Quality-of-life assessment techniques for veterinarians

Assessment of the quality of life of cats affected by paraparesis/paraplegia and urinary retention, and their impact on caregivers

OBJECTIVES

In cats affected by severe thoracolumbar spinal cord pathologies, paraplegia and paraparesis, often accompanied by urinary retention, pose significant challenges, impacting both the cats' welfare and owners' lives. This study aimed to assess the quality of life (QoL) of cats affected by these conditions, and to evaluate the social and familial implications for caregivers.

METHODS

The study was structured into two parts. The first part comprised direct observations of aspects of QoL in cats both in household and shelter settings, while the second part involved the distribution of questionnaires to cat owners and shelter operators.

RESULTS

Cats with paraplegia/paraparesis and urinary retention can maintain a good QoL, with hindlimb mobility significantly influencing QoL scores. Shelter cats showed a comparable QoL to household cats, challenging the anecdotal beliefs that shelter cats with severe neurological impairments are destined to lead substandard lives. Operator surveys highlighted the feasibility of managing these cats in shelter environments, emphasising the importance of collaboration between caregivers and veterinary professionals. Likewise, owner surveys revealed a manageable time commitment for care, with most owners achieving proficiency in manual bladder expression within 1 month. Despite challenges, most of the owners reported positive experiences and did not contemplate euthanasia for their cats. Regular veterinary visits and occasional physiotherapy were common practices among caregivers.

CONCLUSIONS AND RELEVANCE

Owners who respond to the questionnaire and shelter operators have a high commitment to cats with paraplegia/paraparesis. Although the study acknowledges this potential bias, it suggests that dedicated care can ensure a good QoL for cats with severe spinal injuries, both in shelter and household settings. Effective communication between caregivers and veterinary professionals is essential for accurate information dissemination and optimal care provision. This research contributes to raising awareness of managing these conditions and emphasises the importance of collaborative care approaches in veterinary medicine.

Research priorities in veterinary palliative care

Veterinary palliative care consists of end-of-life care of companion animals suffering from terminal or life-limiting diseases. Despite the growing need for veterinary palliative care, little research has been conducted on this topic. This perspective intends to provide an overview of the existing concerns and identify knowledge gaps to motivate further research. As a result, three main areas of research have been identified, namely: i) how to provide palliative care considering welfare implications of different diseases (e.g., pain management); ii) what can be considered a "good death", depending on the individual situation of the animal and its caregiver; iii) how to support caregivers' needs during their companion animal's end-of-life. Therefore, veterinary palliative care involves medical, ethical, and sociological considerations that should be addressed through guidelines and training.

Life with pets study: lower income veterinary clients' perception of pets' quality of life

Perception of quality of life for cats and dogs of low-income Spanish and English-speaking veterinary clients attending problem focused or routine veterinary visits is an important area of focus for community based veterinary service providers. Using a qualitative approach, 50 New York City based American Society for the Prevention of Cruelty to Animals (ASPCA) veterinary clients completed semi-structured interviews as well as a survey about their perception of life with their pets. Veterinary clients shared both human-animal bond (HAB) related and quality of life (QoL) related factors in their daily experience of life with their pets. Results indicated that this demographic perceives QoL similarly to previous QoL research that either does not report sample demographics or reports sample demographics with more affluence. Moreover, 60% of qualitative excerpts included both HAB and QoL themes and 40% were discretely HAB or QoL. An analog single item 10-point scale measuring veterinary client perception of their pets QoL did not differentiate between sample demographics at a statistically significant level. Finally, pet QoL literature has not traditionally reflected diverse demographic identities of veterinary clients or widely included reliable and valid measures of the human-animal bond (HAB). These results support the importance of measuring the HAB when researching pet QoL and provide evidence that lower-income Spanish and English-speaking veterinary clients are similarly bonded and attentive to their pets as other demographics.

Practical Principles of Palliative Care in Veterinary Oncology: Alleviating the Suffering of the Animal, Owner, and Veterinarian

Background

Palliative care for pets is a developing area that encompasses animals with cancer and other chronic and degenerative diseases.

Objectives

To elucidate the guiding principles of palliative care in veterinary oncology.

