Indian Journal of Palliative Care最新文献

{"title":"Exploring the Spiritual Dimension: A Scoping Review of Spiritual Experiences among Individuals with Cancer.","authors":"Rutam Bhalendu Vaishnav, Amol Dongre, Bhalendu Vaishnav","doi":"10.25259/IJPC_433_2025","DOIUrl":"10.25259/IJPC_433_2025","url":null,"abstract":"<p><p>Spirituality significantly shapes how individuals with cancer cope with illness and find meaning throughout the course of the disease. As cancer continues to impose a global burden, understanding these spiritual experiences is essential for holistic, patient-centred care. This scoping review synthesises existing evidence on the constructs and dimensions of spiritual experiences among adults with cancer. Following Arksey and O'Malley's scoping review framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, a systematic search was conducted using medical subject headings terms and keywords across PubMed, Google Scholar and other sources. Eligible studies included adults with confirmed cancer and examined their spiritual experiences. Qualitative, quantitative and mixed-method studies published in English were included. After screening 1,098 records, 133 studies met the inclusion criteria. Data were charted to summarise study characteristics and derive key themes. Among the 133 included studies, 73 were qualitative, 55 were quantitative and 5 were mixed-method. Research spanned 39 countries and included participants across the cancer progression from diagnosis to survivorship and palliative care. Publication trends indicated a steady increase in interest since 2000. Assessment of qualitative component identified core codes of (1) Relationship/Association with God or a Higher Power, (2) Spiritual Practices and Coping, (3) Inner Strength and Transformation, (4) Meaning-Making and Existential Themes, (5) Spiritual Responses and (6) Community and Interconnectedness. Patients frequently relied on prayer, faith and rituals as primary coping mechanisms. Many described inner transformation, strengthened resilience and renewed life purpose. Existential reflections on mortality and life's meaning were common. Some patients also reported spiritual struggles, including doubt or perceived abandonment, reflecting the multidimensional nature of spirituality. The present scoping review explores the multi-dimensional nature of experiences influencing coping, meaning-making, and emotional well-being across illness trajectories. The six identified categories reflect how patients draw on faith, practices, inner strength and community, while navigating through spiritual struggles. The wide variation in constructs and assessment tools underscores the need for more context-specific and culturally sensitive approaches. Integrating spiritual dimension into cancer care can support more holistic, patient-centred care and direction for future research in this area.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"237-243"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891635","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":"Medical Costs of Palliative and Hospice Care versus Usual Care in Terminal Cancer: A Systematic Review and Meta-Analysis.","authors":"Nurlelasari Harahap, Vebby Amelia Edwin, Halimatun Syakdiyah Harahap","doi":"10.25259/IJPC_474_2025","DOIUrl":"10.25259/IJPC_474_2025","url":null,"abstract":"<p><p>To evaluate medical costs associated with palliative care (PC) and hospice care (HC) compared with usual care among patients with terminal cancer, while accounting for variations in cost definitions and models of care. A systematic review and meta-analysis of observational studies were conducted. Literature searches were performed in PubMed, Scopus, and ProQuest (January 2010-July 2025). Eligible studies compared the medical costs of palliative or hospice care with usual care in adult terminal cancer patients. Care models were defined according to study-specific criteria. Data were pooled using a random-effects meta-analysis, and heterogeneity was assessed using the I² statistic. Eighteen studies were included. PC was associated with lower medical costs than usual care (standardised mean difference [SMD] -0.31; 95% confidence interval [CI] -0.35--0.27; <i>p</i> < 0.00001), while HC showed greater cost reductions (SMD -0.64; 95% CI -0.67--0.62; <i>p</i> < 0.00001). The overall pooled effect favoured palliative-oriented models (SMD -0.54; 95% CI -0.57- -0.52). However, substantial heterogeneity (I² up to 100%) likely reflects differences in cost components, care models and health system contexts. PC and HC reduce medical costs and support integration into routine oncology and end-of-life care.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"255-263"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886327","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":"Reflective Learning from Do Not Intubate/Do Not Resuscitate Conversations: A Qualitative Study Using Gibbs Reflective Methodology and Focus Group Discussion.","authors":"Betty Mary Abraham, Richa Geo, Rajashree Kattil Chittazhathu, Shoba Nair","doi":"10.25259/IJPC_262_2025","DOIUrl":"10.25259/IJPC_262_2025","url":null,"abstract":"<p><strong>Objectives: </strong>Do Not Intubate/Do Not Resuscitate (DNI/DNR) decisions are made when a patient has declined resuscitation, has a poor prognosis or if the patient will not survive intubation with sufficient quality of life. The DNI/DNR discussion is always a complex communication process. The primary objective of the study was to describe the reflections on the experience during conversations on DNI/DNR with the family members of the patients referred for palliative care and conversations through a focus group discussion (FGD) with other medical specialty trainees to improve learning through self-reflection.