Caregiver burden in owners of a sick companion animal: a cross-sectional observational study

Assessment of caregiver burden and associations with psychosocial function, veterinary service use, and factors related to treatment plan adherence among owners of dogs and cats

OBJECTIVE To investigate caregiver burden and its potential associations with psychosocial function and veterinary service use among dog and cat owners and with factors related to treatment plan adherence among owners of animals with chronic or terminal disease. DESIGN Cross-sectional, observational study. SAMPLE 124 clients of a small animal hospital. PROCEDURES Study participants were recruited by email. Owners of sick animals were blindly matched with owners of healthy animals (62/group) by age, gender, and companion animal species. Respondents completed electronic questionnaires related to demographics and previously described measures of caregiver burden, psychosocial function, and treatment plan adherence. Veterinary medical records were reviewed to verify animal health status and assess veterinary service use (billable and nonbillable contacts with veterinary staff) in the 12 months prior to study enrollment. Variables were tested for association by statistical methods. RESULTS Questionnaire scores reflected greater caregiver burden; greater symptoms of depression, anxiety, and stress; and poorer quality of life for respondents with sick animals than for respondents with healthy animals. Greater caregiver burden was associated with scores reflecting poorer psychosocial function and with greater veterinary service use. The number of nonbillable, but not billable, contacts was greater for respondents with high caregiver burden than for those without this finding. Treatment plan factors associated with greater caregiver burden included changes in routine because of the animal's condition and perception that following new rules and routines for management of the condition was challenging. CONCLUSIONS AND CLINICAL RELEVANCE Awareness of potential caregiver burden and psychosocial distress in clients with sick companion animals may help veterinarians identify opportunities for an empathic response. Future research should assess directionality of the relationship between these factors.

Validation of an abbreviated instrument to assess veterinary client caregiver burden

Background

Caregiver burden is present in many clients managing illness in a companion animal, but current assessment tools are time‐consuming and lack normative reference values.

Objectives

Statistical reduction of items in a measure of caregiver burden to create an abbreviated version, validation of the abbreviated version, and calculation of reference values.

Animals

None.

Methods

This study was conducted using observational methods. Owners of an ill cat or dog were recruited through social media (n = 429). Veterinary clients with an ill (n = 459) or healthy (n = 961) cat or dog were recruited through a general veterinary and an academic hospital with multiple specialties. The study was conducted in 3 stages: (a) reduction of the Zarit Burden Interview (ZBI) adapted for use in pets via factor and item analyses, (b) psychometric validation of the abbreviated instrument, and (c) standardization of the abbreviated (7 items) and full (18 items) measures.

Results

A 7‐item measure showed high correlations with the full measure (r = 0.88‐0.93) and good internal consistency (α = .71‐.75) across samples of veterinary clients with an ill cat or dog. This abbreviated measure correlated significantly (P < .001) and positively with stress (r = 0.40‐0.75) and negatively with quality of life (r = −0.32 to −0.56). Reference values derived from clients with a healthy companion animal suggest “normal” burden ranges of 0 to 17 on the full measure and 0 to 8 on the abbreviated version.

Conclusions and Clinical Importance

For situations precluding full assessment of client caregiver burden, this brief 7‐item version can be used with good internal consistency and validity. Reference values can help determine if a client's caregiver burden is increased.

Goals of Care: Development and Use of the Serious Veterinary Illness Conversation Guide

Goals of care (GOC) conversations and resulting goal-concordant treatment are the heart of palliative medicine. Despite repeated evidence that GOC conversations offer significant benefit and minimal harm, barriers to widespread and high-quality implementation persist in human medicine. One strategy to overcoming these barriers has been utilization of a structured checklist format for serious illness conversations. The Serious Illness Conversation Guide was developed for human patients and has been modified for use in the veterinary profession. The guide promotes individualized, goal-concordant care planning even when conflict and emotional demands are high.

Perspectives on Feeding and Nutrition

Many palliative care patients have reduced oral intake during their illness. Managing inadequate intake through appetite stimulation and/or artificial hydration and nutrition poses many clinical, ethical, and logistical dilemmas. This article aids the health care team in making appropriate recommendations regarding assisted nutrition and hydration for palliative care and terminal patients. It provides a decision-making framework, including an ethical approach to determining appropriate use of assisted feeding and hydration methods in pets at the end of life. It also summarizes various clinical and logistical approaches to treating decreased food/water consumption, including potential benefits and burdens, should intervention be deemed appropriate.

