Indian Journal of Palliative Care最新文献

{"title":"Effectiveness of Laughter Yoga on Stress in Patients with Cancer in a Selected Hospital.","authors":"Athira Abraham, Jubee Joseph, Susamma Varughese","doi":"10.25259/IJPC_403_2025","DOIUrl":"https://doi.org/10.25259/IJPC_403_2025","url":null,"abstract":"<p><strong>Objectives: </strong>Cancer is a life-changing diagnosis that can cause a lot of emotional pain for both patients and their families. Alongside medical treatments, it is really important to have supportive methods in place that can help ease stress and improve overall well-being. This study aimed to assess the effectiveness of Laughter Yoga in reducing perceived stress among patients with cancer.</p><p><strong>Materials and methods: </strong>This study employed a time-series, non-randomised control group design with pre-test and post-test measures, conducted within the oncology department of a tertiary care hospital. A total of 60 cancer patients were assessed for stress levels using the perceived stress scale (PSS-10). Participants in the intervention group received Laughter Yoga sessions 3 times per week, each lasting 30 min, over a period of 30 days. Post-intervention assessments were conducted on the 10^th, 20^th and 30^th days for both the intervention and control groups through face-to-face interviews.</p><p><strong>Results: </strong>The findings revealed that the mean pre-test stress score in the intervention group was 33.6 ± 5.74, which significantly declined to 18.9 ± 7.45 following the intervention. In contrast, the control group maintained a relatively stable stress score of 32.53 ± 5.72. Statistical analysis indicated a significant difference in mean stress levels across various time intervals before and after the intervention (F = 383.4, <i>p</i> = 0.001). <i>Post hoc</i> Bonferroni tests further confirmed significant reductions in stress levels at each follow-up point, day 10, day 20 and day 30 when compared to baseline measurements (<i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>The study demonstrated that Laughter Yoga was associated with a significant reduction in perceived stress among individuals with cancer, highlighting the importance of integrating such adjunctive therapies into oncology centres to better support patients experiencing varying levels of psychological distress.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"318-327"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on: 'End-of-Life Care Preferences of Terminally Ill Patients: A Cross-sectional Study'.","authors":"Emilia Trofimena Saudella","doi":"10.25259/IJPC_362_2025","DOIUrl":"10.25259/IJPC_362_2025","url":null,"abstract":"","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"333"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humoral Hypercalcaemia in Metastatic Gallbladder Cancer Presenting as Delirium: A Case Report.","authors":"Ajila Ajithkumar, Shamali Poojary, Jayita Deodhar, Raghu Sudarshan Thota","doi":"10.25259/IJPC_150_2026","DOIUrl":"10.25259/IJPC_150_2026","url":null,"abstract":"<p><p>Hypercalcaemia of malignancy (HCM) is a recognised paraneoplastic complication of advanced cancer, with HHM being mediated predominantly by parathyroid hormone-related protein (PTHrP) secretion. While commonly observed in squamous cell carcinomas, it is exceedingly rare in gallbladder adenocarcinoma, with only isolated case reports described in the literature. We report a man in his 50s with metastatic gallbladder cancer who presented with colicky abdominal pain, constipation, fatigue, low mood, delayed responses and insomnia. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders- 5^th Edition criteria. Laboratory evaluation revealed severe hypercalcaemia with a corrected serum calcium of 18.92 mg/dL, suppressed parathyroid hormone of 7.83 pg/mL and markedly elevated PTHrP of 701.3 pg/mL, consistent with HHM. His condition improved with intravenous hydration, bisphosphonates and calcitonin, along with multidisciplinary palliative care addressing psychological, emotional and spiritual concerns. This case highlights the need to recognise hypercalcaemia as a potential cause of delirium, even in rare malignancies, as timely diagnosis may facilitate prompt symptom management and prevent potentially life-threatening complications.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"328-331"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Feedback Survey on Quality of Dialysis Withdrawal and End-of-Life Care in Haemodialysis Patients in Intensive Care.","authors":"Shankar Prasad Nagaraju, Asbin Abdul Aziz, Anuja Dwarkadas Damani, Naveen Salins, Krithika S Rao, Bharathi Naik, Ankur Gupta, Shreya Nair, Ravindra Prabhu Attur, Dharshan Rangaswamy, Indu Ramachandra Rao, Srinivas Vinayak Shenoy, Shriya Narendra Shet Shirodkar, Priya Rani, Mohan V Bhojaraja","doi":"10.25259/IJPC_426_2025","DOIUrl":"https://doi.org/10.25259/IJPC_426_2025","url":null,"abstract":"<p><strong>Objectives: </strong>For end-stage kidney disease (ESKD) patients on maintenance haemodialysis (MHD), end-of-life care (EOLC) and dialysis discontinuation are established in Western nations, but family perspectives in the intensive care unit (ICU) remain understudied in developing nations like India. This study examined families' perceptions of EOLC, dialysis withdrawal and life-sustaining drug discontinuation for MHD patients in our ICU, where the Kidney Supportive Care (KSC) team was part of the Primary Medical Board (PMB).