Those of you who missed the excellent XVII Annual Conference of the Indian Association of Palliative Care that Dr Mohansundaram organized in Trichy, might like to hear about the best of the papers that were presented. From various sections, a jury selected eight papers for prizes. Here is a report by Dr Michael Minton about them.
The commended scientific papers presented at Trichy Palcon 2010 reflect the wide range of issues that confront patients, caregivers and professionals involved with end of life care everywhere. The topics ranged from spirituality to computer technology reflecting the competing philosophies in our contemporary lives.
Dr Naveen R Rodrigues of Vydehi Institute of Oncology & Research Centre,Pain and Palliative Medicine Dept, Whitefield,Bangalore, highlighted the possible malficience from using abstract spiritual practice, however it was a small study of 10 patients,so we must await further corroboration of his initial findings.
However, the introduction and value of palliative care computer programmes to collect patient data was elegantly demonstrated by Dr Priyadarshini Kulkarni from Cipla Foundation, Pune. They had to overcome many difficulties including the use of English but she showed the benefits for the service. As they say “No gain without pain”.
There are two large ventures currently in the UK’s End of Life programme. First, patient’s choice of place of death and secondly the use of an integrated care pathway(Liverpool Care Pathway).Both subjects were discussed with Indian data.
Dr E Divakaran, Director, Institute of Palliative Care, Thrissur, in a paper co-authored with Ms Neeraja & Ms Darsini, Junior Research Fellows, IPC, Thrissur, gave a detailed analysis of 119 interviews with caregivers of recently deceased patients. The majority of patients (88%) had died at home of which 43% had expressed this wish to family before death. The study identified a reluctance of caregivers, males more than females, to discuss dying matters. Further education through home based palliative care services may facilitate improved communication and so help support families.
Ms Sushma Shivananda, P G Student from CMC Vellore highlighted the observation that female patients were more likely to be cared for in the charitable hospice even when there was a relative at home. Palliative care services need to be aware of the potential disadvantaged status of terminally ill women who when well are the more likely caregiver!
Two papers on the introduction of the Indian integrated care pathway were presented demonstrating the experience in Calicut (Ms Shyni N, Institute of Pain and Palliative Care) and Bangalore (Dr Stanley C Macaden).This has led to better documentation on aspects of end of life care. This will benefit the subsequent audits which are an intended part of this approach to universally improve end of life care.Guidelines may carry the danger that they unwittingly replace the health care team’s clinical observations and one must remember that integrated care pathways are an aide-memoire and not a formula.
Psychosocial aspects of care often fall into second place after physical care.However their importance and value were well documented in two papers:
- First, the value of screening for depression or significant mood changes on a regular basis produces dividends and this has been confirmed with the experience of Dr Ravinder Mohan and Ms JaspalKaur in their paper from Cansupport, New Delhi.They presented the use of the General Health Questionnaire(GHQ) with 100 patients who when required could be offered appropriate therapies.
- Secondly, Mr Jose Pulimootil, Co-ordinator of “Footprints”, a project initiated by Institute of Palliative Medicine, Kozhikode,presented its work and experience with paraplegic and other bedfast patients with progressive chronic illness.Previous studies in Kerala have highlighted the plight of these people who can become isolated and despondent at home.This venture demonstrates the value of bringing this group of patients together and targeting their psychosocial needs and achieving encouraging results.Follow up information on this and the other studies would be welcome at future conferences. It is vital that all investigators continue their good work recruiting adequate numbers of patients and show evidence of sustained benefit for them.
Cecily Hall – Session 1
- Analysis of a Survey Regarding the Place of Death of Patients in a Panchayath
Dr. E. Divakaran, Director, IPC, Thrissur
co-authors: Ms Neeraja & Ms Darsini, Junior Research Fellows, IPC, Thrissur
- Depression Screening in Terminally Ill Cancer Patients
Dr. Ravinder Mohan & Ms Jaspal Kaur
CanSupport, New Delhi
- “Footprints” – A social Rehabilitation Project for Bed Ridden Patients
Mr. Jose Pulimootil
Footprints, Institute of Palliative Medicine, Kozhikode
- Spirituality – Practice among cancer patients
Dr. Naveen Rudolf Rodriguez
Bangalore Vydehi Institute of Oncology & Research Centre
Pain & Palliative Medicine Dept, Whitefield, Bangalore
Cecily Hall – Session 2
- Technology boost for efficient Palliative Care Services
Dr. Priyadarshini Kulkarani
- Audit of a protocol for the care of the dying
Ms. M. Shyni N
Institue of Pain and Palliative Care, Calicut
- Are women disadvantaged with respect to the choice of place of care? An audit of gender differences in the education of charitable and paid palliative care facilities
Ms. Sushma Shivananda, Post Graduate student
- Piloting an Indian adoption of the liver pool care pathway at the Bangalore Baptist Hospital, Bangalore India (hospital screening) and also its hospice and home care programme (community version)
Dr. Stanley C. Macaden