Although a QoL assessment is a standalone tool, it can be helpful to complete pain-scoring charts and disease-specific assessment resources at the same time, for example, LOAD( Liverpool Osteoarthritis in Dogs) scoring [ 17 ] or the Canine Arthritis Management home assessment tool [ 18 ], as these tools might highlight the severity of particular aspects of the ageing or disease process. Likewise, it is important to account for results that are a consequence of side effects of treatments; here, completing or reviewing the assessment with a VS or VN will prove beneficial to the owner.
There are many factors to be considered when reviewing the results of a QoL assessment. For some animals, a low score on just one criterion may indicate poor QoL, even when other criteria have high scores; for example, a pain score in a QoL assessment indicating that an animal is in pain may indicate the need for veterinary intervention to improve QoL. It is also important to remember that what is a poor QoL for one animal may be acceptable for another. Not being able to undertake a 30-minute walk off the lead may be acceptable for some breeds of dogs, for example, but it might negatively impact on the wellbeing of other breeds [ 19 ].
Several factors must be considered when completing a QoL assessment, with signalment and owner bias being two major components. Signalment can be described as a complete description of an animal and includes its species, breed, neuter status and age. These factors will influence how an animal experiences and responds to the ageing process. For example, several studies have investigated the concept that the pain response differs among dog breeds [ 20, 21 ]. Therefore, when assessing the pain experienced by an animal, it is essential to consider the signalment, and to factor in whether the species or breed is typically more stoic and more likely to‘ hide’ pain. This is especially true when assessing prey species such as rabbits. Veterinary professionals are aware that these species are naturally less inclined to express chronic pain behaviours, whereas owners of these species may not be able to recognise signs of pain in their animals.
Differences exist not just between species and breeds, but also between individuals; this is one reason why continuity of care is so vital with older patients. When a VS and VN develop relationships with their patients, they become familiar with each animal ' s normal behaviour and characteristics. This familiarity makes it easier to assess pain and QoL, as they can more accurately interpret any changes and account for individual signalment factors. Additionally, the owner will build a bond with the practice team. Seeing a different member of staff on each visit to the practice, especially when visits are emotive, will not help to foster trust between the owner and the practice, nor will it assist in the development of a relationship where the owner feels comfortable to discuss openly what is happening.
Owners vary greatly in their perception of their pet ' s pain and QoL. Some owners may have high expectations based on a previous pet ' s longevity and lifestyle, or previous experience with the breed. Some owners are more sensitive to their pet ' s needs and may rate their pet ' s pain as higher on a pain score than it is when scored by a veterinary professional. Again, continuity of care will help the veterinary team develop strong client relationships, which will enable them to account for such factors when discussing an animal ' s QoL.
Finally, the relationship between owner and pet will also influence how an owner completes a QoL assessment. Veterinary professionals must be mindful of the different types of relationship between owners and their animals, such as a working animal versus a pet, and consider this when discussing end-of-life provisions. It is also important to be cautious about making assumptions about the role of an animal in the owner ' s life.
Despite the points outlined above, owners are still best equipped to complete QoL assessments, given the duration and strength of their relationship with their animals; put simply, they know their pets better than anyone else. However, this familiarity can mean that small changes may not be picked up by those who encounter an animal every day; this is where the QoL assessments really come into their own, as they are a quantitative means of assessing an animal ' s wellbeing. For some owners, completing the assessments with the assistance of veterinary staff will be more successful than doing so independently, as veterinary staff can break down aspects of the assessment and give examples of what each criterion / stage may look like. This highlights a key point at which the VN can step in and start this discussion, and develop the relationship with the pet and owner.
It is imperative that VNs take the time to support owners, to go through QoL assessments with them and to be a‘ sounding board’ for their thoughts, so they can methodically come to the best decision for themselves and their animal. In doing so, VNs can ensure that patients have EoLC and, when appropriate, euthanasia, with the dignity and comfort they deserve.
Supporting an owner during QoL assessment
It has been said that clients will often open up to VNs about concerns and worries they‘ don ' t want to bother the vet with‘ [ 22 ]. For this reason, it is vital that practices actively involve VNs when dealing with more senior patients. VNs can educate owners on how to best manage the clinical signs of many terminal clinical conditions. In short, by teaching owners what EoLC is required, how to provide it and when adjustments will be needed, VNs create more realistic client expectations as well as enabling owners to better assess and manage their pet ' s welfare.
22 Veterinary Nursing Journal