Palliative care and hospice have become an important part of end-of-life care in human medicine and they are becoming more important and common in veterinary medicine.
The National Hospice and Palliative Care Organization (NHPCO) describes palliative care as "treatment that enhances comfort and improves the quality of an individual's life during the last phase of life."
Likewise, the NHPCO defines hospice as "support and care for persons in the last phases of an incurable disease so that they may live as fully and as comfortably as possible."
These definitions are simple and straightforward when it comes to offering guidance for palliative care and hospice for pets approaching the end of their lives.
Hospice is a philosophy of care that respects and values the dignity of the individual. It offers a context within which we may provide medical and non-medical supportive care. Hospice provides a roadmap toward the end of life that can be tailored to meet the needs of the individual pet and family. It involves a unique partnership between the family and the veterinary healthcare team that places the pet at the center of the caregiving circle. Palliative and hospice care is a developing field in veterinary medicine, with organizations such as World Veterinary Palliative Medicine Organization providing training and support for the veterinary team.
"Hospice is a philosophy of care that respects and values the dignity of the individual."
Palliative care is an extension of hospice and is typically begun earlier in the disease process, when treatment can still help to alleviate symptoms and enhance quality of life. The goal of pet palliative care and hospice is to provide the pet with the opportunity to live until he or she dies, maximizing comfort and quality of life until the time when euthanasia becomes the best and most humane option, or the pet dies peacefully before that time arrives.
What are some examples of palliative care?
Palliative care for pets takes many forms. The cornerstones of palliative care include a thorough diagnosis to deal effectively with all a pet's issues, as well as pain management to maximize comfort. One example of palliative care is the support that can be offered to a pet with chronic kidney disease whose kidney failure is progressing and for which the pet can no longer compensate.
Hospitalization for aggressive intravenous fluid therapy may be inappropriate in this situation because the outcome cannot be changed and time in the hospital would be time taken away from the pet spending time with the family.
Fluids delivered under the skin at home by a family member can often serve as a relatively simple, non-invasive way to sustain whatever kidney function remains. In addition to fluids, a family member may give antacids, anti-nausea medication, and kidney-support to maintain overall comfort until quality of life begins to deteriorate.
Does palliative care entail anything other than giving medication?
Palliative care can be as easy or complex as necessary to meet the needs of the pet and human family. Some palliative care patients benefit from massage, therapeutic laser, temperature therapy (heating or cooling devices), acupuncture, chiropractic, and physical rehabilitation techniques. For more information about these therapies, see the handouts "Veterinary Acupuncture," "Therapeutic Massage," "Therapeutic Laser," "Veterinary Chiropractic Care," and "Veterinary Rehabilitation Medicine".
It is impossible to create a standard palliative care plan that benefits every pet. Instead, it is useful to consider what a pet requires to feel as well as possible, despite ongoing medical issues contributing to the end-of-life process.
The key is to work closely with your veterinarian to identify those problems that may compromise your pet's quality of life. Dr. Alice Villalobos, a veterinary oncologist, has created a quality-of-life scale that provides a somewhat objective method for evaluating the very subjective experience of day-to-day living. The quality-of-life scale is designed to be used at home for periodic re-evaluation and to help guide discussions with your veterinarian. See the handouts "Quality of Life at the End of Life for Your Dog" and "Quality of Life at the End of Life for Your Cat" for a description of this scale.
When does palliative care become hospice care for pets?
"Palliative care" and "hospice" are often used interchangeably when discussing end-of-life care for pets. Veterinarians are fortunate in that they can release their patients from unmanageable suffering with the gift of humane euthanasia.
The model of hospice in human medicine involves companioning the dying person until his or her life ends. For animals, however, we recognize that we do not need to allow them to endure pain and discomfort to death. We have the opportunity, obligation, and responsibility to use palliative care techniques to allow pets to live until they die, and when living becomes unbearable, to provide them with a peaceful, pain-free passage from this life.
In palliative care, we stop trying to cure disease and shift our focus to managing symptoms. It is a model for care that focuses on day-to-day happiness and interaction.
Palliative care employs multiple techniques to maximize comfort and quality of life until it's no longer possible. It creates a bridge of care to support a pet as the time for humane euthanasia approaches. It is not a substitute for euthanasia, but it often helps us to delay euthanasia, allowing our pets to remain with us for whatever quality time remains for them.