</p><p><strong>Materials and methods: </strong>A cross-sectional survey examined family input for MHD ICU patients undergoing EOLC and dialysis discontinuation assisted by KSC team (palliative care expert, nephrologist and intensivist). We gathered baseline data, ICU admission causes, 24 h pre-death symptoms and withdrawal advice and used Statistical Package for the Social Sciences 21 for statistical analysis.</p><p><strong>Results: </strong>23/98 MHD patients (82.6% male, mean age 57 ± 12.09 years) underwent EOLC. ICU admissions were mostly for infection (47.8%). The most prevalent pre-death symptom was agitation (86.9%). Haemodynamic decline (82.6%) and disease progression (69.5%) drove withdrawal. All patients underwent dialysis withdrawal and had 'Do Not Resuscitate orders instituted. The rate of ventilator and inotrope withdrawal was 80% and 50%, respectively. 74% of families attended, and 20% received spiritual leader visits during EOLC. All participating family members reported no guilt and provided positive feedback for KSC team engagement during EOLC.</p><p><strong>Conclusion: </strong>Our study highlights complete agreement of families on dialysis withdrawal and providing EOLC support in our ICU setting for ESKD patients. It also emphasises the need for a dedicated PMB with the KSC team for a better EOLC, which provides family satisfaction and avoids redundant interventions.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"264-269"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalised Cancer Pain Management: Myth or Emerging Reality?","authors":"Raghu S Thota, Raghavendra Ramanjulu","doi":"10.25259/IJPC_281_2026","DOIUrl":"https://doi.org/10.25259/IJPC_281_2026","url":null,"abstract":"","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"235-236"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care Quality Improvement Project: Integrating Palliative Care into Oncology.","authors":"Gaurav Chanana, Devavrat Arya, Ramandeep Singh Arora, Megha Pruthi, Harpreet Kaur, Kamlesh Kumari, Harit Chaturvedi, Michael Rabow, Umesh Velu, M M Sunilkumar","doi":"10.25259/IJPC_285_2025","DOIUrl":"https://doi.org/10.25259/IJPC_285_2025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Early palliative-care integration is recognised by the World Health Organization, American Society of Clinical Oncology and European Society for Medical Oncology as an essential component of comprehensive oncology care, yet referral practices in many low- and middle-income countries (LMICs) remain inconsistent. At our cancer care department in a private tertiary superspeciality hospital with integrated medical, surgical, radiation oncology and palliative care services, only 7.5% of newly registered patients with Stage IV cancer were being referred to the specialist palliative-care team. The objective of this palliative care quality-improvement project was to raise the referral rate to 25% within the next 6 months through structured, system-level interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Guided by the National Cancer Grid Enable Quality Improvement in the Patient Care-India programme and the Stanford promoting assessment and improvement of the cancer experience framework, we applied an A3-based Plan-Do-Study-Act cycle. A multidisciplinary team following this methodology refined the problem statement, created a SMART goal, mapped the process using GEMBA walk, performed root-cause analysis using fishbone diagram, formulated key drivers and an impact-effort matrix to prioritise interventions while maintaining a run chart. Key actions included (1) finalising and implementing consensus referral criteria, (2) placing placards in outpatient areas/sending referral criteria on e-mail, (3) ensuring mandatory documentation of treatment intent and referral status in electronic prescriptions and tumour-board reports respectively and (4) bi-monthly compliance audits. The primary outcome was the monthly percentage of patients with Stage IV cancer referred to palliative care, plotted on a run chart from November 2020 to July 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the study period, 537 patients with Stage IV cancer (range 35-72/month) were registered; 66 patients were referred to specialist palliative care (range 4-13/month). In the months of November and December 2020, the baseline referral proportion averaged 7.5%. After sequential implementation of the intervention bundle, referrals rose steadily, and an absolute increase of 10.8% was noted, reaching 18.3% in July 2021 despite pandemic-related limitations. Although the project fell short of its target which was 25%, informal oncologist-palliative-care dialogue and tumour-board documentation of treatment intent and referral status compliance improved. Due to COVID-19-related restrictions, certain activities, e.g. standees, Hindi patient leaflets, could not be implemented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This initiative demonstrates that targeted mentorship, locally