Indian Journal of Palliative Care最新文献

{"title":"Patient-Controlled Therapy with Intravenous Oxycodone in Breathlessness due to Advanced Cancer: A Case Report","authors":"M. Menon, Shiv Pratap Singh Rana, Subashini Perumal, Khawla Fuad","doi":"10.25259/ijpc_84_2023","DOIUrl":"https://doi.org/10.25259/ijpc_84_2023","url":null,"abstract":"Dyspnoea is a debilitating symptom in medicine, especially in palliative care. Opioids are the pharmacological agents of choice in the treatment of dyspnoea in palliative medicine. Morphine is the best-studied opioid, and recent literature on oxycodone is encouraging. In refractory cases, opioid infusion and palliative sedation may have to be used. We present a case that used oxycodone in a patient-controlled device specifically for dyspnoea and its effects in relieving dyspnoea in a fast and timely manner. This helped in meeting the demands of the patient and relieving suffering rapidly with less sedation. This case report is unique in the use of an oxycodone patient-controlled device specifically for dyspnoea.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"24 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns of Primary Caregivers of Children with Complex Chronic Conditions in Kerala: A Qualitative Analysis","authors":"Sajida Abdulla, Hariprasad Pallippurath Gopalakrishna Pillai, Reshmi Ramachandran","doi":"10.25259/ijpc_9_2023","DOIUrl":"https://doi.org/10.25259/ijpc_9_2023","url":null,"abstract":"\u0000\u0000Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala.\u0000\u0000\u0000\u0000Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis.\u0000\u0000\u0000\u0000The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine.\u0000\u0000\u0000\u0000The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care.\u0000","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"60 10","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139384814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptoms, Electrolyte Disturbances and Serum Albumin Levels in Palliative Oncology Patients Admitted Through Emergency: Characteristics and Survival Outcomes","authors":"Mahesh Menon, Subhashini Perumal, Raza Ahmad, Priya Das, Shiv Pratap Singh Rana, Asif Sardar","doi":"10.25259/ijpc_235_2023","DOIUrl":"https://doi.org/10.25259/ijpc_235_2023","url":null,"abstract":"\u0000\u0000Our research aimed to examine the characteristics of palliative oncology patients hospitalised through an emergency to look for the symptom profile, characteristics of dyselectrolytemia and blood investigations, and possible associations with mortality.\u0000\u0000\u0000\u0000After institutional review board approval, a retrospective, observational study of patients hospitalised in our tertiary care specialty oncology hospital was undertaken. Records of hospitalised cancer patients admitted from the emergency department under palliative care from January 2019 to October 2021 were examined. As all admissions during this period were through emergency due to institution COVID-19 protocols, all elective admissions were excluded from the study. Data collected included patient characteristics, blood investigations, and comorbid history of systemic diseases and factors that could be associated with electrolyte imbalance.\u0000\u0000\u0000\u0000There were 157 emergency admissions during the study period. A majority were patients with solid tumours (92.4%). Pain was the most frequent cardinal symptom, along with other symptoms (68/157) or in isolation (33/157), followed by reduced oral intake (32/157) and altered sensorium (24/157). sixty-six patients died within the hospitalisation period. On long-term follow-up, only 8 (5.1%) were surviving. Hyponatraemia (43%), Hypoalbuminaemia (66%), and altered renal function (33.1%) were prevalent. We observed a weak positive correlation between sodium levels and outcome (r = 0.199, P = 0.016) and a strong positive correlation between albumin levels and survival outcomes (r = 0.329, P = 0.000). Patients with normal albumin had a higher chance of survival (odds ratio: 33.1225, 95% confidence interval: 3.415–321.20, P = 0.003).\u0000\u0000\u0000\u0000Pain-reduced oral intake and altered sensorium are common emergency symptoms in oncology palliative care. Mortality is high in these patients. Hyponatraemia, hypoalbuminaemia, and deranged renal functions were commonly seen. Normal sodium and albumin levels were associated with higher chances of survival, and the association was strong for serum albumin levels. This may have prognostic utility.