The bond that many people have with their pets often means that owners struggle with significant grief when their pet dies (Voith, 1985; Hart et al, 1990; Cohen, 2002; Chur-Hansen, 2010). Yet, despite the fact that many view their pets as family members, their death typically does not involve the same types of procedures or rituals that are used with human death (Adams et al, 1999; Chur-Hansen, 2010). In fact, the impact of the death of a pet is often not supported or validated by society (Corr, 1999; Doka, 2008). Too often, owners do not receive the emotional support they need from family or friends (Spain et al, 2019; Park et al, 2021). For these reasons, it is vital that veterinary professionals know how best to support pet owners during their time of loss (Adams et al, 2000). This support involves helping owners with end-of-life decisions and care (Fernandez-Mehler et al, 2013). Pre-planning can help ensure people have a voice in the end-of-life decisions of their loved ones, whether the death is of a human or companion animal. This reduces their stress and enables them to make informed decisions at a time when they are not in crisis (Nogler, 2014; Banner et al, 2019).
While there has been an increased focus within veterinary medicine on recommendations to promote positive end-of-life conversations with pet owners (Bishop et al, 2016; August, 2017; Gardner, 2017), there remains few resources that focus on after-death body care options (Bishop et al, 2016; Ellis, 2017) and little is known about owners' preferences for memorialisation or after-death body care (Kogan et al, 2022).
This study was designed to learn more about owners' preferences regarding end-of-life issues. Results of this study will be used to create data-driven recommendations for veterinary and pet aftercare professionals regarding pet owners' needs pertaining to after-death body care conversations, support and logistics.
Materials and methods
An online, anonymous, cross-sectional survey was developed using Qualtrics (Qualtrics, Inc., Provo, UT, USA). The survey was designed, reviewed and tested by the co-investigators, their colleagues and pet owners. The study was approved by the Colorado State University Institutional Review Board (IRB # 20-9995H).
Survey respondents were recruited from 25 June–10 July 2020 through Amazon's Mechanical Turk (MTurk; Amazon Inc., Seattle, WA, USA) platform, an open online marketplace providing access to potential survey respondents in which survey respondents receive small monetary compensation for completing surveys.
The diversity of participants recruited through MTurk is higher than typical internet samples or American college-based samples, and the quality of data collected meets or exceeds the psychometric standards considered acceptable in published research in the social sciences (Buhrmester et al, 2011).
In order to minimise the influence of geographical and cultural differences on respondent data, the survey was made available only to responders residing in the USA. Participants were adults (18 years or older) who were the current owners of at least one cat or dog, had a regular veterinarian, and had made end-of-life decisions, as an adult, for at least one pet.
Demographic information (age, gender, ethnicity and profession, be it veterinary related, animal/pet related, neither) was collected. Next, participants were asked to indicate to what degree they rely on their veterinarian for recommendations and several types of pet care. They were then asked to indicate how much input they would like from their veterinarian when making choices about their pet's care, including end-of-life issues.
Additional questions asked participants how likely they would be to use several potential information sources to learn about their pet's death and dying process, and after-death body care or memorialisation. The timing of communication regarding after-death body care and memorialisation, including their preference for length of time needed and when the conversation should occur, was also queried. Participants were then asked to indicate how much time they felt they would need with their veterinary team to discuss after-death care options and how they would like to receive this type of information.
Another set of questions asked about the importance of several aspects of after-death body care (e.g. how the body is stored immediately after death) and what option they most prefer (e.g. individual burial or cremation). They were also asked to indicate their concern level with several aspects involved with after-death body care using a 5-point Likert scale, with 1 = not at all concerned and 5 = very concerned. Data were analysed using SPSS statistical analysis software.
Results
The total sample size for analysis was 2043. Not all participants answered every question, so the total responses for each question have been noted if less than the total sample. The mean age of respondents was 39 years (±12.8 years); median = 36 years. Respondents included 1121 (54.9%) dog owners, 454 (22.2%) cat owners, and 468 (22.9%) owners of at least one dog and one cat.
The majority of respondents were female, White, not employed in veterinary- or animal-related professions, and reported visiting their veterinarian at least 1–2 times a year (Table 1).
