Impact of Chronic Disease on Quality of Life for Both the Patient and Caregiver
Veterinary medicine aims to recognize and effectively manage pain in a way that decreases suffering and increases the patient's quality of life for those pets with chronic conditions.
In assessing and determining quality of life, the term “quality” has many meanings. Essentially, “quality” signifies a “general characteristic or overall impression one has of something” (Welmelsfelder 2007). Veterinary professionals recognize quality as a separate entity from quantity, as the concept “more is better” is not necessarily true. Therefore, to optimize an ill patient's quality of life, the veterinarian might encourage treatments that favor the patient's perception of welfare rather than longevity.Illustration of the above concept is seen through the treatment options for a pet diagnosed with cancer. The characteristic methods of cancer treatment are typically surgery, chemotherapy, and/or radiation. Upon evaluating the type of cancer, how quickly it grows or spreads, and its location, a veterinarian must weigh the effects of treatment to the patient's quality of life. This information is then shared with the caregiver, and together, they make an informed decision based on the client's ability to pay for, provide, and emotionally handle the care associated with extended treatment.
For instance, when deciding whether to perform surgery, the veterinarian should determine whether the costs to the animal outweigh the benefits. If the removal of a large tumor also requires removing a vital organ, thus resulting in the loss of an essential bodily function, the costs largely overtake the benefits. If the patient must live in anguish to increase lifespan, it is best to choose an alternative route that allows instead for comfort and contentment. However, if the treatment offers longer life expectancy in addition to a positive prognosis with only acute adverse effects, it is worth further exploring.
Often, those associated acute conditions can be remedied with medication or simple lifestyle changes, generating a wise investment in exchange for long-term well-being.To understand how chronic diseases impact a companion animal, there must first be a clear understanding of what quality of life is and how it is assessed. We can expand on the previous definition of the term “quality” by defining “quality of life” as “the total wellbeing of an individual animal” (August et al. 2009). Although definitions of the term vary, most can agree that quality of life encompasses the physical, social, and emotional components of the animal's life (August et al. 2009) in the current daily environment.
Although veterinary medicine has made vast improvements in assessing quality of life, it wasn't until the past decade that it has been extensively studied and measured in companion animal medicine (Lavan 2013). Due to its complex nature and modernism, no accepted standards or protocols currently exist (August et al. 2009); however, various quality-of-life surveys have been developed and are tailored toward many of the individual chronic diseases. Overall, these questionnaires evaluate a combination of physical versus nonphysical factors, including needs satisfaction, sense of control, social relationships, physical functioning, hygiene, mental status, and management of stress (see Figure 1.1). The principal aim of the surveys is to broadly assess and evaluate over time the states and changes of comfort or discomfort (Lavan 2013).
Due to the common element of self-reporting in determining quality of life, which is obviously not possible for animals, research has been done to support and establish signs, symptoms, mannerisms, and other qualitative measures people can use to gauge this. Although many hope for a more scientific approach to quality for an animal, its primary reliance remains on human perception and interpretation (Welmelsfelder 2007). Hence, studies show that the skill to communicate with a companion animal is age-old and does