Hospice and Palliative Care for Companion Animals Principles and Practice

A thoroughly updated and expanded new edition of the only book providing comprehensive treatment of hospice and palliative care in veterinary medicine

Animals with life-limiting illnesses deserve compassionate, thoughtful, end-of-life care. Their caregivers and families, faced with the loss of a beloved companion, deserve empathy, support, and education, to guide them through an emotionally wrenching period and provide their companion animals with the highest possible quality of life. In recent years, the ethics of care and service to sick and dying animals and their caregivers has been the subject of considerable attention.

Hospice and Palliative Care for Companion Animals, 2^nd Edition provides a thorough update to the first and only complete guide to this field of service, its foundations, and its applications. It addresses the needs of pets, caregivers, and veterinary professionals alike, including fundamental ethical and emotional principles as well as detailed discussion of specific illnesses and life-limiting conditions. The expanded second edition incorporates cutting-edge research into animal behavior and cognition to enrich the reader’s understanding of companion animals’ emotional needs and their experience of illness and death.

Hospice and Palliative Care for Companion Animals, 2^nd Edition readers will also find:

• Existing chapters expanded to incorporate new research and practical experience
• New chapters discussing factors underlying the decision to euthanize, the potential role of ethology in palliative care, and more
• A companion website with educational handouts for use in veterinary practices

Hospice and Palliative Care for Companion Animals is an indispensable resource for caregivers and veterinary professionals alike.

Amir Shanan, DVM, is the Founding President of the International Association for Animal Hospice and Palliative Care and a Founding Partner of the Animal Hospice Group. He owns Compassionate Veterinary Hospice, a veterinary practice dedicated to end-of-life care, in Chicago, Illinois, USA.

Jessica Pierce, BA, MDiv, PhD, is a bioethicist and Faculty Affiliate at the Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, in Aurora, Colorado, USA.

Tamara Shearer, DVM, CCRP, CVPP, CVA, MSTCVM, owns Shearer Pet Health Services and Smoky Mountain Integrative Veterinary Clinic in Sylva, North Carolina, USA, and serves on the faculty of Chi University.

List of Contributors

Acknowledgments

Part I. Core Concepts

Introduction / Jessica Pierce

Evolution of the Relationship Between Humans and Their Companion Animals

New Scientific Knowledge About Animal Emotion and Cognition

Veterinary End-of-Life Care: Are We Keeping Up with New Science?

2 What is “Animal Hospice and Palliative Care”? / Tami Shearer and Amir Shanan

History of Animal Hospice 

Animal Hospice and Human Hospice

3 The Interdisciplinary Team / Tammy Wynn and Amir Shanan

Interdisciplinary Teams (IDT) in Human Hospice and Palliative Care

The IDT in Animal Hospice and Palliative Care

Operating a Successful IDT

Common Mission and Vision

Team Members, Their Roles and Responsibilities

Effective Communication and Collaboration 

4 Quality of Life (QOL) Assessments / Jessica Pierce and Amir Shanan

What are QOL Assessments and Why are They Important? 

QOL and Patient-Centered Care

Physical Discomfort, Emotional Distress, Pain and Suffering

A Variety of Approaches to QOL

McMillan’s Affect Balance Model

QOL Assessment Tools

5 Recognizing Distress / Emma Griggs, Suzanne Hetts and Amir Shanan 

Stress, Distress, Emotions and Suffering

Behavioral Needs of Dogs and Cats

Are Humans Adept at Recognizing Emotional States in Animals?