</p><p><strong>Materials and methods: </strong>This is a qualitative study. A qualitative reflective study of DNI/DNR conversations was made. Reflections on various experiences during the conversation were carried out using the Gibbs reflective tool. FGD with six other speciality post-graduate trainee doctors was audio recorded after informed consent, transcribed verbatim and thematically analysed.</p><p><strong>Results: </strong>Reflections on self-experience during DNI/DNR conversations were summarised under the following: (i) Difficult conversation, (ii) lack of communication and denial, (iii) influence of financial background and (iv) emotional burden on healthcare workers. Themes identified included factors influencing DNI/DNR conversations (patient demographics and disease onset, early initiation of discussions, empathic communication, and rapport building), emotional burden on healthcare workers, and the need for multiple discussion sessions.</p><p><strong>Conclusion: </strong>The analysis revealed that every conversation differs depending on the patient and his or her family members' perspectives. Reflections on various conversations help to identify flaws and improve one's communication skills. Communication skills might improve by practising self-reflection, attending communication skill classes and observing seniors.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"274-281"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891545","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":"Comparison of Two Caregiver Burden Scales in a Low-resource Primary Palliative Care Setting and Deriving a Three-item Caregiver Burden Inventory.","authors":"Arsha Kochuvilayil, Ravi Prasad Varma","doi":"10.25259/IJPC_243_2025","DOIUrl":"10.25259/IJPC_243_2025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to compare the Malayalam versions of the 9-item Achutha Menon Centre-Caregiver Burden Inventory (AMC-CBI) with the 22-item Zarit Burden Interview (ZBI-22), hypothesising that caregiver burden in palliative home care settings could be measured comparably using either tool. We also tried to identify a global question or brief screening items for caregiver burden based on the performance of the AMC-CBI items relative to the ZBI-22. In addition, we explored how participants understood and interpreted the ZBI-22 items.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The study used a convergent mixed-methods design comprising a quantitative survey and qualitative interviews. The survey covered 60 adult primary caregivers of palliative care patients receiving home care in rural Kollam, Kerala, who were interviewed telephonically using a structured interview schedule with the ZBI-22 and the AMC-CBI scales and demographic, socioeconomic and caregiving-related details. Analysis was through descriptive statistics, internal consistency assessments using alpha and omega coefficients and validity assessments using agreement methods on z-transformed scores available in the SimplyAgree package for R and Jamovi, including average bias and limits of agreement and Receiver Operating Characteristic (ROC) analyses. Qualitative interviews were conducted telephonically, audio recorded and done by AMC-CBI. Cognitive interviews (&lt;i&gt;n&lt;/i&gt; = 7) were conducted with four experts and three caregivers, using a semi-structured guide, to explore item clarity, relevance, redundancy and comprehension of ZBI-22. In-depth interviews (&lt;i&gt;n&lt;/i&gt; = 4) were conducted with four additional caregivers (2 cancer, 2 non-cancer cases; one each with low and high burden) to explore caregiving experiences, and transcripts were analysed to compare narrative alignment with ZBI-22 and AMC-CBI items by two independent reviewers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Internal consistency was high for both tools (α and ω &gt; 0.8). Three AMC-CBI items ('lost hope', 'feel sad', and 'financial burden') were selected for a Brief AMC-CBI (ω = 0.787). Both AMC-CBI &lt;i&gt;p&lt;/i&gt; = 0.747) and Brief AMC-CBI &lt;i&gt;p&lt;/i&gt; = 0.731) strongly correlated with ZBI-22. Agreement analyses with z-scores (Bland-Altman, Deming regression) demonstrated good agreement, though one outlier was noted. ROC analysis showed AMC-CBI ≥12 and Brief AMC-CBI ≥3 as optimal cut-offs. Identity-related strain over a long caregiving duration might lead to discordant classification with ZBI-22 more likely to elicit burden. Qualitative interviews highlighted some item complexity and translation issues in ZBI-22, especially with the word '&lt;i&gt;duritham&lt;/i&gt;'. Reviewers found the AMC-CBI easier to apply during transcript coding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Both tools, the AMC-CBI and Brief AMC-CBI correctly categorised caregiver burden levels in comparison to the ZBI-22, but AMC-CBI was more contextually approp","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"296-303"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887447","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":"From Evidence to Implementation: Bridging the Last Mile in Palliative Care.","authors":"Raghu S Thota, Raghavendra Ramanjulu","doi":"10.25259/IJPC_280_2026","DOIUrl":"10.25259/IJPC_280_2026","url":null,"abstract":"","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"233-234"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887469","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: 'The Impact of Gratitude Combined with Relaxation Therapy on Anxiety Reduction in Breast Cancer Patients Undergoing Chemotherapy: A Comparative Study'.","authors":"Sneha Thakur, Amita Aggarwal","doi":"10.25259/IJPC_68_2026","DOIUrl":"10.25259/IJPC_68_2026","url":null,"abstract":"","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"332"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887439","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":"Determinants of Therapeutic Compliance in an Ambulatory Palliative Care Setting: An Observational Study.","authors":"Manjula Anil Kunder, Naveen Salins, Anuja Dwarkadas Damani, Krithika S Rao, Ashwini Kumar, Akhila Doddamani, Aashish Papneja, Gahan S Jois, B Sanjay Kini","doi":"10.25259/IJPC_195_2025","DOIUrl":"10.25259/IJPC_195_2025","url":null,"abstract":"<p><strong>Objectives: </strong>Non-adherence to pharmacotherapy in an ambulatory palliative care setting can negatively affect therapeutic outcomes. Only a limited number of studies have explored the determinants of therapeutic compliance in the Indian palliative care context. This study aims to evaluate therapeutic compliance, assess attitudes toward medication adherence, and the factors influencing it among patients accessing an ambulatory palliative care service in a tertiary care hospital in India.