Quality of Life Scale (HHHHHMM): Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, More good days than bad

Overview

Developer

Villalobos (Pawspice)

Year published

2004

Species

Canine and feline

Domain

End-of-life quality of life

Structure and administration

7 items (Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, More good days than bad), each scored 0-10. Total 0-70, higher is better.

Owner-completed, 4-6 minutes. Default cadence in hospice mode is weekly; the daily Sightline Score check-in handles day-to-day signal.

Cut-off and interpretation

Cut-off threshold

35

Source: Villalobos: total >= 35 with each item >= 5 indicates 'continue palliation'. Sightline applies three bands rounded to a coarser member-facing classification: difficult (<35), watchful (35-49 or any item <5), comfortable (>=50 with every item >=5).

Citation and validation

Villalobos A. Quality-of-life scale helps make final call. Reproduced in Vet Clin North Am Small Anim Pract 2011;41:519-529.

Revisions

• v1.0 (Villalobos 2004): original Pawspice publication. Reproduced and adopted across veterinary hospice practice; the seven items have not been changed.

Target population

Pets in hospice or end-of-life care across both species. Used as the headline weekly read; the daily Sightline Score check-in fills in between.

Available languages

English (UK)

Licence

Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell. The seven-domain Pawspice quality-of-life scale (Villalobos 2004, reproduced in Vet Clin North Am Small Anim Pract 2011;41:519-529) is freely reproduced for clinical use under the routine permission noted on the original scale; Sightline renders the verbatim Villalobos / Wiley-Blackwell credit on every surface that shows the scale.

Scoring algorithm version

sightline-hhhhhmm-v1.0.0

Strengths

• Mnemonic structure (HHHHHMM) makes the seven domains memorable for owners under emotional load.
• Each domain scored independently 0-10, so a single domain collapse (e.g. mobility) is visible alongside the total.
• Free for clinical use with citation; widely adopted across the veterinary hospice community.
• Threshold guidance (>=35 total + each item >=5 = continue palliation) gives clinicians and owners a shared language for the difficult conversation.

Limitations

• Single composite total alongside per-domain scores; no validated per-band severity classification, so Sightline's three-band split is a Sightline-side interpretation aid rather than a published clinical threshold.
• Scored by the owner under emotional load; trajectory across weeks is more reliable than any single point read.
• The 'More good days than bad' item asks the owner to retrospect over the prior week, which can drift; pairing with the daily Sightline Score check-in keeps the day-by-day record honest.
• Phase 1 ships English (UK); founder review confirms wording before public launch.

Why Sightline uses it

HHHHHMM is the canonical hospice instrument. Pairing it with JOURNEYS (Dr Katie Hilst's complementary scale at Journey's Home) and the daily Sightline Score check-in gives Sightline three angles on the same trajectory: Villalobos's comprehensive weekly read, Hilst's decline-signal focused domain detail, and the day-by-day Sightline Score signal. The synthesis line in the hospice dashboard combines all three, with the weighting documented and reviewable.