Famil√s Concerns
Score each section on a scale of 0-2:
O = Iam not concerned at this time.
1 = There is some concern.
2 = I am concerned about this.
I am concerned about the following things:
__ Pet suffering
Desire to perform nursing care for your pet
Ability to perform nursing care for your pet
Coping with loss
Concern for other members of the family (i.e.
children)__ Pet dying alone
__ Not knowing the right time to euthanize
__ Concern for other household animals
Results:
0-4 Your concerns are minimal at this time. You have either accepted the inevitable loss of your pet and understand what lies ahead, or have not yet given it much thought. Ifyou have not considered these things, now is the time to begin evaluating your own concerns and limitations
5-9 Your concerns are mounting. Begin your search for information by educating yourself on your pet's condition; it's the best way to ensure you are prepared for the emotional changes ahead
10-16 Although you may not place much value on your own quality of life, your concerns about the changes in your pet are valid. Now is the time to prepare yourself and to build a support system around you. Veterinary guidance will help you prepare for the medical changes in your pet while counselors and other health professionals can begin helping you with anticipatory grief
Discuss these questions below, and the entire Quality of Life Scale, with your veterinarian.
Below are some open-ended questions that assist gauge your family's time, emotional, and (when appropriate, financial) budgets:
1. Have you ever been through the loss of a pet before? If so, what was your experience (good or bad, and why)?
2. What do you hope the life expectancy of your pet will be? What do you think it will be?
3. What is the ideal situation you wish for your pet's end of life experience? (at home, pass away in her sleep, etc.)
Suggestions on using this quality of life scale:
1.
Complete the scale at different times of the day, note circadian fluctuations in well-being. (We find most pets tend to do worse at night and better during the day.)2. Request multiple members of the family complete the scale; compare observations.
3. Take periodic photos of your petto help you remember their physical appearance.
Resources:
1. AAHA/AAFP Pain Management Guidelines for Dogs and Cats, www.aahanet.org/Library/PainMgmt.aspx
2. Online hospice journal and quality of life scale: www.PetHospiceJournal.com
not need scientific validation to prove its worth (Welmelsfelder 2007).
The best approach to assessing animal quality of life is through a combination of interpretation of behavior and physical traits by both the caregiver and the veterinarian over time. The animal's owner has the day-to-day firsthand experience of understanding changes in mannerisms and personality. Owners also typically administer treatment at home and are the first to notice their pet's reaction, such as side effects to medications or response to a procedure or therapy. Correspondingly, veterinarians play the vital role of determining and communicating the options and effects of various treatments. Healthcare providers offer the knowledge of species- and breed-specific behavioral repertoires as well as extensive experience in observing and acting with different species in various contexts (Welmelsfelder 2007). This proficiency allows them to accurately judge and share with the caregiver the meaning of their pet's body language (Welmelsfelder 2007).
Ideally, quality-of-life surveys could be conducted and discussed with a veterinarian throughout the lifespan of the animal, regardless of health status. By regularly using a quality of life survey for both healthy and chronically ailing patients, the caregiver and the veterinarian can document changes over time, have a familiarity with quality-of-life assessments, and, most importantly, enable the ability to discern minor quality-of-life changes caused by aging, chronic conditions, and/or disability.
For animals suffering from chronic diseases, even the subtlest changes over time can offer a significant impact to their quality of life and may indicate the need for additional or more formal approaches to treatment. Depending on the specific ailments, many patients suffering from chronic diseases experience changes in their levels of “anxiety,” “fear,” “restlessness,” “sociability,” and “playfulness,” which are witnessed and reported by the owner (Welmelsfelder 2007). In these quality-of-life assessments, it is important to distinguish between the physical and mental parameters. For instance, if an owner of an arthritic animal expresses that his/her pet is “slower during walks,” a determination should be made on whether this is because of pain, a mental state, or weakness associated with aging, a physical parameter (Yeates and Main 2009). If the determination is “pain,” adjustments should be made for alleviation.
Similarly, this “body language” established by the physical movement of the animal associated with corresponding psychological qualities displays the verifiable impression of chronic diseases on quality of life. Among countless examples, here are just a few:
1) Consider a sudden onset of blindness, affecting access to food and water (physical parameters), in addition to discerning whether the blindness leads to fear, distress, decreasing the animal's companionship with others, or inability to “explore” during walks (physiological parameters).
