RATIONALE FOR FELINE PAWSPICE CARE

Tenacious cat lovers have generated an increasing demand to spend the last days with their ailing terminal cats at home, preferring to await the inevitable loss patiently and peacefully. The hospice movement was started by the nursing profession to help people die peacefully and painlessly at home with their families and friends. Hospice is about care when cure is not feasible and it serves as a model for veterinary medicine. Veterinarians can lead the hospice movement conscientiously for pets across America by adopting the hospice philosophy into their practices. When a family can not accept early euthanasia or treatment that has little hope for success, Pawspice becomes a very helpful option. Providing palliative and comfort care for cats, when needed or requested, honors the human-animal bond during the difficult days approaching death. The Pawspice philosophy allows all involved to have quality time to cherish their relationship during an extended farewell.

When a beloved cat has an incurable or terminal condition, many families will, if given the option, choose to provide Pawspice care at home. Surveys have shown that veterinarians underestimate their clientele’s needs and wants frequently. How much care are pet owners willing to provide for their beloved ailing cats? For some pet owners, the willingness to care for their cat may have no limits. It is not unusual for clients to change their approach. They might be interested initially in participating in a treatment protocol, but after their cat encounters adverse events, they might decline further treatment and opt for Pawspice care or vice versa.

Entering terminally ill cats into Pawspice programs offers pet owners a buoy. It provides supportive, palliative options for complete care and attention to their cat’s special needs as cachexia, dehydration, anorexia, pain, and lethargy pull the patient downstream toward death.

DISMISSED CLIENTS GO ELSEWHERE

The economic downturn, foreclosures, increased prices for gasoline, oil, and commodities have put a financial squeeze on the middle class. Many Americans will be forced to streamline expenses, including pet care. If a cat’s illness can not be treated because of financial constraints or a logistical problem, that case should not be dismissed.

It is, and will always be, good medicine to provide medical advice compassionately with meticulous home-care instructions to maintain quality of life for that patient. If a cat’s kidneys or heart are in failure; if a previously treated cancer has recurred, metastasized, or has become resistant to treatment; or if a cat was diagnosed in the terminal stages of cancer or diabetes mellitus, in-home hospice care is a wonderful next step that keeps family and cat comfortably in their nest. Offering pet owners a well thought-out, creative, palliative Pawspice plan may be the very best medicine that veterinarians can offer a dying cat to honor the human-feline bond.

Each pet family has their own belief system, personal life style, and tolerance level. They will weigh issues such as their personal finances, the logistics of getting to and from the treatment center, and scheduling for visits and home care requirements. Typically, family members deal with feelings of guilt, sense of duty, and remorse as their cat encounters problems along the bumpy path toward death.

Declining treatment is an emotionally difficult decision for highly bonded caretakers to make. Many old cats have concurrent medical conditions that appeared in their senior years and these conditions can be expected to worsen with time. They also can be expected to complicate treatment of a terminal illness. For example, one third of the pet cat population is overweight and/or obese. When obese cats become burdened with terminal illness and related treatment issues, they are at risk for development of hepatic lipidosis. Studies have shown that having more than one preexisting disorder such as heart disease, chronic kidney disease, or hyperthyroidism, in addition to cancer, is associated with shortened patient survival times.⁷ It is important to keep these factors in mind when recommending aggressive definitive therapy for cats with concurrent disease.

Decision-making for cats can be frustrating. Some procedures such as surgical removal of a large vaccine-associated sarcoma or ear ablation or mandibulectomy for squamous cell carcinoma may seem straightforward. However, the prognosis for surgery alone may be poor without follow-up radiation therapy.^8–11 If the cat’s prognosis does not yield enough survival time to satisfy the owners, they can not justify the emotional or financial costs. Occasionally clients are regretful but willing to sacrifice their cat’s quality of life rather than elect amputation of a limb. Some pet owners have the honest yet teleological feeling that amputation is mutilation and not fair to the cat. Instead, they allow their cat to bear a painful limb for months before euthanasia. It is the attending veterinarian’s ethical duty to oversee pain control for patients like these.

When a family declines the ideal treatment plan, the battle should not be over. When a pet owner asks if there is another, less risky and/or less costly option, the veterinarian must offer the option of Pawspice wholeheartedly. When this is not presented as an option, some clients will sneak away from the hospital and pursue alternative treatments without the doctor’s knowledge or guidance. They may not want to hurt their family veterinarian’s feelings. They may be embarrassed or think that their veterinarian will be angry with them or disapprove.

If the attending veterinarian refrains from being judgmental and continues to offer options that may be more palatable for the family to accept, the client will remain faithful to the practice. Adjusting options toward maintaining quality of life and providing comfort care is better than no care at all. By creating a protocol for supportive care, Pawspice becomes a very acceptable option for clients who otherwise would seek help for their cats elsewhere.