tailored referral criteria and seamless workflow prompts, can substantially strengthen palliative care integration in oncology, laying the groundwork for durable culture change and better pat","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"312-317"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Evidence on Dignity Therapy in Cancer Care: A Review.","authors":"Maria Vinu, Poonam Sharma","doi":"10.25259/IJPC_428_2025","DOIUrl":"https://doi.org/10.25259/IJPC_428_2025","url":null,"abstract":"<p><p>As psychosocial treatments become increasingly important in palliative care, dignity therapy (DT) emerges as a promising intervention. This systematic review aims to synthesize and critically evaluate the evidence on DT interventions in adults with cancer by integrating findings from randomised controlled trials (RCTs), quasi-experimental, qualitative, and mixed-methods studies. The search terms 'Dignity Therapy' AND 'Cancer' were used to identify RCTs, quasi-experimental, mixed methods and qualitative studies related to DT implemented in adult cancer patients from Scopus and Web of Science databases on 20th November, 2024. Critical Appraisal Skills Programme checklists were used to assess the risk of bias in the studies. Twenty studies were included after a two-stage screening process, out of which 7 were RCTs, 6 were quasi-experimental studies, 5 were qualitative studies and 2 were mixed-method studies. These studies demonstrate that DT enhances dignity, reduces psychological distress and improves family dynamics, particularly in culturally adapted formats. Quantitative findings demonstrate significant improvements in dignity-related outcomes (<i>p</i> < 0.01; d = 1.04-2.45), anxiety (d = 1.73), depression (d = 0.94) and physical symptoms including nausea and insomnia (<i>p</i> < 0.05). Qualitative themes reveal core therapeutic mechanisms: Legacy creation, meaning-making, communion, being heard and cultural adaptation reinforcing DT's psychosocial value. DT was effectively delivered by diverse providers, with family-integrated approaches showing promise in collectivist cultures. The geographical scope restricts generalisability to other cultural settings. High attrition rates (up to 44.2%) and small sample sizes weaken statistical power, and the absence of long-term follow-up data obscures DT's sustained effects. The lack of standardised outcome measures also introduces subjectivity, particularly in qualitative analyses, potentially biasing results. This systematic review concludes that while the report underscores DT's promise in palliative care, mixed findings and methodological gaps highlight the need for more robust, inclusive research to solidify its therapeutic role.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"244-254"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Experiences and Information Needs in Palliative Care: A Qualitative Descriptive Study.","authors":"Ni Luh Putu Inca Buntari Agustini, Israfil Israfil, I Gede Putu Darma Suyasa","doi":"10.25259/IJPC_351_2025","DOIUrl":"10.25259/IJPC_351_2025","url":null,"abstract":"<p><strong>Objectives: </strong>Palliative care aims to enhance the quality of life for patients facing terminal or life-threatening illnesses. Unfortunately, many patients encounter difficulties in understanding their condition, treatment processes and available care options due to limited access to clear and relevant information. This often leads to confusion, disrupted decision-making and increased anxiety. This study aimed to explore patient experiences and information needs in the context of palliative care.</p><p><strong>Materials and methods: </strong>A qualitative descriptive design was employed, involving 20 participants, consisting of 10 palliative patients and 10 family members, to triangulate data sources. Participants were selected through purposive sampling based on predefined inclusion criteria. Data were collected through semi-structured face-to-face interviews and analysed using thematic analysis.</p><p><strong>Results: </strong>Five main themes with 10 subthemes were identified: (1) Sources of information about palliative care: information from physicians and nurses, information from family members and information from friends or community; (2) Alternative sources of health information included the internet (e.g., Google, websites) and educational videos on social media platforms (e.g., YouTube and TikTok); (3) Facilitators in accessing health information: Direct information provided by physicians and support from family members in obtaining information; (4) Barriers in understanding health information: difficulty understanding medical terminology and (5) Expectations for the Use of Digital Technology: easily accessible online health information and Digital applications or platforms for communication with healthcare professionals.</p><p><strong>Conclusion: </strong>Patient experiences in accessing palliative care information are shaped by interactions with doctors, family members and communities, while the internet and social media serve as additional sources. Most patients reported no difficulties due to the support of healthcare providers and their families. However, medical terminology created barriers to comprehension. Patients expressed strong expectations for hospitals to implement digital technologies to enhance access to information and continuity of care.