The Animal as Patient: Ethology and End-of-Life Care

Treating the animal patient as a "person" involves refining the capacity to see the patient as clearly as possible. Veterinary end-of-life care can usefully engage with the science of animal emotion and cognition to help bring the patient into 3-D. This article highlights 3 specific areas in which engagement with the ethology literature and more careful attention to the subjective experiences of animals could improve end-of-life care: (1) interpretation and management of pain, (2) assessments of quality of life, and (3) attention to the autonomy of animal patients.

An Objective Exploration of Euthanasia and Adverse Events

Companion animal euthanasia is of great emotional, social, ethical, and medical significance because of the strong bond between pets and their owners. Few studies exist quantifying adverse events during and after euthanasia. Such events have profound effects on pet owners, veterinary professionals and veterinary patients. Best practices or standards of care have yet to be established. Companion animal euthanasia warrants further rigorous investigation regarding current veterinary medical practices due to its significant, complex, and far-reaching effects. Literature evaluating human euthanasia and assisted death in countries where such practices are legal can be a useful area of investigation and collaborative inquiry.

Common Neurologic Problems: Impact on Patient Welfare, Caregiver Burden and Veterinarian Wellbeing

Most neurologic diseases are incurable. Palliative care is vital in the treatment of companion animals with serious or chronic neurologic disease. A Neuropalliative Care Core Skill Set includes multifaceted communication competencies and symptom management. Because some of the most common clinical signs of neurologic disease are also associated with stress of caregiving, veterinarians should understand their clients' unique potential for caregiver burden. Acknowledging caregiver burden in their clients, means that veterinarians treating patients with neurologic disease must be proactive in building their own resilience to the occupational stress inherent in treating their patients and supporting their patients' caregivers.

Caregiver Burden and Veterinary Client Well-Being

This article describes veterinary client caregiver burden, including how it differs from other key client experiences in the palliative care setting. Caregiver burden in human relationships is reviewed. Research examining veterinary client caregiver burden in the context of serious illness (or pet caregiver burden), including the link between pet caregiver burden and client psychosocial well-being, is summarized. Risk factors for development of pet caregiver burden are discussed in the context of beginning to address how it might be reduced or prevented. Finally, suggestions are provided for veterinarians working with clients facing these issues in a palliative care setting.

Depression and anxiety in pet owners after a diagnosis of cancer in their pets: a cross-sectional study in Japan

OBJECTIVE

To determine the presence and predictors of depression and anxiety in pet owners after a diagnosis of cancer in their pets.

DESIGN

Cross-sectional study.

SETTING

A veterinary medical centre specialised in oncology for dogs and cats and two primary veterinary clinics in Japan.

PARTICIPANTS

The participants for analysis were 99 owners of a pet with cancer diagnosis received in the past 1-3 weeks and 94 owners of a healthy pet.

MAIN OUTCOME MEASURES

Self-reported questionnaires were used to assess depression and anxiety. Depression was assessed using the Center of Epidemiologic Studies Depression Scale, and anxiety was measured by using the State-Trait Anxiety Inventory-Form JYZ.

RESULTS

Depression scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders (p<0.001). Within the owners of a pet with cancer, depression was significantly more common in those who were employed than those who were unemployed (p=0.048). State anxiety scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders, including trait-anxiety scores (p<0.001). Furthermore, in owners of a pet with cancer, state anxiety was higher in owners with high trait anxiety (p<0.001) and in owners whose pets had a poor prognosis (p=0.027).

CONCLUSION

The results indicate that some owners tended to become depressed and anxious after their pets had received a diagnosis of cancer. Employment may be a predictor of depression. High trait anxiety and a pet with a poor prognosis may increase owners' state anxiety. Including the pet in a family genogram and attention to the pet's health condition may be important considerations for family practice.

