Hospice and Palliative Care for Companion Animals: Principles and Practice

Cover
Title Page
Copyright Page
Contents
List of Contributors
Acknowledgments
About the Companion Website
Part I Core Concepts
Chapter 1 Introduction
References
Further Reading
Chapter 2 What Is Animal Hospice and Palliative Care?
Introduction
History of Animal Hospice
Scientific and Philosophical Roots
Early Beginnings
Organization and Recognition
Animal Hospice and Human Hospice
Ethical and Legal Differences
Economic Differences
Summary
References
Chapter 3 The Interdisciplinary Team
Interdisciplinary Teams in Human Hospice and Palliative Care
Interdisciplinary Teams (IDT) in Animal Hospice and Palliative Care
Operating a Successful Interdisciplinary Team
Common Mission and Vision
Team members, Their Roles, and Responsibilities
Effective Communication and Collaboration
Summary
References
Chapter 4 Quality of Life Assessments
What are Quality of Life Assessments and Why are they Important in End-of-Life Care?
Definitions of Quality of Life
Quality of Life and Well-being
Quality of Life Assessments and Euthanasia Decisions
The Importance of Context in Quality of Life Assessment
Quality of Life and Patient-Centered Care
Physical Discomfort, Emotional Distress, Pain, and Suffering
Coping and Adaptation
Measuring Quality of Life in Animal Patients
A Variety of Approaches to QOL
McMillan’s Affect Balance Model
Weighing Positive and Negative Affect at the End of Life
Quality of Life Assessment Tools
Quality of Life Assessment Over Time
Summary
References
Further Reading
Chapter 5 Recognizing Distress
Stress, Distress, Emotions, and Suffering
The Stress Response
What Is Distress?
Behavioral Needs of Dogs and Cats
Assessing Quality of Life in Nonhuman Animals
Relevance to Animal Hospice and Palliative Care (AHPC)
Are Humans Adept at Recognizing Emotional States in Animals?
Body Language of Fear, Anxiety, and Pain
Fear-and Discomfort-Related Body Postures Commonly Observed in Dogs and Cats
Pain-Related Facial Expressions Commonly Observed in Dogs and Cats
Relevance to Animal Hospice and Palliative Care (AHPC)
Changes in Behavioral Patterns as Indicators of Pain and Distress
Do Animals “Hide” their Pain?
Decreased Response to and Engagement with their Surroundings
Unusual Patterns of Movement or Positioning
Focused Attention to One Specific Body Part
Displacement Behaviors
Can Sick Animals Suffer from Boredom?
Relevance to Animal Hospice and Palliative Care (AHPC)
End-of-Life Decisions
Conclusion
References
Chapter 6 Balancing Efficacy of Treatments Against Burdens of Care
Establishing the Goals of Care
Assessing Efficacy and Burdens of Medical Treatment
Assessment of Treatment Efficacy
Appetite and Hydration Needs at the End of Life
Emotional Well-Being
Animal Individual Preferences
Do-Not-Resuscitate and “Advance Directives”
Assessment of Treatment Burden
Assessing Diagnostic Procedures
Adverse Events: Treatment-Related Consequences
Steroids and End-of-Life Care
Adverse Events: Indirect Consequences of Medical Care
Assessing the Burdens of Caregiving
Conclusion
References
Chapter 7 Ethical Decision-Making in Animal Hospice and Palliative Care
A Method for Moral Decision-Making
Part 1: Clinical Considerations and Their Moral Dimensions
Part 2: Patient Considerations: How the Animal Feels and What the Animal Wants
Understanding What Animals Want
Will to Live
Respecting What Animals Want
Suffering
Part 3: Human Factors Influencing Moral Decision-Making
Providing Adequate Information
Guiding Client Decision-Making: How Much Is Too Much?