\u0000","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"37 17","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139388724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choice of Place of the Death of Children with Cancer during End-of-Life Care – Parent’s Perspectives in a Developing Country","authors":"Latha Sneha, Swathi Narasimhan, Julius Xavier Scott, S. Shuba, P. S. Rajakumar, Anitha Rani","doi":"10.25259/ijpc_28_2022","DOIUrl":"https://doi.org/10.25259/ijpc_28_2022","url":null,"abstract":"Objectives: The place of a child’s death is an indicator of the quality of paediatric palliative and end-of-life care. This study aimed to identify the choices of parents about the place of death of their children with cancer and to evaluate whether they had any regrets about their choices retrospectively. Material and Methods: All children who were treated in our centre for the past 9 years with palliative intent treatment to improve their quality of life were included in this study. For the children whose place of death was the hospital, data were collected from the case records. For the children who passed away at home, a telephone call was made to the families, informing them of the study, allowing time for there to be any clarifications. A verbal consent was requested for the study. Data were collected through the telephone conversation. Results: Out of the 59 children who died during the study period from 2012 to 2021, 31 children (52.5%) died in hospital settings. Eighteen (58.1%) families who had opted hospital as the place of death had regretted their choices. Families who chose home as a place of death were upset about inadequate pain management. The majority of the families had desired home care services for adequate symptom control and to keep the child comfortable in a familiar environment. Conclusion: Most children with life-limiting conditions continue to die in the hospital setting in developing countries due to a lack of dedicated palliative care services and home care. Most of the families retrospectively, regretted their choices of place of death. Most of the families, however, would prefer home as the place of death, if there was better end-of-life care support for symptom control at home. Specific policies institutional and nationwide need to be formulated to provide guidance to the professionals on the discussion of goals of care and place of care, with a supporting network to ensure its provision.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"36 20","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135042819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectivity of Palliative Care Bundle on Advanced Gallbladder Cancer: A Randomised Controlled Trial","authors":"Kusum K. Rohilla, C. Vasantha Kalyani, Amit Gupta, Manoj Gupta, Nirmal Matella","doi":"10.25259/ijpc_33_2023","DOIUrl":"https://doi.org/10.25259/ijpc_33_2023","url":null,"abstract":"Objectives: The main aim of this study was to develop, test, and compare palliative care bundles to improve functional recovery, resilience, and quality of life among advanced gallbladder cancer patient with their routine palliative care. Material and Methods: This study was to test a palliative care bundle, a single-center, and two-arm randomised controlled trial done on a total of 116 participants (58 in each arm) from July 2019 to December 2021 at All India Institute of Medical Sciences, Rishikesh. Results: By the end of 4 th month, the recruitment rate was 96.7%, retention rate acceptance rate was 95%, and adherence rate was 85%. The palliative care bundle showed that a significant difference in trial outcome index score ( P = 0.014*) indicates the effectiveness of the palliative care bundle related to improvement in physical mobility, resilience, and quality of life of patients and reduced caregiver burden. Reported barriers faced by participants were physical exhaustion (65%), psychological factors (25%), social factors (15%) and unfamiliar surroundings (5%). Caregivers reported barriers that their job (40%), physical fatigue related to the care of their patient (40%), their education (10%), and lack of support for their other family members (10%) were some reasons forcing them not to practice palliative care bundle. Conclusion: The palliative care bundle did not interfere with the palliative treatment plan of any patients and significantly improved physical mobility, resilience, quality of life of patients, and reduced caregiver burden. Hence, a palliative care bundle can be considered in the palliative care of advanced cancer patients during their palliative treatment to provide holistic care.