Table 1. Owner demographics
| Frequency of veterinary visits (n=2041) | At least monthly | 312 (15.3%) |
| 3–4 times/year | 692 (33.9%) | |
| 1–2 times/year | 902 (44.2%) | |
| Less than once a year | 135 (6.6%) | |
| Owner gender (n=2006) | Male | 831 (41.4%) |
| Female | 1161 (57.9%) | |
| Non-binary | 10 (0.5%) | |
| No answer | 4 (0.2%) | |
| Owner ethnicity (n=2043) | Asian | 104 (5.1%) |
| Black/African American | 193 (9.4%) | |
| Hispanic/Latino | 135 (6.6%) | |
| Native American/Alaskan Native | 59 (2.9%) | |
| Native Hawaiian/Pacific Islander | 14 (0.6%) | |
| White | 1623 (79.4%) | |
| Other | 15 (0.7%) | |
| No answer | 12 (0.6%) | |
| Profession (n=2005) | Veterinary-related | 228 (11.4%) |
| Animal/pet related (e.g. dog trainer, groomer) | 237 (11.8%) | |
| Not veterinary or animal/pet related | 1540 (76.8%) | |
| As adult, number of dogs/cats made end of life decisions for (n=2043) | 1–5 | 1874 (91.7%) |
| 6–10 | 132 (6.5%) | |
| More than 10 | 37 (1.8%) |
Crematoria and cemeteries
A total of 1398 (68.4%) participants had made cremation decisions, of which 43.2% (594/1374) indicated a preference to work with a specific crematorium. Nearly all (96%) of these owners reported that being able to work with their preferred crematorium was important to them.
A total of 655 (32.1%) participants reported that they had made burial decisions. Of these, 457/655 (70.2%) reported preferring a specific cemetery and 96% of these owners reported that it was important to them to use their preferred cemetery in the future.
Religious or spiritual beliefs
The impact of religious or spiritual beliefs was queried through a series of questions pertaining to end-of-life decisions (n=2031). For each of these questions, approximately 25% of respondents noted that their religious or spiritual beliefs had a significant impact (Table 2).
Table 2. Impact of religious or spiritual beliefs
| No impact | Moderate impact | Significant impact | No answer/not religious or spiritual | |
|---|---|---|---|---|
| Death and dying process (e.g. euthanasia decisions) | 737 (36.3%) | 505 (24.9%) | 530 (26.1%) | 259 (12.8%) |
| After-death body care (e.g. burial, cremation) | 800 (39.4%) | 49 (24.6%) | 436 (21.5%) | 296 (14.6%) |
| Memorialising your pet after death (e.g. pawprints, urn, pictures) | 734 (36.1%) | 473 (23.3%) | 522 (25.7%) | 302 (14.9%) |
After-death body care
Participants were asked to indicate their level of concern about several statements regarding after-death body care (Table 3), as well as their views of several options for body storage immediately after death but before burial or cremation. Options included blanket/shroud, rubbish bag, designated cadaver bag, and casket.
Table 3. Concern and views regarding after-death body care
| 1 – not concerned at all | 2 | 3 | 4 | 5 – very concerned | |
|---|---|---|---|---|---|
| Minimising the amount of time between my pet's death and their final resting state (burial, cremation) (n=1929) | 201 (10.4%) | 172 (8.9%) | 351 (18.2%) | 544 (28.2%) | 661 (34.3%) |
| How my pet is physically handled by other people after their death (n=1948) | 247 (12.7%) | 208 (10.7%) | 380 (19.5%) | 461 (23.7%) | 652 (33.5%) |
| The cost of my pet's after-death body care (n=1950) | 227 (11.6%) | 186 (9.5%) | 346 (17.7%) | 545 (27.9%) | 646 (33.1%) |
| The type of container my pet is stored in permanently (n=1930) | 281 (14.6%) | 209 (10.8%) | 360 (18.7%) | 470 (24.4%) | 610 (31.6%) |
| Keeping my pet with the physical keepsakes they loved in life (e.g. toys, blanket) immediately after their death (n=1945) | 358 (18.4%) | 241 (12.4%) | 328 (16.9%) | 427 (22.0%) | 591 (30.4%) |
| That my pet might be mislabelled or lost (n=1942) | 358 (18.4%) | 262 (13.5%) | 301 (15.5%) | 439 (22.6%) | 582 (30.0%) |
| That I won't be able to memorialise or honour my pet the way I want (n=1950) | 393 (20.2%) | 300 (15.4%) | 375 (19.2%) | 423 (21.7%) | 459 (23.5%) |
| The type of container my pet is stored in immediately after their death (before burial or cremation) (n=1938) | 360 (18.6%) | 292 (15.1%) | 390 (20.1%) | 440 (22.7%) | 456 (23.5%) |
| Keeping my pet separate from other deceased pets immediately after their death (before burial or cremation) (n=1927) | 376 (19.5%) | 278 (14.4%) | 369 (19.1%) | 419 (21.7%) | 485 (15.2%) |
The most acceptable option was a blanket/shroud (acceptable: 1334, 66.1%), while the least acceptable option was a rubbish bag (unacceptable: 1290, 64%) (Table 4).
