Indian Journal of Palliative Care
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   2016| October-December  | Volume 22 | Issue 4  
    Online since October 10, 2016

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The effects of music therapy on anxiety and depression of cancer patients
Madineh Jasemi, Sanaz Aazami, Roghaieh Esmaili Zabihi
October-December 2016, 22(4):455-458
DOI:10.4103/0973-1075.191823  PMID:27803568
Background and Purpose: Cancer patients often suffer from anxiety and depression. Various methods are used to alleviate anxiety and depression, but most of them have side effects. Music therapy can be used as a noninvasive method to reduce anxiety and depression. This study aimed to examine the effect of music therapy on anxiety and depression in patients with cancer. Materials and Methods: This quasi-experimental study was conducted attaching hospitals in Urmia city. A total number of sixty patients with depression and anxiety were recruited using random sampling method and divided into two groups of control and intervention. Patients in intervention group listened to light music at least 20 min per day for 3 days. The degree of patients' anxiety and depression was assessed by Hospital Anxiety and Depression Scale at baseline and 3 days after music therapy. Data were analyzed by SPSS version 13 using t-test, Pearson, and ANOVA tests. Results: The results showed no significant differences between demographic variable of intervention and control groups. Our findings indicated a significant decrease in the level of depression and anxiety among intervention group. There were significant relationships between anxiety, depression, and sex (P < 0.001, r = 0.42) as well as education (P = 0.003, r = 0.37). Conclusion: This study revealed positive effects of music therapy on decreasing level of depression and anxiety in patients with cancer. Therefore, it is recommended to include music therapy in the nursing care.
  9,533 260 -
Current status of percutaneous transhepatic biliary drainage in palliation of malignant obstructive jaundice: A review
SH Chandrashekhara, S Gamanagatti, Anuradha Singh, Sushma Bhatnagar
October-December 2016, 22(4):378-387
DOI:10.4103/0973-1075.191746  PMID:27803558
Malignancies leading to obstructive jaundice present too late to perform surgery with a curative intent. Due to inexorably progressing hyperbilirubinemia with its consequent deleterious effects, drainage needs to established even in advanced cases. Percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) are widely used palliative procedures each with its own merits and lacunae. With the current state-of-the-art PTBD technique consequent upon procedural and hardware improvement, it is equaling ERCP regarding technical success and complications. In addition, there is a reduction in immediate procedure-related mortality with proven survival benefit. Nonetheless, it is the only imminent lifesaving procedure in cholangitis and sepsis.
  6,658 351 -
Re-designing Orem's self-care theory for patients with chronic hepatitis
Ali Hasanpour-Dehkordi, Nooredin Mohammadi, Alireza Nikbakht-Nasrabadi
October-December 2016, 22(4):395-401
DOI:10.4103/0973-1075.191754  PMID:27803560
Background: Hepatitis is an inflammatory disease which has many adverse effects on patients' life because of its chronic nature. Since Orem's theory of self-care is a grounded theory, the concepts and applications of this theory in patients with chronic hepatitis who have special needs may lead to some challenges. The purpose of this study was to explore self-care in patients with chronic hepatitis. Methods/Design: A directed content analysis was used in this qualitative study. Participants were recruited from a metropolitan area. Data were collected through semi-structured interviews. The verbatim transcripts of the participants' interviews were analyzed according to directed content analysis. Results: In this study, four themes, suggested by Orem, were drawn from the data according to directed content analysis. The codes generated from the data were classified into concepts and then the concepts were assigned into these four themes. These themes were "needs in the matrix of time and place," "self-care agency," "need for change in self-care" and "consequences of hepatitis." Conclusion: The use of Orem's self-care theory cannot meet the need for self-care in hepatitis patients because these patients have vital sexual, respect and belonging, physical, economical, and psychological-behavioral needs, and lack adequate knowledge about self-care. Consequently, the specific self-care model developed in this study helps health professionals identify self-care activities in patients with chronic hepatitis.
