AVC Winter Webinars

This week I enjoyed the first of three ‘Winter Webinars’ run by the Sir James Dunn Animal Welfare Centre at The Atlantic Veterinary College (AVC). For those of you who are not familiar with these, they are web-based seminars (aka ‘webinars’) available to veterinarians and veterinary technicians. Enrolment is free to students – including postgraduates. Last year’s webinars were very good, so I have enrolled again this year. The webinars are hosted at a set time and you login via a link that is emailed to you. There are opportunities to ask the speaker questions during the webinar, and a copy of the recording is emailed to you later. This last point is a real bonus for those of us in different time zones. Last year I could attend the webinar ‘live’, but as it is being run at a different time this year, I watch the recording later instead.

The theme for this year is ‘New Approaches to Old Diseases’ with the aim of going over some approaches for discussing end-of-life (EoL) with clients. The webinars are given by Dr Caroline Hewson and Dr Christine Savidge. Caroline has published widely on EoL care [1-3] and is The Pet Loss Vet. Christine is an assistant professor at the AVC and a small animal internal medicine specialist (Dip.ACVIM).

The first webinar (last week) was titled ‘The Toolbox’. Caroline went over some tools to deliver terminal diagnoses and to identify when to start taking about euthanasia with clients. I am going to briefly review the webinars.

Caroline started by going over why The Toolbox is important; why it is needed in the first place. She said the tools could help us (veterinary professionals) to prevent animals from suffering, to support our clients in talking about EoL and their concerns, and to help our clients be ready for clinical uncertainty. She mentioned a study by Fernandez-Mehler, Gloor [4] where roughly a third of clients would have preferred the EoL issue was raised sooner.

Caroline has FOUR tools in her toolbox. They are: (1) disease trajectory graphs; (2) a key question; (3) communication tools; and (4) a euthanasia decision-making tool.

1 Disease trajectory graphs

These ask, ‘what is the change in physical functioning over time?’ Caroline showed us some examples of disease trajectory graphs from a human paper [5]. These types of graphs provide a visual aide to owners, showing them what the disease progression may look like and what they should expect with their pet. Caroline indicated that we don’t need to have one for every disease, but a few generic ones instead. For example, we could have one for diseases/illness that have long-term limitations with intermittent serious episodes – this could be used for cases of renal insufficiency or heart disease. I like this idea. We can overwhelm our clients with lots of statistics and quote numbers at them from textbooks or the latest research, but a simple diagram invariably shows more than all those numbers ever could.

2 A key question

This is a trigger question for veterinarians to ask ourselves (in our head) when we diagnose a condition and at every check-up with a diseased animal. It is meant to help us decide if it is appropriate to discuss EoL with our client(s). The question is: ‘Would I be surprised if this dog/cat died in the next 6 months?’ The idea being that if you answer ‘no’ (you would not be surprised) then Caroline suggests you must raise EoL with the owner. This is quite a good way of thinking about it. If you, as the veterinarian, think the animal may die soon (i.e. in the next 6 months) then shouldn’t you bring this up with the owner? Wouldn’t it be better to have that discussion sooner rather than later (later potentially being in 8 months’ time, when the owner suddenly realises the animal is suffering terribly and wishes they had contacted you sooner OR wished you had brought it up with them sooner [4])?

3 Communication tools

If you have decided you need to have this EoL discussion, or the owner has come to you wanting to discuss euthanasia, then good communication is key. Caroline has three areas that she thinks are important: empathy, honesty, and finding out information preferences.

Empathy can be learned and involves recognising emotion in others and reflecting this understanding of their emotion back to them. Caroline said that instead of empathising, veterinary professionals can sometimes be guilty of lecturing (i.e. giving lots of information) or distracting (ignoring feelings by offering tea/water/platitudes) clients. Honesty is also important; ‘protecting’ clients from reality isn’t helpful. Asking clients outright how much information they would like to know (i.e. finding out their information preferences) may help with this.

4 Euthanasia decision-making tool

Designed to answer whether the animal has a ‘life worth living’ [6] or to assist the client who asks “How do I know when it’s time?”, Caroline uses her own ‘A-B-C Yardstick for euthanasia decisions’. Much like the ABC’s of CPR, this initialism mneumonic stands for three steps in the decision-making process. In this case, they are:

  • A for ‘Agony’: Is the animal in unmanageable pain or distress OR at imminent risk of these?
  • B for ‘Burden’: Is treatment a burden to the animal?
  • C for ‘Continue to enjoy positives of being alive’: Does the animal have what s/he wants and enjoys?

This is a great little way to get our clients to think about their animal and their treatment, but, like some of the EoL scales already in use [7, 8], it does limit the areas (or domains) [9] considered.