2) Diabetes mellitus is another common chronic condition among cats and dogs. If well managed and treated, a diabetic pet can enjoy the same quality of life as any other pet. However, if uncontrolled or mistreated, diabetes can cause increased water consumption and urination, weight loss, dehydration, weakness, seizures, and possibly death. These quality-of-life ailments are evident through the pet's body language, such as lethargy, smelling like urine, or acting depressed.
3) As common as osteoarthritis is, it might be hard to spot at first considering that the pet's behavioral changes could be subtle.
Arthritis doesn't necessarily mean a poor quality of life for a pet; it is simply joint inflammation caused by an increase in stiffness and immobility. If this inflammation can be controlled, the pet may enjoy a relatively good quality of life. Changes like medications, therapies, and household adjustments can be made to control these painful symptoms. Pets display these symptoms of pain by avoiding once enjoyable activities, acting depressed, moving less, decreasing their hygiene (unable to keep clean due to immobility), and/or changing their eating habits. Anti-inflammatory drugs, holistic therapies, acupuncture, herbal supplements, and household alterations, such as keeping food and water at a comfortable height, adding nonskid runners to avoid slips, and extra warmth at night, can help to regulate the symptoms and provide for a happier life.As indicated in the examples above, chronic diseases can have a significant bearing on a companion animal's quality of life. However, with careful selection and administration, therapies and treatments can help to assure good quality of life. Side effects must be considered so the measures executed will denote visible changes in quality of life or will otherwise provide a positive prognosis for longterm quality despite acute ailments.
While organ systems and treatment issues vary by illness, they all share the commonality of requiring daily attention from a caregiver to perform routine tasks for monitoring and management. Research has highlighted the enormous devotion owners have to their pets and the efforts and expenses they are willing to incur to provide optimal healthcare for them (Kelly 2014). There is an undeniable overlap in comparing the management of a pet's discomfort to that of a human; for both, the caregiver often administers a scheduled regimen of medication, monitors for signs of adverse reactions, and is prepared to transport the patient for emergency treatment if needed. The stakes are high if the conditions are not treated properly, as common results are brain damage or death.
Among many examples, this is the case with diabetes management and allergic reactions to medications. This ambiance creates an immense amount of pressure and highly stressful conditions for the caregiver. As a result of the pressures associated with providing care, a caregiver is likely to experience substantial adjustment problems, higher levels of psychological distress, deprived health, and reduced well-being; thus referred to as “caregiver burden” (Kelly 2014; Christiansen et al. 2013).The pressure is better understood when compiling research that supports the notion of viewing a pet in much the same way as a child. A survey conducted by the American Veterinary Medical Association (AVMA) found that of 47,842 US households, nearly half (49.7%) of the respondents owning at least one pet “considered their pets to be family members” (Kelly 2014). Furthermore, similar to the human caregiving model, women are typically the primary caregivers of pets; AVMA's national study showed that 74.5% of pet owners with primary responsibility for their pets were female (Kelly 2014). Based on this, a conclusion can be made that caregivers of pets, especially mothers, endure the same form of quality of life reduction as do human caregivers.
The most common challenges reported by caregivers are the time it takes to provide extra care, changes in the use of the home to tailor the pet's needs, and restrictions relating to work, a social life, and finances (Christiansen et al. 2013). Many individuals described these changes as “time-consuming,” “tough,” “concerning,” and “annoying” while also being “sad” and “frustrated” with the decline in the human-animal relationship. It is common to hear owners speak of “loss,” “guilt,” and “emotional distress” when caring for a chronically ill patient, as they are trying to weigh treatment options to euthanasia. Overall, caregivers tend to agree with veterinary professionals that the quality of life of their pet is more important than longevity.
In fact, in a recent study, 86% of owners of dogs being treated for cancer were willing to exchange their dog's survival time for an improved or stable quality of life.As advances in veterinary medicine continue, managing the quality of life for both the chronically ill patient and the caregiver is becoming increasingly possible. Palliative care providers offer guidance to families faced with caring for a pet; they aid in creating plans for living well based on the animal's needs and assist in treatment options to provide optimal quality of life for their patients (August et al. 2009). They also help to develop and administer the caregivers' goals while providing emotional and spiritual support. By establishing and following the treatment options provided by a veterinary professional and confiding in this professional, both the pet and the caregiver can enhance their shared quality of life, maximize their time spent together, and make important decisions when the pet's life can no longer be prolonged due to an unacceptable quality of life.