  5,218 183 -
Self-care concept analysis in cancer patients: An evolutionary concept analysis
Ali Hasanpour-Dehkordi
October-December 2016, 22(4):388-394
DOI:10.4103/0973-1075.191753  PMID:27803559
Background: Self-care is a frequently used concept in both the theory and the clinical practice of nursing and is considered an element of nursing theory by Orem. The aim of this paper is to identify the core attributes of the self-care concept in cancer patients. Materials and Methods: We used Rodgers' evolutionary method of concept analysis. The articles published in English language from 1980 to 2015 on nursing and non-nursing disciplines were analyzed. Finally, 85 articles, an MSc thesis, and a PhD thesis were selected, examined, and analyzed in-depth. Two experts checked the process of analysis and monitored and reviewed the articles. Results: The analysis showed that self-care concept is determined by four attributes of education, interaction, self-control, and self-reliance. Three types of antecedents in the present study were client-related (self-efficacy, self-esteem), system-related (adequate sources, social networks, and cultural factors), and healthcare professionals-related (participation). Conclusion: The self-care concept has considerably evolved among patients with chronic diseases, particularly cancer, over the past 35 years, and nurses have managed to enhance their knowledge about self-care remarkably for the clients so that the nurses in healthcare teams have become highly efficient and able to assume the responsibility for self-care teams.
  4,766 196 -
African cultural concept of death and the idea of advance care directives
Rabi Ilemona Ekore, Bolatito Lanre-Abass
October-December 2016, 22(4):369-372
DOI:10.4103/0973-1075.191741  PMID:27803556
An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones' death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat which cannot be achieved if an individual asks for an unnatural death by attempting to utilize advance care directives. Advance care directives are considered to be too individualistic for communitarian societies such as Africa. Coupled with the communitarian nature of African societies are issues such as lack of awareness of advance directives, fear of death and grief, and the African cultural belief system, which are potential barriers to the utilization of advance care directives in the African setting. Hence, the need for culture sensitivity which makes it imperative that patient's family and loved ones are carried along as far as possible, without compromising the autonomy of the patient in question when utilizing advance care directives.
  4,751 139 -
Cancer pain management in developing countries
Shalini Saini, Sushma Bhatnagar
October-December 2016, 22(4):373-377
DOI:10.4103/0973-1075.191742  PMID:27803557
The World Health Organization estimated that more than 60% of the 14 million new cancer cases worldwide in 2012 were reported in the developing part of the world, including Asia, Africa, Central and South America. Cancer survival rate is poorer in developing countries due to diagnosis at late stage and limited access to timely treatment. Since the disease per se cannot be treated even with the best available treatment modalities, what remains important is symptom management and providing comfort care to these patients. The incidence of pain in advanced stages of cancer approaches 70-80%. Lack of preventive strategies, poverty, illiteracy, and social stigma are the biggest cause of pain suffering and patient presenting in advance stage of their disease. The need for palliative care is expanding due to aging of world's population and increase in the rate of cancer in developed and developing countries. A huge gap remains between demand and current palliative care services. Overcoming barriers to palliative care is a major global health agenda that need immediate attention. Main causes of inadequate pain relief remain lack of knowledge among physician and patients, lack of adequate supply of opioids and other drugs for pain relief, strong bureaucracy involved in terms of procurement, and dispensing of opioids. Beside this, poverty and illiteracy remain the most important factors of increased suffering.
  4,182 252 -
Communication needs of patients with breast cancer: A qualitative study
Tahereh Alsadat Khoubbin Khoshnazar, Mrayam Rassouli, Mohammad Esmaeil Akbari, Farah Lotfi-Kashani, Syrus Momenzadeh, Nahid Rejeh, Maryam Mohseny
October-December 2016, 22(4):402-409
DOI:10.4103/0973-1075.191763  PMID:27803561
Introduction: Since communication is considered to be one of the central concepts in caregiving practices, this study aims to examine the perception of women with breast cancer in terms of their communication needs. Methods: In this qualitative study, 20 participants (9 women with breast cancer, 10 of health-care professionals, and one family caregiver) were selected through purposive sampling, and a face-to-face semi-structured interview was conducted with each of them. After data collection, all interviews were transcribed and reviewed, and categories were extracted. The data were analyzed with Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Results: The analysis resulted in two extracted categories: "therapeutic communication" and "facilitating empathy," and five subcategories: "trust-building therapist," "crying out to be heard," "seeking a soothing presence," "sharing knowledge," and "supportive peers." Conclusion: Identifying and promoting the communicative needs of patients could lead to a considerably better care of patients under treatment. Therefore, therapeutic communication, as an integral part, should be incorporated into the care plan for patients with breast cancer and their families in the Oncology and Palliative Care wards.
