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7:05 PM   April 20, 2014
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Informing Clients About Quality of Life and Death

By Alice Villalobos, DVM

Small animal veterinary practice today parallels the pediatrician model.

But veterinary personnel deal with five times more patient illness and death than most health professionals.

Despite the predictable frequency of terminal illness and death, many veterinary hospital personnel lack the skill to properly interact with bereft pet caregivers.

In addition, the intense exposure to end-of-life care issues and death causes some staff members to develop compassion fatigue, a type of burnout that may not be recognized or understood.

The human animal bond is now acknowledged and celebrated as an important part of people's lives and, at times, may be the best relationship a person has.

The role of veterinarians is to facilitate that relationship by keeping animals healthy.

Veterinarians have an increasing obligation to serve the committed pet owner with improved medical techniques and improved communication regarding quality of life and end-of-life care issues.

We also have an increasing obligation to provide support and reverence when a pet dies, and even reach out to comfort the client in the days following the pet's death.

But where and how do clinics become proficient grief management?

Tools for Staff
Some hospitals have hired counselors to educate personnel. Others give out pamphlets or have grief books in a loaning library.

Staff and doctors need to understand attachment and recognize and deal with anticipatory grief when a person is struggling for emotional balance during a pet's illness. In addition, it is important to provide caregivers with a way to assess or measure their sick pet's quality of life to help in the decision-making process.

A helpful tool such as the "HHHHHMM" Quality of Life Scale equips pet caregivers to objectively evaluate their pet's condition (see VPN Source Book 2006, "Quality of Life Scale Helps Decision Making," pp 10-11). Basically, we ask pet caregivers to provide a score on a scale from one to 10 (10 being the best). They score how they perceive their pet's status in specific areas. These areas are Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad days.

A total score equal to or greater than 35 is acceptable for a pet to continue with pet hospice care. The caregiver and attending doctor need to communicate and work together to raise the score in every area to at least 5 or greater. The most important concern is HurtÑthere must be good pain control. The score may be very low in the area of Mobility yet still be acceptable if the family is willing to provide the pet with attention, comfort and hygiene.

It is important to note that our profession has undervalued end-of-life care and pet loss communication. There is a wide variation from one clinic to another in how the public is treated during the pet's decline and during the difficult days of pet loss.

Some people have felt they were treated indifferently with poor communication when their pet was terminally ill or in for euthanasia. Mishandled communication alienates the client. But this crucial time, if handled properly, can fortify the client-clinic relationship.

There is a very helpful new grief management system available to hospitals. It offers helpful tools for doctors, practice managers, technicians and front office staff. Training materials and online expert support are written and managed by Cindy Adams, PhD., MSW, BSW, and Jane R. Shaw, DVM, PhD., who are well-known experts in communication and pet loss support. Adams and Shaw have lectured on these topics for the American Assn. of Human-Animal Bond Veterinarians in various national and international meetings.

The materials come in a tin box containing a training CD and manual, 20 client gift booklets titled, "Coping with Pet Loss," and 20 paw-in-heart pewter medallions, which attach to a card. The cards have a quote from the poet Emily Dickinson, "Unable are the loved to die, for love is immortality." The inside of the card is blank. The manual has suggestions for pet loss condolence messages to hand-write in the card. The back of the card tells the client to carry the medallion as a heartfelt memory and tangible connection to their beloved pet.

The Support System
The Console: Pet Loss Support System is a product of Bioniche Animal Health USA, Inc. The company's website is www.ConsolePetLoss.com and phone number is (888) 549-4503.

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Dr. Villalobos is president of the American Assn. of Human-Animal Bond Veterinarians and is on the editorial review board of the Society for Veterinary Medical Ethics. She may be contacted at dralicev@aol.com.

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