Survey identifies client education gaps in canine end-of-life care

A new report in the Journal of the American Veterinary Medical Association highlights how dog owners perceive end-of-life events—and where veterinary teams may be able to improve client education around pain, quality of life (QoL), and “old age.¹

Using the Dog Aging Project’s validated End of Life Survey (EOLS), researchers analyzed 646 owner responses for dogs that died between December 26, 2019, and March 24, 2021. Most dogs were in the senior life stage at death.¹ The EOLS was designed to capture owner-perceived cause of death, reason for euthanasia, perimortem QoL, old-age characteristics, perimortem veterinary care, and related end-of-life factors.^1,2

The most common manner of death

Most dogs in the cohort were euthanized rather than dying unassisted. Of 646 dogs, 536 underwent euthanasia, dying at the mean age of 13.0 ± 3.0 years, while 110 experienced unassisted death at the mean age at death of 13.2 ± 2.9 years. Age at death did not differ significantly between dogs that were euthanized and those that died unassisted.¹

Among euthanized dogs, most procedures occurred either in a veterinary clinic or hospital (411/536) or at the owner’s home (122/536). A veterinary professional from the dog’s primary care clinic performed euthanasia in 322 of 536 cases, while a veterinary professional from another clinic performed it in 183 cases. Free-text responses suggested that many “someone else” responses reflected at-home euthanasia or hospice services.¹

The study also identified a clinically relevant gap: 95 of 646 dogs died at home without any veterinary involvement.¹ For practitioners, that finding reinforces the importance of proactive end-of-life planning before a crisis develops, particularly for geriatric patients with progressive disease or declining function.

Owners most often cited reasons

Pain and/or suffering was the most common primary reason owners selected for euthanasia, cited for 260 of 536 euthanized dogs . Poor QoL was next, at 133 of 536, followed by poor prognosis, at 105 of 536. No respondent selected cost of care as the most important reason for euthanasia, although 23 owners selected cost as a secondary factor.¹

The authors reported that many owners used free-text fields to describe perceived pain or suffering, including vocalization, depressed mentation, facial or ocular expression, altered mobility, or nonspecific observations of pain.¹ These responses point to a practical communication opportunity: veterinary teams should ask clients what they are seeing at home and how they are interpreting those signs.

That distinction matters. A client may identify vocalization, reduced interaction, or altered mentation as pain, but the differential list may include cognitive dysfunction, systemic illness, anxiety, sensory decline, or other geriatric syndromes. Clarifying the owner’s observation can help the team determine whether analgesia, palliative care, environmental modification, hospice planning, or euthanasia counseling is most appropriate.

QoL declined with advancing age

Owners reported worse perimortem QoL in older dogs. Age at death was the only dog demographic factor significantly associated with QoL category, and the proportion of dogs with favorable QoL in the 2 weeks before death decreased steadily across increasing age groups (P < .001).¹

Among owners who reported QoL decline before death (599/646), the onset varied: 174 of 599 reported decline within hours to days before death, 154 reported decline at least 1 week before death, 177 reported decline at least 1 month before death, and 94 reported decline at least 1 year before death.¹

The most frequently reported reason for QoL decline was health related (316/599), followed by physical manifestations of old age (187/599) and behavioral manifestations of old age (43/599).¹

For clinical teams, these findings support routine QoL discussions during senior and geriatric visits rather than reserving them for terminal appointments. Structured questionnaires can help frame discussions around chronic pain and health-related QoL in dogs.³ Even when a tool is not formally scored, asking owners to track mobility, appetite, sleep, social interaction, elimination habits, comfort, and “good days vs bad days” can make changes more visible and actionable.

Perceived causes of death

The most common owner-perceived causes of death were cancer (192/646), “old age” (190/646), and organ system disease (144/646).¹

Among dogs whose primary cause of death was cancer, the most commonly reported anatomic sites were the spleen, liver, and lymph node. The most commonly reported cancer types were hemangiosarcoma, lymphoma, and osteosarcoma. Most dogs with cancer as the perceived primary cause of death were euthanized (171/192).¹

Among dogs whose primary cause of death was organ system disease, owners most commonly reported kidney/urinary disease, cardiac disease, and neurologic disease. The most frequent specific diagnoses provided in free text included chronic kidney disease/failure within the kidney/urinary category and congestive heart failure within the cardiac category.¹

“Old age” was particularly important in the oldest dogs. Among dogs older than 15 years at death, old age was the most common primary categorical cause of death.^1^ When owners selected old age as the primary cause, the most common specific characteristic was poor mobility due to weakness (59/190), followed by decreased interest in eating or drinking (26/190) and chronological age itself (21/190).¹

That finding has direct implications for client counseling. Owners may use “old age” as shorthand for frailty, mobility impairment, appetite decline, cognitive changes, chronic pain, or progressive multimorbidity. Asking clients to define what “old age” means in their dog can uncover treatable or manageable problems and may improve shared decision-making.

Prognosis discussions remain an opportunity

Most owners sought veterinary care near the end of life. In the 2 weeks before death, 532 of 646 dogs (82.4%) were evaluated by a veterinarian. Approximately half of those owners (264/532) believed their dog would die within the next month, while 81 (15.2%) believed the dog would live beyond 1 month. A notable minority—96 of 532 (18.0%)—reported that prognosis was not discussed, not applicable, or not understood.¹

This result underscores the need for clear, repeated, and documented prognosis conversations. Even when the medical facts seem evident to the clinical team, clients may not understand expected trajectory, likely time course, or what clinical changes should prompt urgent reassessment or euthanasia planning.

Clinical takeaway

The EOLS findings suggest that owners’ end-of-life decisions are strongly shaped by their perceptions of pain, suffering, QoL, and old age. Veterinary teams can support clients by discussing these concepts early, defining them in observable terms, and revisiting them as disease or frailty progresses.

In practice, that may mean incorporating end-of-life planning into senior wellness visits, offering QoL tracking resources, explicitly discussing prognosis, and helping clients distinguish pain from other causes of behavioral or functional change. These conversations can improve palliative care, reduce crisis-driven decisions, and better support families through the final stage of a dog’s life.

References

1. The Dog Aging Project End of Life Survey reveals owners’ perceptions of canine death and highlights areas to improve client education. J Am Vet Med Assoc. Published online July 1, 2026. doi:10.2460/javma.25.12.0863
2. McNulty KE, Creevy KE, Fitzpatrick A, Wilkins V, Barnett BG, Ruple A. Development and validation of a novel instrument to capture companion dog mortality data: the Dog Aging Project End of Life Survey. J Am Vet Med Assoc. 2023;261(9):1326-1336. doi:10.2460/javma.23.02.0078
3. Wiseman-Orr ML, Scott EM, Reid J, Nolan AM. Validation of a structured questionnaire as an instrument to measure chronic pain in dogs on the basis of effects on health-related quality of life. Am J Vet Res. 2006;67(11):1826-1836. doi:10.2460/ajvr.67.11.1826