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"304-311"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quieting the Mind, Healing the Body: Guided Imagery and Mindfulness Meditation among Cancer Patients.","authors":"Gireesh Giriyapura Rudrappa, Leena Kunnath Chacko","doi":"10.25259/IJPC_414_2025","DOIUrl":"https://doi.org/10.25259/IJPC_414_2025","url":null,"abstract":"<p><strong>Objectives: </strong>Cancer and its treatment modalities, such as chemotherapy and radiotherapy, adversely affect physiological stability and psychological well-being, leading to symptoms like pain, anxiety, depression, and stress. Mind-body interventions such as guided imagery (GI) and mindfulness meditation (MM) may help alleviate these symptoms. This study aimed to evaluate and compare the effectiveness of GI and MM on selected bio-physiological and psychological parameters among patients with cancer.</p><p><strong>Materials and methods: </strong>A quasi-experimental pretest-posttest control group design was adopted among 148 patients with stage II and III cancer undergoing chemotherapy or radiotherapy in a tertiary care hospital in South India during 2023-2024. Participants were assigned to GI (n=49), MM (n=49), and control (n=50) groups. Interventions were administered for 15 minutes twice daily over four weeks. Physiological parameters (heart rate, respiratory rate, systolic and diastolic blood pressure, salivary amylase) and psychological variables (pain, depression, anxiety, and stress) were assessed at baseline and post-intervention. Data were analyzed using repeated measures ANOVA, one-way ANOVA, Wilcoxon signed-rank test, and Bonferroni post hoc test, with significance set at <i>p</i><0.05.</p><p><strong>Results: </strong>Both GI and MM groups showed statistically significant improvements in physiological and psychological parameters compared to the control group (<i>p</i><0.001). Significant reductions were observed in heart rate, respiratory rate, blood pressure, salivary amylase levels, pain, depression, anxiety, and stress. MM demonstrated relatively greater improvement in psychological outcomes, while GI showed comparable effectiveness in physiological stabilization.</p><p><strong>Conclusion: </strong>Guided imagery and mindfulness meditation appear to be effective, feasible, and low-cost non-pharmacological interventions that improve physiological relaxation and psychological well-being among patients with cancer. Integration of these interventions into palliative and oncology nursing practice can enhance holistic patient care.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"282-288"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Brainstem Dysfunction and Brain Death and End-of-Life Care Practices: A Two-Year Retrospective Review.","authors":"Aarinola Sanusi, Olusola Kayode Idowu, Abiodun Olabisi Ojedoyin","doi":"10.25259/IJPC_417_2025","DOIUrl":"https://doi.org/10.25259/IJPC_417_2025","url":null,"abstract":"<p><strong>Objectives: </strong>Brainstem dysfunction and brain death are important determinants of End-of-life care (EoLC) decisions in intensive care units (ICUs). In many low- and middle-income settings, withdrawal or withholding of life-sustaining treatment remain ethically and culturally challenging despite high costs and limited critical-care resources. This study reviewed the incidence, causes and outcomes of brainstem dysfunction/brain death and examined relatives' decisions regarding EoL care (EoLC) in a tertiary hospital ICU.</p><p><strong>Materials and methods: </strong>A retrospective chart review was conducted in the ICU of the University College Hospital, Ibadan, covering March 2020- February 2022. Data were extracted from ICU nurses' spreadsheets and patients' case notes and analysed using IBM Statistical Package for the Social Sciences software. Descriptive statistics were used to summarise demographic variables, causes of brainstem dysfunction, duration of survival after diagnosis and family decisions about EoLC.</p><p><strong>Results: </strong>Among 232 ICU deaths during the study period, 24 (10.3%) were preceded by brainstem dysfunction or death. Males constituted 75% of affected patients. The leading causes were severe head injury (54%) and haemorrhagic stroke (21%). About 58% of patients died within 24-72 h of diagnosis and 37.5% had cardiac arrest before brainstem death. Prognosis was discussed with relatives in only 37.5% of cases. The gag and pupillary reflexes were the most frequently used diagnostic tests (100%), while apnoea testing was performed in 12.5% of cases.</p><p><strong>Conclusion: </strong>Brainstem dysfunction accounted for about one-tenth of ICU deaths, predominantly following trauma and stroke. Limited family counselling and cultural reluctance toward EoL decisions remain major challenges. Strengthening communication, ethical awareness and policy support for EoLC could improve patient management and optimise utilisation of limited ICU resources.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"270-273"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}