</p><p><strong>Materials and methods: </strong>One hundred and five adult patients accessing the ambulatory palliative care service and prescribed palliative pharmacotherapy for at least 1 month participated in this observational study. Data were collected using a study questionnaire that included socio-demographic details, the Morisky-Green test and a validated 17-item Likert scale assessing attitudes towards medication adherence. Statistical analysis comprised descriptive statistics, chi-square tests, Fisher's exact test and logistic regression.</p><p><strong>Results: </strong>Adherence to palliative pharmacotherapy was significantly associated with age, with older individuals (>60 years) showing greater compliance with medications compared to the young (<i>p</i> = 0.041, adjusted odds ratio [AOR] = 2.48, confidence interval [CI]: 1.04-5.95). Individuals with lower literacy levels demonstrated greater compliance than those with higher levels of education (<i>p</i> = 0.049, adjusted odds ratio [AOR] = 3.23, CI: 1.01-10.42). Furthermore, women were more compliant towards palliative pharmacotherapy compared to men (<i>p</i> = 0.017, adjusted odds ratio [AOR] = 3.03, CI: 1.22-7.56). Although other factors such as forgetfulness, affordability and assistance to take medications correlated with medication adherence, these were not found to be statistically significant.</p><p><strong>Conclusion: </strong>In the context of Indian palliative care, older age, female gender and lower literacy levels were associated with increased adherence to palliative pharmacotherapy; these demographic associations with compliance with palliative pharmacotherapy warrant further exploration.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 3","pages":"289-295"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887386","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":"End-of-Life Care in India: Withholding and Withdrawal after the Harish Rana Judgement.","authors":"Raghu S Thota, Raghavendra Ramanjulu","doi":"10.25259/IJPC_152_2026","DOIUrl":"10.25259/IJPC_152_2026","url":null,"abstract":"","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 2","pages":"119-120"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149789","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":"Utilisation of Non-pharmacological Interventions for Management of Cancer-related Fatigue in Palliative Care Services - An Audit Cycle.","authors":"Priyanshu Priyanshu, Alisha Karim, Vidya Viswanath, Dharun Prasad Ramani, Dolorosa Fernandes, Raviteja Miriyala, Neeharika Alapati","doi":"10.25259/IJPC_440_2025","DOIUrl":"10.25259/IJPC_440_2025","url":null,"abstract":"<p><strong>Objectives: </strong>Cancer-related fatigue (CRF) is a debilitating symptom that significantly affects the quality of life of patients with cancer. Effective management requires accurate documentation and timely implementation of non-pharmacological interventions (NPIs), which are considered first-line strategies. This study aimed to assess the documentation of CRF and NPIs in palliative care and evaluate the impact of a standardized operating procedure (SOP) on documentation compliance. The aim of the study is to assess the documentation of CRF and NPIs in palliative care and evaluate the impact of implementing a standardised operating procedure (SOP) on documentation compliance.</p><p><strong>Materials and methods: </strong>A retrospective audit was conducted in two phases: pre-multidisciplinary team (MDT) induction and post-MDT induction, followed by a re-audit after six months. Documentation rates for CRF and NPIs were statistically analysed, and associated symptom clusters were identified using Epi Info software (Version 7.6.2).</p><p><strong>Results: </strong>CRF documentation improved from 67% in 2021 to 84% in 2022, and further to 98.5% (February 2023) and 89.3% (March 2023) and 96.7% (September 2023). NPI documentation increased from 0% in 2021 to 36% in 2022, and subsequently to 86.5%, 89.9%, and 86.5% in re-audits. Significant symptom clusters associated with CRF included loss of appetite (<i>p</i> < 0.01), loss of well-being (<i>p</i> < 0.001), and breathlessness (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>Implementation of an SOP significantly improved CRF and NPI documentation. Identification of key symptom clusters provides important insights for targeted interventions and future research in palliative care.</p>","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 2","pages":"207-211"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149503","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 Delivery in Indian Prisons: Challenges and Future Directions.","authors":"Dipankar Dakua, Nengneivah Haokip","doi":"10.25259/IJPC_322_2025","DOIUrl":"10.25259/IJPC_322_2025","url":null,"abstract":"","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"32 2","pages":"226-227"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149534","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}