Comfort over cure: How to implement palliative care into your practice

The term end-of-life care (EOLC) often brings to mind assisting pet owners in their decision to euthanize their pet and orchestrating a thoughtful and compassionate death for patients. And, while providing a peaceful euthanasia experience is vitally important, it is not the only service veterinary professionals can offer for patients at this stage. Veterinary palliative care and hospice care are important services that can greatly impact a pet’s quality of life, the bond they share with their family, and a family’s grief journey long after their pet has passed.  

“Veterinary palliative care has really made strides to benefit pets and their owners by validating comfort over cure, by including owners as partners in the decision-making process, by providing improved quality of life to pets at any stage of life, and by offering a spectrum of care which uses high-quality, evidence-based medicine to tailor care to that individual pet and owner,” said Karin Christopher, DVM, CHPV, International Association for Animal Hospice and Palliative Care (IAAHPC) president. 

However, there remains work to do. 

A mindset shift that really matters 

Palliative care is enormously helpful for many pets of advanced age. However, the field itself still lacks understanding to some degree. 

“We often talk about the ‘paradigm shift’ or ‘mindset shift’ that needs to occur to fully embrace the field of palliative and hospice care,” Christopher said. “This includes not needing to perform invasive diagnostics, not needing to diagnose the underlying problem, and not needing to cure.” Christopher added that although all of this is acceptable within palliative care, it is not required.  

This shift—and the expansion of EOLC beyond simply helping a patient on their final day—should not be relegated to EOLC specialists. General practitioners could more fully embrace the field of veterinary palliative and hospice care in a few ways.  

“Within general practice and emergency room settings, we would like to see more growth of this mindset and of the spectrum of care philosophy,” Christopher said. “Many veterinarians already practice this and just don’t know it.” 

Understanding palliative vs. hospice care 

While palliative care and hospice care share similarities, there are still distinct differences between the two.   

“Remember that palliative care is essentially comfort care that manages symptoms and can be offered at any stage of life, and in conjunction with curative treatments,” Christopher said. “The term ‘hospice’ is reserved for terminally ill pets that are within the last 6 months of their lives.”  

Any veterinarian, in any type of practice, has the ability to use hospice or palliative care to manage their patients, she said. “Find someone within your clinic or organization who is empathetic and good with communication, then utilize them as the point of contact to discuss this kind of care,” Christopher recommended. “Remember that empathetic connection and good communication often outweigh our medical decisions in the eyes of the client.”   

Putting the family front and center 

Regardless of whether a family and their pet are seeking hospice or palliative care, a family-centered care approach is an important element to understanding and implementing a sensitive, effective, and realistic EOLC plan for each pet patient and the family going through the difficult process themselves. In other words, pets and their families are a unit when it comes to EOLC.  

“Intentional recognition of the entire family as the patient is important,” Christopher explained. “Factors such as finances, physical abilities, time, beliefs, the type of bond, and past experiences can all affect care and decision-making, so one must consider the whole picture. More conversations and use of scales to assess quality-of-life and pain in pets would go a long way for better–and early–management within the clinic setting.” 

If you’re in general practice and do not yet have much experience with palliative care, Christopher offers several steps you can take to expand your offerings and provide better quality of life for pets in their end-of-life stage: 

1. Listen to what the client asks for or needs for their situation. Ask questions to better understand their goals and challenges. 
2. Be empathetic to the entire situation and family without judgment. Make sure your team understands the importance of this approach. 
3. Remember that people’s inability to care for their pets at our desired standard does not negate the amount of love that they have for them.   
4. Provide more time for palliative care discussions. Build this into your appointments to ensure you have the opportunity to provide information and answer questions. 
5. Offer quality-of-life and pain scales that clients may complete ahead of their appointment times to start the conversation.  
6. Get good histories on the home environment to see where improvements can be made to improve movement, ambulation, eating, drinking, etc. Videos from the client can be particularly helpful. There are often opportunities to discuss traction, ramps, raised/lowered food and water bowls, different bedding, etc., which can greatly improve quality-of-life.
7. Consider telehealth or teleadvice appointments to improve access for clients who are unable to move their pets due to size, pain, etc.
8. Use medication that is flavored and otherwise formulated to maximize ease of administration, including the use of compounded medications where needed.  
9. Provide client education in appointments, social media, and your website to help clients recognize signs of pain and early cognitive decline, understand the importance of weight management, and learn how to monitor quality of life. 

Looking for more resources? The 2016 AAHA/IAAHPC End of Life Care Guidelines is a great place to start. Additionally, Christopher recommends checking out the IAAHPC.org website, where the following can be found: 

• IAAHPC Hospice and Palliative Care Guidelines 

• Membership information 

• Certification Program information for veterinarians, technicians and advocates (CHPV, CHPT and CHPA) 

• Dates for the annual conferences that cover all aspects of animal hospice and palliative care   

• Animal hospice and palliative care research initiatives  

Photo credit: © Chalabala + via Getty Images Plus 

Disclaimer: The views expressed, and topics discussed, in any NEWStat column or article are intended to inform, educate, or entertain, and do not represent an official position by the American Animal Hospital Association (AAHA) or its Board of Directors.