August 15, 2006

 

 More veterinarians offer hospice care for pets - August 15, 2006

 

From pet hospice clinics to student-run programs, the veterinary profession continues to develop ways to care for terminally ill pets

posted August 1, 2006
 

Considering the rising popularity of the human-animal bond, it seems only natural that veterinarians are increasingly offering clients hospice care for their terminally ill pets.

While many veterinarians may already provide end-of-life care for pets, some veterinarians have taken steps to market hospice care to pet owners as a specific, comprehensive service. Some veterinarians have even established clinics devoted to hospice care.

The Pet Hospice and Education Center in Columbus, Ohio, serves as one example of the type of hospice care available to pet owners. Dr. Tami S. Shearer founded the center in 2003 after years of traveling to clients' homes to provide the service. The 1,200-square-foot facility sits adjacent to her companion animal hospital, Shearer Pet Hospital.

"I have offered pet hospice services probably for about 20 years and really didn't think of it as �hospice care,'" Dr. Shearer said. "I thought of it just as doing my job and just offering creative options for people."

The center is not used to house terminally ill pets. Instead, Dr. Shearer and her hospice team of two registered veterinary technicians and two veterinary assistants use the facility for consultation services and to teach clients to care for their pets while at home. Clients may also bring their pets into the facility for treatment.

Dr. Shearer developed a five-step hospice protocol to improve her ability to share information with pet owners and to teach other veterinarians expanded care ideas for terminally ill pets. The five-step strategy is as follows: evaluation of the pet owner's needs, beliefs, and goals for the pet; education about the disease process, aging, and pain management; development of a personalized plan for the pet and pet owner; application of hospice care techniques; and emotional support during and after the process. An offsite psychologist and volunteer social workers help Dr. Shearer with the last step.

"As a profession, we need to offer these types of services because I think that the pet owners are looking for it," Dr. Shearer said.

The center became a nonprofit organization in 2004. Dr. Shearer said she would like to offer clients the option of hospice care even when they can't afford it.

"My long-term vision was, and still is, that no one should have to euthanize their pet because they can't afford palliative care," she said.

Pawspice: An End-of-Life Care Clinic, based at the Crossroads Animal and Referral Center in Norwalk, Calif., also offers hospice care for terminally ill pets. Dr. Alice E. Villalobos established the clinic in June. The clinic focuses on teaching pet owners how to care for their terminally pets at home. For certain procedures, however, Dr. Villalobos said she has patients brought to the clinic where medical equipment is readily available.

"We decided to open the Pawspice clinic because we wanted to establish this as a real service to pet owners," said Dr. Villalobos, who also serves as the 2005-2006 president of the American Association of Human-Animal Bond Veterinarians.

"People love their animals, and when their pet is diagnosed with a terminal illness, they're not ready to immediately euthanize that pet," she said. "They want to say goodbye, they want to take their time, and they're demanding we give them that time—with quality."

Dr. Villalobos said that Pawspice does not suggest that pet owners should not euthanize their pets, but rather, educates and prepares family members for a peaceful, painless death for their pets. She developed a scale for pet owners and veterinarians to help them determine the quality of life of terminally ill pets. If the pet owners and the veterinary staff can meet the basic desires at a satisfactory level, she said, there is justification for preserving the lives of the pets. The basic desires rated on the scale are hurt, hunger, hydration, hygiene, happiness, mobility, and more good days than bad days.

"Between the time of diagnosis and death, we can stretch that out many times with a wonderful quality of life if we give the pet pain management that is really going to be effective to help (it) feel good—not better, but good," Dr. Villalobos said. She encouraged veterinarians to recruit attending colleagues who will target medical support, palliation, and pain management that can create and sustain a good quality of life for terminally ill pets.

In addition to veterinarians, a group of about 30 veterinary students at the Colorado State University College of Veterinary Medicine and Biomedical Sciences offers hospice care for pets through a program called CSU Pet Hospice. The students voluntarily participate in the program and travel to the homes of terminally ill pets to provide care and offer support for the grieving pet owners. The program was established in 2003 and is associated with the Argus Institute for Families and Veterinary Medicine.

"The goal of CSU Pet Hospice is to provide a positive end-of-life experience in a comfortable setting," said Kelly Carlsten, a second-year student who serves as co-manager of the program.

All animals involved with the CSU program have a relationship with a CSU veterinarian, or a referring veterinarian in the community, and have been given a diagnosis of a terminal condition. The relationship with the referring veterinarian ensures that the animal receives adequate veterinary care, and the student volunteers can serve as a liaison between the client and veterinarian. Carlsten said the updates make it easier for veterinarians to monitor their terminally ill patients without numerous stressful visits to a veterinary clinic. A counselor at the Argus Institute and a faculty veterinarian train the student volunteers on dealing with client grief.

Overall, the program has provided care to 26 pets, including 12 so far in 2006.

"The majority of the patients we are involved with are cancer patients because of the location of the Cancer Center at CSU," Carlsten said. "Our services have always been free, but recently we have created an animal care fund for Pet Hospice clients who are financially unable to provide end-of-life care for their animal."

The program gives veterinary students a unique opportunity to become more comfortable with caring for terminally ill pets and working with pet owners.

"The experience is more intimate and has enhanced my understanding of the depth of the human-animal bond," Carlsten said. "It has helped me realize that as companion animals continue to play a more significant role in people's lives, veterinary care must become more compassionate and personalized."

While the popularity of veterinary hospice care grows, a nonprofit organization called the Nikki Hospice Foundation for Pets has worked since 1998 to promote the service to pet owners and veterinarians.

Based in Vallejo, Calif., the foundation's activities include assisting pet owners in locating veterinarians who already offer hospice care, disseminating information on hospice care to the veterinary profession, and developing standards for veterinary hospice care and effective pharmacologic protocols for end-of-life signs, as well as many other activities.

Kathryn D. Marocchino, president and founder of the foundation, said the veterinary hospice care movement is primarily driven by the public's demand. So far, the foundation has received favorable responses from pet owners who opted for the service.

"Those who have taken the journey and gone through this experience with their animals," she said, "really provide us with absolutely glowing testimonials of how important it was for both them and the animal and what a tremendously rewarding experience they felt it was."

To help educate veterinarians about hospice care, the Nikki Hospice Foundation plans to host the first international symposium on veterinary hospice care in 2007. Meanwhile, veterinarians can learn more about the concept by calling the foundation at (707) 557-8595 or visiting www.pethospice.org.

In addition, information for veterinarians is available in the AVMA Guidelines for Veterinary Hospice Care, which were established in 2001. To order a copy of the guidelines, contact the AVMA at (800) 248-2862, Ext. 6655.

While recognizing that many veterinarians are only beginning to hear about hospice care for pets, Marocchino remains confident the concept will continue to grow in popularity. "What we would like to see—and I think that this will happen—is veterinary hospice care to become a household word," she said. "Just like the human hospice care program, it's going to become very much the norm."

The AVMA Guidelines
for Veterinary Hospice
Care can be ordered
online at
www.avma.org/products/
hab/hospice.asp
.