Setting up a hospice and palliative care service in a small-animal practice (Proceedings)
As the human population ages and has more personal exposure to palliative and hospice care, pet owners are aware that there are benefits to having those services available for pets too. Pet owners are requesting palliative and hospice care services for their pets.
The term hospice comes from the Latin word hospitium, which means to host. Hospice is defined as a facility or program designed to provide a caring environment for supplying the physical and emotional needs of the terminally ill. The term palliate comes from the Latin word palliare, which means to cloak or conceal. Palliative care is focused on the relief of suffering to achieve the best quality of life regardless of the disease outcome. Palliative care is not hospice care, but the services may overlap during the approach of death.
The American Veterinary Medical Association recognizes hospice care and has guidelines that support the practice of good veterinary medicine. A copy of the guidelines can be obtained from the AVMA.A human study of 122 caretakers showed that a lack of preparedness when a person was dying resulted in a prolonged grieving period of more than 9 months, with major depression. Because of the strong bond between some people and their pets, it is reasonable to assume that similar data may apply to the loss of a pet thus highlighting the need for palliative and hospice care for pet owners.
The following information should help any veterinarian utilize the philosophy of palliative and hospice care and perform an added service.
The first step in offering palliative or hospice care is to define what services a veterinarian will provide and what services that will be referred. For example, palliative care for mammary carcinoma where there is a large ulcerated mass may include a surgical intervention to remove the lesion to improve quality of life even though cure is not intended would require a full service hospital to provide proper care. However, when offering consultations on care, one could offer advice on the surgical palliation and refer out to a clinic. The later would require a small office or even be done on a house call basis.
It is recommended to reserve a special place in the hospital to provide palliative care or hospice consultations. Hospitals with limited space should consider doing a hallway conversion, exam room face lift, lease a small office space, or convert a storage room. House calls also provide another means to deliver the service to pet owners.
Maybe more important than where the services are provided is making sure they are delivered in a proper environment where there is comfortable temperature for the pets, it is comfortable for pet owners, there is a quiet environment with a minimum of noise distractions, and there should be few if any interruptions and seating available for all of the family members.
Besides what a general practice already has, special supplies that need to be available include but are not limited to:
Ample supply of clean, soft bedding
Disposable under pads, diapers
Assistive mobility devices-slings
Once the space and the environment are prepared then patients can receive care. Dr. Shearer developed the 5 Step Hospice Care Plan for the non-profit Pet Hospice and Education Center. It serves as a template to structure the pet and pet owner's care needs.
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 summary, most veterinarians can apply hospice care techniques since the foundation of care is based on a philosophy of care that can be utilized in most environments.