Guiding the Choice between Euthanasia and Continued Palliative Care
Societal Ethics and the Role of Cultural Values
Ethical Business Practices
Moral Stress, Decisional Regret, and Mental Health
Conclusion: Finding the Path of Least Regrets
References
Chapter 8 Supportive Relationships: Veterinarians and Animal Hospice Providers’ Nonmedical Roles
Defining the Nonmedical Roles of Veterinary Professionals and Other Animal Hospice Providers (except licensed mental health professionals)
The Role of Source of Support
The Role of Educator
The Role of Facilitator
The Role of Resource and Referral Guide
Resources
Extended Services
Limiting the Role of Animal Hospice Veterinary Professionals and Other Providers (except licensed mental health professionals)
Know Thyself, Healer
Conclusion
Grief Support Resources
Memorials and Grief Support Resources
Counselors and Grief Support
Grief Support Training
Books for Caregivers
Books for Veterinarians
References
Chapter 9 Management and Administration: Business Models
Guidelines for Animal Hospice and Palliative Care Practice
Service Delivery Models
Model 9.1 Hospice in the Veterinary Hospital Setting
Model 9.2 Hospice with Specialized Mobile Veterinarians
Model 9.3 Animal Hospice Case Managers
Model 9.4 Animal Hospice Sanctuaries/Rescues
Practicalities of Starting an Animal Hospice Service
Telehealth as a Bridging Component for all Models
Conclusion
References
Part II Patient Care
Chapter 10 Cancers in Dogs and Cats
Approach to End-of-Life Cancer Patients
Tumors of the Skin and Soft Tissues
Canine Lymphoma
Head and Neck Cancer
Oropharyngeal and Neck Tumors in Dogs and Cats
Nasal Passage Cancer
Brain Tumors
Cancer of the Skeletal System
Abdominal Tumors
Hemangiosarcoma in Dogs
Transitional Cell Carcinoma
Hepatic, Pancreatic, Intestinal, Adrenal, and Renal Cancer
Chest Cavity Tumors
Palliative Cancer Medicine
Advances in Noninvasive Technology for the Diagnosis of Cancer
Summary
Conflicts of Interest
References
Chapter 11 Integrative Therapies for Palliative Care of the Veterinary Cancer Patient
Nutrition and Food Therapy
Herbs and Supplements
Herbal Supplements
Antioxidants
Medicinal Mushrooms
B Vitamins
Digestive Enzymes
Probiotics
Vitamin D
Omega-3 Polyunsaturated Fatty Acids (PUFAS)
Curcumin
High Dose IV Vitamin C Therapy
Acupuncture
Manual Massage Therapies
Energy Therapy (Biofield Therapy)
Sound Therapy
Reiki, Therapeutic Touch, and Healing Touch Therapies
Ozone Therapy
Hyperbaric Oxygen Therapy
Cannabis and Cannabidiol (CBD) Oil
Essential Oils
Homeopathy and Homotoxicology
Chiropractic
Photobiomodulation Therapy (PBM)
Summary
References
Chapter 12 Chronic Kidney Disease
Description of Disease
Disease Trajectory
Clinical Manifestations of Disease
Management
Management of Factors that Accelerate Chronic Kidney Disease Progression
Dehydration
Nonregenerative Anemia
Systemic Hypertension
Proteinuria and Activation of the Renin–Angiotensin–Aldosterone System
Renal Secondary Hyperparathyroidism
Symptomatic, Supportive, and Palliative Therapies
Oral Ulcerations and Uremic Gastritis
Nausea/Vomiting
Constipation/Obstipation
Loss of Appetite
Urinary Tract Infection
Hyperphosphatemia
Hypokalemia
Seizures
Dietary Considerations
Other Comfort Measures
Conclusion
References
Chapter 13 Congestive Heart Failure
Description of Disease
Disease Trajectory
Clinical Manifestations of Disease
Palliative Management
Pulmonary Edema/Cardiac Function
Diuretics
Ace Inhibitors
Positive Lonotrope, Vasodilator
Calcium Channel Blocker
Pleural and Abdominal Effusion
Hypokalemia
Prerenal Azotemia
Balancing Renal and Cardiac Disease
Coughing
Respiratory Distress
Aortic Thromboembolism
Dietary Considerations
Heart-Gut Interactions in Heart Failure
Other Considerations
Conclusion
References
Chapter 14 Respiratory Distress
Airway Collapse
Description
Trajectory/Prognosis
Manifestations
Management
Pharmacologic
Physical
Nutritional
Surgery
Brachycephalic Airway Obstruction Syndrome
Description
Trajectory/Prognosis
Manifestations
