2023 AAFP/IAAHPC feline hospice and palliative care guidelines

Abstract

The '2023 AAFP/IAAHPC Feline Hospice and Palliative Care Guidelines' are authored by a Task Force of experts in feline hospice and palliative care convened by the American Association of Feline Practitioners and the International Association for Animal Hospice and Palliative Care. They emphasize the specialized communication skills and ethical considerations that are associated with feline hospice and palliative care, with references to other feline practice guidelines for a more complete discussion of specific diseases, feline pain management best practices and cat friendly interactions. A comprehensive, multi-step hospice consultation allows for tailoring the approach to both the cat and the family involved in the care. The consultation includes establishing 'budgets of care', a concept that greatly influences what can be done for the individual cat. The Guidelines acknowledge that each cat and caregiver will be different in this regard; and establishing what is reasonable, practical and ethical for the individual cat and caregiver is important. A further concept of the 'care unit' is introduced, which is extrapolated from human hospice and palliative care, and encourages and empowers the caregiver to become a part of the cat's care every step of the way. Ethical considerations include a decision-making framework. The importance of comfort care is emphasized, and the latest information available about how to assess the quality of a cat's life is reviewed. Emotional health is as equally important as physical health. Hence, it is fundamental to recognize that compromised physical health, with pain and/or illness, impairs emotional health. A limited discussion on euthanasia is included, referring to the AAFP's End of Life Educational Toolkit for recommendations to help the caregiver and the veterinary professional ensure a peaceful passing and transition - one that reflects the best interests of the individual cat and caregiver.

Keywords: Quality of life; bond; budgets of care; cancer; care unit; chronic kidney disease; comfort care; communication; consultation; degenerative joint disease; end-of-life; ethics; euthanasia; evaluation; grief; hospice care; pain; palliative care.

Figure 1

The ‘four box’ method combines four foundational principles of clinical bioethics to assist clinical decision-making. QOL = quality of life. Adapted from Jonsen et al (2010)

Figure 2

(a) Feline patient before a personalized hospice and palliative care plan was put in place. (b) The same patient after the implementation of a complete care plan, including adequate pain control, nutritional support and comfort care. Images courtesy of Clara Showalter and Katrina Breitreiter

Figure 3

(a) Hospice patient with a painful bleeding tumor. The photograph was taken prior to the implementation of pain control. (b) The same patient after receiving multimodal pain control using a combination of buprenorphine and gabapentin. Images courtesy of Clara Showalter and Katrina Breitreiter

Figure 4

The three components of the feline physical environment. Adapted from Halls (2016)

Figure 5

The ‘five pillars’ framework, developed to describe a cat’s essential needs in the veterinary practice setting, applies equally to the cat’s home environment, and can help to guide caregivers in adaptations that might be needed to accommodate the particular needs of hospice and palliative care patients. Adapted from Taylor et al (2022)

Figure 6

(a) These two cats enjoyed a strong social bond for more than 5 years. (b) During the last stages of life, the orange tabby cat withdrew and no longer wanted to be near the other cat. Images courtesy of Ilona Rodan

Figure 7

(a,b) A safe resting and sleeping area imparts a sense of control, familiarity and predictability, which is especially important for cats that are physically and/or emotionally compromised. Images courtesy of (a) Ilona Rodan and (b) Katrina Breitreiter

Figure 8

All of the cat’s resources in the home should be easily accessible. (a) This cat has been provided with pet steps to help reach their bed. (b) A bench allows this cat to get to their favorite resting spot in the sun. Images courtesy of (a) Ilona Rodan and (b) Sheilah Robertson

Figure 9

Many hospice and palliative care patients have difficulty entering and exiting litter boxes. (a) At least one lip of the box should be lower. (b,c) A cement mixing box or storage box with its low sides makes a good option. Images courtesy of (a) Ilona Rodan and (b,c) Heather O’Steen

Figure 10

If play is still enjoyable, it should be one-on-one and based on the cat’s energy level. Image courtesy of Ilona Rodan

Figure 11

Where possible, combining tablets in a gelatin capsule is a useful way of minimizing the frequency of administrations - so helping to preserve the cat-caregiver bond and patient quality of life when frequent medications are necessary. Image courtesy of Ilona Rodan

Figure 12

An esophagostomy tube may reduce stress by being used to administer nutrition, fluids and medication. The tube pictured here is covered with a soft padded collar. Image courtesy of Sam Taylor

Figure 13

(a,b) Raising food and water dishes off the floor helps to provide a better feeding and drinking position for cats with degenerative joint disease and other comorbidities affecting mobility and comfort. Images courtesy of (a) Ilona Rodan and (b) Heather O’Steen