Factors Influencing Decision-Making in Companion Animal Euthanasia: A Mixed-Methods Study of Pet Owners and Veterinarians.

Euthanasia in companion animal practice represents one of the most emotionally and ethically challenging decisions in veterinary medicine, requiring clinical judgment, effective communication, and sensitivity toward both animal welfare and pet owner well-being. This mixed-methods exploratory study investigated decision-making in small animal euthanasia from both pet owner and veterinarian perspectives. An online questionnaire completed by 228 pet owners from 17 countries was supplemented by two semi-structured interviews involving small animal veterinarians with different professional backgrounds. The qualitative interview component was exploratory and was used to contextualize the survey findings. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative responses were examined thematically. Illness (63.3%) and age-related decline (31.6%) were the most frequently reported reasons for euthanasia. Most pet owners assessed their animal's condition through personal observation (53.5%) or veterinary advice (39.2%), whereas structured quality-of-life tools were rarely used (7.3%). Emotional attachment represented the most influential factor in decision-making (69.3%). Pet owners who explicitly reported receiving emotional support from their veterinarian experienced significantly lower emotional burden (Holm-adjusted