What’s the different between hospice care and palliative care?
The terms hospice care and palliative care are often used interchangeably because there is such a close relationship between the two, however there is an important distinction. Palliative care is always present with hospice care, but hospice care isn’t always present with palliative care. The main difference is the presence or absence of terminal disease and curative treatment. Part of the reason they are used as synonyms arises from how often they are used in conjunction with each other. Most people think about palliative care in a hospice care setting.
Animal hospice care is a program that “addresses the physical, emotional, and social needs of an animal in the advanced stages of a progressive, life-limiting disease or disability.” It “also addresses the psychological, emotional, social, and spiritual needs of the caregiver(s) in preparation for the death of the animal and the subsequent grief.” It “is provided by an interdisciplinary team under the direction of a licensed veterinarian.” Animal hospice does not have a time period qualification, so it can support the patient until death occurs without intervention or more commonly, when the caregiver(s) decide euthanasia is appropriate. Providing animal hospice is not “giving up,” or merely waiting for death to occur. It is an active approach to ensure comfort and quality of life and, in some cases, even extends the life of the animal.
Animal palliative care is a program that mitigates the suffering of the patient and the caregiver(s) by providing symptom relief and enhancing quality of life. It often includes pain management, but pain isn’t the only disease symptom that affects quality of life. Nausea, lethargy/weakness, itch, seizures, insomnia, anxiety, cognitive changes, and difficulty breathing can also be debilitating. People often say, “I don’t want my pet to suffer.” But, what exactly constitutes suffering? So often the primary concern is pain. However, we have all experienced how miserable many of the items on the previous list can be, especially if the symptoms are chronic. Palliative care is more than just pain management. It’s more than just symptom relief. It also seeks to enhance quality of life.
Palliative care can be implemented during the aging process and at any stage of a disease or disability, while allowing curative treatment to still be explored. In order to initiate palliative care, a patient must have one or more of the following: terminal geriatric status, a chronic disability, a chronic, progressive diagnosed disease, or a chronic, progressive undiagnosed disease.
My cat has feline interstitial cystitis, which is a chronic disease defined by chronic urinary pain with periodic episodes of increasingly painful urinary symptoms. He’s three years old and will live with this disease for the rest of his life. His treatment plan consists of pain medications, supplements, environmental and behavioral modifications, and alternative treatments. When he has episodes of increased pain, he has acute medications that we give for a few days to help keep him comfortable. His condition isn’t life-limiting, but it is life-altering from a quality of life perspective. When he’s experiencing a pain episode, he’s restless, vocalizes during the early morning hours and fights with his housemate cat. Many cats with FIC also urinate outside the litter box, which for many caregivers can become unmanageable over time.
When providing animal hospice and palliative care, several bioethical considerations need to be addressed. We should always be mindful of the patient’s autonomy, avoid unnecessary or inadvertent pain, suffering or negligence, and administer fair and just treatment for everyone. Acknowledging and respecting each animal and each caregiver’s individual personality, preferences, and autonomy helps to ensure that we are meeting everyone’s needs, mitigating suffering, and enhancing quality of life.
It is understandable that the terms hospice care and palliative care get used interchangeably when so many of their underlying goals overlap. Their commonalities vastly outnumber their singular difference. And for the most part, that is a good thing. However, using these terms interchangeably could lead to circumstances where animals who could benefit from palliative care, but are not in need of hospice, miss out on receiving much-needed comfort care.
Hospice care is specifically for a life-limiting disease in its advanced stages, but it doesn’t mean that we are giving up. Providing comfort care specifically tailored to a particular patient’s symptoms helps improve quality of life for however long that life lasts. Palliative care is much broader. It is comfort care, that doesn’t need to wait for a specific diagnosis or age and can be provided alongside curative treatments. It should be considered in any situation where a chronic, progressive illness or disability exists or with any noticeable changes to an animal’s quality of life.
Regardless of the classification care that your pet needs, Crossroads Veterinary Hospice is able to evaluate you and your pet’s needs to ensure the best quality of life possible. Our staff is specifically trained in pain management and end-of-life care. We are dedicated to consistent communication to quickly address changes in your pet’s condition to maintain quality of life. We will also help prepare and guide you and your family through saying goodbye to your pet.
1. Amir Shanan, Jessica Pierce, Tamara Shearer, Ed. Hospice and Palliative Care for Companion Animals: Principles and Practice. Wiley & Sons, 2017, p. 5-6.