Utilizing Telehealth for Hospice/Palliative Care

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Relieving pain and suffering, and affirming death as a natural process, is the goal in hospice and palliative veterinary care. This delicate practice can occur with Anipanion’s telemedicine platform and is a service any veterinary hospital or clinic can implement. Difficult conversations can occur while the pet parent and patient are comfortable in their own surroundings and receive focused attention from the veterinarian or technician. Here are a few examples as to how this service can be implemented in practice.

 

Grief Support

  • While sending flowers and heartfelt cards are a must for the bereaved pet parent, your practice can offer grief counseling sessions as well
  • Send your client an invitation to schedule an optional grief counseling session or send information for a pet loss helpline
    • Counseling sessions could be included in euthanasia cost or Anipanion membership cost
  • Send client asynchronous chat messages to express empathy
  • Deactivate all reminders from deceased patient

 

Quality of Life Discussion (QOL)

  • Quality of life discussions are very time consuming and emotional
  • The pet parent must be emotionally ready to receive the information and have the hard conversation about the patient. The pet parent may not be ready or prepared to have this discussion while in a hospital setting.
  • Setup a telehealth session in Anipanion with the pet parent for a time when they are ready for a QOL discussion
  • QOL questions to ask and discuss:
    • Mentation of pet
    • Changes in pet personality
    • Is the pet able to eat and drink
    • Urinate and defecate
    • Any vomiting/diarrhea
    • Level of mobility
    • Chronic medical issues
    • Palliative care that has been tried
    • Financial limitations
    • Do the bad days outnumber the good

 

Palliative Care Sessions

Palliative care can be applied to numerous medical conditions

  • Osteoarthritis
  • Neoplastic disease
  • Renal failure
  • Trauma
  • Wound management
  • Diabetes
  • Congestive heart failure

Palliative care session can be scheduled on an as needed basis or on a routine basis

  • Discuss expected course of disease and patient’s quality of life during disease process
  • Discuss patient’s current lifestyle and pet parent goals for pet throughout disease process
  • Discuss palliative options
      • Acupuncture
      • Rehabilitation
      • Pain medications
      • Anti-inflammatories
      • CBD products
      • Assisi loops
      • Laser Therapy
      • Nutraceutical Supplements
      • Anti-anxiety medications
      • Hydrotherapy
  • Discuss changes in household to meet patient needs
      • Creating nonskid floor surfaces
      • Paw grips
      • Litter box modifications
      • Raising food/water dishes
      • Creating a safe place for pet to rest
      • Special bedding/orthopedic cushioning
      • Limiting access to stairs
      • Easy access to outdoors
  • Discuss patient responses to aforementioned therapies
      • Pain
      • Energy
      • Mobility
      • Appetite

Create modified palliative care plan and reassess with further Anipanion telehealth sessions regularly to ensure efficacy of care plan

 

Planning Euthanasia

Discuss the process and set expectations

  • IV catheter
  • Injectable medications
  • Length of time of euthanasia process
  • Agonal breathing, muscle twitching
  • Auscultation of heart
  • Pronounce death upon absence of heart beat

What happens next

  • Cremation options
  • Take home for private burial
      • How patient will be processed for transport home

Remembrances

  • Lock of fur
  • Paw print
  • Nose print
  • Decorative memorabilia

Payment

  • Collect payment prior to procedure

The majority of the patients that need hospice and palliative care do best when at home. No cranky old cat wants to come to the clinic (nor do cranky old cat owners want to bring them); Old dogs can easily slip on clinic floors, and are hard to load into vehicles.

Using telehealth to provide these services are better for the pet both mentally and physically, prepare the pet owner for difficult decisions, and help your team set expectations for an extremely difficult time in a pet (and pet owner’s) life.

 

Patient

Pet:
Goober

Client:
Tia

Signalment:
14 yo, MN, 80 lb black lab

Medical History: UTD vaccines and preventive care. Goober has chronic OA, LARPAR, and hypothyroidism. Signs of cognitive dysfunction are evident as well.

Goober has slowly been declining over the past year. He can no longer get up and down stairs, load into the car, and breathing has become difficult. He has started defecating in the home and vocalizing abnormally in the middle night.

Goober presents to you for his annual wellness. When speaking with Tia, you senset she is starting to think about euthanasia, but is not ready for the conversation yet. With her two young kids by her side, phones ringing, and dogs barking, Tia does not feel comfortable having such an emotional conversation at this time.

She refills his medications and leaves.

 

Scenario A

 

Time marches on, and in the craziness that is vet med, no one from your clinic had time to follow up with Tia about Goober.

3 months later, Goober presents on emergency in respiratory distress as a consequence of end stage LARPAR. Tia understands it is time to euthanize Goober, but is emotionally distressed since she did not prepare for this day to come.

Tia has so many questions, but due to Goober’s critical state and obvious suffering it is recommended to euthanize immediately to end his pain and discomfort.

Since his euthananasia was not planned and he came in on emergency, there was no calmness or privacy, only chaos and public emotion.

Goober was euthanized on the table in the treatment room while receiving oxygen and triage amidst the other doctors, nurses, and patients. Tia was so emotional and distraught and wept over his body in the treatment room.

Two other emergencies are headed in and you need that treatment table, so you kindly offer to move Goober to a private room for Tia to have final moments with him in private.

When you move Goober to the room, fluid begins to exit his nose, he urinates, and takes an agonal breath. Tia seeing this screams at you for letting her dog lay in his own filth and excrement. She leaves in a hurricane of emotion without deciding if she wants Goober cremated or taken home for burial.

Goober’s body is placed in the freezer and 3 attempts to call Tia were made over the next few weeks to determine what she would like to do with his remains. Tia calls the clinic irate that the clinic dare call her and leave voicemails about her recently deceased dog while she is still mourning.

Tia wishes to have him cremated, but will not be paying since she was rushed into euthanizing him, no one prepared her or answered her questions about the process, she embarrassed herself in front of everyone while crying in the treatment room, and now the clinic is harassing her about what to do with his remains. Needless to say, you have lost this client.

 

Scenario B: Anipanion Telehealth

 

While refilling Goober’s medication, you recommend an end of life Anipanion telehealth session with Tia at a time that is more appropriate. You recommend she bring a list of questions for you both to discuss. Tia gives you a few days and times when she is available.

You and Tia connect via Anipanion video 2 weeks later. You coach her through quality of life questions and Tia concluded with your advice and guidance that euthanasia is the kindest and best option for Goober at this point.

You discuss the euthanasia process step by step from beginning to end. You also alert Tia to the more unpleasant post-mortem body processes, so she is not surprised when it happens (like agonal breathing, urination, defecation, and fluid from mouth and nose).

You discuss what Tia would like to do with Goober after the euthanasia is complete. Tia decides to cremate.

You schedule a date and time for euthanaisa and collect payment today, so this will not have to occur the day of the procedure when Tia will be emotional.

The day of euthanasia arrives 1 week later. Since it was scheduled, a private room is prepared with soft lighting, flowers, a candle, and a soft blanket for Goober.

Goober is calm and the euthanasia is preformed without a hitch. Tia gets private last moments with him and was prepared so the aftermath was not shocking. Tia leaves sad, but thankful for your service and kindness.

When his remains arrive, Tia comes into the clinic with a gift card for the clinic to buy lunch and is forever grateful for how Goober’s death was handled. She refers many of her friends to your clinic and is looking for a new puppy

 

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