Decision making and welfare assessment in canine osteoarthritis

Little has previously been described about how or why owners, veterinary nurses or veterinary surgeons make decisions about pets under their care. The Animal Welfare Act (2006) and the Royal College of Veterinary Surgeons’ oath should ensure the health and welfare of pets in the United Kingdom (UK) is the central focus of those decisions. The aim of this thesis was to characterise the nature and basis of decisions made about the treatment and welfare of osteoarthritic dogs by owners, veterinary surgeons and veterinary nurses. Three studies were performed. Firstly, two rapid reviews identified and appraised the outcome measures used in the peer-reviewed literature to assess canine quality of life and canine osteoarthritis. Secondly, thirty-two interviews were performed with owners of dogs with osteoarthritis and five focus groups were performed with veterinary surgeons and veterinary nurses who manage osteoarthritic dogs. Thematic analysis performed on transcripts of those interviews and focus groups identified key themes. Thirdly, a prospective study was performed to test a novel home monitoring outcome measure for use by owners of osteoarthritic dogs, developed using data gathered in the previous studies. The first study found outcomes assessed in the peer-reviewed literature focus predominantly on physical health. Those assessments are frequently unvalidated, may be subject to bias and neglect other aspects of the dogs’ welfare impacted by osteoarthritis and its management. The second study identified four important themes in the interviews and focus group data in relation to decision making. Most owners were highly motivated to make good decisions about their dogs’ welfare. However, many barriers to dog-focused decisions were recognised including: incorrect prior knowledge; ineffective veterinary consultations, in part due to different language used by owners and veterinary surgeons; the lack of available, relevant evidence on which to base decisions; an inability to reliably interpret canine behaviour; and risk aversion. A wide range of impacts of canine osteoarthritis on the welfare of the dogs, their owners and the veterinary professionals caring for those dogs were described. The third study identified several significant deficits in existing outcome measures designed for owners to assess their osteoarthritic dogs. Dogs with osteoarthritis may have day-to-day variations in their physical health and demeanour and owners appear to assess a complex mix of inputs to, and indicators of, their dogs’ welfare when decision making. More work is needed to develop outcome measures that are relevant to owners and more accurately reflect all aspects of canine welfare. This thesis is the first in-depth body of work using evidence synthesis and qualitative methods to characterise how decisions are made about osteoarthritic dogs under veterinary care. Most decisions about osteoarthritic dogs are made by owners using unvalidated assessments with little veterinary guidance. Valid, relevant and practical outcome measures are needed to collect information on which decisions can be based. Evidence does not exist to guide the majority of decisions made; the evidence that does exist appears to be poorly disseminated, particularly amongst owners. Relevant evidence must be created through well designed clinical trials to support those decisions then widely disseminated. Veterinary consultations are not always effective in making decisions focused on the best interests of osteoarthritic dogs, particularly in relation to their welfare; differences in language and perspectives may play a significant part in this. Future work in this field should involve collaboration between owners, veterinary professionals in general and specialist practice, animal welfare scientists and experts in dog behaviour. Methodological approaches taken and conclusions drawn from this thesis may be relevant to many other veterinary diseases.