Management
Pharmacologic
Physical
Nutrition
Surgery
Airway Inflammation
Description
Trajectory/Prognosis
Manifestations
Management
Pharmacologic
Physical
Nutritional
Pneumonia
Description
Trajectory/Prognosis
Manifestations
Management
Pharmacologic
Physical
Nutritional
The Suffering of Dyspnea: Palliative Care
References
Chapter 15 Gastrointestinal Conditions
Inflammatory Bowel Disease
Description of Disease
Disease Trajectory
Clinical Manifestations of Disease
Palliative Management
Medical Support
Immunosuppressive Therapy
Antibiotic Therapy
Additional Support Therapy
Nutritional Support
Fecal Microbial Transplantation (FMT): The Ultimate Probiotic
Pancreatitis
Description of Disease
Disease Trajectory
Clinical Manifestations of Disease
Palliative Management
Medical Support
Analgesia
Antiemetics
Antibacterials
Immunosuppressants
Subcutaneous Fluid Therapy
Nutritional Support
Cholangitis/Cholangiohepatitis Syndrome
Description of Disease
Disease Trajectory
Clinical Manifestations of Disease
Palliative Management
Medical Support
Antimicrobial Therapy
Immunosuppressive Therapy
Analgesia
Antiemetics
Support Therapy
Subcutaneous Fluid Therapy
Nutritional Support
Conclusion
References
Chapter 16 Musculoskeletal Disorders
Osteoarthritis
Description
Trajectory/Prognosis
Manifestations
Management
Cranial Cruciate Ligament Pathology
Description
Trajectory/Prognosis
Manifestations
Management
Medical Management
Surgical Management
Strains, Sprains, and Myofascial Pain
Description
Trajectory/Prognosis
Manifestations
Management
Coxofemoral Luxation
Description
Trajectory/Prognosis
Manifestations
Management
Fractures
Description
Trajectory/Prognosis
Manifestations
Management
Conclusion
References
Chapter 17 Nervous System Disease
Intervertebral Disc Disease
Description
Trajectory/Prognosis
Manifestations
Management
Cervical Spondylomyelopathy
Description
Trajectory/Prognosis
Manifestations
Management
Fibrocartilagenous Embolic Myelopathy
Description
Trajectory/Prognosis
Manifestations
Management
Vestibular Disorders
Description
Trajectory/Prognosis
Manifestations
Management
Laryngeal Paralysis/Geriatric Onset Laryngeal Paralysis Polyneuropathy
Description
Trajectory/Prognosis
Manifestations
Management
Degenerative Myelopathy
Description
Trajectory/Prognosis
Manifestations
Management
Disorders of Micturition/Urination
Description
Trajectory/Prognosis
Manifestations
Management
Bladder Is Difficult or Cannot Be Expressed
Bladder Can Be Expressed with Effort
Straining to Urinate with Spurts of Urine Produced
Bladder Easily Expressed with Continuous Leakage
Urine Leakage when Urine Accumulates
Ancillary Therapies for Micturition Disorders
Conclusion
References
Chapter 18 Cognitive Dysfunction
Description
Trajectory/Prognosis
Manifestations
Management
Client Education and Prevention
Behavior Modification and Environmental Enhancement
Diet Modification
Supplements
Alternative Care
Pharmaceutical Interventions
Conclusion
References
Chapter 19 Pharmacology Interventions for Symptom Management
Introduction
Pain
Clinical Signs of Pain
Behavioral Indicators of Pain
Pharmacology for Pain Management
Nonsteroidal Anti-Inflammatory Drugs
Glucocorticoids
Acetaminophen
Opioids
Tricyclic Antidepressants
Serotonin-Norepinephrine Reuptake Inhibitors
Anticonvulsants
N-methyl-d-aspartate Receptor Antagonists
Monoclonal antibodies
Pharmacologic Protocols
Assessing Response to Treatment
Anxiety
Dysphoria
Weakness or Fatigue
Respiratory Symptoms
Dyspnea
Cough
Nausea and Vomiting
Anorexia and Cachexia
Dehydration
Constipation
Oral Health
Ulcers
Dry Mouth (Xerostomia)
Conclusion
References
Chapter 20 Physical Medicine and Rehabilitation for Hospice and Palliative Care Patients
Physical Medicine vs. Physical Rehabilitation
Considerations for Physical Medicine with Hospice and Palliative Care Patients
Assistive Devices: Priority in Hospice Care
Slings and Harnesses
Straps and Bands
Protective Footwear
Support of Joints: Orthotic Devices