  3,594 123 -
Speech outcome in oral cancer patients - pre- and post-operative evaluation: A cross-sectional study
Gomathi Saravanan, Venkatesan Ranganathan, Anitha Gandhi, V Jaya
October-December 2016, 22(4):499-503
DOI:10.4103/0973-1075.191858  PMID:27803574
Aim: The tongue plays a major role in articulation. Speech outcome depends on the site of lesion, extent of resection, and flexibility of the remaining structures. The aim of this study is to evaluate the speech outcome measures such as sounds that are misarticulated and speech intelligibility and its connection to tumor site before and after surgery. Methodology: Totally, 24 (12 pre- and 12 post-operative patients) patients who had buccal and tongue cancer underwent speech intelligibility rating and articulation screening. Result: The results show that the speech outcome is worse in postoperative patients when compared to preoperative patients. The articulation errors produced by tongue cancer patients were more than the errors produced in buccal cancer patients. The type of reconstruction also affects the speech outcome. Conclusion: The perceptual analysis of oral cancer patients showed specific articulation issues and reduced intelligibility of speech in regards to site of lesion and type of reconstruction surgery. To reduce the speech errors, effective rehabilitation is recommended. A comprehensive speech evaluation and analysis of error patterns would help us in planning the rehabilitative measures of speech which is the most important factor in re-establishing interpersonal communication and well-being of the individual.
  3,246 106 -
Structural challenges of providing palliative care for patients with breast cancer
Tahereh Alsadat Khoubbin Khoshnazar, Maryam Rassouli, Mohammad Esmaeil Akbari, Farah Lotfi-Kashani, Syrus Momenzadeh, Shahpar Haghighat, Moosa Sajjadi
October-December 2016, 22(4):459-466
DOI:10.4103/0973-1075.191828  PMID:27803569
Introduction: To establish a palliative care system (PCS) in Iran, it is necessary to identify the potential barriers. Aim: This study aims to highlight the views of stakeholders to know the challenges of providing palliative care for women with breast cancer. Materials and Methods: Semi-structured in-depth interviews are used with purposeful sampling conducted in Tehran, Iran; from January to June 2015. Twenty participants were included in the study: nine patients with breast cancer and ten health-care providers. The interviews were analyzed using qualitative directed content analysis based on Donabedian model. Data credibility was examined using the criteria of Lincoln and Guba. Results: Based on the pattern of Avedis Donabedian model, two main categories were identified: (1) palliative care services in the health system still remain undefined and (2) lack of adequate care providers. The subcategories emerged from the main categories are: (1) Inexistent home care, (2) specialized palliative care being in high demand, lack of: (a) Rehabilitation program and guidelines, (b) treatment/training protocols, (c) inefficient insurance and out-of-pocket costs, (d) patient referral system, (e) nontransparency of job description, and (f) weakness of teamwork. Discussion: The findings of the study identify views and perceptions of patients as well as the health professionals around the challenges of providing palliative care. To establish a structured PCS, we need to meet the challenges and remove perceived barriers to, including but not limited to, building up knowledge and awareness of health professionals, educating professional, and developing updated, well-defined, and standard treatment protocols, tailored to local conditions.
  2,819 110 -
Clinical impact of education provision on determining advance care planning decisions among end stage renal disease patients receiving regular hemodialysis in university malaya medical centre
Albert Hing (Wong), Loh Ee Chin, Tan Li Ping, Ng Kok Peng, Lim Soo Kun
October-December 2016, 22(4):437-445
DOI:10.4103/0973-1075.191788  PMID:27803566
Introduction: Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. Aim: To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Materials and Methods: Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Results: Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. Conclusion: The ACP educational brochure clinically impacts patients' preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.
