Abstract
Objectives
The aim of this study was to use an online survey to obtain information from cat owners about their experiences of medicating their cats.
Methods
An online survey containing 35 questions on experiences of medicating cats was circulated to cat owners globally.
Results
In total, 2507 surveys from 57 countries were analysed; 1724 from ‘cat owners’ and 783 from ‘cat owners+’ (respondents with significant cat experience, including veterinary professionals). Around half (50.7%) of cat owners were ‘sometimes’ or ‘never’ provided with information or advice on how to administer medication; however, 91.8% of those given information found it ‘somewhat’ or ‘very’ useful. Around half (53.6%) of owners sought information from the internet about how to administer medication. Total cat owners (cat owners and cat owners+) administered liquids (61.3%), pastes (45.3%) or tablets (39.5%) directly into their cat’s mouth; fewer (22.6–24.1%) hid these medications in food. Total cat owners rated tablets significantly harder to administer than liquids; 53.0% chose liquids as their first-choice formulation while 29.3% chose tablets. Insulin injections and ‘spot-ons’ were significantly easier to administer than any oral medications. Over half (51.6%) of owners reported that medicating their cat(s) had changed their relationship with them; 77.0% reported that their cat(s) had tried to bite or scratch them when medicating. Other challenges included the cat(s) spitting out tablets (78.7%), refusing medication in food (71.7%) and running away (52.7%). Of the owners who failed to complete a course of medication (35.4%), 27.8% stopped near the end of the course, while 19.3% stopped after a few doses, in both cases as medicating was too difficult.
Conclusions and relevance
Owners appreciate being provided with information about the administration of medication. Frequent challenges when medicating cats include potential human injury and damage to the owner–cat relationship. Pharmaceutical companies should provide a range of formulations to ease compliance. Veterinary clinics should provide information/demonstrations and internet links when prescribing medications.
Keywords: Medicating, compliance, tablets, liquids, owners, communication
Introduction
Medications, in the form of tablets, liquids, capsules, powders, pastes, transdermal preparations, ‘spot-ons’ and injections, are prescribed to cats by veterinarians for owners to administer at home, both for the treatment of illnesses, and the prevention and treatment of parasitic infection. Owners may find giving the prescribed medications to their cat challenging and ‘compliance’ (also termed ‘adherence’) to medication courses is a poorly studied area of feline practice. 1 A previous smaller study 2 showed that a quarter of cat owners were unable to give some doses of medication prescribed, with owners reporting challenges including cats refusing medication in food, spitting out the medication or hypersalivating. Medication formulation may affect adherence in cats. 3 For example, formulations designed for cats (as opposed to human medications) are usually easier to administer, 2 although only 35% of cats in the study took the drug willingly. Liquids (solutions and suspensions) may be easier to administer, 2 with fewer missed doses than tablets, 4 but tablets were preferred by owners for long-term administration.2,4 There is a need to create palatable medications for companion animals,2,3 but this may be easier in dogs than cats as they are, by their nature, more fastidious. 5
In human medicine, medication adherence is identified as a target outcome to reduce healthcare costs and use of health services, 6 and parallels in challenges to adherence are seen in paediatric medical practice. 7 Multicomponent and behavioural interventions can produce marked effects on human adherence 8 and an American Animal Hospital Association (AAHA) review 9 suggested that the same may be true in animals, showing that good communication and provision of written information was strongly correlated with adherence. In the AAHA survey, pet owners shown one or more ways to administer medication had a significantly higher rate of ‘never missing a dose’ than those not shown. 9
Attempts to medicate unwilling cats can result in human injury, 2 but failure to complete a course of medication has wider human health implications if antibiotic courses are not completed, potentially promoting antibiotic resistance, which is a major concern in veterinary and human medicine. 10 Perceptions that cats are challenging to medicate may promote the use of highest priority, critically important antimicrobial drugs, such as cefovecin 11 in a long-acting subcutaneous injection formulation, or other antibiotics such as fluoroquinolones, led by formulation rather than spectrum, which may not comply with the International Society for Companion Animal Infectious Diseases guidelines 12 and raises antibiotic stewardship concerns. Additionally, incomplete antibiotic courses may lead to subtherapeutic antibiotic serum levels, impacting efficacy and the development of resistance. Improved compliance is likely to result in improved treatment success, optimised preventive healthcare, reduced antibiotic resistance and an improved cat–owner bond. Understanding barriers to medicating cats will assist the pharmaceutical manufacturers and veterinary profession when creating and prescribing medicines for cats.
