110 | The REAL difference vet nurses make to quality of life (and why we NEED to talk about it)
Today I wanted to sit down with you and talk about something we’re often afraid to mention - and that’s quality of life.
Not end of life, not euthanasia, but quality of life. An often misunderstood term, and one we need to normalise. Because the truth is, quality of life is the ultimate goal every single one of us have for every single one of our patients, every day. We make a bigger difference to it than you realise, and the evidence to back that up is VERY clear.
Too often, we talk about quality of life conversations like they belong at the end - like they're the last thing on the list, the conversation you have when everything else has been tried. But in reality? Quality of life is everything. It’s part of every chronic disease management plan, every nurse-led appointment, every phone call follow-up. And our role in this is huge.
So we are going to get into the evidence today. We're going to look at what the research really says about which factors most influence quality of life in our patients with chronic conditions, whether that's diabetes, CKD, osteoarthritis, chronic enteropathy, or other long-term diseases. And we’re going to explore how we, as veterinary nurses and technicians, can make a difference to this.
Let's get into it.
Quality of life in our veterinary patients does not mean end of life
If you take one thing away from this episode, let it be this: quality of life conversations are not the same as euthanasia conversations.
If I asked you right now, ‘when do you typically talk to a client about their pet's quality of life?’ I'd be willing to bet that a significant number of you would say: when we’re running out of options, or when we’re concerned that QoL is bad and we need to think about PTS.
And look, I get it - that’s what we’ve all implicitly been taught. Euthanasia IS the context in which QoL conversations are most explicitly named. We pull out the QoL scales, we talk about good days and bad days, we ask the client whether their pet is still doing the things they love. And don’t get me wrong, all of that is important (and necessary!).
But if the only time we're having those conversations is when we're approaching the end, we have missed an enormous opportunity.
Quality of life assessment is a clinical tool. It should be used the same way we'd use blood pressure monitoring in a CKD cat, or glucose sensors or fructosamine measurement in a diabetic patient. That is - regularly, proactively, and as a way of understanding where our patient is and whether what we're doing is actually working for them and their family.
Why does quality of life make a difference to how we treat our patients?
One of the most important considerations when it comes to quality of life is this: a lot of the factors that most significantly impact quality of life in our patients with chronic conditions are not actually medical.
They are about what's happening in that household on a Monday morning when someone’s let the cat out before their medication dose and the client is running late for work.
They’re about how they’re going to get their pet to eat a renal diet.
They’re about whether the client is going to have to cancel their holiday because the petsitter they’d booked doesn’t feel comfortable giving insulin injections.
This means that we can intervene, support our clients, and improve their perception of QoL at an early stage - as long as we’re having those conversations.
Let me give you an example.
There was a study - one that looked at quality of life in cats with CKD - that found QoL scores related to eating, appetite, and the management aspects of care (things like giving medication and getting to vet appointments) were lower in cats with CKD compared to healthy cats.
Now, we know that reduced appetite in CKD patients is associated not just with how the cat feels physically, but with wider outcomes associated with QoL.
A cat that's not eating well is a cat the client is worried about, a cat that's harder to medicate, a cat that the client might describe as ‘not themselves’.
This causes a shift in the human-animal bond, because our clients start to see their pets as patients, not companions. And that shift is one of the most significant factors in whether management continues or doesn't.
It’s also something we can really help with if we know about it. We can talk to clients about how to improve appetite. We can talk to them about how to transition to an appropriate therapeutic diet effectively. And we can give them pointers on things like medication administration and how to prepare their cat for vet appointments in a less stressful way.
So the quality of life question is not just is this cat comfortable right now. In reality, iy should be: what is the lived experience of this patient and their family, and what can we do right now to make it better?
And to improve that, we need to be talking about it.
What the evidence really says about quality of life (and how we make a difference to this as vet nurses)
The studies I read when preparing my lessons - particularly on diabetic nursing - were honestly so significant it made me sit down and record this episode, so let’s talk about them.
