Plus-Hex CLINICAL
Lap of Love QoL assessment
The Lap of Love QoL assessment [ 9 ] is a quick and easy-to-use resource to which owners could be directed when they are concerned that their pet ' s QoL is compromised. This assessment asks owners to complete a brief QoL scale alongside a‘ family concerns‘ questionnaire [ 9 ], and prompts owners to seek veterinary care where appropriate.
The assessment can also act as a springboard to a more formal assessment, if needed [ 10 ]. If the Lap of Love score category advises that the owner seek a veterinary consultation, it is recommended this be done face to face.
Ohio State University QoL assessment
In an Ohio State University( OSU) QoL assessment [ 11 ], the owner answers a series of questions covering all aspects of the pet ' s life and rates them from‘ strongly agree’ to‘ strongly disagree’. Each answer is associated with a numerical value; at the end of the assessment all the values are added up to give a total score, with higher scores representing a better QoL.
The OSU assessment should be completed with a VS. Using the OSU assessment to guide decision-making, the VS and owner should agree on an EoLC plan, as well as the owner ' s expectations and limitations regarding this care. A designated VN could then be given the responsibility of reviewing the QoL assessment with the owner, with the frequency of reviews dictated by the severity of the case or the owner ' s concerns. These reviews could be done via a phone call or face to face in the practice. VNs are qualified and able to support owners and refer to the VS where required.
HHHHHMM assessment
Alice Villalobos, DVM, DPNAP, a renowned veterinary oncologist, introduced a QoL programme for terminally ill pets known as‘ pawspice care’, the animal equivalent of hospice care [ 12 ]. The programme includes the management of a patient ' s clinical signs, a description of basic care and the transition to‘ palliative care’.
Villalobos developed a system to help owners and the veterinary team assess the QoL of a pet that has been diagnosed with a terminal illness [ 13 ]. Based on the abbreviation HHHHHMM( Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad), the assessment is geared towards evaluating the five needs set out in the Animal Welfare Act 2006. What is most evident about this resource is the concept that‘ we’ re not just treating a dog or cat that belongs to a person, we’ re treating an entity called the bond’ [ 12 ].
Autumn Animals end-of-life assessment
Some owners may be overwhelmed by questionnaires such as the OSU QoL assessment. In these cases, the assessment developed by Autumn Animals [ 14 ] could be helpful. Autumn Animals was founded by Sieske Valk, a VN who specialises in supporting owners caring for older pets at home. The assessment consists of eight simple questions; for each one, owners move a slider to the response they feel is most appropriate for their pet. Points are designated depending on the answer and are added together to provide an overall score, with higher scores indicating a better QoL.
Grey Muzzle app
The Grey Muzzle Quality of Life Calendar app allows users to journal their pet ' s days on Apple and Android devices [ 15, 16 ].( Download availability may vary according to the user ' s country / location.) Pet owners log whether their pet has had a good, bad or OK day, and the app enables them to view their answers visually in the form of a pie chart. Owners should be encouraged to consider what percentage of bad days, or ratio of bad to good days, they are happy to accept before moving on to the next medical intervention for their pet.
Although this app offers a clear visual representation of QoL, owners should be advised to determine whether a day( or week) is‘ good’ or‘ bad’ by using an additional, more detailed QoL assessment, such as the HHHHHMM or OSU QoL resources.
Using QoL scales in decision-making
Commonly, QoL assessment is used to plan EoLC and track the changes in a pet ' s wellbeing. These assessments account for all aspects of life, both physical and mental. There will come a point where these assessments highlight to an owner that their pet ' s wellbeing is compromised and euthanasia may need to be discussed.
It would be best practice for an owner to complete the assessments independently and then review the overall score with a VS or VN. Where multiple individuals care for a pet, asking each person to complete an assessment independently will account for different relationships and perspectives and help to reduce bias. It would be valuable to consider the benefits of getting younger( but aware) children involved in completing assessments to aid their understanding of the decisionmaking process.
Evaluating QoL assessments
When using any QoL assessment, consideration should be given as to whether it needs to be used in conjunction with other behavioural and medical assessments.
Volume 40( 4) • August 2025
21