Table 2.

Application of the ISOQOL guidance on implementing patient-reported outcomes in clinical practice to companion animal veterinary practice

1. Identify the goals for collecting quality-of-life assessment information in clinical practice For example, is the assessment aiming to screen for welfare deficiencies to be targeted for improvement among the whole clinic population or for monitoring the progress of individual patients?

2. Select the patients, setting, and timing of assessments A tool could be used on all of the clinic’s companion animal population or just for certain species or groups of animals such as hospitalized patients. Will the assessment occur at the time of the visit to the clinic or would it be sent to carers beforehand?

3. Determine which questionnaire(s) to use Here the term “questionnaire” can be interpreted broadly to range from asking a few open verbal questions to a lengthier written or electronic format with or without quantitative scoring. Depending on the desired focus of assessment and response format, choosing a published assessment tool that has demonstrated some degree of peer review and validation is desirable. However, if there is not one available, then it is reasonable to devise one appropriate to need, with reference to human and veterinary literature. Amalgamating elements from a variety of existing tools may also prove useful.

4. Choose a mode for administering and scoring the questionnaire For example, will carers fill in the assessment before seeing a veterinarian or nurse? Where will they do this? Will they have time and space to complete the assessment – on paper or electronically? Or will the veterinary team interview carers and/or make their own assessments?

5. Design processes for reporting results This is an important step to be clear on before implementing an assessment program. The person responsible for receiving and subsequently reporting the reports, as well as how this process will fit into the clinical workflow pattern, will need to be determined. This could depend on how quickly the report is required but, particularly with electronic capture, it may be possible to have immediate formatted reporting within the time of the veterinary consultation.

6. Identifying aids to facilitate score interpretation To interpret quantitative results, clinicians may be guided by comparisons either with scores derived during assessments of the same animal at different time points or against scores from wider populations. Whereas for human quality-of-life assessment tools, there may be research studies that generated reference scores for similar patients or the general population, initially at least, it is likely that comparisons will be generated from the using practice’s own data.

7. Develop strategies for responding to issues identified by the questionnaires Without compromising the autonomy of the clinician, who usually has to integrate information from a range of sources, guidance on how best to respond to the welfare issues raised during the assessment may help to encourage steps along the path from assessment to quality-of-life improvement.

8. Evaluating the impact of the intervention on the practice Even informal small-scale evaluations, such as discussion at practice meetings, can be useful, eg, if aiming to improve the usefulness of the assessment. Further low-cost/short-time evaluations such as carer or veterinary staff surveys, or analysis of samples of data, should be possible within veterinary clinics. Larger-scale evaluations, eg, with “control” groups, may require greater investment in time, money, and particularly expertise, but these should be undertaken, where possible, eg, in collaboration with a University.

Note: Data from Snyder et al.⁶⁰

Abbreviation: ISOQOL, International Society for Quality of Life Research.