The aim of this study was to conduct a worldwide survey of cat owners in order to find out: how medications are given to cats, what information is provided by veterinary clinics, what the challenges of administering medications are, and what the cats’ behavioural responses to being medicated are, as well as owner preferences for formulation and barriers to completion of a medication course.
Materials and methods
An online survey was created to collect data from cat owners on their experiences of medicating their cats. The survey included 35 questions on a range of topics from experiences of administering different forms of medications, use of online pharmacies, preferences for medication formulation, support from the veterinary clinic, negative feline behavioural responses to being medicated and the impact on the owner’s relationship with their cat. Drop-down menus allowed respondents to select answers to several questions, including selecting from a list of categories to distinguish cat owners without veterinary or professional pet experience (termed ‘cat owners’) from veterinary professionals and those working with cats in other capacities (termed ‘cat owners+’); the latter group included veterinary professionals, cat behaviourists, breeders, fosterers, those working with unowned cats and anyone who spent considerable time with cats. The full survey is included in the supplementary material.
The survey was publicised via several routes to encourage responses; these included via social media and veterinary organisations, as well as via the Vet Professionals and International Cat Care databases, and the International Society of Feline Medicine newsletters to members. Press releases were supplied to veterinary publications and publicity was gained via several veterinary corporates and pharmaceutical companies. The survey was open for 4 months between February and May 2021.
Data were collected via the Vet Professionals website and stored using FormSite (Vroman Systems) and downloaded into a Microsoft Excel spreadsheet.
For analysis, some questions were more applicable to cat owners than cat owners+ (eg, advice given by veterinary surgeon), hence the data were separated. In other questions, data from both groups were included (termed ‘total cat owners’), and, in appropriate cases, statistical analysis was performed to look at the differences between cat owners and cat owners+.
Descriptive statistics were performed, as well as a χ2 test to compare groups when appropriate. P values <0.05 were considered to be significant. Free-text statements were examined individually.
Ethical approval for this study was provided by The Human Ethical Review Committee (HERC) at the Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK.
Results
A total of 2702 responses were received between February 2021 and May 2021; however, 195 respondents were not cat owners and were excluded from the study, leaving 2507 surveys for analysis. This included 1724 from cat owners and 783 from cat owners+. Of the cat owners+, there were 346 veterinarians, 301 veterinary nurses or technicians, 46 veterinary receptionists, 33 boarding cattery staff, 29 veterinary behaviourists and 29 cat breeders; the remainder were a combination of shelter staff, fosterers and those working with animals in other capacities (some respondents selected more than one role).
Respondent demographics
Survey responses were received from cat owners in 57 countries. The majority of respondents were from the UK (69.9%), with 14.76% from the USA and Canada, 10.2% from European Union countries and 2.8% from Australia and New Zealand; the remainder were from outside of these locations (eg, South America and Africa).
Source of medication
Almost all respondents had been given medications from their veterinarian to give to their cat at home (98.9%). A total of 642 (25.6%) owners had obtained medication from an online pharmacy with a prescription from their veterinarian.
Experience of medicating
The majority of cat owners and cat owners+ had experience of administering tablets (95.5%), ‘spot-on’ preparations (78.3%) and liquids (77.5%). See Table 1 for total cat owners’ experiences of medication formulations.
Table 1.