BARRIERS TO PROVIDING PAWSPICE CARE

Change is not easy, yet change we must. A number of barriers may prevent a practice from moving into providing Pawspice services for their clients’ dying pets. Personnel and staffing problems would be at the top of most veterinarians’ lists of challenges. Finding a way to associate the special Pawspice services rendered with a fee structure is second.

Dedicated people are essential to help the practice offer an effective Pawspice service. Extra training in client communications, attachment theory, and grief management would be a minimum requirement for staff participants. Other barriers to establishing a Pawspice would be low staff morale, a rushed atmosphere, and a lack of willingness and patience. The Pawspice staff needs to be willing and able to visit client homes to minister to the ailing pet and comfort sad people effectively. If the general practice does not provide for Pawspice house calls, then referral to a house call doctor would be appropriate and much appreciated by many families.

It is somewhat difficult to charge for “high touch” services including the phone consultations and home visits. However, there is a steady demand for end-of-life services. One must realize that cat clients expect and are willing to pay for specialty Pawspice services. Create a special Pawspice fee schedule that includes fees for continuous and repetitive care and for extended consultations or home visits by a nursing staff or the doctor. Charging clients professional fees for end-of-life care services should parallel the practice’s normal, established fees, which generally are based on time and services rendered. Some practices are making the noble attempt to have a nonprofit organization to fund pet hospice services. This endeavor may place an unnecessary workload on the staff and constitute a barrier toward offering end-of-life services.

The paperwork and consent forms for Pawspice patients also may become a barrier. If a cat has a poor prognosis and the family desires therapy that is not expected to help, it is appropriate to document the situation in the medical chart. Read the phrases out loud for clarification and then ask the client to initial or sign the statement with the date and time. This process of informed consent will prevent most of the common misunderstandings and keeps everyone on the same page during therapy.

HOW DOES ONE START?

First of all, step away from suggesting utilitarian, premature euthanasia as an option when a feline friend is diagnosed with a potentially terminal disease. Cat lovers present their sick cats to veterinarians seeking help. Many pet owners are offended by the “knee jerk” suggestion of euthanasia for their sick or elderly cat. Society wants something between cure versus kill. They are really seeking and deserve compassionate care and expertise in end-of-life issues.

A good working definition of euthanasia is, “The act or method of causing a painless and peaceful death, so as to end suffering: to deal with those dying of incurable, painful diseases.” It is crucial to refrain from suggesting or insisting on euthanasia if the client declines definitive or ideal therapy for their cat. Clients come to veterinarians for advice. Clients do not expect nor do they want veterinarians to euthanize their terminally ill cat prematurely without exhausting reasonable options. Offer the client more resourceful options. Inform clients that pain relief and a good quality of life are paramount. Start with pain relief and comfort care. This gives the family more choice and time to do their own research so they can make an informed decision regarding therapy that will satisfy their particular situation. Clients may feel that the recommended ideal procedures must be pursued as an “all-or-none” option. Other clients may be confused because their cat’s overall prognosis was poor regardless of which therapy was elected. Veterinarians may say that the cat is in pain, yet the cat may be discharged without adequate pain control or supportive home care recommendations. It is important for veterinarians to know that many cat owners feel dismissed, abandoned, unsupported, and disappointed at this juncture because of lack of care when they need care most. Offering Pawspice care will certainly help to keep our profession more heartfelt, cherished, and celebrated in the eyes of the public. Caring for the feline species’ unique needs requires a special form of medical finesse that is greatly needed and appreciated by those who love their cats.¹²

Once the practice is comfortable with the philosophy behind Pawspice, start booking appointments to explain and teach Pawspice care. Through examination room consultations, veterinarians and nursing staff can gracefully and kindly provide the education and support needed for the efficient home-care of ailing cats on a fee-for-service basis. Pet owners will gladly pay for the education that facilitates the control of pain and the art of providing good nutritional and hydration support for their pet. These consultation and demonstration sessions give clients the ability to care for their terminal feline friends with expertise. Daily, weekly, or monthly rechecks and home-care are essential for monitoring and fine-tuning care of the Pawspice patient.

Finally, delete the use of insensitive terms such as “disposal” on all hospital release forms, euthanasia forms, and invoices. Revise the terms for this service with more sensitivity. Clients feel insulted with the literal translation that their deceased cat’s body will be disposed of. If the forms in your hospital contain this offensive terminology, be sure to cross it out. Use words such as “making arrangements” for private cremation, group cremation, or burial.

VALIDATE “THE BOND”

Each member of the veterinary team must be helpful, kind, and respectful during Pawspice. It is essential for staff members to acquire good communication skills to properly counsel and comfort the emotions of the clients to help them face the final days with their feline best friend. Front desk staff, room attendants, and nurses should be informed to be especially considerate and accommodating to Pawspice clients. Their behavior should be focused to help support the emotional needs of sensitive clients who must say goodbye to their highly bonded pet. Staff members can play an important role to uplift the emotions of sad cat owners by validating their special bond with a few words of empathy such as, “We know that you share a special bond with Fluffy and that you love Fluffy very much.”