Support for Paralysis/Pararesis: Carts and Drag Bags
Four Simple but Important Manual Therapies and Therapeutic Exercises
Range of Motion
Assisted Standing and Walking
Proprioceptive and Balance Techniques
Massage and/or Tui-na
The Role of Acupuncture for Hospice and Palliative Care Patients
Innovative and Noninvasive Techniques
Kinesiology Taping
Extracorporeal Magnetotransduction Therapy: EMTT
Extracorporeal Shockwave Therapy
Targeted Pulsed Electromagnetic Field Therapy
Other Therapeutic Modalities for Hospice and Palliative Care Patients
Thermal Modalities
Photobiomodulation Therapy (also known as Laser Therapy)
Pulsed Signal Therapy
Electrotherapy
Therapeutic Ultrasound
Manual Therapy/Medical Manipulation/Chiropractic Care
Conclusion
References
Chapter 21 Integrative Medicine in Animal Hospice and Palliative Care
Terms
Going Mainstream
Safety and Adverse Reactions
Healing Philosophies
Nutritional Supplements
Herbal Medicine
Essential Oils
Other Therapies
Ensuring Quality of Life
Reliable Choices and Client Education
Conclusion
Educational Opportunities
References
Chapter 22 Nursing Care for Seriously III Animals: Art and Techniques
Introduction
Nurses’ Medical Roles
Intake
Planning of Care
Ongoing Monitoring and Assessments
Frequency of Assessments
Parameters of Assessments
Assessment of Pain
Pain Scales
Assessment of Other Signs of Discomfort
Assessment for Dehydration
Assessment of Medication Administration
Assessment of Mobility
Assessment of Mental and Emotional Status
Delivery of Care: Nursing Care Considerations
Comfort for the Patient
Oral and Ocular Comfort
Nutrition
Hydration
Treating Fluid Deficit (Dehydration)
Maintenance Fluids Administration
Calculating Fluid Deficit
Hygiene
Bedding
Environment
Mobility
Range of Motion (ROM)
Transitions
Standby Assisted Standing
Weight Shifting Exercises
Assisted Standing Exercises
Aids for Assisted Standing
Mobility Carts
Nursing Care for Recumbent Patients
Urination
Defecation
Respiration
Skin Care
Mobilizing the Recumbent Patient
Nurses as Advocates and Educators
Nurses’ Role as Advocates for Patient and for the Caregiver
Nurses’ Role as Educators
Awareness of Signs of Pain
Hygiene and Safety
Death and Dying
Conclusion
References
Further Reading
Chapter 23 Comfort Care During Active Dying
Natural Death and Euthanasia
Goals of Caring for the Dying Patient
Advance Preparation and Education of Caregivers and Hospice Team
Desirable Environment of Care
Prognostication
Changes During Early and Late Stages of Active Dying
Available Information
Changes During Early Stages of Active Dying
Physical Changes
Behavioral Changes
Indications of Pain
Changes During Late Stages of Active Dying
Behavior, Sleeping Pattern, Responsiveness
Respiration
Eyes, Mucus Membranes, Jaw, and Extremities
Muscle Twitching, Stretching, and the Agonal Position
Odor
Summary
At the Time of Death
The Different Types of Active Death
Managing Clinical Signs During Active Dying
Management of Pain
Management of Anxiety and Agitation
Fatigue and Weakness
Loss of Ability to Swallow
Respiration
Cardiac Dysfunction and Renal Failure
Diminished Skin Vitality
Mucosal and Conjunctival Care
Incontinence
Administration of Medications, Fluids, and Food
Administration of Fluids
Administration of Food
Administration of Medications
Summary
References
Chapter 24 Euthanasia in Animal End-of-Life Care
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
Intravenous Injection
Intracardiac Injection
Intraperitoneal Injection
Intrahepatic Injection
Intrarenal Injections
Variability and Unpredictability
References
Part III Caregiver Needs: Providing Support
Chapter 25 Caregivers’ Emotional Burden: Understanding, Acknowledging, and Addressing Caregivers’ Emotional Burden
Caregiving Experience
The Mental Health Impact of Caregiving
Supporting caregivers’ Emotional Needs
The Role of a Licensed Mental Health Professional
Qualified Mental Health Professionals
Summary
References
Chapter 26 Caregiver Burden in the Companion Animal Owner
What Is Caregiver Burden?
