Casa Querencia
Quality of Life Questionnaire
Making end of life decisions for your pet is emotional, heart wrenching, and difficult. This questionnaire may help you to better determine in an objective/subjective manner the quality of life that your pet is experiencing now and may help with your decision making process. It can also help us to assess chronic pain and help formulate a treatment plan to manage that pain if euthanasia is not indicated at his time. Points
1. How much do you think that the disease is disturbing your pet’s quality of life? Very much (0) A little (2)
Much (1) Not at all (3) ______
2. Does your pet still do what it likes (eg, play or go for walk)?
No (0) Frequently (2)
Rarely (1) In a normal way (3) ______
3. How is your pet’s mood?
Totally altered (0) Changed a little bit (2)
Some episodes of altered (1) Normal (3) ______
4. Does your pet keep its hygienic habits (ie, doe your dog clean itself)? No (0) Less that before (2)
Rarely (1) Yes (3) _______
5. How often do you think that your pet feels pain?
All the time (0) Rarely (2)
Frequently (1) Never (3) ______
6. Does your pet have a appetite? No ( 0) Only eats when forced; will eat more of what it likes (1)
Little (2) Normal (3) ______
7. Does your pet get tired easily?
Yes, always (0) Rarely (2 )
Frequently (1) No (3) ______
8. How is your pet sleeping?
Very badly; not sleeping (0) Almost normally (2)
Badly (1) Normally (3) ______
9. How often does your pet vomit? Always (0) Rarely (2)
Frequently (1) Never (3) _______
10. How are the intestines of your pet functioning?
Very bad (0) Almost normally (2)
Badly (1) Normally (3) ______
11. Is your pet able to position itself to defecate and urinate? Never positions itself to urinate or defecate (0)
Rarely positions itself to urinate or defecate (1)
Sometimes positions itself to urinate or defecate (2)
Urinates and defecates normally (3) ______
12. How much attention is your pet giving to the family?
Indifferent (0)
Little attention (1)
Increased attention; the dog is needy (2)
Has not changed (3) _______
Total points for your pet _______
Interpretation of Results:
Points
30 – 36 Healthy pets score in this range.
25 – 30 Your pet is experiencing mild to moderate discomfort and probably needs medical attention.
12- 25 Indicates pain related to severe disease, possible cancer, or arthritis (strong pain medicine and careful monitoring are indicated). <12 Your pet’s suffering is severe. An in depth conversation with your pet’s doctor is needed to decide on hospice-type care verses Euthanasia in order to alleviate pain and debilitation.
Please call us if you’d like to discuss this with your veterinarian. Our doctor’s can help you decide what is best for your pet and for your family.
Reference: JAVMA, vol. 226, No. 8 April 15, 200
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