Methods

This article was structured from an extensive literature review and addresses the growing need for improved palliative care in veterinary medicine. Methods of quality of life assessment in animals with cancer, owner education, and the importance of an interdisciplinary team approach are discussed.

Results

Palliative care aims to improve the animal's quality of life, alleviating its physical, emotional, and social suffering. Through attentive communication, palliative care also seeks to alleviate owners suffering from the moment of diagnosis to mourning the patient's death.

Conclusions

The importance of offering palliative care alongside anticancer techniques and treatments should not be underestimated and should ideally use a multidisciplinary team approach.

Influence of feline brachycephaly on respiratory, gastrointestinal, sleep, and activity abnormalities

OBJECTIVE

To determine the influence of brachycephaly on respiratory, gastrointestinal, sleep, and activity-related parameters in cats.

STUDY DESIGN

Prospective questionnaire-based study.

ANIMALS

A total of 194 BC and 1003 non-BC cats.

METHODS

Owners completed an online questionnaire regarding respiratory, gastrointestinal, sleep, and activity-related parameters. Response options were scored, and individual scores summed to give a total clinical severity score for each cat.

RESULTS

Brachycephalic cats had more frequent snoring (odds ratio [OR] 6.89; 95% confidence interval [CI]: 5.06-9.41), sneezing (OR 6.52; CI: 4.75-8.98), nasal discharge (OR 8.26; 95% CI 5.77-11.85), coughing (OR 1.75; CI: 1.17-2.59), and dyspnea (OR 5.32; CI: 3.42-8.28); shorter activity before becoming dyspneic (OR 2.71; CI: 1.93-3.79), slower recovery from activity (OR 3.17; CI: 2.19-4.57), lower activity levels (OR 2.16; CI: 1.59-2.95), and increased respiratory noise (OR 6.68; CI: 4.71-9.52); and more hypersalivation (OR 2.50; CI: 1.47-4.16), halitosis (OR 1.40; CI: 1.00-1.95), and difficulty chewing (OR 5.19; CI: 3.65-7.38). Median clinical severity scores were higher for BC cats than non-BC cats (p < .0001).

CONCLUSIONS

Brachycephalic cats (BC) were at risk for respiratory, gastrointestinal, and activity-related symptoms compared to non-BC cats.

CLINICAL RELEVANCE

Some BC cats exhibit clinically relevant symptoms and behaviors as reported by owners. Medical or surgical interventions may improve these symptoms and warrant investigation.

Validation of the HHHHHMM Scale in the Italian Context: Assessing Pets’ Quality of Life and Qualitatively Exploring Owners’ Grief

Witnessing a companion animal’s death can be a stressful psychological experience for human guardians, affecting their ability to grieve. The veterinary and psychological sciences offer useful tools for supporting human guardians during their companion animal’s terminal illness. Accordingly, the present study aimed to validate the HHHHMM Quality of Life Scale in the Italian context. The study followed a mixed-methods design and involved 314 participants. The Mourning Dog Questionnaire (MDQ), Lexington Attachment to Pets Scale (LAPS), Pet Bereavement Questionnaire (PBQ), and open-ended questions were adopted to test the research hypotheses and qualitatively explore the grieving experience. The results showed that the model’s fit was partially adequate, with all parameters being significant and over 0.40. Moreover, human guardians’ anger levels were high when their companion animal’s quality of life was poor, and greater levels of grief were associated with higher levels of attachment. Gender differences were observed only with the LAPS, and a negative correlation with age was found with the LAPS and PBQ. A thematic qualitative analysis revealed four themes: continuing bonds, coping strategies, shared moral values, and perceived support. Thus, the research reaffirmed the importance of adequate veterinary and psychological support for human guardians experiencing the loss of companion animals.

Ala vestibuloplasty improves cardiopulmonary and activity-related parameters in brachycephalic cats

OBJECTIVE

To evaluate the effects of ala vestibuloplasty on cardiopulmonary and lifestyle-related parameters in brachycephalic (BC) cats.

STUDY DESIGN

Prospective cohort.

ANIMALS

Client-owned BC cats (n = 19).

