Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.Palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.
Approaches to improve the application of palliative care include education, training, and research endeavors. Educational efforts in palliative and end-of-life care have targeted nurses, physicians, and other disciplines associated with clinical care. WHO recommended three foundation measures for developing Governmental policy, Education, and Drug availability. They are important for establishing a sustainable , and achieving meaningful coverage. The introduction of Palliative care into the curricula of the under graduate education of all doctors and nurses is recommended as an efficient way to broaden the base of Palliative coverage at the national level. A milestone has been achieved in Palliative as MCI has recognized MD in Palliative Medicine from this year and this will help it to develop as a specialty in our country. IAPC has worked for this since many years.
Research in Palliative care is very essential to deliver high-quality palliative care. Finding and using the best available evidence should be part of our professional lives. Evidence-based is need of the hour. We need to do high quality trials in palliative . Many developments like Megestrol for cancer cachexia, Biphosphonates for pain in bone metastasis, Opioids for the palliation of breathlessness in terminal illness have come from the research in palliative . There is good scope for developing a research culture in the Indian palliative scenario. Sustainable and quality research in India will be possible by establishing a network of individuals—doctors, nurses, paramedics, other professionals, institutions, and organizations, including commercial establishments who have a stake in the practice. The issues that can improve the palliative delivery and the areas where evidence of practice is still weak can be identified by forming network and collaborative groups for the application of study and research methods in India
Palliative care improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social or spiritual. The quality of life of caregivers improves as well.
Each year, an estimated 40 million people are in need of palliative ; 78% of them people live in low- and middle-income countries.
Worldwide, only about 14% of people who need palliative care currently receive it.
Unnecessarily restrictive regulations for morphine and other essential controlled palliative medicines deny access to adequate palliative care.
Adequate national policies, programmes, resources, and training on among health professionals are urgently needed in order to improve access.
The global need for palliativewill continue to grow as a result of the ageing of populations and the rising burden of noncommunicable diseases and some communicable diseases.
Early delivery of palliative reduces unnecessary hospital admissions and the use of health services.
Palliative care involves a range of services delivered by a range of professionals that all have equally important roles to play – including physicians, nursing, support workers, paramedics, pharmacists, physiotherapists and volunteers –– in support of the patient and their family.
A number of trends in health care today decrease the chances of cancer patients having access to palliative care. These range from the limited availability of palliative services to the philosophy of patient care that dominates our health care system. Most patient care is disease-oriented. It can assist in changing from a disease-focused approach to a patient-centered philosophy, where the needs of the patient and the patient/family goals are essential to planning care. Patient-centered care broadens the focus and requires clear coordination across specialties and disciplines and access to palliative care physicians and nurses. The goal of palliative should continue to focus on the relief of suffering and the improvement of the quality of life for patients with advanced illnesses.
An additional challenge to implementation of palliative care is the limited evidence for this specialty. Studies are needed that provide evidence to guide better decisions regarding symptom management, different health care models, decision-making approaches about treatment options, communication on sensitive topics such as death, and support for family caregivers. The existing strength in India, i.e. IAPC, the Indian Journal of Palliative , palliative care facilities, experts and professionals in this field should be jointly utilized to mount coordinated research activities in palliative.
Medical insurance does not play a significant role in hospice and palliative care provision in India. With a small number of healthcare professionals struggling to attend to millions and millions with various diseases, it is difficult for the average doctor to set aside time from his curative practice for palliative care.
Palliative care does require passion and commitment. Clinicians are urged to learn more about palliative in order to overcome some of these barriers. Therefore, attending local and national presentations of palliative care to increase the knowledge base is an essential initial step. This can occur through local presentations, national meetings, on-line courses, and individual reading and exploration.
Educating people in palliative through programs offered overseas can be useful in some instances, but it is not always an ideal solution. The way forward is to draw on the existing, successful models that have been described, to develop usable and dynamic educational initiatives within India itself, from model palliative-care teaching centers attached to inpatient or community units, thereby making close and relevant partnerships between theory and practice. The centers for palliative care teaching should be culturally sensitive and relevant to the Indian situation. Collaborations between the government of India, Indian Association of Palliative care and WHO, provide further optimism regarding future development. India has the potential to lead the way and enlighten others rather than being subservient to those countries that enjoy resource wealth.
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The role of palliative care at the end of life is to relieve the suffering of patients and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms patients experience. As death approaches, the symptom burden of a patient may worsen and require more aggressive palliation. As comfort measures intensify, so does the support provided to a dying patient’s family. Once death has occurred, the role of palliative care focuses primarily on the support of the patient’s family and bereavement.