09/03/2025
Quality-of-life scales. Are they all they're cracked up to be?
QofL scales are utilized in human medicine for end of life care.
The QofL scales used in human medicine tend to be disease specific.
The QofL scales in human medicine are validated.
In addition, QofL for people is broken down in to consideration of physical and emotional aspects.
🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾
We have a few QofL scales to reach for in veterinary medicine.
BUT QofL scales in veterinary medicine are NOT validated.
As importantly they are mostly based on physical quality of life.
Consider that as vets we are trained to focus on physical quality of life for our patients. In contrast, as pet owners, chances are your focus may be more on the emotional quality of life of your pet.
So is there the risk of an incompatability in how we approach the decision making for end-of-life care from opposite sides of the consulting room table?
🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾
As vets we use QofL scales to assist you, the caregiver, in deciding on the right time for euthanasia.
QofL scales can be used objectively to correctly identify a sadly deteriorating situation for your companion.
But emotions are understandably at play. So QofL scoring can also be subjective, with risk of the score being manipulated.
Perhaps as a caregiver you will skip over, and overlook, and cross things off in its completion. Because to do otherwise would lower the final score.
🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾
The other thing to bear in mind is that QofL scales do not take in to account the whole scope of end-of-life care.
They do not take the client's quality of life nor the animal's will to live in to account, all of which should be part of the palliative care or euthanasia decision making.
🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾
Veterinary end of life care is in its infancy, so much so that we don't have the research behind it as yet, the backing of evidence based medicine we love so much in all other fields of veterinary medicine. Because of this, by necessity, a lot of our practices are extrapolated from human end of life care.
We need an improved validated scale for veterinary palliative medicine to provide assessment not only for the quality of life but also your pet's:
⦁ will to live and ability to live (autonomy is a natural condition for animals in the wild).
⦁ emotional quality of life and ongoing desire for human interaction.
Also for:
⦁ the caregiver's quality of life and the caregiver's ability to provide the nursing care involved.
⦁ the quality of the dying process.
🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾🐾
In further posts I will discuss QofL scales in more detail but, having stated their significant limitations, I will also look at where the current leaders in veterinary palliative medicine are preferring to turn to assess patients at end of life.
Pic of Bob who joined our family from the Cinnamon Trust in his old age along with his sister Zak ❤️
IVS Ltd is an independent veterinary referral service providing acupuncture and pain clinics in SW UK