METHODS

Cats were assessed preoperatively by airway computed tomography (CT), endoscopy, contrast echocardiography, cardiac biomarkers, and structured owner questionnaire. Ala vestibuloplasty was performed bilaterally, and blood values, imaging, and owner questionnaire responses were re-evaluated 8-20 weeks postoperatively.

RESULTS

Cats were presented for predominantly respiratory clinical signs attributable to brachycephaly. Preoperatively, all cats had stenotic nares, prolonged normalized pulmonary transit time (nPTT) (mean 5.43 ± 1.10 s), and a hyperattenuating pulmonary pattern. No complications occurred following surgery. Postoperatively, nPTT (mean 3.89 ± 0.74 s, p < .001) and frequencies of sneezing (p = .002), snoring (p = .006), open-mouth breathing (p = .0004), and nasal discharge (p = .019) were decreased. Cats exhibited increased activity (p = .005), less frequent dyspnea during activity (p < .001), longer duration of activity before becoming dyspneic (p = .002), faster recovery from activity (p < .001), and decreased respiratory noise (p < .001). Median questionnaire scores improved from preoperative to postoperative (p < .001).

CONCLUSION

Anatomic, echocardiographic, and CT changes were common in this cohort of clinically affected BC cats. Pulmonary blood flow and respiratory function were improved after surgery.

CLINICAL SIGNIFICANCE

Stenotic nares are the predominant airway abnormality in BC cats. Ala vestibuloplasty is a safe procedure that improves cardiac and CT abnormalities and respiratory and other clinical signs in BC cats.

Ethical and Practical Considerations Associated with Companion Animal Euthanasia

The reality that euthanasia in veterinary practice can end animal suffering but can also be used in circumstances that do not serve an animal's interest, can be a benefit for animals, and a burden for veterinary professionals, respectively. This essay addresses ethical and practical concerns associated with companion animal euthanasia, including defining euthanasia, why and when euthanasia should be performed, applying euthanasia in practice, contemporary methods, aftercare of deceased animals, and the consequences of euthanasia and dysthanasia for animals, animal owners, and veterinary professionals. We contend that an intention-based definition of euthanasia should be strictly applied in veterinary practice and that practitioners view euthanasia decisions as requests that can (and in some cases should) be declined, rather than as mandates.

Palliative care for cancer patients in veterinary medicine

Neoplasms account for approximately half of the deaths of dogs over ten years of age. This finding, associated with the fact that canine cancer patients will often suffer from the consequences of the systemic spread of the tumour and paraneoplastic syndromes, shows the importance of understanding palliative care by veterinarians and owners. In view of this, this review aims to address palliative care that can be used in veterinary medicine to promote the patient's well-being and quality of life.

Risk Factors Regarding Dog Euthanasia and Causes of Death at a Veterinary Teaching Hospital in Italy: Preliminary Results

The decision to request and proceed with euthanasia in a dog is complex and predictors of such decisions are important. This study investigates the risk factors (demographic and clinical) associated with the main clinical causes and methods of death (euthanasia or unassisted death) in a population of dogs. By comparing euthanasia to unassisted deaths, the authors assess causes of death to evaluate their relative impacts on decision-making to choose euthanasia compared with an unassisted death. For this, goal data from electronic medical records of dogs who had died (unassisted death and euthanasia), obtained from an Italian referral veterinary teaching hospital from 2010 to 2020, were analyzed. The causes of death were categorized by pathophysiological process and the organ system. Univariate and multivariable logistic regression analyses were performed to identify the factors that significantly affect the probability of undergoing euthanasia and to individuate independent significant predictors of euthanasia and unassisted death, respectively. Death rate by euthanasia was 40.7% (125/307), by died unassisted 50.8% (156/307), whilst only 8.5% of dogs (26/307) died accidentally. The main causes of death for euthanasia were due to neoplastic (75.6%), degenerative (64.3%), and congenital (60%) diseases. Furthermore, the findings reveal that in deaths by euthanasia, the significant risk predictors were female gender, age, and neoplastic and degenerative processes; while in unassisted deaths, the significant risk predictors were male gender, age, and infection/inflammatory conditions. These preliminary outcomes highlight the information of this study which may be used to evaluate strategic interventions and health promotion strategies to be implemented, with consequent welfare gains for the canine population.