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"36 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135042826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care Need in India: A Systematic Review and Meta-analysis","authors":"Ankit Chandra, Aninda Debnath, Baridalyne Nongkynrih","doi":"10.25259/ijpc_140_2023","DOIUrl":"https://doi.org/10.25259/ijpc_140_2023","url":null,"abstract":"Background: To achieve sustainable development goal 3.8, countries must prioritise the provision of palliative care. We aimed to estimate the prevalence of palliative care needs in India. Methods: A systematic literature search was conducted in databases of PubMed, Cochrane, Embase, Web of Science, and EBSCO Host. We included community-based studies published in English between inception and April 30, 2023. We excluded hospital-based studies that were conducted solely including diseased patients. Data were extracted independently, and a quality assessment was performed. To estimate the pooled prevalence and 95% confidence intervals (CI), we used the random-effects model. Heterogeneity was assessed using the Q statistic and I 2 test. Subgroup analyses were conducted based on the study site, urban–rural distribution, gender, and age groups. Publication bias was evaluated using a funnel plot and Egger test. STATA software was used for data analysis. Results: Out of the 2632 articles identified, 8 cross-sectional studies were included. Using the random-effects model, the pooled estimate of palliative care needs was found to be 6.21/1000 population (95% CI: 2.42–11.64). The southern region showed a prevalence of 10.83/1000 compared to 2.24/1000 in the northern region. Urban areas had a prevalence of 3.34/1000, while rural areas had a prevalence of 7.69/1000. Among females, the prevalence was 9.64/1000, compared to 6.77/1000 among males. Notably, individuals aged over 60 years had a higher prevalence of palliative care needs, with a rate of 37.86/1000 population. Conclusion: This systematic review and meta-analysis highlight a substantial need for palliative care in India, with a prevalence of 6.21 individuals/1000 population.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"37 20","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135042989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Impact of Yoga on the Quality of Life of Breast Cancer Patients: A Systematic Literature Review","authors":"Jayajith Nair, Anju Mishra, Anjali Midha Sharan","doi":"10.25259/ijpc_306_2022","DOIUrl":"https://doi.org/10.25259/ijpc_306_2022","url":null,"abstract":"Patients with breast cancer (BC) typically undergo multimodal treatment over an extended period and deal with a wide range of symptoms that severely impair their overall quality of life (QoL) and prognosis. Concern about the health-related QoL of persons diagnosed with cancer as well as the calibre of care they receive is increasing every day. This study aims to assess the impact of yoga on the QoL of patients with BC. PRISMA guidelines served as the foundation for the methodologies used to identify the studies. A total of 480 records were found using PubMed/Medline and Google Scholar databases. A final set of 22 studies was assessed for the work based on the exclusion and inclusion criteria and study eligibility. Yoga has a moderate effect on BC patients. Pranayama has been shown to have a positive effect on improving the QoL. The study observed that yoga was more useful during actual treatment for cancer than after completion. The various randomised controlled trials (RCT) and meta-analysis included in this study believe that yoga has a positive effect. However, the outcomes of various studies do not support this point completely. According to the safety information that is currently available, yoga is not associated with severe adverse outcomes. There is no concrete evidence that establishes the role of yoga as one of the alternative medicines in treating BC patients after chemotherapy. More clinical trials are needed to investigate the advantages of yoga in the overall improvement of QoL in BC patients.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"38 14","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135043177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care in Drug Resistance Tuberculosis: An Overlooked Component in Management","authors":"Deependra Kumar Rai, Priya Sharma","doi":"10.25259/ijpc_141_2022","DOIUrl":"https://doi.org/10.25259/ijpc_141_2022","url":null,"abstract":"Palliative care should be an important component in the management of drug resistant tuberculosis (DRTB); however, it is not given much importance. Even in the current scenario, many patients and their caregivers consider multidrug-resistant and extensively drug-resistant tuberculosis (TB) as a terminal illness and considering it almost as a death sentence, this group of patients also require palliative care. There is a misconception about considering palliative care as a treatment component in the terminal stage of an illness where curative treatment has no role in improving the survival of the patient. However, the real meaning of palliative care is to relieve suffering in all stages of the disease and is not limited to end-of-life care only. Palliative care in DRTB aims to improve the quality of life, intractable symptoms and physical, psychosocial and spiritual suffering of patients as well as their caregivers. There is an imminent need to train all TB healthcare workers regarding basic palliative care and integrate palliative care into the TB healthcare system.