One of the hardest things veterinarians have to do is to counsel owners about assessing a pet’s quality of life as it begins to decline. Because our animals can’t verbalize their specific desires when it comes to end of life care, owners and, to a lesser extent, veterinarians are forced into the role of proxy decision makers. We have the ability to extend or end a sick or injured pet’s life, and deciding what he or she would want under the circumstances is never easy.
Quality of life (QoL) surveys are helpful during this difficult time. They can focus our attention on the most important aspects of what the patient is experiencing. A single QoL survey provides some information, particularly at the extremes of the contentment — suffering continuum, but these tools really shine when they are performed on a frequent and regular basis. In this way, current scores can be compared to those taken in the past. Owners and veterinarians can then more easily pick up trends and address problems before they become extreme.
I generally recommend that my clients assess quality of life in their terminal ill pets at least once a week (more frequently as the end approaches). This is a bit of a compromise because, frankly, I would like them to perform the survey more or less every day but don’t want to impose on the precious time they have left with their pets. I don’t want their last memories of a beloved companion to be primarily associated with paperwork.
It turns out that an extremely simple QoL survey — one that would be ideal for daily use — might suffice. A recent study found that out of a survey that included 23 questions about the QoL of both the patient and primary caregiver (touching upon physical, psychological, and social functioning), only the three following questions were significant predictors of the patient’s QoL as assessed by the owner:
Your dog's playfulness and activity level now is:
a. Excellent b. Very good c. Good d. Fair e. Poor
Your dog has signs of illness now:
a. Never b. Seldom c. Sometimes d. Often e. Always
Your dog is happy according to you:
a. Always b. Often c. Sometimes d. Seldom e. Never
Now, this was just a small pilot study performed on 29 dogs who were undergoing chemotherapy, so we really don’t know how applicable it might be, but it offers an intriguing option for less “invasive” but more frequent QoL assessments.
How hard would it be to keep these three questions out on a piece of paper or spreadsheet and jot down your answers once a day? Until we get a feel for how this works in the real world, I’ll probably recommend this in addition to weekly assessments rather than replacing these more comprehensive surveys, but in the future, who knows?
Dr. Jennifer Coates
Iliopoulou MA, Kitchell BE, Yuzbasiyan-Gurkan V. Development of a survey instrument to assess health-related quality of life in small animal cancer patients treated with chemotherapy. J Am Vet Med Assoc. 2013 Jun 15;242(12):1679-87.