A Word About Research Data, the Terminology Used, and this Article’s Audience
Caregiver Burden Is Present in Owners of Seriously Ill Companion Animals
How Caregiver Burden Differs from Other Client Experiences in this Context
How Does Caregiver Burden Affect the Veterinary Client?
Impact of Caregiver Burden on the Client
Impact of Caregiver Burden on the Patient
Research-Based Suggestions for Interacting with the Burdened Owner
Understand the Owner’s Perspective
Collaborate on the Care Approach
Lighten the Load
One Size Does Not Fit All: Toward Individualized Client Interactions
Interacting with the Distressed Client
Interacting with the Resilient Client
Interacting with the Non-Distressed Client
Interacting with the “Other Influences” Client
More than Compassion Fatigue: When Client Burden Transfers to the Clinician
The Burden Transfer DANCE
Conclusions
References
Chapter 27 Addressing Spiritual Needs of Caregivers
Spiritual Needs of Caregivers
Spiritual Distress
Taking a Spiritual History
When to Call in the Experts (and Who Are the Experts?)
Spiritual Questions Unique to Veterinary Practice and Hospice and Palliative Care
Including a Chaplain on the Interdisciplinary Veterinary/Hospice Team
Resources
References
Chapter 28 Factors Contributing to the Decision to Euthanize Pet Dogs and Cats
Introduction
Pet Factors: Symptoms and Clinical Signs that Affect Quality of Life
Appetite and Weight Loss
Appetite
Weight Loss
Elimination Disorders
Impaired Mobility
Sensory and Cognitive Decline
Dyspnea and Respiratory Compromise
Perception of Pain
Pet Factors: Severe Illness Diagnosis
Cancer
Organ Failure: Congestive Heart Failure
Endocrine Disorders: Diabetes Mellitus
Pet Owner Factors: Psychosocial Factors of Caregiving
Conclusion
References
Chapter 29 Supporting Other Needs
Caring for the Caregiver: Addressing Emotional and Physical Needs
Maintaining Self-Care
Maintain Personal Nutrition and Sleep
Engage in Exercise
Make Time for Relaxation
Time Considerations of Hospice Care
Managing Time Commitments of Care
Tips for Balancing Caregiving with Ongoing Responsibilities
Understanding the Physical Labor of Care
Utilizing Proper Body Mechanics During Delivery of Care
Environmental Considerations of Hospice Care
Assessment of the Physical Space
Household and Environmental Modifications
Financial Considerations of Hospice Care
Cost of Medications
Cost of Diagnostics
Cost of Other Healthcare Providers
Cost of Environmental Modifications
Cost of End-of-Life Care
Helping to Defer Costs of Hospice Care
Pet Health Insurance
Equipment Rental, Recycling, and Reduced Cost Programs
Creating a Memorial Fund
Creating a Donation Bank
References
Further Reading
Chapter 30 Aftercare
Hospice Options and Accompanying Rituals
Emotional Support: Honoring the Journey
Assisting Children, Other Pets, and Family Members in Their Journey
After-Death Care Options
Summary
References
Index
EULA