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"39 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135041627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issues Related to Children-Faced by Armed Forces Families When Caring for Patients in Palliative Care – A Qualitative Study","authors":"Savita Butola, Damini Butola","doi":"10.25259/ijpc_58_2023","DOIUrl":"https://doi.org/10.25259/ijpc_58_2023","url":null,"abstract":"Objectives: Access to palliative care is limited, especially in rural India. Children needing care by palliative teams may themselves be patients, or siblings and children of patients. Armed forces families face characteristic lifestyle challenges – frequent transfers, living in difficult and remote areas, serving personnel staying apart from families for long periods – very different from issues faced by civilians. Military service increases the risk of psychosocial burden for serving personnel as well as families. Most depend on private and state medical services for palliative care so it is important for the palliative community to understand their issues. This study aimed to explore the issues related to children – faced by armed forces families when caring for patients in palliative care. Material and Methods: Qualitative study based on thematic analysis of semi-structured interviews with caregivers – either serving personnel or their dependents, in three centres. Results: Analysis of the 15 interviews showed that armed forces families face complex challenges related to children when caring for the palliative patient due to frequent movement, lack of paediatric palliative services in far-flung areas, disruption of the continuity of care, social isolation, language, and cultural barriers when living in non-native areas, inability to build and access family and community support and financial burden due to restrictive reimbursement policies. Conclusion: Although medical and administrative support within the organisation provides a cushion, wives have to manage alone in the father’s prolonged absence, and safety is a concern for children when living outside the campuses and serving personnel report guilt, anger, and helplessness at not being present when needed. Awareness of these issues can enable palliative workers to provide more meaningful support tailored to the needs of service families.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"44 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135868861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation of Palliative Care Referral from the Intensive Care Unit for Advanced Stage Metastatic Cancer Patients: A Quality Improvement Process from a Tertiary Referral Cancer Institute from South India","authors":"Kalpana Balakrishna, Thendral Ramasamy, Meenakshi V. Venketeswaran","doi":"10.25259/ijpc_267_2022","DOIUrl":"https://doi.org/10.25259/ijpc_267_2022","url":null,"abstract":"Objectives: Critically ill cancer patients in the intensive care unit (ICU) did not have any palliative care (PC) intervention as there was no PC referral from the ICU. The project aimed to initiate PC referral for at least 50% of progressive palliative intent cancer patients in intensive care to enhance communication with patients and caregivers. We included PC physicians, oncologists, and psychologists in the team for this project. Material and Methods: We used the A3 problem-solving method of quality improvement (QI) and also used the Plan Do Check Act process. The first baseline assessment over 6 months of ICU deaths of patients who could have benefited from PC referral was collected; this made us realise that PC could have been initiated for some patients. Process maps of patient admission into the ICU and the process of their discharge were constructed. Analysis of root causes that were barriers to referral was examined. We made a PC trigger tool after team consultations and consensus and started using it to initiate PC referrals. PC discharge protocol was also initiated. Educational discussions were held with residents and nurses to ensure the continued use of the trigger tool. Results: PC referral from intensive care slowly went up from 0% to beyond 50% by November 2019 and reached over 70% by March 2020; patients getting discharged had details of PC centres near their homes. Conclusion: Structured QI process and introducing the PC trigger tool led to the outcome of 50% PC referral for critically ill patients in ICU.","PeriodicalId":13319,"journal":{"name":"Indian Journal of Palliative Care","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}