We know that a staggering number of our chronic disease patients are euthanased early - because there are preconceived barriers to treatment and notions of the impact a disease has on quality of life.
And once we know that, we can challenge those preconceptions and use nursing care to support our clients - directly reducing euthanasia rate.
Take the Big Pet Diabetes Survey for example. This survey was completed by over 1000 vets, who were asked about the perceived frequency of euthanasia in their diabetic patients, and the reasons behind it.
According to the results, 1 in 10 diabetic pets were euthanased at the point of diagnosis, and another 1 in 10 within the first year of treatment.
Think about that for a second. We're not talking about pets with uncontrolled disease, or pets with serious concurrent conditions. We're talking about newly diagnosed patients who, with appropriate management, could have good quality lives for years.
So what are the reasons for early euthanasia in these patients?
The survey asked vets to rate the factors involved when diabetic animals are euthanased or treatment is stopped. And among things like concurrent disease, some of the main factors were
Cost of treatment
Too much impact on the client’s lifestyle
Injection problems
Difficulty keeping a regular schedule
These aren’t directly medical reasons - they’re client factors. But with support, and education, and by using veterinary nurses to help those clients feel capable and confident managing their pet’s disease at home, we can make a significant difference to this.
The same patterns appear across other chronic conditions.
In cats with CKD - one of the most common long-term conditions we see - the research consistently shows that how well a patient does is heavily influenced by client factors.
They include things like:
Whether the client can get their cat eating a renal diet
Whether they can administer medications consistently
Whether they can administer subcutaneous fluids at home
Those things require education, support, and follow-up care. They don't just happen because we hand someone a bag of fluid and a leaflet - and if your clinic aren’t using nurses to help with this process, you and your clients are missing out.
In osteoarthritis, client compliance is described repeatedly in the literature as a major challenge.
We know that many clients tend to attribute behavioural changes to old age rather than to pain. As a result of this, they may not maintain an exercise or weight management plan consistently - and when our clients don’t feel they can follow the management plan we’ve set, our patients lose quality of life.
Not because the condition itself is untreatable, but because the support around treatment isn't there.
The role of caregiver burden in quality of life for veterinary patients
The concept of caregiver burden has been important in human healthcare for a long time, and we’re starting to explore this term more in veterinary medicine.
Caregiver burden is very real (and I say this both as a medicine nurse AND as someone who shares her home with complex medical cats!) and it’s also a very underappreciated factor in how we manage chronic disease.
Research has shown that caregivers of pets with chronic or terminal illness experience significantly greater stress, symptoms of depression and anxiety, and poorer quality of life than caregivers of healthy pets.
In fact, people caring for a chronically or terminally ill pet were about twice as likely to show clinically meaningful signs of depression and high stress compared to those caring for a healthy pet.
This is really significant consideration - half of people caring for seriously ill pets demonstrated significantly increased levels of burden.
This burden affects their ability to carry out our treatment plan. It affects their ability to give medications consistently. It makes them less able to cope emotionally when their pet has a difficult day, or if they need to bring them back in to see us.
And it changes how they see their pet - as a patient, not as a companion. And all of this impacts the human-animal bond.
Because when a client starts to see their pet more as a patient, with all of the fear and exhaustion and responsibility that carries, the relationship changes. And that change impacts the daily interactions that make up that animal's world.
Things like play sessions, comfortable lap time, the ability to relax and enjoy time together, walks that are about enjoyment rather than just going to the toilet - all of it gets filtered through anxiety. And ultimately, the animal's quality of life deteriorates not because their disease has progressed, but because the emotional environment around them has changed.
And THIS is where we come in as veterinary nurses and technicians.
Why vet nurses make a significant difference to quality of life
We know why QoL is impacted in many of our patients, and why it’s important - but what can we do about it?
There are, I think, four key areas where we make a difference to quality of life in our chronic patients. So let’s talk about each of them.
