Hospice and palliative care get full day at AVMA

As veterinary medicine progresses, many pet owners have grown to expect the same type of care for their pets as they expect for themselves or human loved ones. One of these expectations is hospice care.

At the American Veterinary Medical Association’s (AVMA) annual convention in Atlanta, Ga., this year, an entire day was devoted to hospice and palliative care and end of life choices for pets. The sessions were well-attended, with many having standing room only, a testament to growing interest in this field among veterinarians and technicians.

One attendee, Gina Smith, DVM, a veterinarian at Allatoona Animal Hospital in Woodstock, Ga., said she was looking for ideas for how to start providing this service in her practice. Smith said there is some demand for hospice care among her clients.

“It’s not considerable, but there is some,” Smith said. “Especially clients who can’t afford expensive procedures like chemotherapy, they want to keep their pet comfortable and happy within a tight budget.”

Tami Shearer, DVM, CCRP (Certified Canine Rehabilitation Practitioner), owns a practice in western North Carolina, specializing in rehabilitation, pain management, and hospice care. Shearer spoke about setting up hospice and palliative care in small animal practices, and gave advice on specific ways to implement this service in a practice.

Shearer said that creating a comfortable environment is key to providing hospice care and consultation. A space with non-slip flooring, bedding and which is kept at a comfortable temperature for both the pet and the clients is important. The actual space itself is not as important as the environment, she said, but it is necessary to set aside a designated space for hospice. She said converting a hallway, giving a face lift to an exam room, converting a storage room or even leasing a small office are good, creative options for creating hospice space.

“Hospice is thought of as a philosophy of care,” Shearer said. “So you can apply that philosophy in a variety of ways.”

In her talk, Shearer outlined a five-step pet hospice care plan, which can be used to ensure that all bases are covered when providing this service.

Step 1: Evaluation of the pet owner’s needs, beliefs and goals for their pet.

There are many things to consider in terms of what the client expects, wants and is able to pay for. Sometimes a client’s past medical experience will shape their future decisions, Shearer said. Client beliefs regarding death and euthanasia are also important considerations. Other things to discuss are preferences for hospitalization vs. outpatient vs. home care, and what to do with the pet’s body if it dies at home.

“Until we take time to look at and sort out these issues, we probably can’t serve that client in the best way,” Shearer said.

Step 2: Education about the disease process.

Understanding the details of the disease process will allow the pet owner to make the most informed decisions about their pet’s care, Shearer said. This includes describing the death process, whether by natural causes or through euthanasia, based on the specific disease the pet has.

Step 3: Development of a personalized plan for the pet and the pet owner.

The veterinarian needs to take into account both the psychosocial concerns of the pet owner and the needs of the pet at all times. Staff must respond appropriately when a pet’s condition changes, based on these needs.

Step 4: Application of hospice or palliative care techniques.

This step is about educating the client on how best to take care of their pets at home. Techniques such as how to administer subcutaneous fluids or how to assist the pet in urinating or defecating should be demonstrated for the client. Written information should also be provided, and Shearer said staff should have the client repeat the technique in front of them so that it is clear the client is able to do it. Providing a list of side effects for any drugs the pet is given is also important.

Step 5: Emotional support during the care process and after the pet’s death.

The veterinarian must show empathy throughout the entire process, Shearer said. This includes the time after the pet has died, when the family may still be grieving. In addition to the medical staff, other people such as a social worker or spiritual advisor can be valuable members of the support team for this step.

“Most of us are good at sending sympathy cards,” Shearer said. “But because of time constraints we don’t always follow up a month later to see how that family is doing.”

Other sessions in the hospice series discussed pain management, quality of life and euthanasia techniques.

Jamie Totten, DVM, of Cross Lanes Veterinary Hospital in Cross Lanes, W.Va., said the sessions on hospice care were her first exposure to this topic in any detail.

“Honestly I was pretty reluctant, I’d never heard of it,” Totten said. “But I think it’s a great service and I would consider offering components of it to my clients.”

Totten said that the HHHHHMM Quality of Life Scale, put forward by Alice Villalobos, DVM, DPNAP, was one of the more valuable things she took away from the talks. The HHHHHMM scale is a way of rating a patient’s quality of life. It stands for: “Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, More good days than bad.” The medical staff and the client can rank the pet together on these criteria with a score of 1-10. Most of the time, a score of five or above is acceptable, but depending on the overall score and how likely each factor is to improve, the staff and family can make the best decision for the pet.

“Those are going to be really helpful to me when I’m giving something solid to the clients,” Totten said. “They want something tangible that involves the whole family.”