Welcome to www.qol-pet.com quality of life tool bank
Why do we need to measure quality of life in our animals?
When we teach colleagues on this subject, we regularly hear: "With my experience, I can now assess quality of life very well myself – I am much better at it than those mathematical calculations of yours!". And most of the time we answer that we believe that will be true most of the time (and we believe it is). But we also point out that it is important that practitioner and owner look at quality of life in the same way. As soon as there is a difference of opinion about quality of life, this leads to tension in the relationship between client and practitioner, as well as to a suboptimal climate for making the right decisions. The need for euthanasia may then be clear to such a colleague, but cannot be carried out because of an owner who sees it all differently. It is also essential to qualify and quantifiy the context, in order to be able to truly practice contextualised care.
A second point I would like to make clear to colleagues why it is worth the time investment to use quality of life assessment tools is the following: even the most experienced colleague is not always right. And if we are wrong, it comes at a high price, namely the suffering of the animal.
To illustrate: the lack of structured quality of life assessment tools has already led to a small revolution in human medicine years ago. This is in response to a number of remarkable studies. Sugarbaker et al. (1982) looked at quality of life in people under treatment for sarcoma of the legs. The researchers hypothesized that a new surgery and radiation treatment, in which the leg was not amputated, led to better quality of life than the old treatment, leg amputation. You would say a reasonable assumption, because who wouldn't want to keep both his or her legs?
But then came the surprise: when they looked in more detail, using validated quality of life assessment tools, they saw that patients who did go for amputation reported a better quality of life. They scored better on questions about psuchoscoial impact on their lives, overall function, economic impact, mobility, sex-life and pain. If this had not been specifically looked at, the conclusion might have been very different.
A second interesting conclusion of this study was that just asking about all aspects of their quality of life had a positive effect on the quality of life scores of the patients. In other words, it made the relationship between caregiver and care recipient more positive and powerful.
These are powerful examples that make it clear that we in veterinary medicine also need to take quality of life assessment more seriously. We must assume that, as in human medicine, this greatly benefits the quality of our care. For example, if an anxious cat needs daily oral medication, we may see the negative impact of the disease decrease, but this can be largely overshadowed if there is also a daily fight between cat and owner because of that same medication.
And if we regularly talk about quality of life throughout the animal's life, together with the owner, in a structured way, using tools developed for and by pet owners themselves, and validated in a scientific way (using so-called psychometric statistics), this will certainly lead to a greater chance that owner and caregiver will choose the same point to proceed with euthanasia.
WELCOME TO WWW.QOL-PET.COM QUALITY OF LIFE TOOL BANK
But you can't measure quality of life, can you?
The tendency is to believe that this is a subjective subject; You can't argue about taste either, right? We can't measure quality of life objectively, can we? Nothing could be further from the truth. How do we measure blood sugar? The glucose is metabolised by an enzyme in the sensor, which releases electrons, which is translated into an electrical signal, and which is translated into a number. That number is just a number – in every intermediate step of this measurement process, an inaccuracy creeps in. Nevertheless, if you do enough tests with those blood sugar levels, you will see that there is a pattern of truth in it. We can also do this when measuring seemingly immeasurable entities, such as quality of life. If you then think that you have created something that measures quality of life, you use it with hundreds of owners and animals. You analyse the results of this with so-called psychometric statistics to look at the patterns of shifts. If the tool doesn't work properly, those patterns are missing; If it does work well, the statistics show this.
What kind of tools can we use in practice?
If we look at human medicine, especially in studies of people who cannot communicate well (think of babies, children, elderly people with dementia), we suddenly learn that these techniques have been used successfully for years and are a regular part of studies, as well as daily practice. Veterinary medicine is therefore lagging far behind; But we quickly make up for that deficit. Whereas in the past the focus was usually only on blood values and survival times, and not on objective quality of life parameters, more and more studies are appearing with examples of tools that we could all use in our practices tomorrow. In general, there are two types of tools: tools that assess overall quality of life (see e.g. the study "Psychometric Validation of a General Health Quality of Life Tool for Cats Used to Compare Healthy Cats and Cats with Chronic Kidney Disease.") and tools that are disease-specific (see e.g. the study Development and evaluation of a health-related quality-of-life tool for dogs with Cushing's syndrome.). The advantages of overall quality of life assessment tools are that they can be applied to any animal with any disease; They are often short and therefore quick to use. The main disadvantage is that they do not address the impact of specific aspects of specific diseases and their treatment. For conversations about the aging animal and also euthanasia conversations, the overall quality of life tools can be very useful. In an ideal world, but especially in difficult situations (for example, when the care team and owner do not agree on the time point of euthanasia), it can be useful to use two or more tools (one general tool and one disease-specific tool). This can then make both parties think in the same way about what quality of life is and what exactly it means for the animal in question. Just as we look at metabolism with a blood biochemistry profile of the laboratory, it is wise to see quality of life in the same light: blood biochemistry measures different metabolic factors (e.g. related to liver, kidneys, muscles, etc.) and we can choose a minimal blood profile or a complete profile. A single quality of life assessment tool looks at quality of life (or a part of it) in one way; Two tools see more than one, three even more.Nevertheless, it would be nice if we clinicians and paraveterinarians started using at least one tool regularly throughout an animal's life. This will probably also prevent us from ending up in a situation where the care team considers euthanasia to be correct because of suboptimal quality of life, while the owners do not agree with this. Ideally, therefore, the use of one of the available tools should be introduced before the quality of life has deteriorated or before illness or aging processes occur.Many of these studies are in the English language, but nevertheless often easy to consult on the internet or to translate by us in practice.
Where do I find these tools?
Where can I find these tools?
Right here! Start browsing the tools below. Many examples of quality of life assessment tools are assembled on this independent, free to use website, which is accessible through www.qol-pet.com.
Do you know of a tool that is missing, email info@veterinaryspecialistconsultations.com and we will add it. This way we can help each other in our mission to make rigorous quality of life assessment the new standard in veterinary medicine. Thank you!
Now there is truly no excuse anymore to not use quality of life assessment in your clinic as from tomorrow.
*Please note: this area is under development and will be expanded soon*