Table 4. Participants' views on acceptability of after death body storage options (before burial or cremation)
| Unacceptable | Neutral | Acceptable | |
|---|---|---|---|
| Blanket/shroud | 87 (4.3%) | 596 (29.5%) | 1334 (66.1%) |
| Rubbish bag | 1290 (64.0%) | 413 (20.5%) | 314 (15.6%) |
| Designated cadaver bag | 163 (8.1%) | 789 (39.1%) | 1065 (52.8%) |
| Casket | 152 (7.5%) | 831 (41.2%) | 1034 (51.3%) |
Communication regarding pet death, dying and after-death body care
The next segment of the survey focused on pet owners' preferences regarding communication and support by their veterinarian in relation to end-of-life issues. They were first asked if their veterinarian was the primary resource, one resource of many, or not a resource, for several services including recommendations related to pet death and dying (primary resource: 974/1995, 48.8%) and recommendations related to after-death body care and memorialisation (primary resource: 762/1966, 38.8%).
Participants were next asked to indicate how likely they would be to use veterinarian/veterinary staff; animal/pet professionals, friends, family and other pet owners; internet, or pet-related resources as a resource for information about end-of-life issues (n=2031). Participants indicated that they were more likely to use veterinarians and veterinary staff for information regarding pet death and dying, as well as after-death body care and memorialisation, than any other source (Table 5).
Table 5. Stated likelihood of using potential sources of information about pet death or dying and after-death body care and memorialisation
| Not at all likely | Somewhat unlikely | Neither likely nor unlikely | Somewhat likely | Extremely likely | |
|---|---|---|---|---|---|
| Pet death or dying | |||||
| Veterinarian/veterinary staff | 32 (1.6%) | 83 (4.1%) | 180 (8.9%) | 733 (36.1%) | 1003 (49.4%) |
| Friends, family, other pet owners | 129 (6.4%) | 214 (10.5%) | 435 (21.4%) | 952 (46.9%) | 301 (14.8%) |
| Animal/pet professions (not veterinary, e.g. dog daycare, groomers, pet sitters) | 442 (21.8%) | 351 (17.3%) | 408 (20.1%) | 560 (27.6%) | 270 (13.3%) |
| Pet death related resources (e.g. crematorium/cemetery staff, doula/chaplain) | 333 (16.4%) | 254 (12.5%) | 447 (22.0%) | 740 (36.4%) | 257 (12.7%) |
| Internet (e.g. websites, blogs) | 284 (14.0%) | 274 (13.5%) | 460 (22.6%) | 757 (27.3%) | 256 (12.6%) |
| After-death body care and memorialisation | |||||
| Veterinarian/veterinary staff | 150 (7.4%) | 156 (7.7%) | 252 (12.4%) | 810 (39.9%) | 663 (32.6%) |
| Friends, family, other pet owners | 200 (9.8%) | 187 (9.2%) | 413 (20.3%) | 893 (44.0%) | 338 (16.6%) |
| Animal/pet professions (not veterinary, e.g. dog daycare, groomers, pet sitters) | 492 (24.2%) | 293 (14.4%) | 434 (21.4%) | 569 (28.0%) | 243 (12.0%) |
| Pet death related resources (e.g. crematorium/cemetery staff, doula/chaplain) | 347 (17.1%) | 217 (10.7%) | 373 (18.4%) | 765 (37.7%) | 329 (16.2%) |
| Internet (e.g. websites, blogs) | 348 (17.1%) | 246 (12.1%) | 435 (21.4%) | 750 (36.9%) | 252 (12.4%) |
After assessing the likelihood of using veterinarians as an information resource, pet owners were asked to indicate how much information they would like from their veterinarian in regards to preventative or wellness care, serious illnesses (e.g. cancer), accidents, end-of-life issues (if and when to euthanise), and after-death body care (n=2042). The most common answers for end-of-life issues were ‘I typically want input from my vet; but I like to make decisions as equal partners’ and for after-death body care, it was ‘I typically want input from my vet but I like to mostly make decisions myself’ (Table 6).
