Companion Animal Owner Perceptions, Knowledge, and Beliefs Regarding Pain Management in End-of-Life Care

Perceptions and opinions of pet caregivers in mainland and Hong Kong China about surgery, pain management, and anesthesia in dogs and cats

Small animal caregivers' perceptions and previous life experiences play a pivotal role in patient care, making effective communication fundamental within the veterinary business. Despite the large and growing scale of the pet industry, data on small animal client-centered information about veterinary services in Mainland China (MC) and the Hong Kong Special Administrative Region (HKSAR) China are lacking. The objective of this study was to investigate the perceptions and opinions of small animal caregivers about surgery, pain management, and anesthesia in dogs and cats in these geographical regions through a validated online survey using content validity index. A total of 2080 valid answers were collected by convenience sampling over 45 days. Descriptive statistics were used to summarize data; the chi-square test and generalized linear models were used to test the associations between demographics and responses. Overall, caregivers appeared favorable toward the use of analgesia in their pets, with concerns over the potential adverse effects produced by analgesic drugs. Joint pain and ear infections were generally rated as conditions that would be less prone to require analgesia. Significant associations were observed for demographic factors such as gender, age, and geographical area, whether participants were healthcare providers, and whether their pets had undergone surgery before. Although many respondents expressed uncertainty in recognizing pain in their pets and administering analgesics, they also expressed a desire to learn and to be informed. This study highlights areas and factors that may determine the perceptions and opinions of small animal caregivers that form a unique human-animal bond in China. Client communication should be addressed on a case-by-case basis and adapted to the geographical area, as the individual background and demographics may have an ultimate impact on treatment goals and patient care.

Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale? A large bilingual global survey

OBJECTIVES

This study aimed to investigate if cat caregivers could reliably assess acute pain using the Feline Grimace Scale (FGS), and if participant demographics could affect scores.

METHODS

An online survey in English and Spanish was advertised by International Cat Care and other platforms (March-May 2021) using convenience sampling. Eligible participants were caregivers >18 years old and non-veterinary health professionals. Participants and a group of eight veterinarians scored 10 images of cats with different levels of pain. Data were analysed using linear models and intraclass correlation coefficient (ICC; α <0.05). Interpretation of the ICC was <0.2 = poor; 0.21-0.4 = reasonable; 0.41-0.60 = moderate; 0.61-0.80 = good; and 0.81-1.0 = very good.

RESULTS

A total of 3039 responses were received with 1262 completed answers from 66 countries (86%, 11.1% and 2.9% identified as female, male or other, respectively). Scores for each action unit (AU; ear position, orbital tightening, muzzle tension, whiskers change and head position) and their sum (FGS score) were not significantly different between caregivers and veterinarians, except for muzzle (caregivers 0.9 ± 0.0; veterinarians 0.7 ± 0.1; P = 0.035). The ICC single (caregivers) was 0.65, 0.69, 0.58, 0.37, 0.38 and 0.65, respectively, for AU ears, eyes, muzzle, whiskers, head and sum of scores. Demographic variables did not affect FGS scores.

CONCLUSIONS AND RELEVANCE

Total FGS scores had good reliability when used by cat caregivers, regardless of demographic variables, showing the potential applicability of the instrument to improve feline pain management and welfare worldwide.

"What Would You Do?": How Cat Owners Make End-of-Life Decisions and Implications for Veterinary-Client Interactions

Cats are the most common companion animals in New Zealand. Advances in veterinary care means that cats are living longer and there are many older cats. End-of-life decisions about cats are complicated by owner-cat relationships and other psychosocial factors. Our study explored the ways in which end-of-life decisions were being made by owners of older and chronically ill cats in New Zealand and the role of their veterinarian in the process. Qualitative data were gathered via retrospective semi-structured interviews with 14 cat owners using open-ended questions. Transcripts of these interviews were explored for themes using template analysis and nine themes were identified. Four were animal-centered themes: cat behavior change, pain was a bad sign, signs of ageing are not good, and the benefits of having other people see what owners often could not. Five were human-centered themes: veterinarians understanding owners' relationships with their cat, normalizing death, the need for a good veterinarian to manage end of life, veterinary validation that owners were doing the right thing, and a strong desire to predict the time course and outcome for their cat. End-of-life decision making is complex, and the veterinarian's role is often poorly defined. Our owners appreciated the expertise and validation that their veterinarian provided but continuity of care was important. Future research aimed at exploring the veterinarian's perspective during end-of-life decision making for cats would be a valuable addition to the topic.

Human Embryo Models and Drug Discovery

For obvious reasons, such as, e.g., ethical concerns or sample accessibility, model systems are of highest importance to study the underlying molecular mechanisms of human maladies with the aim to develop innovative and effective therapeutic strategies. Since many years, animal models and highly proliferative transformed cell lines are successfully used for disease modelling, drug discovery, target validation, and preclinical testing. Still, species-specific differences regarding genetics and physiology and the limited suitability of immortalized cell lines to draw conclusions on normal human cells or specific cell types, are undeniable shortcomings. The progress in human pluripotent stem cell research now allows the growth of a virtually limitless supply of normal and DNA-edited human cells, which can be differentiated into various specific cell types. However, cells in the human body never fulfill their functions in mono-lineage isolation and diseases always develop in complex multicellular ecosystems. The recent advances in stem cell-based 3D organoid technologies allow a more accurate in vitro recapitulation of human pathologies. Embryoids are a specific type of such multicellular structures that do not only mimic a single organ or tissue, but the entire human conceptus or at least relevant components of it. Here we briefly describe the currently existing in vitro human embryo models and discuss their putative future relevance for disease modelling and drug discovery.