Medication formulations that total cat owners (cat owners and cat owners+) had experience of administering to their cats
| Formulation | Respondents with experience |
|---|---|
| Tablet | 2395 (95.5) |
| ‘Spot on’ | 1964 (78.3) |
| Liquid | 1940 (77.4) |
| Capsule | 1132 (45.1) |
| Eye drops/ointment | 1112 (44.4) |
| Powder or granules | 1014 (40.4) |
| Paste | 935 (37.3) |
| Ear drops | 916 (36.5) |
| Cream or ointment on the skin | 807 (32.2) |
| Insulin injections | 409 (16.3) |
| Other | 267 (10.6) |
| None of the above | 5 (0.2) |
Data are n (%)
Cat owners = owners without significant cat experience; cat owners+ = respondents with significant cat experience, including veterinary professionals
Advice and support from the veterinary clinic on medicating their cat
Information or advice on how to administer medication was described as ‘always given’ by 47.5% of cat owner respondents and ‘sometimes’ or ‘never’ by 50.7% (40.0% and 10.7%, respectively). How information was provided is illustrated in Figure 1. When information was provided, this was mainly a verbal explanation by a veterinarian (77.9%), with a demonstration by a vet or nurse to 55.1% of cat owner respondents. Two-thirds (67.0%) of cat owners were advised if the medication could be given with food, and less than half of cat owners giving a tablet or capsule were told if the tablet could be crushed or the capsule opened (45.9%). Of cat owners given information, 91.8% found the information ‘somewhat’ or ‘very’ useful.
Figure 1.
How information on medicating was provided to cat owners.
Cat owners = owners without significant cat experience
Cat owner respondents who found medication difficult to administer only contacted their veterinary clinic for help in 41.8% of cases, and of these 67.5% reported that the clinic was able to provide a solution to their difficulties.
Advice from other sources
When cat owners were asked if they had sought advice from the internet on how to give medications to their pets, 53.6% answered that they had.
How owners administer medication
Table 2 shows how cat owners and cat owners+ prefer to administer various types of medication. The majority of people administer liquids (61.3%), pastes (45.3%) or tablets (39.5%) directly into their cat’s mouth. Capsules are more often opened and mixed with a small amount of food or a treat (37.3%). Around a quarter of respondents answered that they hide pastes (24.1%), tablets (23.4%) and liquids (22.6%) in a small amount of food or a treat, whereas just over two-thirds (67.6%) added powders/granules to food or a treat. Only 16.8% of owners crushed tablets into food or a treat, and 9.9% and 9.5%, respectively, used a pill-giving device for tablets or capsules. It was noted that 11.3% of respondents answered ‘other’ for how they administer pastes and information recorded in free text included ‘putting onto the cat’s paw to let it lick it off’ as the most common method.
Table 2.
How total cat owners (cat owners and cat owners+) prefer to give medications (excluding answers ‘I can’t remember’ and ‘I have never been asked to give that type of medication’)
| Preferred method of administering medication | Formulation | ||||
|---|---|---|---|---|---|
| Tablets | Capsule | Liquid | Paste | Powder/granules | |
| I open the cat’s mouth and put it in with my fingers | 887 (39.5) | 498 (32.9) | NA | NA | NA |
| I open the cat’s mouth and administer directly with a syringe | NA | NA | 1229 (61.3) | 568 (45.3) | NA |
| I hide the medication (whole) in a small amount of food or a treat | 525 (23.4) | 135 (8.9) | 453 (22.6) | 302 (24.2) | 919 (67.6) |
| I add the liquid/paste to a liquid treat | NA | NA | 168 (8.4) | 96 (7.7) | 209 (15.4) |
| I add the liquid/powder to a liquid cat treat and syringe directly into the cat’s mouth | NA | NA | 28 (1.4) | NA | 38 (2.8) |
| I mix the powder/granules with water and syringe directly into the cat’s mouth | NA | NA | NA | NA | 115 (8.5) |
| I open the capsule and mix the contents with a small amount of food or a treat | NA | 565 (37.3) | NA | NA | NA |
| I open the capsule and mix the contents with a small amount of liquid and give by syringe directly into the cat’s mouth | NA | 68 (4.3) | NA | NA | NA |
| I crush the tablet and mix it with a small amount of food or a treat | 377 (16.8) | NA | NA | NA | NA |
| I open the cat’s mouth and put it in using a pill ‘shooter’ or ‘popper’ | 223 (9.9) | 143 (9.5) | NA | NA | NA |
| It varies too much to say | 110 (4.9) | 53 (3.5) | 40 (2.0) | 34 (2.7) | 31 (2.3) |
| Other | 99 (4.4) | 44 (2.9) | 66 (3.3) | 142 (11.3) | 47 (3.5) |
| I offer it on its own (eg, in an empty food bowl) | 24 (1.1) | 8 (0.5) | 21 (1.0) | 97 (7.7) | NA |
| Total respondents | 2245 | 1514 | 2005 | 1254 | 1359 |
Data are n (%)
NA = not applicable; cat owners = owners without significant cat experience; cat owners+ = respondents with significant cat experience, including veterinary professionals
Challenges of medicating cats and the effect on cat owners
Table 3 and Figure 2 illustrate answers to the question ‘In general, how easy do you find it to administer each of the following formulations?’, with answers ranked from 1 (very easy) to 10 (impossible). Cat owners were significantly more likely to rate tablets between 7 and 10 than liquids (P ⩽0.05), and significantly more likely to rate ‘spot ons’ between 1 and 3 than any other formulation apart from insulin injections, which 70.9% of respondents ranked between 1 and 3.
