important that owners feel they are provided with all the information they need to make an informed decision about EoL care and euthanasia, and to give their consent [ 11 ]. Therefore, double appointments or 30 – 40-minute consultations should be provided to allow sufficient time for discussion, reassurance and questions, based on the individual owner ' s circumstances and their pet ' s health status [ 6 ]. It is crucial to dedicate enough time to allow owners to process their decision and say a final farewell.
As mentioned earlier, any financial constraints should always be discussed, with full transparency around costs, and the plan should be clear, concise and recorded on the patient ' s file. Team members should be encouraged to show particular compassion during any discussions around EoL care and euthanasia. If possible, a dedicated‘ quiet space’ should be provided for euthanasia, which has soft bedding, dimmed lighting where appropriate, and privacy for the consultation [ 8 ].
QoL assessment
It is important to provide a safe space for advice and support, and to allow owners to be educated on their beloved pet ' s QoL. Fulmer et al. [ 4 ] provided a summary definition of a QoL tool as‘ a set of questions designed for pet owners and veterinarians to measure the QoL of either cats or dogs. The tool could be in the form of a scale or questionnaire and contain an indefinite number of domains or items’.
Yearly booster appointments or health check-ups can be a good opportunity to discuss an animal ' s QoL, favourite activities, eating habits and behaviour, and the answers given can be used as a tool to detect any deterioration over time. QoL assessment tools can be discussed early on in a pet ' s life, as education can enable owners to feel empowered and more confident in decision-making. QoL assessment tools are numerical scoring systems used as indicators of change [ 12 ], and can also aid caregivers ' decision-making around easing suffering. The Peaceful Pet Goodbye QoL Checker( Appendix 1) [ 13 ], for example, can be used to assess pets on a daily or weekly basis to determine whether there has been a deterioration in their condition. The maximum score per day is 12( 84 for the week). If the day score is below 8 on average, it is suggested that the caregivers contact the VS for advice on appropriate management.
Additionally, posters can be displayed in waiting rooms to make owners aware of the aspects of their pet ' s general health and behaviour they should monitor, the potential signs of concern and when to seek advice. This can provide owners with the knowledge and confidence needed to identify any changes. It may also reduce the likelihood of them facing an unexpected discussion about euthanasia and the potential guilt associated with not recognising the decline in their pet ' s health.
The British Veterinary Association( BVA) and the World Small Animal Veterinary Association( WSAVA) have highlighted the benefits of using practice-based QoL assessment tools [ 14, 15 ]. They can aid in evaluating treatment, improving care and reviewing welfare at home. Generally, early observations of changes in a pet ' s health can be addressed with medications, pain relief and / or mobility supplementation, for example. However, guidance should be sought on whether euthanasia could be the most appropriate course of action [ 13 ].
Another QoL assessment tool, created by veterinary oncologist Alice Villalobos, is referred to as the HHHHHMM scale( Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad), with each section rated on a scale of 1( poorest) to 10( best)( Appendix 2) [ 16 ].
This can be a useful tool for owners to use at home if they are leaning towards euthanasia or if they feel there has been a decline in their pet ' s health. Medications, treatment and preventive measures may be suggested, or a QoL consultation can be arranged if all other options have been exhausted.
In order to understand when euthanasia may be warranted, a decision tree has been formulated by the BVA. This is a helpful tool for the veterinary caregiver to refer to when faced with the management of a potential euthanasia case( Appendix 3) [ 17 ].
Compassionate communication
Conversations about euthanasia with owners can be easier to navigate when a good relationship has already been established between the owner and the veterinary team. Compassionate communication should be a priority, with a client-centred approach. This will help to ease their feelings about euthanasia and improve their perceptions of end-of-life conversations [ 9 ]. An owner ' s perspective of euthanasia can be complex, so it is important to explore their thoughts, belief systems, religious stance and feelings about extensive veterinary care or possible euthanasia( Figure 1).
Figure 1. It is vital to explore owners ' feelings about euthanasia.
14 Veterinary Nursing Journal