Trends in the development of human stem cell-based non-animal drug testing models

In vivo animal models are limited in their ability to mimic the extremely complex systems of the human body, and there is increasing disquiet about the ethics of animal research. Many authorities in different geographical areas are considering implementing a ban on animal testing, including testing for cosmetics and pharmaceuticals. Therefore, there is a need for research into systems that can replicate the responses of laboratory animals and simulate environments similar to the human body in a laboratory. An in vitro two-dimensional cell culture model is widely used, because such a system is relatively inexpensive, easy to implement, and can gather considerable amounts of reference data. However, these models lack a real physiological extracellular environment. Recent advances in stem cell biology, tissue engineering, and microfabrication techniques have facilitated the development of various 3D cell culture models. These include multicellular spheroids, organoids, and organs-on-chips, each of which has its own advantages and limitations. Organoids are organ-specific cell clusters created by aggregating cells derived from pluripotent, adult, and cancer stem cells. Patient-derived organoids can be used as models of human disease in a culture dish. Biomimetic organ chips are models that replicate the physiological and mechanical functions of human organs. Many organoids and organ-on-a-chips have been developed for drug screening and testing, so competition for patents between countries is also intensifying. We analyzed the scientific and technological trends underlying these cutting-edge models, which are developed for use as non-animal models for testing safety and efficacy at the nonclinical stages of drug development.

Assessment of Veterinary Students' Responses to Questions Regarding Small Animal Pain Recognition and Analgesic Treatment Options

Pain recognition and treatment in companion animals are important aspects of veterinary medicine, yet the teaching of these concepts may not be adequate at all academic institutions. This study was designed to evaluate veterinary students' ability to recall signs of pain and specific analgesic drugs in dogs and cats. We hypothesized that students in the fourth, or final, year of their veterinary curriculum would have a better understanding of pain recognition and be able to recall more analgesic options. A brief, voluntary, and anonymous open question survey was made available to all veterinary students, years 1 to 4, at our institution. The questions included, "How does a cat/dog show signs of pain?" and "What pain medications are used in cats/dogs?" Survey responses were collated according to the students' year in the curriculum, and the most common responses for signs of pain and analgesic medications recalled by the students in both the cat and dog were compared for significant differences. Results showed that students in the class of 2017 (seniors) had no superior recall of analgesic medications or recognition of pain in cats or dogs compared to the other classes. Vocalization was the most common sign of pain recalled with at least 50% responses from all classes. Carprofen was the most commonly recalled analgesic for dogs (the difference between classes, p = .04). Meloxicam was the most commonly recalled analgesic for cats (the difference among classes, p < .001). Based on these results, areas of improvement were identified for our analgesic curriculum.

Determining priority welfare issues for cats in the United Kingdom using expert consensus

Background

Cats are the most popular pets in the UK, yet relatively little research has been conducted into the welfare of cats living in a home environment. The purpose of this study was to determine and prioritise welfare issues for cats using a Delphi method.

Methods

Cat welfare experts (n=14) were asked to identify and rank welfare issues for cats in the UK. An initial list of 118 welfare issues was generated by an anonymous online discussion board of experts and thematic analysis using NVivo. Subsequently experts ranked the list of welfare issues according to severity, duration and prevalence using a 6-point Likert scale. All issues with a median score of 3 or above (n=43) were included in the second survey to determine agreement on the rankings of issues. Finally, a subsection of experts attended a two-day workshop to discuss the welfare rankings and determine the final prioritised list of welfare issues.

Results

The issues considered to be the most severe and/or likely to cause prolonged cat suffering included social behaviour issues, diseases of old age, obesity, owners not seeking veterinary care and poor pain management. The welfare issues perceived to be most prevalent included neglect/hoarding, delayed euthanasia, inherited conformational defects/diseases, social or environmental restriction, and poor pain management.

Conclusions

The outcomes suggested that, although issues such as cat behaviour required further research, owner education was an important factor in improving cat welfare.

Determining priority welfare issues for cats in the United Kingdom using expert consensus

BACKGROUND

Cats are the most popular pets in the UK, yet relatively little research has been conducted into the welfare of cats living in a home environment. The purpose of this study was to determine and prioritise welfare issues for cats using a Delphi method.

METHODS

Cat welfare experts (n=14) were asked to identify and rank welfare issues for cats in the UK. An initial list of 118 welfare issues was generated by an anonymous online discussion board of experts and thematic analysis using NVivo. Subsequently experts ranked the list of welfare issues according to severity, duration and prevalence using a 6-point Likert scale. All issues with a median score of 3 or above (n=43) were included in the second survey to determine agreement on the rankings of issues. Finally, a subsection of experts attended a two-day workshop to discuss the welfare rankings and determine the final prioritised list of welfare issues.

RESULTS

The issues considered to be the most severe and/or likely to cause prolonged cat suffering included social behaviour issues, diseases of old age, obesity, owners not seeking veterinary care and poor pain management. The welfare issues perceived to be most prevalent included neglect/hoarding, delayed euthanasia, inherited conformational defects/diseases, social or environmental restriction, and poor pain management.

CONCLUSIONS

The outcomes suggested that, although issues such as cat behaviour required further research, owner education was an important factor in improving cat welfare.

Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model

Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians, and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and health care providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation of clinical ethics committees as a mechanism to analyze, discuss, and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method, as well as the approach that was taken to create a clinical ethics committee.