Table 3.
Cat owners’ and cat owners+’ ease/difficultly of administration rating for administering different formulations of medication
| Formulation | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Rating | Tablet | Capsule | Liquid | Paste | Powder | ‘Spot on’ | Cream/ointment | Ear drops | Eye drops | Insulin injection | ||||||||||
| CO | CO+ | CO | CO+ | CO | CO+ | CO | CO+ | CO | CO+ | CO | CO+ | CO | CO+ | CO | CO+ | CO | CO+ | CO | CO+ | |
| 1 (very easy) | 172 (11.7) | 122 (18.4) | 99 (11.1) | 128 (21.6) | 268 (21.5) | 212 (33.3) | 115 (16.6) | 91 (18.9) | 155 (20.0) | 111 (22.9) | 516 (38.4) | 276 (42.5) | 199 (25.5) | 158 (35.9) | 91 (13.3) | 69 (16.6) | 50 (6.8) | 58 (21.9) | 108 (40.8) | 107 (43.0) |
| 2 | 124 (8.4) | 118 (17.8) | 82 (9.2) | 79 (13.3) | 176 (14.1) | 123 (19.3) | 73 (10.6) | 87 (18.1) | 97 (12.5) | 74 (15.3) | 237 (17.6) | 126 (19.4) | 144 (18.5) | 91 (20.7) | 72 (10.6) | 63 (15.11) | 75 (10.2) | 61 (12.7) | 42 (15.8) | 50 (20.1) |
| 3 | 156 (10.6) | 121 (18.2) | 94 (10.5) | 95 (16.0) | 191 (15.3) | 98 (15.4) | 101 (14.6) | 100 (20.8) | 123 (15.9) | 83 (17.1) | 159 (11.8) | 63 (9.7) | 120 (15.4) | 62 (14.1) | 125 (18.3) | 73 (17.51) | 98 (13.3) | 75 (15.6) | 38 (14.4) | 40 (16.1) |
| 4 | 114 (7.8) | 60 (9.0) | 86 (9.6) | 69 (11.6) | 131 (10.5) | 62 (9.7) | 83 (12.0) | 57 (11.8) | 83 (10.7) | 60 (12.4) | 110 (8.2) | 43 (6.6) | 82 (10.5) | 39 (8.9) | 86 (12.6) | 38 (9.11) | 92 (12.5) | 74 (15.4) | 13 (4.9) | 16 (6.4) |
| 5 | 178 (12.1) | 73 (11.0) | 122 (13.6) | 70 (11.8) | 154 (12.3) | 53 (8.3) | 113 (16.3) | 60 (12.5) | 107 (13.8) | 62 (12.8) | 105 (7.8) | 52 (8.0) | 92 (11.8) | 30 (6.8) | 92 (13.5) | 60 (14.40) | 83 (11.3) | 62 (12.9) | 20 (7.5) | 9 (3.6) |
| 6 | 116 (7.9) | 39 (5.9) | 69 (7.7) | 34 (5.7) | 84 (6.7) | 21 (3.3) | 58 (8.4) | 25 (5.2) | 65 (8.4) | 37 (7.6) | 67 (5.0) | 26 (4.0) | 48 (6.1) | 29 (6.6) | 58 (8.5) | 40 (9.59) | 67 (9.1) | 35 (7.3) | 10 (3.8) | 8 (3.2) |
| 7 | 190 (13.0) | 53 (8.0) | 97 (10.8) | 46 (7.8) | 97 (7.8) | 29 (4.5) | 58 (8.4) | 25 (5.2) | 54 (7.0) | 30 (6.2) | 57 (4.2) | 22 (3.4) | 35 (4.5) | 16 (3.6) | 70 (10.3) | 34 (8.15) | 95 (13.0) | 45 (9.4) | 9 (3.4) | 9 (3.6) |
| 8 | 160 (10.9) | 35 (5.3) | 92 (10.3) | 39 (6.6) | 72 (5.8) | 25 (3.9) | 45 (6.5) | 23 (4.8) | 31 (4.0) | 17 (3.5) | 57 (4.2) | 18 (2.8) | 28 (3.6) | 12 (2.7) | 43 (6.3) | 20 (4.80) | 76 (10.3) | 34 (7.1) | 12 (4.5) | 4 (1.6) |