Animal Welfare Considerations and Ethical Dilemmas Inherent in the Euthanasia of Blind Canine Patients

Simple Summary

Although many dogs with blindness diagnosis can reach a similar age compared to those not affected, often the owners require euthanasia of their animals. This choice leads to conflicting moral principles relating to what is better for the animal and the owner. This article discusses the suitability of euthanasia in blind dogs. To better assess factors influencing the choice of euthanasia, four different scenarios were constructed that described various situations regarding the animal’s aptitude, pet owner, and veterinarian relations.

Abstract

In dogs, several primary or secondary diseases affecting the ocular structures may cause blindness. In cases where the visual impairment is not associated with severe systemic involvement and the animal can still have, predictably, a good “long-term” quality of life, the veterinarian should inform the owner about the differences between humans and animals, concerning the type of visual perception. In the light of the daily findings in veterinary clinic practice, the Authors report four different scenarios with conflicting views between veterinarians and owners about the euthanasia request for a blind dog. They underline how the diagnosis of incipient or already established blindness in dogs can sometimes lead to an inappropriate request for euthanasia.

Quality of Life Measurement in Dogs and Cats: A Scoping Review of Generic Tools

Simple Summary

Quality of life (QoL) assessment tools play an important role in veterinary medicine by optimising companion animal welfare and directing treatment decisions. No distinct guidelines are currently available for tool design and appraisal. Nine published generic QoL assessment tools designed for use in dogs and cats were compared to each other. Each tool was uniquely individual in terms of structural design, psychometric evaluation and statistical analysis. Although each tool was unique, the majority assessed similar aspects of dog and cat QoL, namely activity level, the desire for interaction and appetite. These findings provide a reference point for future tool development by emphasizing the need for more consistency in reporting methodology and statistical validation, as well as highlighting potential valuable aspects of QoL in dogs and cats.

Abstract

Quality of life (QoL) assessment in companion animals is an essential aspect of veterinary medicine that helps guide treatment decisions and ensures optimal animal welfare. Veterinarians and pet owners can use disease-specific or generic QoL assessment tools to evaluate an individual animal’s QoL. The aim of this scoping review was to identify and assess published generic QoL assessment tools suitable for use in either dogs or cats. A literature search identified 82 relevant publications, nine of which contained appropriate generic QoL assessment tools in accordance with inclusion and exclusion criteria. Each tool was assessed for evidence of psychometric evaluation including statistical analysis, reliability and validity. Commonly included items were determined to highlight potential important aspects of dog or cat QoL. Five of the nine publications used a statistical method such as factor analysis to determine tool design and structure. Although at least one aspect of reliability and validity was assessed for seven of the tools, none were validated across all measures. Two of the publications contained minimal to no statistical analysis. Common items for both dogs and cats included those regarding activity level, the desire for interaction and appetite. In addition, common items for cats included those regarding mood and grooming. This scoping review identified and evaluated currently available generic QoL assessment tools, providing a reference point for future tool development and validation.

Supportive Care for People With Disabilities as Working Partnerships With Their Assistance Dogs Are Ending: A Perspective From Veterinary Oncology

People with disabilities and those working to train, provide and support assistance animals, along with their veterinary teams, would all benefit if they RETHINK their perspective and viewpoint, and roles when these very special relationships come to an end. The end of the relationship may be when the assistance animal must retire, must be redirected, or euthanized due to illness or cancer. The loss or separation at the end of an assistance animal's service marks a heavy loss for the disabled person. Emotions emerge when the assistance animal is sick or has developed cancer or is approaching the difficult period known as “end of life.” Anticipatory grief and heartbreak may be very difficult to manage and support. We can help ease the burden of decision making when euthanasia is needed for the assistance animal. If the disabled person takes on the good shepherd role and if the veterinary team emulates the minister or Mother Nature's role at the end of life or at the end of the working relationship, heartache may be lifted from both sides of the leash.

