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Any discussion about quality of life and how you should go about assessing it is likely to lead you down a complex moral maze. What is quality of life? What factors should vets consider? How do you assess that robustly? How can you be sure?
For a busy vet in practice, the prospect of using a tool that could inform decision making quickly must be very attractive. And that is likely to be the future, according to James Yeates, chief executive of Cats Protection and a specialist in animal welfare and law. But we are not there yet.
There are, of course, multiple quality of life (QOL) assessment tools available to vets. Research conducted by Zoe Belshaw, a clinical lecturer at Nottingham university, recently found more than 50 available for dogs alone. However, most were unpublished, unvalidated or only partially validated.
Awareness of them is low too. Vet Claire Roberts is currently undertaking a PhD research project at Bristol university, aiming to assess the impact of QOL tools in practice. In a survey of 110 vets in general and referral practice, she found only 29 per cent were familiar with any tools and a smaller proportion had ever used them.
At this year’s BVA congress, Yeates discussed the various approaches to considering an animal’s QOL. It isn’t just something to be considered in the lead up to euthanasia, he said. And neither is it an issue that is just concerned with an animal’s overall biological function or level of pain. It’s about the net value of an animal’s life rather than the absence of negative factors.
The best approach for assessing quality of life right now is via a shared model of assessment – between vets and owners
Yeates has come to the conclusion that the best approach for assessing QOL right now is via a shared model of assessment – between vets and owners. In a consultation, vets can help clients think in the right way about their animals by bringing their expertise (assessment and prediction of what might happen); owners can bring their knowledge of their pet over time.
If both parties think holistically about an individual animal over an extended time period, it follows they will arrive at the right QOL decision, argues Yeates. And if a tool can assist that conversation, it is a worthwhile addition to the consultation. The successful PetWise MOT consultations rolled out by PDSA are built using this approach, for example.
But many experienced vets will have found their own methods for arriving at good QOL decisions with owners. Nick Gray, a first-opinion practitioner in Kendal, Cumbria, uses four themes to frame his questioning – dignity, pain, freedoms and response.
At a basic level this means he asks questions such as ‘is your cat’s dignity compromised by her loss of bladder control?’ or ‘are there indications she is in pain or discomfort?’ Also, ‘is your dog able to walk to the park?’ and ‘does he still wag his tail and greet you?’
He varies the order of questions according to the circumstances and he finds it an efficient and effective way to get owners to think about their animal’s QOL in a more holistic way and, importantly, arrive at good decisions. ‘I can fit this questioning approach into a 10-minute consultation – it’s a quick method. It gives clients a structure to hang their own assessment around.’
Experience is probably the golden ticket here – early indications from Roberts’ research has found that experienced vets are confident operating in this space. Certainly first-opinion vet and former BVA president Robin Hargreaves has repeatedly made the case that vets are more than equipped to lead here. However Roberts’ research has also found an appetite for decision support tools from less experienced practitioners.
So perhaps while vets wait for the future to deliver the perfect tool or algorithm to help them assess QOL, the best answer – certainly for now – is in the past. It’s in the voice of experience.
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