| 9 | 125 (8.5) | 24 (3.6) | 75 (8.4) | 17 (2.9) | 43 (3.4) | 12 (1.9) | 21 (3.0) | 6 (1.2) | 22 (2.8) | 6 (1.2) | 22 (1.6) | 13 (2.0) | 18 (2.3) | 1 (0.2) | 19 (2.8) | 16 (3.84) | 50 (6.8) | 22 (4.6) | 3 (1.1) | 1 (0.4) |
| 10 (impossible) | 131 (8.9) | 18 (2.7) | 78 (8.7) | 16 (2.7) | 31 (2.5) | 2 (0.3) | 24 (3.5) | 7 (1.5) | 37 (4.8) | 5 (1.0) | 13 (1.0) | 10 (1.5) | 14 (1.8) | 2 (0.5) | 26 (3.8) | 4 (0.96) | 51 (6.9) | 15 (3.1) | 10 (3.8) | 5 (2.0) |
| Total | 1466 | 663 | 894 | 593 | 1247 | 637 | 691 | 481 | 774 | 485 | 1343 | 649 | 780 | 440 | 682 | 417 | 737 | 481 | 265 | 249 |
Data are n (%) and exclude answers of ‘not applicable’ or ‘can’t recall’
CO = cat owner; CO+ = cat owner+; cat owners = owners without significant cat experience; cat owners+ = respondents with significant cat experience, including veterinary professionals
Figure 2.
Rating of ease/difficulty of administering various formulations of medications (cat owners).
1 = very easy; 10 = impossible; cat owners = owners without significant cat experience
The most frequently reported challenge was the cat spitting out the tablet (78.7%), with the cat refusing the medication in food reported by nearly three-quarters of respondents (total cat owners; 71.7%). A total of 77.0% of total cat owner respondents answered that their cat tried to bite or scratch them. Further information on reported challenges is illustrated in Table 4 and Figure 3.
Table 4.
Negative behavioural responses to medicating reported by total cat owners (cat owners and cat owners+)
| Behavioural response | Cat owners | Cat owners+ | Total respondents |
|---|---|---|---|
| My cat spat the tablet out | 1308 (82.7) | 500 (70.1) | 1808 (78.7) |
| My cat would not eat the medication in food or a treat | 1152 (72.9) | 493 (69.1) | 1645 (71.7) |
| My cat would try to run away from me | 861 (54.5) | 348 (48.8) | 1209 (52.7) |
| My cat tried to scratch me | 745 (47.1) | 294 (41.2) | 1039 (45.3) |
| My cat tried to bite me | 524 (33.1) | 204 (28.6) | 728 (31.7) |
| My cat would not tolerate the tablet being put into its mouth | 771 (48.8) | 270 (37.9) | 1041 (45.4) |
| I could not hold my cat still for long enough | 700 (44.3) | 221 (31.0) | 921 (40.1) |
| I could not open my cat’s mouth | 700 (44.3) | 162 (22.7) | 862 (37.6) |
| I could not catch my cat | 327 (20.7) | 110 (15.4) | 437 (10.0) |
| Other | 95 (6.0) | 62 (8.7) | 157 (6.8) |
Data are n (%)
Cat owners = owners without significant cat experience; cat owners+ = respondents with significant cat experience, including veterinary professionals
Figure 3.