One: Early and ongoing assessment of quality of life
We need to normalise quality of life in conversation. Not necessarily by using QoL scales all the time - though there are many to choose from if you think a ‘full’ assessment is indicated, and I’ll link some in the show notes for you - but, we need to at least be mentioning it.
There are some specific tools for different chronic diseases I wanted to mention, as these can be useful:
Diabetes: DIA-QoL-pet tool
Chronic kidney disease: VetMetrica QoL tool
Osteoarthritis: Canine brief pain inventory, Feline musculoskeletal pain index
There are lots of ways to ask about QoL without asking our clients to sit down and fill in a questionnaire. We can target the questions in our clinical history collection to do the assessment ourselves, for example.
Or we can use a simple question like ‘on a scale of 1-10, how do you feel they are?’ if you think it’s more appropriate for that individual client.
However you’re asking it, make sure you’re asking it - and doing it regularly, so we can look at trends and patterns over time. And don’t forget to ask about the client, too - since we know many QoL factors impact them more specifically.
Two: Address caregiver burden proactively
When a client comes in and they're struggling - maybe they're tearful, maybe they're resistant to a recommendation, maybe they're just visibly exhausted - our instinct is often to focus on the clinical information. On the monitoring plan, on the dose, on the next blood test, on how we can change the patient’s management to ease things.
And don’t get me wrong, all of that matters a LOT. But, if we don’t also address how the client is feeling, we’re not doing all we can for that patient.
Acknowledging caregiver burden is not about being a therapist. It's about saying: ‘This is a lot to manage. How are you finding the twice-daily injections? Is there anything that would make the routine easier?’
It's about normalising the difficulty while also finding solutions to help the client cope more easily.
Research specifically on diabetic pet caregivers found that among the most important QoL concerns were worries about what to do if their pet had a hypoglycaemic episode, concerns about being able to leave their pet with friends or family, and anxiety about the impact of care on their own life.
Every single one of those concerns is something we can address as vet nurses and technicians. We can teach people what to do in a hypoglycaemic emergency. We can help them identify a neighbour or family member who can be trained in insulin administration. We can help them build a system that fits around their actual life rather than a ‘gold standard’ protocol.
We know that education and problem-solving reduce caregiver burden. When clients feel capable - when they have the knowledge and the skills to respond to what's happening at home - they’re less stressed, and as a result, patient care improves.
Three: Focus on the bond, not just the disease
A cat with CKD can still enjoy a nap in their favourite spot, enjoy a treat, play when they want to, and enjoy a cuddle.
A dog with osteoarthritis can still go for a slow lead walk around the field, at their pace, have a good sniff of everything and enjoy the sunshine.
Why am I saying this? Because quality of life is not the absence of disease. It is the presence of the things that make life worth living for that individual patient.
And our job is to help our clients identify what those things are, monitor whether they're still happening, and intervene when they’re not. And that intervention doesn’t mean euthanasia - it means looking at what adaptations allow our patients to still enjoy life.
In our nurse clinics, we can ask: ‘What does a good day look like? What do they do that tells you they’re enjoying life?’
And then once we’ve established that baseline, we can review it regularly by asking things like ‘Are they still doing that? Has anything changed?’
By approaching QoL in that way, we’re not focussing on a number on a scale. We’re putting our clients back in the role of expert on their own pet - making sure their animal is treated as a companion, not just a patient.
For patients with osteoarthritis, for example, we know that client compliance with environmental modifications (things like ramps instead of stairs for example) makes a real difference to daily comfort. And these are all things we can help with as veterinary nurses and technicians, for example in a nurse clinic.
Four: Following up with chronic disease patients as veterinary nurses
One of the things that the Big Pet Diabetes Survey highlighted was that euthanasia rates were significantly lower in referral and university teaching hospital settings compared to general practice.
