Veterinary hospice care guidelines (Proceedings)


Veterinary hospice care guidelines (Proceedings)

Aug 01, 2011

Many of the hospice and palliative care principles that have been successfully adopted in human hospice for decades are now being embraced to provide end of life care for terminal pets and their families by veterinary professionals. Steve Miles, M.D. said, "Death is not a medical event. It is a personal and family story of profound choices, of momentous words and telling silences." While death has remained a constant over the course of history the process of dying has changed for humans as well as companion animals. Medical advances have changed death, frequently, from a sudden event into an often long journey with many events. We have increased the lifespan of our pets, created complex medical choices and shaped a new population of pets with chronic illnesses.

End of life care is 'patient centered' medicine and, some postulate, should be, at the very least, offered for those who have a limited life expectancy. The term palliative care is frequently used when discussing end of life care. The word 'palliative' means to abate or reduce the intensity. The concept of palliative care is based on the provision of comfort and relief. Palliative care is care of the 'whole patient'. This includes the body, mind, heart and spirit. The goal of palliative care is to make life the best it can be when individuals are living with declining health. Palliative care can be delivered in the absence of hospice care, but hospice care is not delivered in the absence of palliative care. Having euthanasia as an option has assured those in veterinary medicine that the vow they take to not allow animal suffering is somewhat guaranteed. Therefore, hospice care is a paradigm shift for many in veterinary medicine. The emergence of veterinary hospice and palliative care is being explored as a comprehensive healthcare option delivered by cohesive veterinary teams trained in end of life care to bring comfort, dignity and choice to terminal pets and their families. As an example, newer chemotherapy options have allowed pets to live much longer than in the past. But, not all families want to pursue treatment for disease, or they've sought treatment and now the pet is out of remission, or, perhaps finances or personal beliefs are preventing a family from pursuing treatment. Hospice care is not emergent care. Many pets coming into hospice care are pets that have had chronic health issues and are now at a time where curative measures are no longer seen as an option. It is the hope of the trained veterinary hospice team to help their patients live quality lives to the fullest while supporting the family that loves them for whatever time they have left. The following is standard hospice criteria to determine if this type of care is an appropriate option:
     › A poor prognosis has been given and treatment is not being pursued
     › Treatment has been pursued, but the patient is now out of remission and is not expected to recover
     › The patient has a 6 months or less prognosis
     › Euthanasia is being offered as an option, but the patient is not emergent

Medical conditions that benefit from hospice care

Not surprisingly, cancer is the most common condition seen in end of life and palliative care. Cancers such as Osteosarcoma, Mast Cell, Lymphoma and genitourinary tumors are but a few of the conditions that potentially have a wide range of palliative care options that may be offered to a family exploring end of life care. Renal failure, Cardiac failure and CNS conditions such as brain tumors and spinal cord tumors may also be good candidates for end of life care. Other conditions, such as FCE, neuropathies and polyneuropathies that may not be terminal but, hospice care may provide benefit to the family and pet by providing supportive home care to afford them the time to make further decisions regarding euthanasia or management are certainly to be considered in this type of care.