The pertinence of palliative care in India’s care protocol - Hindustan Times
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The pertinence of palliative care in India’s care protocol

ByHindustan Times
Dec 10, 2022 01:25 PM IST

The article has been authored by Umang Vohra, MD and global CEO, Cipla.

'A part cannot be well, unless the whole is well' is a notion that is inherently true when it comes to a person's wellbeing. However, when it comes to serious illnesses such as cancer, dementia, heart, kidney or respiratory disease, patients often do not receive enough information about the trajectory of the illness; in terms of how they can better manage the symptoms of the treatment and achieve a better quality of life. The patients' caregivers are equally overwhelmed and unsure how best to support them. In an already overburdened health care system, the ‘wellness’ of patients is often overlooked as the focus is only on treating the ‘illness’. More often than not, the management of a patient’s illness become a priority, and the ‘person’ behind the patient is forgotten. What can we do to make our healthcare system become more person-centred?

The Lancet Commission on Palliative Care in 2017 reported that only 4% of Indians have access to palliative care.
The Lancet Commission on Palliative Care in 2017 reported that only 4% of Indians have access to palliative care.

Traditionally, palliative care has only been associated with end-of-life care, specifically for people with cancer. While the adoption of this approach to health care right from the early stages has yet to be fully explored in the larger health care ecosystem, palliative care is recognised as essential care for all serious illnesses that should begin right from diagnosis. Research published in The Indian Journal of Palliative Care also supports the early integration of palliative care, leading to better health-related quality of life outcomes for patients and caregivers. It is estimated that about 58% of the total disease burden is due to non-communicable diseases - all diseases that can benefit from palliative care.

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Palliative care generally involves the collaboration and coordination of a multidisciplinary team that becomes a catalyst for change in several ways. A palliative care team often consists of a doctor, nurse, social worker and counsellor, who work closely with the patient's treating physician. The palliative care clinical team addresses the pain and symptoms, the counsellor focuses on how the illness impacts the patient's daily life, and the social worker assists the family in getting linked to resources they may require to continue treatment. The team listens to both the patient and the caregiver as they come to terms with the diagnosis; to prepare them for the next steps in their treatment, help them be pain-free, and achieve their best quality of life.

They provide care to patients at palliative care centres, patients admitted to hospitals outpatient basis. Recently, outreach teams have also extended their efforts to patients in the comfort of their homes - so that even those unable to reach a hospital or health care centre can continue to receive this care. The specialists working closely together help place the needs of the patients and their caregivers at the heart of care.

Integrating palliative care into India’s healthcare protocol comes with an opportunity to optimise efficiencies and enhance resources as the treating physician leads the management of the disease and the palliative care team focuses on the impact of the illness on the person. The potential of this embedded model of care is that the treating physician directs the patients to visit the palliative care team for pain and symptom management and counselling - freeing up the physician’s time. The palliative care team can also guide the treating physician on any concerns, background and family information, that will help in decision-making on the treatment plan. The palliative care team can provide a continuum of care to patients and their caregivers through integration into the health care ecosystem.

Currently, people have limited access to palliative care. The Lancet Commission on Palliative Care in 2017 reported that only 4% of Indians have access to palliative care. We, therefore, need to connect many more people to this care so that patients and families know that at no point should they feel alone or live in pain. Initiatives such as the Saath Saath helpline - a national palliative care helpline (1800-202-7777) that links callers to their nearest palliative care centre can help get the word out.

The road ahead may be long, but it is achievable with the collaborative effort of everyone in the health care system and our communities. Together, we can strengthen our health care system to be more person-centred. Let us all take on this challenge.

The article has been authored by Umang Vohra, MD and global CEO, Cipla.

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