  2,705 86 -
Patient and health-care provider interpretation of do not resuscitate and do not intubate
Heather Pirinea, Thomas Simunich, Daniel Wehner, John Ashurst
October-December 2016, 22(4):432-436
DOI:10.4103/0973-1075.191784  PMID:27803565
Background: Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretations of the do not resuscitate (DNR), do not intubate (DNI), and the Physicians Orders for Life-Sustaining Treatment (POLST) form result in ineffective communication and confusion between patients, family members, and HCPs. Methodology: An anonymous, multiple choice online and paper survey was distributed to patients, family members of patients (PFMs), and HCPs from December 12, 2012 to March 6, 2013. Data regarding demographics, the accuracy of determining the correct definition of DNR and DNI, the familiarity of the POLST form and if a primary care physician had discussed advanced directives with the participants were collected. Results: A total of 687 respondents participated in the survey. Patients and PFMs could not distinguish the definition of DNR (95% confidence interval [CI] [1.453-2.804]) or DNI (95% CI (1.216-2.334)) 52% of the time while HCPs 35% and 39% of the time (P < 0.0005). Regarding the POLST form, 86% of patients and PFMs and 50% of HCPs were not familiar with the POLST form. Sixty-nine percent of patients and family members reported that their primary care physician had not discussed advance directives with them. Twenty-four percent of patients and family members reported that they had previous health-care experience and this was associated with increased knowledge of the POLST form (P < 0.0005). An association was also seen between the type of HCP taking the survey and the ability to correctly identify the correct definition of DNR (P < 0.0005). Conclusion: Discussion of end of life care is difficult for patients and their family members. Often times multiple discussions are required in order to effectively communicate the definition of DNR, DNI, and the POLST form. Education of patients, family members, and HCPs is required to bridge the knowledge gap of advance directives.
  2,715 73 -
Fatigue and quality of life outcomes of palliative care consultation: A prospective, observational study in a tertiary cancer center
Arunangshu Ghoshal, Naveen Salins, Jayita Deodhar, Anuja Damani, Mary Ann Muckaden
October-December 2016, 22(4):416-426
DOI:10.4103/0973-1075.191766  PMID:27803563
Purpose: Fatigue is one of the most common symptoms seen in patients with advanced cancer. It is known to influence the Quality of Life (QoL) of patients. This study examines the interrelationship of fatigue and QoL in patients with advanced cancer on palliative care. Methods: A prospective cohort study was conducted in the outpatient clinic of the Department of Palliative Medicine from January to June 2014. Patients with advanced cancer registered with hospital palliative care unit, meeting the inclusion criteria (Eastern Cooperative Oncology Group [ECOG] ≤3, Edmonton Symptom Assessment Scale [ESAS] fatigue score ≥1), and willing to participate in the study were assessed for symptom burden (ESAS) and QoL (European Organization for Research and Treatment of Cancer QoL Core 15-Palliative module [EORTC-QoL PAL15]). All study patients received standard palliative care consultation and management. They were followed up in person or telephonically within 15-30 days from the first consult for assessment of outcomes. Results: Of a total of 500 cases assessed at baseline, 402 were available for follow-up (median age of 52 years; 51.6% male). On the EORTC-QoL PAL15 scale, overall QoL, emotional functioning, and constipation were found to be significantly associated with severity of fatigue at baseline (P < 0.05). Statistically significant improvement in fatigue score was observed (P < 0.001) at follow-up. Improvement in physical functioning and insomnia were significantly associated with better fatigue outcomes. Conclusions: Fatigue improved with the standard palliative care delivered at our specialty palliative care clinic. Certain clinical, biochemical factors and QoL aspects were associated with fatigue severity at baseline, improvement of which lead to lesser fatigue at follow-up.
  2,647 125 -
Assessment of anxiety and depression in oral mucositis patients undergoing cancer chemoradiotherapy: A randomized cross-sectional study
Nallan CSK Chaitanya, Komali Garlapati, Danam Reshma Priyanka, Sravani Soma, Ujwala Suskandla, Niharika Harsha Boinepally
October-December 2016, 22(4):446-454
DOI:10.4103/0973-1075.191797  PMID:27803567
Introduction: Oral mucositis is an unavoidable complication occurring during the treatment of cancer by radiotherapy, concurrent chemoradiotherapy (CCRT), or chemotherapy. This is a painful sequelae, significantly affecting the nutritional intake and quality of life. Materials and Methods: A multicentric cross-sectional study was done at four cancer centers in Hyderabad. About 455 subjects of both genders between 20 and 80 years undergoing cancer treatment such as chemotherapy (Group I), CCRT (Group II), radiotherapy within 14 days of initiation (Group III), and radiotherapy after 14 days of initiation of therapy (Group IV) who had oral mucositis were included in the study. A self-addressed Hospital Anxiety and Depression Scale questionnaire was used to assess the anxiety/depression in cancer therapy-induced oral mucositis patients. Results: Group III had established anxiety (58.82%) followed by Group IV (47.5%) of patients showing severe oral mucositis. In Group I, 47.17% and in Group II, 40% patients with borderline anxiety had mild mucositis, which was statistically significant (P = 0.01). Group III had established depression in 56.36%, followed by Group IV with 39.62% patients showed severe oral mucositis. Group I and II had mild to moderate mucositis, which was associated with established depression at statistically significant result (P = 0.02). Conclusion: Group IV had maximum participants with anxiety and depression, closely followed by Group II, Group III, and least in Group I. Thus appropriate intervention in the form of nonpharmacological and pharmacological treatment is warranted.