Negative behavioural responses to medicating reported by total cat owners (cat owners and cat owners+).
Cat owners = owners without significant cat experience; cat owners+ = respondents with significant cat experience, including veterinary professionals
Respondents were asked how restraining/holding their cat to give it medication made them feel, and for cat owners+ 62.2% felt confident handling their cat, significantly more than the 38.2% of cat owners (P ⩽0.05). Just under half of cat owners (46.7%) worried that they would hurt their cat, and 34.0% worried that they would get bitten or scratched; in both cases, this was significantly less for cat owners+ (P ⩽0.05). Further data are provided in Table 5.
Table 5.
How cat owners and cat owners+ felt restraining/holding their cat to give medicine
| How owner felt | Cat owners | Cat owners+ |
|---|---|---|
| Worried I would hurt my cat* | 699 (46.7) | 121 (18.1) |
| Confident to handle my cat* | 572 (38.2) | 417 (62.2) |
| Worried I would get bitten or scratched* | 508 (34.0) | 150 (22.4) |
| Worried I would do it wrong* | 348 (23.3) | 52 (7.8) |
| No problem, I found it easy* | 162 (10.8) | 155 (23.1) |
| Not confident – I feel unsure how to hold my cat* | 126 (8.4) | 15 (2.2) |
| Other | 113 (7.5) | 73 (10.9) |
Data are n (%)
Significant difference between cat owners and cat owners+ (P <0.05)
Cat owners = owners without significant cat experience; cat owners+ = respondents with significant cat experience, including veterinary professionals
Of 2166 responses, just over half (51.6%) of total cat owners reported that giving medication to their cat at home had changed their relationship with them.
Completing medication courses
Cat owners were asked if they always finished the course of medicine their veterinary clinic had given them; 62.5% answered ‘yes, always’, 24.2% ‘yes, most of the time’ and 11.2% ‘no, not always’. Cat owners were then asked if they have not always finished a course of medication, which of a choice of reasons accounted for their decision. The answer selected most frequently was ‘I stopped near the end of the course as the medicine was difficult to give’ (27.8%), with 19.3% answering that they ‘stopped after a few doses as the medicine was so difficult to give’. Further answers are illustrated in Figure 4.
Figure 4.
How cat owners answered the question ‘If you have not always finished a course of medicine, which of the following possible reasons accounted for that decision’.
Cat owners = owners without significant cat experience
Preferred formulations for oral medication
Respondents (total cat owners) chose liquids (53.0%) as the preferred first-choice formulation from options of tablets, capsules, pastes, powder/granules and liquids. This was followed by tablets (28.8%), powder/granules (6.2%), paste (6.0%) and, lastly, capsules (3.6%) (Figure 5 shows first and second choices of medication formulation). Of those choosing liquid as a first choice, 29.3% chose tablet as a second choice. Of those choosing tablets as first choice, 26.1% chose liquids as second choice. In both cases, answers from the remaining respondents were spread between different formulations.
Figure 5.
Total cat owners’ (cat owners + cat owners+) preferred choice of medication formulation.
Cat owners = owners without significant cat experience; cat owners+ = respondents with significant cat experience, including veterinary professionals
Discussion
In the veterinary profession it has long been accepted that giving medications to cats is challenging; however, little published literature supports this assumption or examines the reasons for, and potential consequences of, attempts to medicate cats and the risk of poor compliance.1,2 In the current study we examined owners’ experiences of medicating their cats at home using an online survey. Siven et al 2 sampled 46 owners and found that 24% were unable to give the prescribed doses, calculating compliance as 76%. In the present study nearly two-thirds (62.5%) of cat owners answered that they ‘always’ completed a course of medication, although owner-reported estimates of compliance are likely to be overestimates.13 The aim of this study, however, was more to assess the challenges of medicating cats according to owners, and in this regard it showed that for half of respondents, failure to complete a course of medication was due to an inability to medicate their cat.