Table 6. Participants' views on amount of input they want from their veterinarian for a range of medical issues
| I typically want minimal input from my vet, I typically know what I want | I typically want input from my vet but I like to mostly make decisions myself | I typically want input from my vet; but I like to make decisions as equal partners | I typically want significant input from my vet | I typically do not need to hear the details; I want my vet to make decisions for me | |
|---|---|---|---|---|---|
| Preventative care/wellness | 132 (6.5%) | 452 (22.1%) | 710 (34.8%) | 648 (31.7%) | 100 (4.9%) |
| Serious illness | 88 (4.3%) | 319 (15.6%) | 662 (32.4%) | 763 (37.4%) | 210 (10.3%) |
| Accidents | 86 (4.2%) | 277 (13.6%) | 601 (29.4%) | 827 (40.5%) | 251 (12.3%) |
| End of life issues (when/if to euthanise) | 112 (5.5%) | 484 (23.7%) | 785 (38.4%) | 496 (24.3%) | 165 (8.1%) |
| After-death body care | 386 (18.9%) | 611 (29.9%) | 554 (27.1%) | 357 (17.5%) | 134 (6.6%) |
Pet owners were then asked when they would prefer to have conversations with their veterinarian about after-death body care and memorialisation options (n=2023). The most common answer was ‘after my pet becomes sick but before death’ (822, 40.6%), followed by ‘during my pet's death, such as during a euthanasia appointment’ (458, 22.6%), ‘when my pet is still healthy’ (315, 15.6%), ‘after my pet's death when I've had time to process the loss’ (191, 9.4%), ‘never’ (161, 8.0%), ‘don't know’ (61, 3.0%) and ‘other’ (15, 0.7%).
When asked how much time they would like with their veterinary team to discuss after-death care options (e.g. types of aftercare, cost of services, memorialisation, body handling) (n=2023), the most common response was 5–10 minutes (667, 33.0%), followed by 11–20 minutes (549, 27.1%), 21–30 minutes (300, 14.8%), 1–5 minutes (253, 12.5%), more than 30 minutes (152, 7.5%), and don't know (102, 5.0%). The next set of questions asked how pet owners would like veterinarians to share information about after-death body care options (with an option to select all that apply), to which 1449 (71.6%) indicated they prefer to review and discuss after-death body care options together in the veterinary hospital, and 1116 (55.2%) indicated they would like to be given after-death body care materials to view/read at home later.
In relation to the previous question, participants were asked how important they feel it is that their veterinarian visit or tour the recommended aftercare facility (n=1914). Most participants felt it was either very (692, 36.2%) or moderately important (915, 47.8%).
To ascertain the amount of information pet owners want to know about the death and dying process, they were asked to indicate their preference for the level of detailed information given to them regarding several aspects of death/dying and aftercare (n=2020). With the exception of ‘What happens to my pet at the cemetery or crematorium’, the most common response was ‘I want general information but don't need all the details’ (Table 7).
Table 7. Owner preference for amount of information given about specific death/dying and aftercare aspects
| I want all the details | I want general information but I don't need all the small details | I would prefer to just be told what I need to know | |
|---|---|---|---|
| The death/dying process (euthanasia, hospice) | 763 (37.8%) | 943 (46.7%) | 314 (15.5%) |
| What happens to my pet after death while still at the veterinary hospital (before being transported to cemetery or crematorium) | 618 (30.6%) | 770 (38.1%) | 632 (31.3%) |
| What happens to my pet at the cemetery or crematorium | 572 (28.3%) | 696 (34.5%) | 752 (37.2%) |
| Options to memorialise my pet | 912 (45.1%) | 687 (34.0%) | 421 (20.8%) |
Discussion
The results of this study provide insights into pet owners' preferences relating to end-of-life issues, including after-death body care preferences and what role they would like their veterinarian to play during this process. Of the respondents, 49% reported viewing their veterinarian as the primary resource for information about pet death and dying, and 39% viewed them as the primary resource for information about after-death body care and memorialisation. Furthermore, most owners expect their veterinary teams to be informed about local after-death body care options and memorialisation and be willing to have end-of-life conversations.