Overall, I enjoyed the first webinar and look forward to hearing Dr Savidge speak to us this week about the use of disease trajectories in renal disease.

References

  1. Hewson, C., Grief for pets – Part 1: Overview and some false assumptions. Veterinary Nursing Journal, 2014. 29(9): p. 302-305.
  2. Hewson, C., Grief for pets Part 2: Realistic client care so that you ‘do no harm’. Veterinary Ireland Journal, 2014. 4(8): p. 431-436.
  3. Hewson, C., End-of-life care: the why and how of animal hospice. Veterinary Nursing Journal, 2015. 30(10): p. 287-289.
  4. Fernandez-Mehler, P., et al., Veterinarians’ role for pet owners facing pet loss. Veterinary Record, 2013. 172(21).
  5. Lynn, J. and D.M. Adamson, Living well at the end of life: Adapting health care to serious chronic illness in old age. RAND white paper, 2003.
  6. Yeates, J.W., Is ‘a life worth living’ a concept worth having? Animal Welfare, 2011. 20(3): p. 397-406.
  7. Villalobos, A. and L. Kaplan, Canine and feline geriatric oncology: honoring the human-animal bond, ed. L. Kaplan. 2007, Ames, Iowa: Blackwell Publishing.
  8. Hilst, K., J.O.U.R.N.E.Y.S.: A quality of life scale for pets. 2013.
  9. Mellor, D.J. and N.J. Beausoleil, Extending the ‘Five Domains’ model for animal welfare assessment to incorporate positive welfare states. Animal Welfare, 2015. 24(3): p. 241-253.
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While I was away…

As I have been on holiday (and a little bit MIA while preparing for my PhD Confirmation), I thought I would write a post on what I have missed. I am still playing catch-up, so this is not exhaustive, but these are a few matters of interest that have come up while I have been away:

AVA Conference 2017

The program for the 2017 AVA Conference in Melbourne came out just before I left. It has a great line-up of animal welfare talks. I am disappointed that I will not be able to make it this year, but I will be at the ANZCVS Science Week instead – I hope to see you there.

UFAW International Symposium 2017

The line-up for the UFAW 2017 Symposium looks fantastic too! The theme is ‘Measuring animal welfare and applying scientific advances – Why is it still so difficult?’. This is something very close to my heart and another one I wish I could attend. But unfortunately, the PhD calls. I will begin interviews for my second study this year.

OIE vacancy for specialist in Animal Welfare

Earlier in the month the OIE listed this amazing job opportunity in Animal Welfare based in Brussels, Belgium. The closing date is the 3rd of March 2017. If only I was ready for this great opportunity…

Cats to keep their claws in NJ?

New Jersey could be one of the first states in the USA to restrict declawing of cats to only those deemed necessary by a veterinarian. This could pave the way to restrictions throughout the entire USA. In New Zealand, “The declawing of cats to alleviate social or behavioural problems should be contemplated only when retraining has proved ineffective and euthanasia is the only alternative” (Code of Welfare 2007 – Companion cats). This stance will not be changing with the new Animal Welfare regulations in New Zealand. Cats have claws and removing them simply because they lead to traits that we regard as ‘undesirable’ bears a strong resemblance to ear cropping and tail docking in dogs.

On the subject of cats

Because ‘cat welfare matters’, this next story is about ‘designer cats’. Dogs have had plenty of attention recently as we have heard about the issues associated with brachycephalic (flat-faced) breeds. But it’s not just dogs whose welfare is negatively affected by breed standards. Our feline friends have problems too! International Cat Care has written a great article that tells us the truth about ‘designer cats’. A cat with short legs? How adorable! Not so for the cat…check out their radiographs. And brachycephalic cats have problems too. We need to breed for function, not form. “…many (if not all) of these cats are likely to suffer pain and/or compromised welfare.”

Women in Science

A little off topic, but our welfare is important too! This last one begins with a conversation I overheard while on holiday. I was waiting to order my brunch at a café and overheard three women behind me. Their topic for discussion? Which of their friends had ‘got the fattest’ after high school. Wouldn’t it have been nice if I had overheard them discussing which friend had done great things with her life? Who had a fantastic career? Who was doing ‘well’? Now don’t get me wrong, I am not one to talk. I have joined in similar discussions in my time. But what good is this doing us? This lead me to think about how women undersell ourselves and each other and how this could affect our success. The 11th of February was International Day of Women and Girls in Science and I pretty well missed it. We need to support women in science to achieve great things. I love hearing about what women are accomplishing every day. My main PhD supervisor is a fantastic scientist. She has, and will continue to, achieved great things. Let’s celebrate a little better next year so that we can support women to achieve even more – for science and animal welfare! Mark it in your calendar.