This study showed that half of cat owners ‘sometimes’ or ‘never’ received information on how to administer the medication that their cat had been prescribed, a third were not told if the medication could be given in food and less than half of owners were told if a tablet could be crushed or a capsule opened. This suggests support for clients could be improved and this, in turn, may improve compliance. Data from the American Animal Hospital Association report 9 suggest that demonstrating how to medicate a patient could reduce the number of missed doses. This is supported by the present study, as 91.8% of owners provided with information found it ‘somewhat’ or ‘very’ useful. Most information was provided verbally, with <5% of cat owners being directed to online information or videos. However, around half of owners looked for information online, suggesting there is an opportunity to provide clients with reliable online sources and videos to help them understand how to give medication to their cat. In a review of interventional tools to improve human medication compliance, 14 single components (eg, information or education) seem ineffective; however, when combined with other interventions, such as skills training and even medication packaging design, clinical outcomes may be improved. Alarmingly, in the present study, less than half of cat owners contacted the clinic to discuss their challenges, although of those who did, two-thirds found it helpful. Maintaining an open and honest dialogue regarding the difficulties of medicating cats is important, encouraging owners to report challenges so help can be provided or alternative formulations discussed. In the present study, a quarter of respondents obtained medication online, potentially missing opportunities for such dialogue on administering the medication. Without support, there is potential for damage to the relationship between the owner and the clinic, and reluctance to return or even report their cat’s illnesses promptly for fear of being dispensed further medications they cannot give.
Most cat owners in this study administered medications directly into their cat’s mouth, with around a quarter hiding medications (ie, pastes, liquids and tablets) in food/treats. Ensuring owners are aware of options such as hiding drugs in food when giving medications, and the names of preferred treats, may increase the number of owners trying this method of improving cat compliance. However, 72% of total cat owners reported their cat ‘would not eat the medication in food or a treat’. Clearly there is a need to create palatable oral formulations that are voluntarily accepted by cats using research into palatability in this species. 3
Respondents were asked about formulation preference and significantly more cat owners selected liquids as a first choice and were significantly less likely to rate liquids between 7 and 10 than tablets (with 1 very easy and 10 being impossible); that is, they generally found liquids relatively easy to give. However, 29% selected tablets as a preferred first choice, and second choices varied between formulations. Pastes and capsules were least preferred for both first and second choice of formulation. Siven et al 2 showed an owner preference for liquid and suspension formulations, and liquid preparations have been associated with fewer missed doses in cats; 4 however, as the current study showed, there is variation between cat owners and cats with regard to choice of formulation, suggesting that offering clients different formulation options may be optimal to encourage compliance.
It is clear that cat owners in the current study found ‘spot-on’ administration significantly easier than other formulations of routine medication; however, unexpectedly, insulin injections were found to be simple to administer in many cases, with approximately 40% of cat owners rating them as easy to give. This may be because owners of diabetic cats are given more support, and demonstrations of insulin administration, so they feel more confident about medicating their cat; however, there are still gaps in provision of this training, as 51% of owners in one study 15 were not supervised when drawing up and administering insulin.
Cat owners met challenges administering medication. Nearly 80% of total cat owners reported their cat ‘spat the tablet out’ and, 45% and 32%, respectively, reported that their cat tried to scratch or bite them. Given the risk of a cat bite or scratch wounds requiring medical attention, 16 this is a concern. If we accept that giving medication to cats can be difficult, then we should consider the effect on the owner, as well as the potential negative impact on the cat’s welfare. ‘Caregiver burden’ is a term used in human healthcare to describe an individual’s response to caring for a family member. In veterinary medicine, the owners of animals with chronic or terminal illnesses show increased caregiver burden, leading to higher stress and anxiety and a lower quality of life. 17 In the present study, just over half of total cat owners reported that giving medication to their cat had changed their relationship with them; a similar proportion reported that their cat tried to run away from them and 47% of cat owners felt worried that they would hurt their cat when restraining them to give medication. As veterinary professionals we should not underestimate the negative consequences to owners of trying to medicate their cats.
