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Palliative care in India
6/5/2020 11:40:14 PM

Dr. Aditya S. Pawar

Health is a state of physical, mental and social well-being by definition. Doctors strive to keep their patients in a healthy state, but we learn that medicine has limitations. There are times when there are no interventions available to prolong the patient’s life. However even in those situations, a doctor’s responsibility never ceases. He offers most precious skill learned, which is to provide comfort, understanding the goals of the patient, helping them cope with their symptoms and provide support to the family and care givers. This is where palliative care comes in; focusing on relief from the symptoms and helping patients understand a serious illness with overall goal to improve quality of life for both the patient and their families.
Palliative care is a team-based approach for people with serious illness and helps address emotional, social, and spiritual aspects of life. It’s a philosophy that patient care does not only include medical care but an overall holistic approach in patient’s well-being. The goal is to provide comfort to patient and help them live with their illness. Studies have shown that, with palliative care, patients with serious illness live longer and have better quality of life.
The concept of palliative care is not new in India; however, it’s far from reaching its full potential yet. Multiple obstacles in the growth of palliative care exist for example our growing population, poverty, and geographical diversity, restrictive policies with medication, workforce development, national palliative care policy and lack of institutional interest. In 2015, global league in access to end-of-life ranked India at 67th position out of 80 countries. Despite challenges; need and provision of palliative care continues to grow and has potential to grow further by increasing awareness among physician and patients. Every physician must acquire skills of palliative care to improve communication with patient and their families. Not only this improves patient satisfaction but helps physicians in forming long term relationships with their patients.
There is a robust need for introducing palliative care in MBBS curriculum so that doctors are able to learn early in their career. It teaches how to lead communication with families and patients regarding their goals of care and end of life wishes. Patients can continue to receive palliative care while they simultaneously receive medical care for their illness. Palliative care providers work closely with patients, primary care provider and other team members such as cardiologist, oncologist or any other specialty. Symptoms such as pain, constipation, nausea, anxiety, trouble sleeping, depression, fatigue, emotional distress, loss of appetite, spiritual questions, breathing problems can have significant distress on patients and are important to address. The alleviation of symptoms helps patient gain strength to carry on with their daily life. It improves their ability to handle medical treatments. This leads to informed decision making as it helps patients think clearly without symptom burden. Medical conditions such as cancer, cardiac disease, congestive heart failure, chronic obstructive pulmonary disease, kidney disease, Alzheimer’s, Parkinson’s and Amyotrophic lateral sclerosis are examples where palliative care may be beneficial. Example of services supported by palliative team can include but not limited to palliative radiation and surgery, medication for pain management, nerve blocks to decrease pain, breathing and relaxation exercises, and acupuncture to help lower anxiety or pain.
A palliative care team consists of a specialist such as a physician, nurse, and social worker. Their working is different from hospice as patients who qualify for hospice are generally with medical condition with life expectancy less than 6 months. Palliative care can begin as soon as diagnosis is made with serious illness. It helps people of any age, at any stage of disease or condition. This includes people who are still receiving medical care that could cure their conditions.
We are blessed that our society and culture provides strong social support to patients. With the addition of palliative care, the quality of life of patients can be improved further. Helping patients and families in time of their suffering is the paramount duty of health care providers. In March 2019, Jammu and Kashmir got its first center for palliative care program and treatment of cancer, which is a welcome step. Looking ahead, we have a long way to go to increase use of palliative care especially in Jammu and Kashmir, as they demand is far more than supply at present. We need to increase access and develop policies that provide guidelines for palliative care access to patients and physicians. It needs to be integrated with medical care with support of hospice programs.
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