionate, advanced serious disease communication may reduce the likelihood of premature or difficult euthanasia events.
The palliative appointment may begin with an in-depth conversation around the client’s understanding of the history, diagnosis, and current medications of their pet and then develop a plan based on the client’s goals of care. After a thorough discussion regarding history, a complete physical examination with pain assessment would be the next step. After that, the diagnosis, prognosis, and clinical outcomes of chronic disease or end-stage organ dysfunction can be discussed. A plan can then be developed based on the client’s goals of care and may proceed to a discussion of palliative care, hospice, or humane euthanasia options. Veterinarians may explore a client’s fears, beliefs, and physical abilities necessary to be an effective caregiver. The clinician and client may use different tools to determine goals of care, and what the pet will or can tolerate may influence end-of-life decisions.