Dr Rohit Lahori
The rapid scenario of the world is bringing changes in all aspects of the life of human beings. These dynamic changes hence call for the need for research and development in the field of the betterment of human life. Palliative care for the patient in need is a field that drastically affects human life and can provide an ethical and more humanitarian way to live with dignity. India has crude death rate of 7/1000 and a population of more than 1.40 billion, the total number of people dying every year in India is about 9 million, there is a health transition in India and is a major public health challenge of growing magnitude. More people are dying of cancer than before – 17 % of all deaths in 2020, up from 12% in 1990. In India, there are 8 lakh new cases per year. We have2.5 million cancer patients in India, 80% of them are diagnosed at stage IV, only 0.4% have access to Pain and Palliative care. 1 in 5 suicides in India are committed by a person living with an advanced, chronic or life-limiting condition. Globally 14% of individuals require palliative care. Each year, around seven million Indians with terminal conditions may need palliative care therapies to relieve the refractory symptoms that have not responded to prior treatments and are present toward the end of life which includes Physical discomfort as most important worry. Other typical signs of these fatal illnesses include nausea, shortness of breath, anxiety, and depression. Demographically, the need for palliative care will increase from 38.0% in 2014 to 56.0% by 2040. Annually, 40 million people require palliative care. Around 78% of persons needing palliative care reside in low- and middle-income economies
The Quality of Life of patients with any incurable disease can be improved with Palliative Care (PC). PC is all about looking after people with chronic and life limiting illnesses that cannot be cured, relieving their suffering and supporting them through difficult times. This is possible in any setting-hospice, hospital or at home. PC is an approach that improves the quality of life of patients with life-threatening illnesses, and their families through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (World Health Organization). The PC is a vital and integral part of all clinical practice, whatever the illness or its stage. The need for PC in a developing country like India is huge, where cure is often impossible, because of late presentation and limited treatment. In India existing palliative care facilities are lagging behind the rest of the world. However, some states have better approaches and facilities, but overall research suggests the need for more development in the field of palliative care. India needs a systematic approach to improving palliative care. These improvements include increasing the workforce, better application of policies, good political support, and educating health care workers and patients requiring palliative treatment. One of the primary parts of palliative care is setting appropriate goals for clinical scenarios with poor prognoses. “Life is worth living every day until the last one.” A dignified death is every human’s right. With the numbers of terminally ill people growing over the years, the need to improve the quality of life of these people has gained significant attention.
India with its growing population carries a huge burden of patients suffering from life-limiting diseases. Many of whom have exhausted all meaningful treatment options. Palliative care is an interdisciplinary approach that aims at improving the quality of life of both terminally ill patients and their caregivers. . India currently ranks 59 out of 81 countries in the Quality of Death index. A larger number of patients in India come to the hospital at more advanced stages of the disease, as compared to the western world, many pursue the rest of their treatment at tertiary care hospitals. . Enabling care of such patients at a local secondary care hospital is a more cost-effective and more efficient use of health care resources. Patients, as well as their loved ones and friends, are involved in palliative care. The contact between patients, caregivers, and medical personnel is improved through palliative medicine. Palliative medicine not only provides emotional and spiritual support but also creates a network of assistance to allow the sufferer to live as self-dependent as possible, i.e., it makes patients autonomous and active. Palliative care has increased the caretaking of patients and their loved ones with therapy. It improves medical care quality while cutting expenses. It allows people to maintain their comfort level by preventing and reducing pain and suffering. Palliative treatment facilitates communication between sufferers and their loved ones. According to a recent survey, more than 108 entities currently provide facilities to improve the quality of life and palliative treatment services in 16 states/union territories in India, of which J&K (UT) takes pride in starting these services in all the districts of the UT, thus making these services available at grassroots level. These are mainly restricted to major cities and regional cancer centres, . The Government of India (GoI) launched the National Program for Palliative Care (NPPC) in 2012. Ever since then Government of India has been earmarking funds under NRHM flexi pool for initiating and scaling up palliative care services in various states depending on the Program Implementation Plan submitted by each state. The NPPC strategy is in line with 2014 World Health Assembly Resolution for achieving universal access to palliative care as part of Universal Health Coverage. The provision of palliative care needs the active support of family, members of which serve as primary care-givers, community volunteers and the health system. The HWC at SHC and PHC levels need to work in close collaboration with frontline workers to identify those in need of palliative care, mobilize and sensitize volunteers and community level collectives. World Hospice and Palliative Care Day (WHPCD) 2023 will be on the 14th of October. This year’s theme is Compassionate Communities: Together for Palliative Care. WHPCD is an annual unified day of action to celebrate and support hospice and palliative care around the world. Community has a big role in the management of these patients by providing the supportive care to families and the patient.
(The author is pain and Palliative Care Specialist Govt Hospital Gandhi Nagar Jammu)
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