Veterinary palliative medicine is a form of care in which a decision has been made stop attempts to cure a terminal or life-limiting illness. Some diseases that we treat in cats are managed over the long term without any hope for a cure. These include osteoarthritis, chronic kidney disease, and congestive heart disease. Managing these and other chronic diseases is not the same as palliative care.
Palliative medicine is care that's delivered as a cat approaches the end of life. The most common circumstances that precede the decision to initiate palliative care include:
Incurable cancer provides an example for explaining the principles and practices of veterinary palliative medicine. Palliative care in the face of life-limiting cancer is as individual as the patient and type of cancer.
The first step in creating a palliative care plan for your cat is to meet with your veterinarian to discuss the expected course of the disease and how it will affect your cat's quality of life. This visit also gives you a chance to talk about your cat's daily activities. This is a crucial first step because it allows everyone to participate in the palliative care planning. The cat's lifestyle is an important consideration for defining good quality of life versus poor or unacceptable quality of life (see handout "Quality of Life at the End of Life for Your Cat").
"An essential part of establishing goals of palliative therapy is
understanding the expected course of the life-limiting disease."
Once a cat's daily life activities have been identified, it is important to define family beliefs, the family's needs as care unfolds, and the goals for the cat as death approaches. An essential part of establishing goals of palliative therapy is understanding the expected course of the life-limiting disease - in this case, cancer. Knowledge about disease allows for the development of a personalized palliative care plan.
Pain management is the most important part of palliative care in cats. Pain is best managed from a multimodal perspective, which means using multiple therapies together, both pharmacologic (medications) and nonpharmacologic, to achieve maximum comfort.
Several classes of medication, as well as nutritional supplements (nutraceuticals), can be used together to combat pain. Your veterinarian may also suggest one or more nonpharmacologic therapies to address musculoskeletal pain:
Palliative care includes modifying the home environment to maximize mobility and prevent injury to the cat, whose balance and ability to move normally may be compromised. Some simple modifications include:
Palliative care for a cat can encompass many aspects of day-to-day life. The key parts of palliative care are controlling pain, maintaining mobility, and adapting the environment to keep your cat engaged in family activities. Your veterinary team will partner with you to put together the most appropriate palliative care plan for your cat.
Contributors: Malcolm Weir, DVM, MSc, MPH; Tammy Hunter, DVM; Robin Downing, DVM, CVPP, CCRP, DAAPM
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