Knowing when to broach conversations around after-death body care and memorialisation can be challenging (Shanan, 2011). This study found that 41% of pet owners would like to talk about aftercare options when their pet becomes terminally ill, but before the death event itself. Some pet owners reported preferring to discuss after-death body care while their pet is still healthy, suggesting that it may be beneficial for some clients and veterinary teams to broach the subject during geriatric visits, before the pet becomes gravely ill. Additionally, 28% of owners said they would like everything finalised well in advance of death, suggesting that a significant number of pet owners could benefit from pre-planning.
Over 50% of respondents indicated they were concerned about after-death body care, including the time between death and final resting place (63%), how their pet is handled by others after its death (58%) and type of container their pet is permanently stored in (61%); similar to results from previous studies (Fernandez-Mehler et al, 2013). Other aspects of after-death body care that can impact owners' decisions are religious or spiritual beliefs. These beliefs were reported to have a significant impact on aftercare decisions for approximately 25% of respondents.
The responses to a series of questions related to after-death body care include several areas worth noting. For example, 53% of the respondents had concerns that their pet's body may be mislabelled. While mistakes can happen, it is suggested that protocols pertaining to body labelling and care should be explored to minimise the risk of mislabelling.
When assessing owners' views regarding aftercare facilities, 84% of respondents reported feeling that it was important for their veterinary team to visit the aftercare facilities they recommend. First-hand knowledge of local aftercare facilities has also been deemed important by the American Veterinary Medical Association (2023).
In terms of talking to veterinary teams about after-death body care and memorialisation, nearly 75% of respondents indicated that they would like 20 minutes or less to review available options. Providing printed material, having information on hospital websites, and partnering with pet aftercare companies may be useful to supplement these conversations. When pet owners were asked how much detail they wanted regarding information about aftercare, the common response was a desire to be told general information, rather than all the details, although a sizable minority (between 28 and 45% depending on the specific topic) indicated they wanted to know specifics. Therefore, the authors suggest that conversations about aftercare options with pet owners could be tailored to individual owner's needs by asking them the level of detail they prefer.
Based on results of this study, the authors suggest making the recommendations outlined in Table 8 to veterinary teams when discussing end of life and aftercare with owners.
Table 8. Recommendations for dissemination of information regarding end of life and related procedures with owners
| Dissemination of information | Take the time to address owners' aftercare concerns and options | ||
| Ask owners if they have a preferred crematorium or cemetery and respect their decisions | Present a choice of local pet aftercare options if owners have no preference | ||
| Provide written explanations of aftercare services and offerings, including cost considerations | |||
| Use standardised forms whenever possible to reduce liability risk and increase transparency | |||
| Procedures | Follow pet owners' choices closely | ||
| Use designated cadaver bags or containers | |||
| Use procedural checklists and technology to track bodies, when possible, to minimise chances of mistakes | Immediately label bodies (ideally within 30 minutes of appointment completion) | ||
| Submit pet information to aftercare companies as soon as possible (ideally within 1 hour) | |||
| Ensure pet bodies leave the hospital with proper labelling and instructions | |||
| Partnering with aftercare companies | Visit local pet aftercare facilities annually to familiarise yourself with their offerings and policies and ensure they meet industry standards | ||
| Encourage aftercare companies to: | Provide emotional assistance to pet owners | ||
| Obtain bodies as quickly as possible (ideally within 24 hours) | |||
| Demonstrate high quality, respectful body handling standards with or without owners present | |||
| Play an active role in pet owner education and pre-planning | |||
Conclusions
This study examined pet owners' preferences and expectations related to end-of-life and, specifically, after-death body care. Limitations to this study include the fact that the data collected represents the views of American pet owners who were willing to take an online survey regarding end-of-life issues, so may not be generalisable to other populations. Further research and the establishment of best practices are warranted in several areas and exploration of the potential benefits and challenges of veterinary hospitals partnering with pet aftercare companies and services could be of value.
The results of this study suggest that most pet owners are concerned about their pet's aftercare and want their veterinary team to help guide them through the process. Pet owners trust their veterinary team to carry out their end-of-life wishes. It is important that veterinary teams offer aftercare communication and services with respect and transparency, facilitating a positive end-of-life experience for all those involved.
KEY POINTS
- Pet owners are more likely to turn to veterinary staff for information and support regarding their pet's death, after-death body care and memorialisation than any other source.
- Pet owners have substantial concerns over several aspects of after-death body care, including body mislabelling and type of container used for short-term and long-term storage.
- Veterinary teams have an opportunity to improve support for grieving pet owners by aligning with their specific aftercare needs.