Treating The Owner As Well As The Pet: The Reality of Caregiver Burden in Veterinary Practice

Amelia is the proud owner of “Nosy”, an 18-year-old Morgan gelding that has a history of recurrent laminitis attributable to equine metabolic syndrome and pituitary pars intermedia dysfunction. Following his diagnosis, Amelia made a commitment to “Nosy” to do all she could to manage both conditions and reduce the frequency of laminitis episodes. This involved daily administration of oral medication; strict dietary management including adherence to a prescribed ration (no treats), weighing of feed, soaking and rinsing hay; frequent exercise when sound; routine farriery; and naturally, despite all preventative measures, constant worrying about when the next bout of laminitis will occur.

As veterinarians we are always striving to reach a definitive diagnosis and subsequently devise an appropriate treatment plan, which will either cure or manage said disease. Understandably the patient is always at the forefront of our minds, we want to do all we can to alleviate their symptoms and suffering, but how often do we truly consider the owner’s experience as the nominated caregiver? As advances in veterinary medicine allow us to prolong the lives of our patients with chronic or terminal illness, it becomes really important for vets and vet nurses to acknowledge the impact that longer-term management regimens may have on the owner.      

Caregiver burden is well recognised in human medicine, and is associated with a variety of perceived negative experiences including feelings of guilt, anger towards the patient, financial strain and fear of what the future holds [1]. So, is the same true for our companion animal owners? Do they experience similar feelings of distress associated with caring for a chronically or terminally ill pet? Do they too suffer caregiver burden? If so, what can we as veterinary professionals, do to ease their burden?

A review of the veterinary literature confirms that caregiver burden is a reality for our owners [2,3,4], and can be quantitatively assessed using a modified Zarit Burden Interview (ZBI). Recently, Spitznagel et al. (2019) validated a further abbreviated version of the ZBI for use in pets, which was positively correlated with stress and negatively with quality of life. This 7-item instrument included the following questions, each scored on a 5-point scale ranging from “never” to “nearly always”:

1. Do you feel that because of the time you spend with your pet that you don’t have enough time for yourself?
2. Do you feel stressed between caring for your pet and trying to meet other responsibilities for your family or work?
3. Do you feel you have lost control of your life since your pet’s illness?
4. Do you feel angry when you are around your pet?
5. Do you feel embarrassed over your pet’s behaviour?
6. Do you feel you should be doing more for your pet?
7. Do you feel you could be doing a better job in caring for your pet?

Although there are currently no cut-offs to definitively categorise levels of burden, this questionnaire could certainly be implemented in veterinary practice to better understand an owner’s perspective. Yes, this might take a little bit of extra time, but 100% it would be worth it! Intentionally taking the time to ask an owner how they are feeling and how their pet’s illness may be impacting their life will undoubtedly go a long way in building trust and cementing client relationships. Could this ultimately improve patient outcomes? Quite possibly, especially if we can validate owner’s concerns and make them feel better supported when discussing the challenges they face. 

So, in Amelia’s case, what are some support strategies we could consider?

1. Use the abbreviated ZBI (aZBI) described above to quantitatively assess her current caregiver burden.
2. Arrange a 3-monthly check-in to evaluate her experience - this is separate to “Nosy’s” recheck appointments, it is specifically for Amelia. A team approach could certainly be considered, with the check-in performed telephonically with a veterinary nurse. At each check-in, the aZBI could be completed to determine how her perceived burden is changing.
3. Create a support group within the practice for owners of horses/ponies with endocrinopathic laminitis. Knowing that other owner’s are faced with similar issues - that they are not alone; and having a forum on which to ask questions or discuss how they are feeling is of extreme value.
4. The initiation of a conversation pertaining to an end-of-life plan if “Nosy’s” clinical presentation deteriorates or Amelia’s burden associated with caring for him increases over time. For many owners, the fear of not knowing when to make the decision for euthanasia induces significant stress and anxiety, so by having an open conversation about the situation can be incredibly useful for decision making. 

Acknowledging and attempting to quantify caregivers burden will not only facilitate effective client communication, but will also provide veterinary professionals with a better understanding of the client experience when caring for a companion animal with a chronic or terminal condition. Having a better insight into the client’s perspective may not only help improve patient outcomes, but might even assist veterinarians cope with stress induced by anxious or distressed clients.

Food for thought? Be sure to join our Platinum CPD community and never miss an update! We would love to hear your thoughts on this important topic, so please feel free to comment below.

1. Britton K, Galioto R, Tremont G, Chapman K, Hogue O, Carlson MD, Spitznagel MB (2018) Caregiving for a Companion Animal Compared to a Family Member: Burden and Positive Experiences in Caregivers. Front. Vet. Sci. 5:325. https://doi: 10.3389/fvets.2018.00325
2. Christiansen SB, Kristensen AT, Sandoe P, et al. Looking after chronically ill dogs: impact on the caregiver's life. Anthrozoos. 2013;26: 519-533.
3. Spitznagel MB, Jacobson DM, Cox MD, et al. Caregiver burden in owners of a sick companion animal: a cross-sectional observational study. Vet Rec. 2017;181:381-387.
4. Spitznagel MB, Mueller MK, Fraychak T, Hoffman AM, Carlson MD. Validation of an abbreviated instrument to assess veterinary client caregiver burden. J Vet Intern Med. 2019;33:1251-1259. https://doi.org/10.1111/jvim.15508