April 11, 2024

What Is Palliative Medicine Really About?

Written by our expert

Dr. Anand S Sarkar

Dr. Anand S Sarkar

Fellow in Palliative Medicine (GMC,Kozhikode), International Association for Study of Pain (IASP) South Asian Member

What Is Palliative Medicine Really About?
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What is Palliative Care?

Even though dying is a natural part of life, it's frequently handled like a sickness. Consequently, a great number of people pass away in hospitals, alone and agony.

The main goals of palliative care are to predict, avoid, diagnose, and treat symptoms that patients with a serious or life-threatening illness experience. It also assists patients and their families in making crucial medical decisions.

Regardless of diagnosis, the ultimate goal of palliative care is to improve the patient's and the family's quality of life.

Palliative care plays a more active role as the end of life draws near and is centered on proactive symptom treatment and psychosocial support, even though it is not dependent on prognosis like hospice care is. 1

History and Development of Palliative Care

In 1967, Dame Cicely Saunders, the founder of St. Christopher Hospice in London, pioneered the modern hospice and palliative care movement.

For the first time in the world, many patients with terminal illnesses came together, with staff committed to providing instructions on the best supportive care. 2 In India, the concept of palliative care was introduced in the mid-1980s. In 1975, the  Government of India initiated a National Cancer Control Program. 

The first Palliative care service was initiated in 1986 as a hospice, the Shanti  Avedna Sadan in Mumbai. Over the next five years, two more branches were established, one each in Delhi and Goa.

However, patients outside these institutions had no access to palliative care. In the 1990s, two major developments changed this: the formation of the Pain and Palliative Care Society (PPCS) in Calicut, Kerala, in 1993 and the formation of the Indian Association of Palliative Care in 1994. 3

Palliative Care: Ethos and Dimension

When a sick person has an incurable illness, what should we do? There are people worldwide who suffer greatly both near the end of their lives and during the shortening of their lifespan.

This is precisely the population that palliative care aims to assist, together with their families. The definition of palliative care provided by the WHO is cited here.

Palliative care, to put it simply, is the treatment of patients with terminal illnesses to minimize their suffering, maximize their quality of life until death, and support their families during trying times.

It is helpful for the affluent, the poor, the elderly, the young, and those confined to hospitals or homes. 

WHO's Definition of Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. 4

Why Is Palliative Care Needed for Terminal Illness?

At first, the management of diseases in contemporary medicine was centered on medications, surgery, and other curative measures. Palliative care acknowledges that people are composed of much more than simply their physical beings.

Families and the greater community are also impacted by the integral components of emotions, thoughts, social concerns, and spiritual suffering. It is only when we address all these areas that we are helping the whole person. This is called holistic care 5.  

Who Needs Palliative Care?

WHO Key Factsheet 2015 6: 78% of the estimated 40 million individuals who require palliative care annually are in low- and middle-income nations.

Just 14% of those in need of palliative care worldwide presently get it. 

Palliative care is required for a wide range of diseases. 

  • Worldwide, the majority of adults in need of palliative care have chronic diseases such as: 
    • Cardiovascular diseases (38.5%) 
    • Cancer (34%) 
    • Chronic respiratory diseases (10.3%) 
    • AIDS (5.7%) 
    • Diabetes (4.6%) 
  • In India, non-communicable diseases cause 53% of deaths. Among these, diseases  that require palliative care are listed below 7
    • Cardiovascular: 12.4% 
    • Chronic obstructive lung disease: 10.8% 
    • Cancer: 10 lakhs new cases per year; the largest number of oral cancers in the world
    • Diabetes: highest in the world: maybe >300 lakhs; Type 2: 3.8% rural, 12% urban 
  • Many other conditions may require palliative care, including: 
    • Kidney failure 
    • Chronic liver disease 
    • Neurological disease: Multiple sclerosis, Parkinson’s disease 
    • Rheumatoid arthritis 
    • Dementia 
    • Congenital anomalies 
    • Drug-resistant tuberculosis 

The gravity of the situation can be acknowledged by the fact that more than 26,000  individuals suffering from cancer, AIDS, paralysis, and other chronic illnesses ended their life in 2013, accounting for nearly 20% of all deaths caused by self-harm in India. 8 

Pain is one of the most frequent and serious symptoms experienced by patients in need of palliative care. Opioid analgesics are essential for treating the pain associated with many advanced progressive conditions. For example, 80% of AIDS and cancer patients & 67% of patients with CVS disease or COPD will have moderate to severe pain at the end of life.

Takeaway

  1. Palliative care unit Offers solace from discomfort and other upsetting symptoms.
  2. Recognizes life and accepts death as a natural process 
  3. It does not aim to speed up or delay death 
  4. Incorporates spiritual and psychological components of patient care
  5. Provides a support network to enable patients to lead as active a life as possible until their passing. 
  6. Provides a network of support to assist the patient's family in coping with the patient's illness and bereavement.
  7. Where necessary, bereavement counseling is provided by applying a collaborative approach to meeting the needs of patients and their families.
  8. It will improve life quality and perhaps positively impact how an illness develops.

References

  1. Baines M, European Journal of Palliative Care, 2011; 18 (5): 223–227.
  2. Rome RB, Luminais HH, Bourgeois DA, Blais CM. The role of palliative care at the end of life. Ochsner J. 2011 Winter;11(4):348-52. 
  3. Rajagopal MR www.cancercontrol.info/cc2015/the-current-status-of-palliative-care-in-india.
  4. https://www.who.int/cancer/palliative/definition/en/. 
  5. Bond C, Lavy V, Ruth Wooldridge R, Published 2008 by Help the Hospices; ISBN: 978-1-871978- 71-1 
  6. http://www.who.int/mediacentre/factsheets/fs402/en/ 
  7. WHO World Health Statistics Report 2016.
  8. John EA: One in 5 suicides in India is due to chronic illness. http://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/one-in-5-suicides in-india-is-due-to-chronic-illness/articleshow/45043369.cms

Do you have any specific questions for Dr. Sarkar? Shoot an email to [email protected]

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