  2,549 123 -
Perspective of orthopedists on pain management in osteoarthritis: A qualitative study
Jose Austine, Shoba Nair, Kiyana Mirza
October-December 2016, 22(4):410-415
DOI:10.4103/0973-1075.191764  PMID:27803562
Context: Osteoarthritis (OA) is a degenerative disorder characterized by pain, stiffness, and loss of mobility of the joint. As the most prevalent form of arthritis and a leading cause of impairment, it is imperative to understand the treating doctor's perception of pain relief among these patients. Objectives: To assess orthopedists' perspectives on pain management in OA. Materials and Methods: In this qualitative study, a guide-based interview was conducted on 15 orthopedists of a tertiary care hospital and audio-recorded simultaneously. A grounded theory approach was adopted for data transcription with an inductive approach for thematic manual analysis. Results: Five themes emerged - (1) quality of life: OA produces significant disease burden causing severe impairment; (2) pain management: although patients usually demand immediate pain relief, a multipronged approach to treatment emphasizing on physiotherapy and surgery rather than analgesics is needed. Most participants preferred individual discretion while others felt the need for systematizing pain management; (3) precautions/side effects of treatment: paracetamol is often prescribed due to its better benefit − adversity profile as compared to nonsteroidal anti-inflammatory drugs and weak opioids; (4) barriers: participants expressed several barriers to optimal pain management; (5) counseling: Participants concurred that counseling would improve patients' quality of life. Conclusions: Participants agreed that OA being associated with debilitating pain and impairment requires optimal pain management for improving patients' quality of life. As crucial as counseling is, it is often compromised due to the large outpatient load. The doctors concurred that a multi-disciplinary team approach is needed to integrate and optimize pain management in OA.
  2,572 92 -
Impact of health awareness campaign in improving the perception of the community about palliative care: A pre- and post-intervention study in rural Tamil Nadu
Ankit Chandra, Sonali Sarkar, S Adinarayanan, Karthik Laksham Balajee
October-December 2016, 22(4):467-476
DOI:10.4103/0973-1075.191832  PMID:27803570
Background and Objective: The only way to provide palliative care to a huge number of people in need in India is through community participation, which can be achieved by improving the awareness of the people about palliative care. We conducted a study to assess the impact of health awareness campaign in improving the awareness of people about palliative care. Materials and Methods: This was a pre- and post-intervention study conducted in Kadaperikuppam village of Vanur Taluk in Villupuram district, Tamil Nadu. One respondent each from 145 households in the village was interviewed regarding the knowledge and attitude on palliative care before and after the health awareness campaign using a pretested questionnaire. Health awareness campaign consisted of skit, pamphlet distribution, poster presentation, giving door-to-door information, and general interaction with palliative team in the village. Two weeks after the campaign, postintervention survey was conducted using the same questionnaire in the same subjects to assess the impact of the intervention. Results: The awareness regarding palliative care during the preintervention was nil. After the intervention, it increased to 62.8%. However, there was a decline in the attitude and the interest of the people toward palliative care. Interpretation and Conclusions: Health awareness campaigns can increase the awareness of people in the rural parts of the country about palliative care. However, to improve the attitude of the community about delivery of palliative care services, more sustained efforts are required to make them believe that palliative care can be provided by community volunteers also and not necessarily only by professionals.
