"What Would You Do?": How Cat Owners Make End-of-Life Decisions and Implications for Veterinary-Client Interactions

Handling End-of-Life Situations in Small Animal Practice: What Strategies do Veterinarians Contemplate During their Decision-Making Process?

This study researched end-of-life (EoL) decision-making processes in small animal practices in the Netherlands, focusing on strategies veterinarians contemplate during this process. Fourteen veterinarians were interviewed about animal end-of-life decision-making. The results of these interviews show that the decision-making process consists of three steps. The first step is to assess the animal's health and welfare. During the second step, veterinarians consider the position of the owner. Based on steps 1 and 2, veterinarians decide in step 3 whether their advice is to a) euthanize or b) contemplate one or more strategies to come to a decision or potentially alter the decision. These results can support members of the veterinary profession to reflect on their decision-making process. If veterinarians know what strategies their peers use to deal with EoL situations, this can help to reduce the stress they experience in such situations. In addition, veterinarians may find inspiration for new strategies in the study results. For the veterinary profession itself, the current results can be used as a starting point for describing best practices for EoL decision-making in small animal practice.

Euthanasia of dogs and cats by veterinarians in New Zealand: protocols, procedures and experiences

AIMS

To collect data on protocols used by New Zealand veterinarians to perform euthanasia of dogs and cats, and to explore opinions towards the training they received in euthanasia during veterinary school.

METHODS

A cross-sectional survey was administered to all veterinarians registered with the Veterinary Council of New Zealand. The survey asked respondents about their practices' policies for euthanasia; protocols for performing euthanasia of dogs and cats; opinions towards euthanasia training received in veterinary school; and subsequent experiences with euthanasia in practice. Descriptive statistics were provided for all quantitative study variables and thematic analysis was performed on the free-text comments.

RESULTS

The survey was completed by 361/1,448 (24.9%) veterinarians in companion or mixed animal practice. The mean number of dogs and cats euthanised each month were 7.2 (median 5; min 0; max 60) and 7.9 (median 5; min 0; max 60), respectively. Fewer than half of respondents reported that their clinic had a standard protocol for euthanising dogs (147/361; 40.7%) and cats (157/361; 43.5%). For euthanasia of dogs, 119/361 (32.9%) always used sedation while 71/361 (19.7%) indicated that they would not use sedation. For euthanasia of cats, 170/361 (47.1%) always used sedation while 53/361 (14.7%) indicated that they would not use sedation. Placement of IV catheters, methods for patient restraint, preferences towards the presence of owners during euthanasia, services provided with euthanasia, and discussions with owners were also highly variable and handled case-by-case depending on the client, patient, and clinical scenario. When asked about the euthanasia training received at veterinary school, it was generally ranked as below satisfactory, with approximately one third of respondents indicating that they received no training in dealing with emotional clients (113/361; 31.3%), sedation protocols for euthanasia (107/361; 29.6%), or managing compassion fatigue (132/361; 36.6%). Most respondents (268/361; 74.2%) received no formal training in euthanasia after graduation and learned from experience or discussions with colleagues. Providing animals and owners with a good experience during the euthanasia process was highlighted as important for managing compassion fatigue.

CONCLUSIONS

Euthanasia is a common procedure in companion animal practice and there is considerable variation in how veterinarians approach both the technical and non-technical elements. Training provided during veterinary school was generally considered below satisfactory, particularly regarding managing compassion fatigue and clients' emotional needs.

CLINICAL RELEVANCE

Providing veterinarians with additional training on adapting their euthanasia protocols to different clinical scenarios may improve the experience for patients, owners and veterinary staff.

The views of farm animal veterinarians about their roles and responsibilities associated with on-farm end-of-life situations

Farm animal veterinarians are often involved in on-farm end-of-life (EoL) decisions and questions concerning euthanasia. These decisions can be challenging for the veterinarian, particularly if the interests of the animal and owner conflict. Moreover, the challenge is related to fundamental assumptions about roles and responsibilities veterinarians ascribe to themselves in EoL situations. Getting insight into what roles and responsibilities veterinarians perceive in these situations is important to understand the challenges veterinarians face and to explore ways to enable them to manage such situations. Existing literature and professional guidelines do not provide sufficient clarity and guidance in terms of the role conception and responsibilities of veterinarians in on-farm EoL situations. The objective of the current qualitative study was to better understand the views of farm animal veterinarians in the Netherlands regarding their roles and responsibilities associated with on-farm EoL situations. In-depth semi-structured interviews were conducted with 19 farm animal veterinarians. In terms of roles in EoL situations, our analysis shows that 1) seven roles can be distinguished based on the interviews, 2) two contextual dimensions influence role perception: a) the stage in which a veterinarian gets involved at the end of an animal’s life and b) the question of whose interests should be taken into consideration and how to prioritize (conflicting) interests by a veterinarian, 3) veterinarians enact a number of the identified roles and the combination of roles varies between individuals and 4) the individual veterinarian changes between roles depending on contextual aspects. In terms of responsibilities in EoL situations, analyses show that 1) individual veterinarians perceive a combination of five identified responsibilities, and 2) the perception of responsibilities relates predominantly to specific animal sectors. This insight into the roles and responsibility perceptions of veterinarians facilitates understanding the challenges veterinarians face in on-farm EoL situations and creates a starting point for how veterinarians can be supported to deal with potential conflicts of interest. These insights could also be valuable in the training of future veterinarians and lifelong learning of veterinarians as it provides a starting point to reflect on, and discuss, one’s role and responsibility in EoL situations.

Using electronic health records to explore negotiations around euthanasia decision making for dogs and cats in the UK

BACKGROUND

End-of-life decision making for animals happens daily in veterinary practice. However, access to such discussions as they happen is difficult, in view of the highly emotional circumstances of end-of-life consultations. Despite the expanding literature on euthanasia, few studies have explored the circumstances of euthanasia disagreement or delay.

METHODS

To explore euthanasia discussions in veterinary practice, consultations recorded in electronic health records in a UK veterinary surveillance database (SAVSNET) were examined. From a sample of 2000 identified consultations, 69 canine and 76 feline consultations were purposively sampled for detailed thematic analysis. Specifically, consultations were selected if they involved a decision to delay euthanasia, including disagreement about the timing of euthanasia.

RESULTS

Reasons identified for euthanasia refusal or delay included client-related factors (e.g., allowing other family members to say goodbye, differing opinions on the quality of life) and veterinary surgeon-related factors (eg, the wish to carry out further investigations or to try a new treatment). In the instance of refusal or delay, palliative treatment was commonly provided to preserve animal welfare.

CONCLUSION

This study illustrates some of the processes used to negotiate end-of-life decision making in dogs and cats. Its findings shed light on the importance of palliative care in providing owners with time to decide.