The beginning of the end

A growing number of Australian vets are providing end-of-life services to help clients through the difficult decisions and emotional distress associated with caring for sick and ageing pets. By Angela Tufvesson

Pets are living longer and better than ever before thanks to more effective medical care, improved safety provisions like keeping cats indoors, and an understanding that eating well and exercising regularly is just as important for animals as it is for owners.

But because humans continue to outlive most mammals, the death of a furry friend is inevitable for most clients. And just like the death of a close relative, the death of a pet can be an emotional and troubling time, with research revealing that even though most clients are satisfied with the care of their vet, as many as 14 per cent don’t return to the same practice with subsequent pets.

So what can vets do to help clients manage grief and retain their custom? An emerging field known as ‘end of life’ care is helping vets deliver specialised services to elderly pets and pets with serious illnesses.

An emerging field

Veterinarian Dr Emma Whiston runs My Best Friend, a dedicated end-of-life practice in Melbourne that offers palliative care, hospice care and home euthanasia services. “Pain management and quality of life are the cornerstones of end-of-life care,” she says. “It’s about managing the symptoms of the disease without curing the disease.

All veterinarians do palliative care, but the specialised service has really come up in the last few years.”

Indeed, the International Association for Animal Hospice and Palliative Care —a global body dedicated to promoting knowledge and guidelines for comfort-oriented care to pets approaching end of life—is just seven years’ old.

Dr Jackie Campbell is the founder of Queensland-based Sunset Home Veterinary Care, which specialises in palliative care, home euthanasia and grief counselling. Dr Campbell says the practice has grown rapidly in the last  12 months.

“A lot of clients are saying they just weren’t getting the direction they needed for longer care,” she says. “They’re told, ‘This is it, there’s not much more we can do for you and the next step is euthanasia’. For me palliative care is the phase in between those two conversations.

“The demand in the veterinary industry is coming from people who are seeing it in the human world and wanting it for their pets,” says Dr Campbell.

“Plus, vets are doing such a good job with preventative care. We’re managing our pets very well in routine practice and there’s a growing population of elderly pets that need more care.”

“Pain management and quality of life are the cornerstones of end-of-life care. It’s about managing the symptoms of the disease without curing the disease.”—Dr Emma Whiston, owner, My Best Friend vet practice

Many clients experience intense grief after the loss of a pet, with some research finding that up to 30 per cent of owners work through grief that lasts six months or longer and 12 per cent suffer from severe grief.

Dr Campbell says clients who are well supported by their veterinary team throughout the end-of-life phase will experience less grief and recover quicker than those who don’t. “There’s so much we can do medication-wise and treatment-wise, and having clients who are well prepared for the process of the euthanasia decision is really important for managing their grief, which ultimately results in a quicker recovery time for them coming back into the practice with the next pet,” she says.

Dr Whiston agrees: “The way we help clients before, during and after the death of their pet directly affects their relationship with the practice going forward. If we don’t take enough care and put in the time, it can really make a difference as our actions impact on clients’ grief. Some research shows that up to 15 per cent of people refrain from adopting other pets after a death because it’s  too painful.”

In practice

Dr Campbell and Dr Whiston offer only mobile services and in-home consultations. “It’s better as a mobile service because most animals are blind or have severe arthritis so mobility is an issue, and there’s often anxiety about the clinic or car trip,” says Dr Whiston. “Plus, it’s easier to make assessments and recommendations when you can see the animal in their own home.”

That said, Dr Campbell says it is possible for end-of-life care to be incorporated into the suite of services offered by bricks-and-mortar vets. “We are mobile, but I absolutely think clinics should be starting to offer palliative-care services within the clinic,” she says. “If you start to advertise that you offer palliative-care services, people will ask for it—it’s a new revenue stream.”

When it comes to the specifics of client management during end of life care, discussions about euthanasia can be the most difficult. Dr Campbell says vets often need to be proactive about starting conversations about euthanasia. “It’s very hard for a lot of clients to verbalise that they’re in the head space of wanting to talk about euthanasia, so if the vet is able to do that, it makes things a whole lot easier. It doesn’t accelerate the timeframe that we’re working with—it just allows people to have slightly less reservation and hesitation about talking to us about it.”

What’s more, she says contrary to popular belief most clients don’t know when the time has come to make a final decision about euthanasia. “The reality is a lot of people don’t know when it’s time—they really have no idea what that phrase means,” says Dr Campbell.

“[It’s about getting] away from expecting clients to know when it’s time and having a plan for how you help them work through what their values are and what’s ultimately important to them at the end. Do they want to preserve life for as long as possible or is quality more important to them?” Quality of life assessment tools measuring pain, appetite, demeanour and mobility can help clients work through these questions. “Not everything needs to be covered in one sitting,” says Dr Campbell. “And using well-trained nurses and support staff is both smart and effective for a practice.”

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