Caregiving for a Companion Animal Compared to a Family Member: Burden and Positive Experiences in Caregivers

Introduction: Research in human caregiving shows burden is often present in the caregiver and can be reduced by interventions that increase positive perceptions of caregiving. Recent work suggests burden is also present in owners of a seriously ill companion animal. To help determine if findings from the human caregiving literature are likely to generalize to companion animal caregiving, we undertook a comparison of burden and positive aspects of caregiving in these groups. Material and Methods: Caregivers recruited through social media disease support and information groups completed self-report questionnaires of burden and positive aspects of caregiving in an online research protocol. Owners of a seriously ill companion animal (n = 117) and caregivers of a family member with dementia (n = 252) were cross-sectionally compared. Analyses in the full sample were repeated in a subset (n = 75 per group) of caregivers with blindly matched demographic profiles. Results: Burden was elevated in both dementia and companion animal caregiver groups, though higher overall for dementia caregivers (p < 0.001 for full and matched samples). In contrast, greater positive aspects of caregiving were reported by companion animal caregivers (p < 0.001 for full and matched samples). In both groups, positive aspects of caregiving were negatively associated with burden (full sample p < 0.001; matched sample p < 0.05). Exploratory item analyses suggested the two groups show comparable experiences of fearing the future, guilt, and financial strain (p = ns for full and matched sample). Discussion: Although both groups showed elevated burden, companion animal caregivers reported less burden and a more positive appraisal of caregiving. Elements of burden showing similarities across groups provide a foundation for understanding caregiver burden in the companion animal owner. The inverse correlation between positive aspects of caregiving and burden suggests the impact of positive caregiving experiences should be considered in burden interventions, but because companion animal owners already positively appraise caregiving, enhancing positive aspects of caregiving may not offset burden as it does in human caregiving samples.

Caregiver burden in the veterinary dermatology client: comparison to healthy controls and relationship to quality of life

BACKGROUND

Skin disease in companion animals often requires long-term management which may contribute to caregiver burden in the dermatology client.

HYPOTHESES/OBJECTIVES

We expected greater caregiver burden in dermatology clients relative to healthy control veterinary clients and that no difference would be present between healthy controls and dermatology clients reporting good skin disease control. Within the dermatology sample, we hypothesized that greater caregiver burden would correlate with client perception of the animal's severity of disease (ASD), animal skin disease quality of life (ASD-QoL), and client general quality of life (CG-QoL) and skin disease-related quality of life (CSD-QoL).

PARTICIPANTS

Participants were 358 dog owners, including veterinary dermatology clients (n = 152) and healthy general veterinary control clients (n = 206).

METHODS AND MATERIALS

Cross-sectional online assessments were completed for client caregiver burden (both samples) and CG-QoL, CSD-QoL, ASD-QoL and ASD (dermatology sample only).

RESULTS

Caregiver burden was greater in dermatology clients overall relative to healthy controls (P < 0.001); it was comparable for those reporting good skin disease control (P > 0.05). Within the dermatology group, correlations between caregiver burden and CSD-QoL were high (r = 0.58; P < 0.001). CG-QoL was predicted by caregiver burden (P < 0.001) but not significantly by CSD-QoL (P > 0.05).

CONCLUSIONS AND CLINICAL IMPORTANCE

In the presence of good skin disease control, caregiver burden in dermatology clients is as low as general veterinary clients with a healthy dog. Understanding client experiences of companion animal skin disease may be optimized by assessing caregiver burden.

Predicting caregiver burden in general veterinary clients: Contribution of companion animal clinical signs and problem behaviors

Caregiver burden, found in many clients with a chronically or terminally ill companion animal, has been linked to poorer psychosocial function in the client and greater utilization of non-billable veterinary services. To reduce client caregiver burden, its determinants must first be identified. This study examined if companion animal clinical signs and problem behaviors predict veterinary client burden within broader client- and patient-based risk factor models. Data were collected in two phases. Phase 1 included 238 companion animal owners, including those with a sick companion animal (n=119) and matched healthy controls (n=119) recruited online. Phase 2 was comprised of 602 small animal general veterinary hospital clients (n=95 with a sick dog or cat). Participants completed cross-sectional online assessments of caregiver burden, psychosocial resources (social support, active coping, self-mastery), and an item pool of companion animal clinical signs and problem behaviors. Several signs/behaviors correlated with burden, most prominently: weakness, appearing sad/depressed or anxious, appearing to have pain/discomfort, change in personality, frequent urination, and excessive sleeping/lethargy. Within patient-based risk factors, caregiver burden was predicted by frequency of the companion animal's signs/behaviors (P<.01). Within client-based factors, potentially modifiable factors of client reaction to the animal's signs/behaviors (P=.01), and client sense of control (P<.04) predicted burden. Understanding burden may enhance veterinarian-client communication, and is important due to potential downstream effects of client burden, such as higher workload for the veterinarian. Supporting the client's sense of control may help alleviate burden when amelioration of the companion animal's presentation is not feasible.

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation

Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.