Now, there will be LOTS of reasons for that, including things like client demographics and differences in case selection. But one likely factor is the follow-up structure that specialist settings tend to have, with things like more nurse-led monitoring clinics, more regular client contact, and more structured support.
Am I saying that diabetes care is better in referral settings? No. What I’m saying is that we need to replicate that structure, that utilisation of our skills as vet nurses, regardless of the practice you work in.
A chronic disease management clinic - whether that's specifically for diabetic pets, CKD patients, OA patients, or a more general nurse clinic - gives us a regular opportunity to check in with our patient and their family.
It gives us the chance to notice early if there are issues with giving medication, or sticking to the diet plan, before that becomes a reason for treatment to stop.
It gives us the chance to celebrate progress, which matters more than we sometimes realise.
And it gives us the information - be that from quality of life information, or physical exam findings, or questions the client has asked - to take things back to the vet, and improve the way we manage things for that individual patient (and their caregiver).
This is where we make the biggest difference as nurses and technicians.
So if you want to start doing more to support your patients, here’s where to start.
First: if your practice doesn't already utilise nurses in caring for chronic patients, pitch it.
I’m not suggesting a massive overhaul here - start with one disease, one nurse, one clinic, one slot per week.
The evidence is really clear - we know that nurse-led chronic disease monitoring improves compliance, improves QoL, and takes pressure off the vet team. It’s a no-brainer.
Second: next time a client comes in who looks tired, overwhelmed, or tearful about their pet's condition - acknowledge it.
As if they’re OK - genuinely.
Say you know it’s a lot.
Remind them how well they’re doing managing things.
It costs 30 seconds, but it will give you a ton of information on how we could improve things for that client and their pet - all of which improves QoL.
Third: start normalising QoL conversations early.
Find a way to work a brief QoL question in when you’re seeing a patient with a chronic disease for the first time. Make it normal. Make it expected. Make it part of the check-in, the same way any other monitoring test would be.
Quality of life isn’t end of life - and the only way we break that stigma is by normalising talking about it.
Did you enjoy this episode? If so, I’d love to hear what you think. Take a screenshot and tag me on Instagram (@vetinternalmedicinenursing) so I can give you a shout-out and share it with a colleague who’d find it helpful!
Thanks for learning with me this week, and I’ll see you next time!
References and Further Reading
Bijsmans et al. (2016). Psychometric Validation of a General Health Quality of Life Tool for Cats Used to Compare Healthy Cats and Cats with Chronic Kidney Disease. Journal of Veterinary Internal Medicine, 30(1), pp. 183–191.
Niessen et al. (2017). The Big Pet Diabetes Survey: Perceived Frequency and Triggers for Euthanasia. Veterinary Sciences, 4(2), p. 27.
Niessen et al. (2010). Evaluation of a quality-of-life tool for cats with diabetes mellitus. Journal of Veterinary Internal Medicine, 24(5), pp. 1098–1105.
Niessen et al. (2012). Evaluation of a quality-of-life tool for dogs with diabetes mellitus. Journal of Veterinary Internal Medicine, 26(4), pp. 953–961.
RCVS (2026). Caregiver burden and the client perspective on veterinary care [Online] RCVS. Available at: https://www.rcvsknowledge.org/resource/caregiver-burden-and-the-client-perspective-on-veterinary-care/
Roberts et al. (2021). Construction of a conceptual framework for assessment of health-related quality of life in dogs with osteoarthritis. Frontiers in Veterinary Science, 8, e. 741864.
Spitznagel et al. (2017). Caregiver burden in owners of a sick companion animal: a cross-sectional observational study. Veterinary Record, 181(12), p. 321.
Spitznagel et al. (2019). Validation of an abbreviated instrument to assess veterinary client caregiver burden. Journal of Veterinary Internal Medicine, 33(3), pp. 1251-1259.
Spitznagel et al. (2022). Relationships among owner consideration of euthanasia, caregiver burden, and treatment satisfaction in canine osteoarthritis. The Veterinary Journal, 286, e. 105868.