Palliative Care Services at Home: Viewpoint from a Multidoctor Practice

A growing, multidoctor, mobile hospice and palliative care practice in Louisville, Kentucky, is described. Services are exclusively dedicated to palliative medicine, hospice, and end-of-life care. The characteristics of, and unique considerations associated with, this practice's patient population are discussed. Demand for hospice and palliative care services is increasing even though these fields are in the early stages of growth and development, and availability of services is limited. Research is an essential step toward improving care provision and evaluating the value of hospice and palliative care services in terms of patient comfort, quality of life, and survival time.

Preliminary description of aging cats and dogs presented to a New Zealand first-opinion veterinary clinic at end-of-life

AIMS To conduct a preliminary investigation into the chronic disease conditions and clinical signs present in aging New Zealand companion animals at end-of-life and to describe the timing, circumstances, and manner of death. METHODS The medical records database of a first-opinion, companion animal, veterinary practice in Auckland, New Zealand was searched to identify all canine and feline patients ≥7 years of age that were subjected to euthanasia or cremated in the period between July 2012-June 2014. The free-text medical notes were analysed for information on the circumstances surrounding the death, previous diagnoses of chronic disease conditions, and the presence of clinical signs associated with decreased quality-of-life at the time of euthanasia. RESULTS The median age at death was 15 (max 22) years for the 130 cats and 12 (max 17) years for the 68 dogs in the study sample. Euthanasia at the clinic was carried out for 119/130 (91%) cats and 62/68 (91%) dogs, with the remainder recorded as having an unassisted death. The frequency of deaths was highest during December for both cats and dogs. Cost was mentioned as an issue in the medical records for 39/181 (21.6%) patients that were subjected to euthanasia. At the time of euthanasia, 92/119 (77.3%) cats and 43/62 (69.4%) dogs were recorded as having >1 clinical sign associated with a decreased quality-of-life. Inappetence and non-specific decline were the two most commonly recorded clinical signs for both dogs and cats. Cardiovascular disease (44/130, 34%), renal failure (40/130, 31%), and malignant neoplasia (36/130, 28%) were the most common chronic disease conditions recorded for cats. Degenerative joint disease (22/68, 32%), malignant neoplasia (14/68, 21%), and cardiovascular disease (8/68, 12%) were the most common chronic disease conditions recorded for dogs. CONCLUSIONS AND CLINICAL RELEVANCE These preliminary findings highlight that aging companion animals in New Zealand frequently have chronic disease conditions and clinical signs that may potentially be associated with decreased quality-of-life at the time of death. Further in-depth studies are required to determine whether there is a greater role for veterinarians in counselling owners about end-of-life care and euthanasia decisions.

Impact of canine overweight and obesity on health-related quality of life

Canine obesity is increasing in prevalence in the UK and raises concerns about dog welfare. This study compares the health-related quality of life (HRQL) of dogs of varying body condition: overweight and obese (BCS 4 and 5) versus non-overweight dogs (BCS 2 and 3), obese (BCS 5) versus non-overweight (BCS 2 and 3) and an overall comparison between all four BCS (BCS 2, 3, 4 and 5) using a novel, validated HRQL instrument which is both web and mobile tablet/phone app based. Of 271 dog owners who were approached, 174 completed a web-based instrument (2013) or a mobile tablet app instrument (2014) during the summers of 2013 and 2014. Automatically generated scores in four domains of HRQL (energetic/enthusiastic, happy/content, active/comfortable, calm/relaxed) were compared for dogs with each of the body condition scores (BCS 2-5). For all body condition scores a statistically significant difference was found between the HRQL scores in two of the domains: energetic/enthusiastic (p=0.02) and active comfortable (p=0.004). When BCS 2 and 3 were compared to BCS 4 and 5, statistical significance was found in the same two domains - energetic/enthusiastic (p=0.01) and active comfortable (p=0.001) - as it was in comparison of non-overweight (BCS 2 and 3) compared to obese dogs (BCS 5): energetic/enthusiastic (p=0.012) and active comfortable (p=0.004). These results suggest that overweight and obese dogs have a reduced HRQL in two of the domains compared to non-overweight dogs, and that differences in HRQL are detectable between BCS scores 2, 3, 4 and 5.