  2,515 115 -
Awareness and attitude of select professionals toward euthanasia in Delhi, India
Sheetal Singh, Shakti Gupta, IB Singh, Nirupam Madaan
October-December 2016, 22(4):485-490
DOI:10.4103/0973-1075.191856  PMID:27803572
Introduction: The topic of euthanasia has induced differences not only among professionals in the medical fraternity but also in other fields as well. The dying process is being lengthened by the new state of art technologies erupting as such higher pace, and it is at the expense of standard quality of life and of a gracious death. Aim: To study the awareness and attitude toward euthanasia among select professionals in Delhi. Methodology: It was a questionnaire-based descriptive cross-sectional study. The study population included doctors, nurses, judges, lawyers, journalist, and social activists of Delhi. Tool included a sociodemographic questionnaire, two questions to know awareness regarding euthanasia and a modified euthanasia attitude scale used to measure attitude toward euthanasia. Data were analyzed using Stata 11.2. Results: Through our study, it is evident that professionals who participated in the study (judges, advocates, doctors, nurses, journalists, and social activists) in Delhi were familiar with the term euthanasia. No significant difference was seen in the attitude of professionals of different age group and sex toward euthanasia. Conclusion: Through this study, it is found that judiciary group most strongly endorsed euthanasia. The attitude of doctors was elicited from mixed group with doctors belonging to different specialties. Oncologists are not in favor of any form of euthanasia. However, doctors from other specialties did support euthanasia.
  2,496 91 -
Qualitative research in palliative care
Odette Spruyt
October-December 2016, 22(4):367-368
DOI:10.4103/0973-1075.191739  PMID:27803555
  2,355 147 -
End-of-life characteristics of the elderly: An assessment of home-based palliative services in two panchayats of Kerala
R Jayalakshmi, Suhita Chopra Chatterjee, Debolina Chatterjee
October-December 2016, 22(4):491-498
DOI:10.4103/0973-1075.191857  PMID:27803573
Background: Home-based palliative services form the cornerstone of Kerala's palliative program. However, two issues need research: (a) whether family-homes can be considered as the locus of ageing and dying for marginal populations who experience deprivation and poverty and (b) whether the present delivery structure meets the needs of elderly population. These issues are examined in the context of two rural areas. The study explores end-of-life characteristics of the elderly - their sociodemographic status and living patterns, morbidity profile, and functional status. It also looks into the accessibility and utilization of palliative services and respondents' satisfaction with different components of the services. Materials and Methods: A descriptive cross-sectional survey design is used. Data were collected based on the interviews of sixty service users sampled randomly from a roster of palliative care services. Semi-structured interviews were substantiated by personal field observations. Results: The study has found people living under extreme financial distress with inadequate shelter and poor social security provisions. The health profile is characterized by high level of functional dependence. Many dependent widowed women were living alone without appropriate care and shelter. The palliative program as perceived by the respondents is characterized by few doctor visitations and poor frequency. Conclusion: The study concludes that home-based palliation in its present form does not promote good end-of-life care. It lacks an integrated approach with good service-mix. It raises serious questions on family-home as the locus of ageing and dying for marginal populations, and suggests need for restructuring of the palliative program.
  2,308 109 -
Initial experience of head and neck cancer patients treated in an oncologist led palliative cancer care clinic at a tertiary cancer care center in uttar pradesh: Is the initiative of a full-fledged palliative care for cancer patients justified
Punita Lal, Mranalini Verma, Gaurav Kumar, Resham Shrivastava, Shaleen Kumar
October-December 2016, 22(4):477-484
DOI:10.4103/0973-1075.191854  PMID:27803571
Introduction: Poor socioeconomic status and illiteracy attribute to the advanced presentation of head and neck cancer (HNC) patients in India and are candidates for palliation in our setup. We set up a palliative cancer care clinic (PCCC), and an audit of initial 153 HNC patients is presented. Aims and Objectives: To assess the impact of palliative cancer care services. Methodology: Data of advanced HNC patients suited for palliation were collected to document demography, symptomatology, cancer treatment, and supportive care. Results: One hundred and fifty-three patients were seen during January 2013 to March 2015 in the PCCC. Seventy-two (47%) referral cases were due to disease progression and 81 (53%) due to " de novo" advanced cases. Median follow-up for this group was 5.3 months. Ninety (59%) cases needed some degree of assistance for their normal activities. Sixty-seven (44%) patients belonged to poor socioeconomic status and 65 (43%) were educated up to equivalent of high school. One hundred and thirty-five (88%) patients had an adequate family support. Pain was the most common presenting symptom in 134 (87%) cases with adequate relief in 112 (84%) patients with another 13 (09%) could not be assessed. Overall median duration of symptoms was 6 months. Cancer-directed therapy was used in 143 (93%) patients. Near the end of life in 47 (73%) out of 63 documented cases, caregivers were psychologically prepared for the inevitable. Conclusion: The role of palliative care team in alleviating physical, psychosocial, and emotional issues of patient and family members was significant. PCCC seems to be a feasible working model in our setup.