Challenges in medicating cats may result in antibiotic courses not being completed, doses being missed or requests by owners for inappropriate long-acting injections, all with potential impacts on antimicrobial resistance. The use of cefovecin has been studied in several countries, with a recent Australian study showing that it is used more commonly in cats than dogs, and in scenarios where antimicrobials may not be indicated or where an antimicrobial of lower importance to human health is recommended. 18 However, missed doses of other antibiotics given orally, some of which are also critically important antimicrobials (eg fluoroquinolones), resulting in sub-therapeutic serum levels will also promote antimicrobial resistance, 19 and as studies show cats are prescribed antimicrobials more frequently than dogs, 20 this is of serious concern. Compliance with appropriate oral antibiotics may be facilitated by supporting clients to improve their ability to medicate their cat using tablets, liquids or pastes (as determined by the particular antibiotic that is recommended), and limiting the use of long-acting injections without indication.
Owners with experience of handling cats (cat owners+) felt significantly more confident handling their pet and significantly less concerned about getting bitten or scratched, or hurting their cat. These findings, along with other data from this study showing the cat owner+ group found medicating their cat easier than the cat owner group, suggest that training, experience and familiarity with the species aids compliance. This can be used as further evidence that support and training are beneficial to cat owners when they need to medicate their cat.
Given the lack of published information on medication compliance in cats, 1 it is hoped that the present study will contribute to the literature, encourage veterinary clinics to support and educate their clients on how to administer medications to cats, and demonstrate to pharmaceutical companies the importance of considering administration, formulation, palatability and choice when designing medications for this species.
Limitations of the study
Limitations of the study include the nature of an online survey, which selected for cat owners who use the internet and are motivated to complete the survey. They may also have been motivated to complete the survey due to either negative or positive experiences of medicating their cats, and a desire to discuss this experience. It is also possible that in some questions compliance is overestimated due to reluctance to admit that they found medicating their cat so difficult. For this reason, ‘failure’ to complete a course of medication, or finding giving medication ‘impossible’, may have been underestimated. The survey focused on oral medications, and did not specifically discuss the transdermal route, and ease of administration of these medications requires further study. Additionally, specific types of medication were not investigated (eg, antibiotics and analgesia), nor was how the frequency of administration might affect compliance. The survey was only available in English, which selected for completion in predominantly English-speaking countries.
Despite the limitations, the survey gained a large number of respondents from many countries and results showing a wide range of experiences giving medications, meaning the results are useful and may help with future conception of medication formulations for cats, and encourage further support from veterinary professionals to owners.
Conclusions
Cat owners face several challenges when medicating their cats, the most serious being the potential risk of human injury, damage to the cat–owner bond and uncompleted courses of medication. This study provides novel information on the negative reactions to medicating and the effect on caregivers, as well as the importance of providing support to caregivers. Veterinary clinics should support clients by demonstrating how to medicate their cats, and directing owners to reliable sources of information. Although liquid formulations were generally preferred and ‘spot-on’ and insulin injections were found to be the easiest to give to cats, different options should be provided. Pharmaceutical companies should focus on palatability and ease of medicating.
Supplemental Material
Survey on ease of medicating cats
Acknowledgments
The authors would like to thank the veterinary professionals and cat owners who completed and even promoted this survey. The authors would also like to thank Kim Cockburn at Vet Professionals for uploading and promoting the questionnaire and her assistance in analysing the data.
Footnotes
Accepted: 9 February 2022
Author note: The results of this study were presented, in part, as an abstract presentation at the 2021 ISFM World Feline Congress.
Supplementary material: The following file is available online:
Survey on ease of medicating cats.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical approval: This work did not involve the use of animals and therefore ethical approval was not specifically required for publication in JFMS. Although not required, where ethical approval was still obtained, it is stated in the manuscript.
Informed consent: This work did not involve the use of animals (including cadavers) and therefore informed consent was not required. No animals or people are identifiable within this publication, and therefore additional informed consent for publication was not required.
ORCID iD: Samantha Taylor 
https://orcid.org/0000-0002-8668-0777
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Associated Data
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Supplementary Materials
Survey on ease of medicating cats