Dr Ashutosh Gupta
World Hospice and Palliative care day is a unified day of action to celebrate and support hospice and palliative care around the world. It takes place on the second Saturday of October every year and Voices for Hospice takes place on the same date every two years. This year the awareness day will be on Saturday 9th October.
The 2021 theme is – “Leave no one behind – equity in access to palliative care”
What is Palliative care?
WORLD HOSPICE & PALLIATIVE CARE DAY
We start our discussion with a 6th century anonymous beautifully stating that “we cure seldom, comfort many times and palliate always”. Palliative care is specialized medical care for people living with serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. It is an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether Physical, Emotional, Social and religious.
Palliative care uses a team approach to support patients and their caregivers. It involves addressing suffering involves taking care of issues beyond physical symptoms. This includes addressing practical needs and providing bereavement counselling. It offers a support system to help patients live as actively as possible until death.
What is Hospice Care?
Hospice care focuses on the care, comfort and quality of life of a person with a serious illness who is approaching the end of life. Like palliative care, hospice provide comprehensive comfort care as well as support for the family but in hospice, attempts to cure the person’s illness are stopped.
Why we need Palliative Care?
Whether we are young or old, sick or well – the one thing we all have in common is that dying will be a part of our lives. For those with a serious, life limiting condition, palliative care can make it a more positive experience. It can enable people to be comfortable at the end of their lives and ease their concerns and that of their families, allowing them to enjoy their time together.Moreover, due toinappropriate communication between physician and patient and family, Palliative care can also support medical professionals as their patients transition from receiving treatments that aim for a cure, to care that seeks the best quality of life and symptoms management.
Principles of Palliative Care
* Affirms life and regards dying as a normal process.
* Intends neither to hasten nor postpone death.Offers a support system to help patients live as actively as possible until death.
* Offers a support system to help the family cope during the patient illness and in their own bereavement.
* Integrates the psychological and spiritual aspects of patient care.
Team of Palliative Care
Palliative care uses a team approach to support patients and their caregivers.This includes addressing practical needs and providing bereavement counselling.The team comprises of Doctors including general practitioners, palliative care specialists and other specialist doctors; Nurses; Allied health professionals including social workers, physiotherapist, clinical psychologist, pharmacists, dietitians; Secretary, Priest and Volunteers.Specialist palliative care staff are trained with specific skills and knowledge to help patients, their family and care-givers.. Palliative care staff have expertise in symptom management, emotional, spiritual, practical and cultural care.
Barriers in Palliative care
* Trust between staff and family
* Patient and family education (other caregivers).
* Education and training of palliative care for medical staff, particularly physicians and nurses is not available
* Lack of awareness among policy makers,health professionals and the public about what palliative care is, and the benefits it can offer patients and health systems
* Cultural and social barriers, such as beliefs about death and dying
* Misconceptions about palliative care, such as that it is only for patients with cancer, or for the last weeks of life
* Misconceptions that improving access to opioid analgesia will lead to increased substance abuse. Morphine is not readily available across the country. Opioids prescription is still restricted to 3-10 days.
Morphine consumption can be used as an approximate measure of the availability of pain control and hence availability of this form of palliative care. Developing countries consumed only 6% of global consumption of morphine( almost 80 percent of the world’s population). While 10 countries together accounted for 87% of total world consumption of morphine.
Palliative care in India
Palliative care remains an undeveloped and under resourced area of healthcare. Lack of palliative care training and the lack of awareness of needs. There is a need for a national programme of palliative care and to have a dedicated society for hospice care.
Palliative care services in GMC Jammu
Palliative Care services started in GMC Jammu in February 2020 in form of OPD services. There was a problem in sustaining because of the COVID and OPD room was taken over for vaccination. But our team never lost heart. We shifted to indoor palliative care services in oncology ward where our services were carried on in full swing.Following the patterns of recent concepts in palliative care, we have shifted our approach from giving care to end of life services to integration of palliative services from the very beginning of diagnosis of cancer. Our team immediately adopts the patients in oncology ward as soon as they are admitted. Our team coordinates with the oncology team. Both Oncology services and palliative care services are provided side by side.
* Our Consultants /residents are having daily rounds of patients in oncology ward along with oncology residents /consultants.
* While oncology doctors are looking after the cure, we are looking after the care. So, both care and cure are going side by side.
* OPD services are resumed in September 2021 and are fully functional.
What we need from the Government?
* National policies and programs for palliative care.
* Palliative care programs should be incorporated in the existing health care systems.
* Health care workers should adequately trained in palliative care.
* Availability of both opioid and non- opioid analgesics, and annual estimation of stock.
* Regular review, with the aim of permitting importation, manufacture, prescribing, stocking,dispensing, and administration of opioids for medical purposes.
* Legally empowering physicians,nurses and pharmacists to prescribe, stock, dispense, andadminister opioids.
* Review of the controls governing opioid use.
In the end, All must die someday. It’s not “If”, but “when”, and “How”. If death is inevitable…
Let’s ensure a good death
(The author is Professor and Head Regional Cancer Center, GMC Jammu)
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