  2,239 75 -
The palliative care information act and access to palliative care in terminally ill patients: A retrospective study
Kitty Victoria, Sarita Patel
October-December 2016, 22(4):427-431
DOI:10.4103/0973-1075.191774  PMID:27803564
Background: Studies have shown that over 50% of end-of-life discussions take place for the first time in the hospital and that terminally ill patients often have unrealistic views regarding the possible scope of treatment. The Palliative Care information Act (PCIA) was passed in an attempt to address the lack of access for terminally ill patients to palliative care services. A multi-database systematic review was performed on published studies from 2010 to present, and there were none found measuring the effectiveness of the PCIA. Objectives: We aimed to study the effect of the PCIA on access to palliative care services. Methods: We conducted a retrospective chart review of all terminally ill patients who died at Kingsbrook Jewish Medical Center from January 2010 to August 2013 in relation to passing of the PCIA. Results: Prelaw (prior to the law passing), 12.3% of the terminal patients received palliative care consults, 25% during the transition period (time between passing of law and when it came into effect) and 37.7% postlaw (after coming into effect) (P < 0.001). Conclusions: Legislation can have a significant effect on terminally ill patient's access to palliative care services and can change the culture of a hospital to be more pro-palliative for the appropriate populations.
  2,105 88 -
Continuous cervical epidural analgesia in metastatic spinal cord compression
Mahesh Menon, Nafisa Taha, Navita Purohit, Vatsal Kothari, Shweta Singh
October-December 2016, 22(4):507-510
DOI:10.4103/0973-1075.191860  PMID:27803576
Metastatic spinal cord compression is a devastating complication of cancer. Patients may often require high doses of opioids that may cause side effects, myoclonus being one such. A 63-year-old male suffering from malignant spinal cord compression was admitted to our institution. The primary team managed him conservatively with pharmacotherapy with no relief of pain, and he experienced myoclonus and sedation as adverse effects. A continuous cervical epidural catheter with local anesthetic infusion was inserted for 5 days to control his pain. This relieved his pain, which was sustained even after we removed the epidural catheter on day 5, for up to 64 days until the time of his death. Continuous cervical epidural local anesthetic infusions may help with refractory pain by deafferentation of noxious stimuli. Central neuraxial blocks may be a valuable rescue in selected patients.
  2,081 79 -
Aggressive surgery in palliative setting of lung cancer: Is it helpful?
Suman Byregowda, Kumar Prabhash, Ajay Puri, Amit Joshi, Vanita Noronha, Vijay M Patil, Pankaj Kumar Panda, Ashish Gulia
October-December 2016, 22(4):504-506
DOI:10.4103/0973-1075.191859  PMID:27803575
With increase in survival and progression-free survival in the advanced metastatic cancers, the expectation of quality of life (QOL) has increased dramatically. Palliative care plays a vital role in the management of these advanced cancer patients. At present scenario, palliative care in advanced cancer has seen a completely different approach. Aggressive surgical procedures have been performed to improve the QOL in the advanced cancer patients. We report a case of advanced lung cancer with pathological femur fracture, treated with extensive total femur replacement surgery to provide better QOL.
  2,019 71 -
Conference report: International update on pain management and palliative care advances 2016
Mayank Gupta
October-December 2016, 22(4):512-513
DOI:10.4103/0973-1075.191862  PMID:27803578
  1,671 84 -
Preoperative palliative care: A conceptual framework
Mayank Gupta
October-December 2016, 22(4):511-512
DOI:10.4103/0973-1075.191861  PMID:27803577
  1,592 78 -
Online since 1st October '05
Published by Wolters Kluwer - Medknow