Is
palliative care only for the dying patients?
Care
of the dying patient (Terminal Care) is an important part of
palliative care however palliative care is not terminal care alone.
It starts as supportive care when the diagnosis of a life threatening
illness is made, continues as terminal care if the illness progresses
and provides bereavement support for the family after the death of
the patient. Palliative Care is not in conflict with curative care.
The principles of symptom control and psychosocial support used in
palliative care are beneficial to the patient even when the disease
is curable.
Is
palliative care only for cancer patients?
No.
Palliative care is not disease specific. In addition to advanced
cancer, stroke, patients with end stage respiratory, cardiovascular,
renal and other diseases such as AIDS benefit from palliative care.
Availability of palliative care services will also help to reduce
suffering in the majority of the elderly in their last phase of life.
It has also been observed that patients with life threatening
diseases can benefit from the additional psycho social support and
symptom relief offered by palliative care services when the disease
is curable.
Are
there any special medicines involved?
The
medicines used for symptom relief are the same drugs used in the
practice of modern medicine. However their use in combination with
other supportive treatment modalities using a holistic approach is
what makes the difference.
Is
morphine the main drug that is used?
Morphine
is one of the medicines used by palliative care physicians. About 20%
of the patients in pain with advanced diseases will need strong
opioid drugs like morphine. The World Health Organisation has
suggested a simple three step protocol (WHO analgesic ladder) for the
management of pain in advanced diseases. Oral morphine is one of the
drugs used in this protocol.
What happens to the treatment for the underlying disease when the patient gets registered for palliative care?
Palliative
care is not in conflict with treatment to control or slow down the
underlying incurable disease. This treatment is continued in the most
appropriate form depending on the stage of the disease and the
benefit that the patient can get and it will be stopped only when it
can cause more harm than good to the patient.
Where can palliative care be delivered?
Palliative
care can be delivered in the institutional or community setting. Most
patients with progressive incurable diseases prefer to be at home if
services to keep them comfortable are available. The methods used are
simple and low technology. Hence most of the patients in need of
palliative care can be looked after in the primary health care
setting in the community.
Who
can deliver palliative care?
A
patient with advanced incurable disease will have a lot of physical,
emotional, social and spiritual problems. Such patients will need
appropriate care for the rest of their lives. It is not possible for
doctor or nurse or hospital to address these complex problems alone.
What is ideally needed is a team of trained doctors and other health
care workers supported by trained volunteers in the community.
What
is Community Based Palliative Care?
Since
most of the patients prefer to be at home in the last phase of their
life, it will be ideal if palliative care services are available to
them in the community. Community Based Palliative Care is the term
commonly used to refer to palliative care services organised by the
local community, with home based care as its corner stone. Community
based palliative care services also has good participation from the
members of the local community. Palliative care institutions should
be available to support these community based home care programs.
What
is a hospice?
The
term ‘Hospice’ was originally used to denote a standalone
inpatient palliative care service. In many cultures, the term later
became synonymous with palliative care. A lot of people use the terms
hospice care, palliative care and end of life care interchangeably.
Do
the doctors, nurses, other health workers and community volunteers
involved in palliative care need any special training?
Delivery
of proper care to a bed ridden, incurably ill or dying person
involves a lot of skills and knowledge which is not yet part of the
main stream education and training programs in our country. So the
health care professionals and community volunteers involved in
palliative care need to undergo education and training programs to
improve their knowledge and skills.
How
can one get trained in palliative care?
Training
programs are offered by various institutions and organisations
involved in palliative care in the country. Specific training
programs for doctors, nurses and community volunteers are available
at different palliative care centres in the country.
The
state of Kerala has managed to develop an integrated health service
delivery model with community participation in palliative care.
Institute of Palliative Medicine has been playing a major role in
shaping up this model. The evolving palliative care system in Kerala
tries to address the problems of the incurably ill, bedridden and
dying patients irrespective of the diagnosis, age or social class.
The program in Kerala is also expanding to areas like community
psychiatry and social rehabilitation of the chronically ill.
Palliative care has been declared by Government of Kerala as part of
primary health care. Combined efforts by Civil Society Organisations,
Local Self Government and Government of Kerala have resulted in the
best coverage anywhere in Low and Middle Countries for palliative
care in Kerala. The ‘Quality of Death’ study by Economist
Intelligence Unit (2010) states that “Amid the lamentably poor
access to palliative care across India, the southern state of Kerala
stands out as a beacon of hope. While India ranks at the bottom of
the Index in overall score, and performs badly on many indicators,
Kerala, if measured on the same points, would buck the trend. With
only 3% of India’s population, the tiny state provides
two-thirds of India’s palliative care services.