Body Language of Fear, Anxiety and Pain

Changes in Behavioral Patterns as Indicators of Pain and Distress

Distress and End of Life Decisions

6 Balancing Efficacy of Treatment Against Burdens of Care / Kris August

Establishing the Goals of Care

Assessing Treatment Efficacy

Burdens of Diagnostics and Treatment

Diagnostic Procedures

Adverse Events and Consequences

Assessing the Burdens of Caregiving

7 Ethical Decision-making / Jessica Pierce and Amir Shanan

A Method for Moral Decision-Making     

Clinical Considerations

Patient Consideration

Human Factors Influencing Moral Decision-making

Providing Adequate Information

Guiding Client Decision-making

Societal Ethics and the Role of Cultural Values

Ethical Business Practices

Moral Stress, Decisional Regret, and Mental Health

Finding the Path of Least Regrets

8 Supporting Relationships: Providers’ Non-Medical Roles / Amir Shanan and Laurel Lagoni

Bond-centered Client Care: Helping More Than Just Animals

Supporting, Educating, Facilitating and Guiding to Resources

Setting Boundaries When Providing Support

9 Management and Administration -- Business Models / Kathy Cooney

Guidelines for Animal Hospice and Palliative Care Practice

Service Delivery Models

Model 1: Hospice in the Veterinary Hospital Setting

Model 2: Hospice with Specialized Mobile Veterinarians

Model 3: Animal Hospice Case Managers

Model 4: Animal Hospice Sanctuaries/Rescues

Practicalities of Starting an Animal Hospice Service

Telehealth as a Bridging Component for All Models

Part II. Patient Care

10 Cancers in Dogs and Cats / Betsy Hershey and Alice Villalobos

Approach to End-of-Life Cancer Patients

Tumors of the Skin and Soft Tissues

Canine Lymphoma

Head and Neck Cancer

Cancer of the Skeletal System

Abdominal Tumors

Chest cavity Tumors

Palliative Cancer Medicine

Advances in Non-Invasive Technology for Diagnosis of Cancer

11 Integrative Therapies for the Palliative Care of the Veterinary Cancer Patient / Betsy Hershey

Nutrition and Food Therapy

Herbs and Supplements

Acupuncture

Manual Massage Therapies

Energy Therapy

Ozone Therapy

Hyperbaric oxygen therapy

Cannabis and CBD oil

Essential Oils

Homeopathy and Homotoxicology

Chiropractic

Photobiomodulation Therapy

12 Chronic Kidney Disease (CKD) / Shea Cox and Christie Cornelius

Clinical Manifestations

Management of Factors that Accelerate CKD Progression

Symptomatic, Supportive and Palliative Therapies

13 Congestive Heart Failure (CHF) / Shea Cox and Christie Cornelius

Clinical Manifestations

Palliative Management

14 Respiratory Distress / Cheryl Braswell

Airway Collapse

Brachycephalic Airway Obstruction Syndrome

Airway Inflammation

Pneumonia

Palliating the Suffering of Dyspnea

15 Gastrointestinal Conditions / Shea Cox and Christie Cornelius

Inflammatory Bowel Disease

Pancreatitis

Cholangitis/Cholangiohepatitis Syndrome

16 Musculoskeletal Disorders / Tami Shearer

Osteoarthritis

Cranial Cruciate Ligament Pathology

Strains, Sprains and Myofascial Pain

Coxofemoral Luxation

Fractures

17 Nervous System Disease / Tami Shearer

Intervertebral Disc Disease

Cervical Spondylomyelopathy

Fibrocartilaginous Embolic Myelopathy

Vestibular Disorders

Laryngeal Paralysis/Geriatric Onset Polyneuropathy

Degenerative Myelopathy

Disorders of Micturition

18 Cognitive Dysfunction / Tami Shearer

Clinical Manifestations

Management

19 Pharmacology Interventions for Symptom Management / Shea Cox

Pain

Anxiety

Dysphoria

Weakness and Fatigue

Respiratory Symptoms

Nausea and Vomiting

Anorexia and Cachexia

Dehydration

Constipation

Oral Health and Dry Mouth

20 Physical Medicine and Rehabilitation / Tami Shearer

Considerations for Physical Medicine

Assistive Devices

The Role of Acupuncture 

Innovative and Non-Invasive Techniques

LASER and Other Therapeutic Modalities 

Manual Therapies and Therapeutic Exercises

21 Integrative Medicine in Animal Hospice and Palliative Care / Kris August

Going Mainstream: Complementary and Integrative Medicine Terminology

Safety and Adverse Reactions

Healing Philosophies

Nutritional Supplements

Herbal Medicine and Essential Oils

Reliable Choices and Client Education

22 Nursing Care for Seriously Ill Animals - Art and Techniques / MaryEllen Goldberg and Shea Cox

Nurses’ Medical Roles

Assessment for Pain and Other Signs of Discomfort

Delivery of Care: Nursing Care Considerations

Nursing Care for Recumbent Patients

Nurses as Advocates and Educators

Death and Dying

23 Comfort Care During Active Dying / Gail Pope and Amir Shanan

Natural Death and Euthanasia

Goals of Caring for the Dying Patient

Changes During Early and Late Stages of Active Dying

At the Time of Death 

Managing Clinical Signs During Active Dying

Administration of Medications, Fluids and Food

24 Euthanasia in Animal End-of-Life Care / Kathy Cooney

Decision-Making for the Animal Hospice Patient

Advance Preparation and Education of the Professional Team

Advance Preparation and Education of Caregivers and Family

Euthanasia Setting: Desirable Environment of Care

Euthanasia Techniques and Criteria

Variability and Unpredictability

Part III. Caregiver Needs: Providing Support  

25 Caregivers’ Emotional Burden: Recognizing, Acknowledging and Addressing Human Distress / Amir Shanan

The Caregiving Experience

The Mental Health Impact of Caregiving

Supporting Caregivers’ Emotional Needs

The Role of a Licensed Mental Health Professional

26 Pet Caregiving Burden / MaryBeth Spitznagel and Mark Carlson

What Is Caregiver Burden? 

How Does Caregiver Burden Affect the Veterinary Client?

Research-Based Suggestions for Interacting with the Burdened Owner

When Client Burden Transfers to the Clinician

27 Addressing Spiritual Needs of Caregivers / Carol Rowehl

Spiritual Needs of Caregivers - Peace, Hope, Justice, Growth

Spiritual Distress

Taking a Spiritual History

Spiritual Questions Unique to Veterinary Practice and Hospice and Palliative Care

Including a Chaplain on the Interdisciplinary Veterinary/Hospice Team

28 Factors Contributing to the Decision to Euthanize Pet Dogs and Cats / Beth Marchitelli and Nathaniel Cook

Pet Factors: Symptoms and Clinical Signs that Affect Quality of Life

Pet Factors: Severe Illness Diagnosis

Pet Owner Factors: Psychosocial Factors of Caregiving

29 Supporting Other Needs / MaryEllen Goldberg and Shea Cox

Maintaining Self Care

Understanding the Physical Labor of Care

Time and Space Considerations

Financial Considerations

30 Aftercare / Coleen Ellis

Etiquette of Respect and Dignity

Body Care Options

Memorialization: Creating a Tribute

The Role of Pet Loss Professionals 

Index

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