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Hospice and palliative care protocols (Proceedings)

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Oct 01, 2008

Over the past 10 years, the veterinary community has talked about hospice care but few tools were available to facilitate the efficient application of the philosophy for the veterinary practice.

A 5 Step Hospice Care Plan was developed by Dr. Tami Shearer to act a template so no part of pet's care would get overlooked. It acts as a check and balance system to insure all is being done for a gravel ill or dying pet. It places strong emphasis on the psychosocial concerns of the pet owner.

5- Step Hospice Plan

1. Evaluation of the pet owner's needs, beliefs, and goals for the pet.

2. Education about the disease process.

3. Development of a personalized plan for the pet and pet owner.

4. Application of hospice or palliative care techniques.

5. Emotional support during the care process and after the death of the pet.

In order for a protocol to be successful, the care delivered by the veterinary professional must be consistent with the beliefs of the pet owner. Investigation of these psychosocial concerns allows for proper development of a personalized program. Communication is a major part of the foundation that palliative and hospice care is built upon.

When designing a plan for an ill pet, it is important to consider whether the pet owner has desires for diagnostic testing to track the disease trajectory or to make treatment adjustments. The owner may also have a preference regarding where a pet spends its time. For example, some pet owners choose not to consider hospitalization but will opt for outpatient or home care for their pet.

As part of the protocol, it is important to become familiar with the disease process so that factual information can be shared with the pet owner about life expectancy, symptoms of the disease and common side effects. This knowledge allows the pet owner to be able to make better choices on the pet's behalf.

Development of a personalized plan for the pet and pet owner should take into consideration the earlier discussion about the family's beliefs and desires for the pet. In addition to managing the symptoms of disease, the plan should take into account the willingness of the pet to take medications and how the pet reacts to the stress of hospital visits.

It is important to treat all processes that interfere with quality of life. Appropriate drug therapy must take into consideration side effects and drug interactions. For example, veterinarians should treat a painful otitis even in a dying pet to prevent additional discomfort from the infection or inflammation.

It is worthwhile to review therapies that would be considered standard of care for the more commonly seen conditions like nausea, diarrhea, constipation and dyspnea. Creating handouts for clients outlining how to care for pets that exhibit these symptoms may be worthwhile. It is also important not to forget important nursing care tips like these:

Provide comfort with good pain management.

Tend to all secondary disease symptoms.

Provide clean soft bedding located in a comfortable area with access to social interaction with family.

Provide non-slip flooring.

Provide thermal comfort.

Prevent dry, sore mouth by use of a mouth moisturizer.

Prevent dry, sore eyes by the use of an eye lubricant or artificial tears.

Allow good access to palatable foods and fresh water.

Provide opportunities to urinate and defecate frequently, using assisted standing devices if needed.

Provide attention to satisfy the pet's emotional needs.

Avoid environmental dangers such as fly strike, heatstroke, and freezing.

Never restrict water.

When restraint is necessary, use conservative restraint to minimize breathing problems and pain from arthritis.

Keep pet clean around the genitals, rectum, feet, eyes, and mouth by using baby wipes or mild soap with luke warm water.

Provide hygiene aids including disposable pads, diapers, and hygiene panties.

Block off stairs to prevent falls and move furniture so that the pet does not get wedged between pieces.

Provide mobility aids, such as specially designed slings and carts.

A description of the dying process whether by natural causes or by euthanasia, should be shared with the pet owner based on the specific disease trajectory prior to the death of the pet. The amount of detail of events should be adjusted according to the pet owner's need to know.

An emotional support system for the owner should be implemented as soon as a terminal disease is diagnosed. This emotional support system might call upon the services of other professionals including human hospice medical advisors, ethicists, clergy, psychologists, social workers, and volunteers who have advanced training in human palliative and hospice care.

In the lecture, examples of the handouts used by Dr. Shearer will be reviewed that enables the veterinary staff to easily design a care plan for pet owners. Practices can personalize their own versions.

Following a five step protocol allows the veterinarian and staff to feel confident that no process of care is neglected and it actually frees time that can be spent building a relationship with the pet and pet owner.