Indian Journal of Palliative Care最新文献

Objectives: Burnout is a significant occupational hazard among palliative care physicians, driven by the emotionally demanding and high-stress nature of their work. Despite its implications for physician well-being and patient care, limited data are available on burnout within Indian palliative care settings. This study aimed to assess the prevalence of burnout and explore associated demographic and occupational factors among palliative care physicians across India.

Materials and methods: A cross-sectional survey was conducted among 68 palliative care physicians across India using a non-probabilistic convenience sampling approach. Participants completed a semi-structured socio-demographic questionnaire along with the Copenhagen Burnout Inventory (CBI), which measures burnout across three domains: personal, work-related and client-related. Given the non-normal distribution of data, non-parametric statistical tests were employed for analysis.

Results: The majority of physicians (85.3%) reported low overall burnout, whereas 10.3% experienced moderate burnout and 4.4% reported high burnout, based on established CBI cut-off scores. Notably, higher work-related and client-related burnout scores were observed among junior physicians and those practising in mixed-care settings. Engagement in regular physical activity was significantly associated with reduced overall burnout (P = 0.039), indicating its potential protective effect.

Conclusion: Although most palliative care physicians in India demonstrated low levels of burnout, a significant minority exhibited moderate to high burnout-particularly in domains related to work and patient care. These findings highlight the need for targeted interventions aimed at improving institutional support, encouraging physical well-being and optimising work environments to mitigate burnout and enhance the sustainability of palliative care practice.

Objectives: The aim of this study was to evaluate and compare the efficacy, safety, opioid-sparing effect and functional outcomes of computed tomography (CT)-guided versus fluoroscopy-guided celiac plexus neurolysis (CPN) in managing pancreatic cancer pain. The study integrates pain phenotyping using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale to assess response in neuropathic subtypes.

Materials and methods: This was an ambispective observational study conducted at King George's Medical University, encompassing a retrospective cohort (January 2020-December 2022) and a prospective cohort (January 2023-December 2024). Sixty patients with histologically confirmed pancreatic adenocarcinoma and baseline pain scores of ≥7 on the visual analogue scale (VAS) were included. Patients underwent bilateral posterior retrocrural CPN under either CT (n = 30) or fluoroscopic (n = 30) guidance. Neurolysis was achieved using absolute alcohol (6-10 mL) mixed with 2% lignocaine (2-3 mL). Pain scores (VAS and LANSS), opioid use (in morphine equivalents) and functional outcomes (karnofsky performance status [KPS] and short form 36 health survey questionnaire [SF-36]) were recorded at baseline, immediate post-procedure, 1 week, 1 month and 3 months. Complication rates and opioid dose reduction were also evaluated. Statistical analysis was conducted using the Statistical Package for the Social Sciences v26.0 with a significance threshold of P < 0.05.

Results: Both groups were comparable at baseline in terms of age, sex and initial pain scores. The mean VAS decreased from 8.9 ± 1.2 to 5.4 ± 2.1 in the CT group and from 8.8 ± 1.1 to 5.8 ± 2.3 in the fluoroscopy group at 3 months (P = 0.042). LANSS scores showed greater improvement in the CT group (baseline 13.8 ± 1.4-8.2 ± 2.1) compared to the fluoroscopy group (13.6 ± 1.5-9.5 ± 2.3; P = 0.038). Opioid dose reduction of ≥30% was observed in 66.7% (CT) versus 60.0% (fluoro). Functional improvement, assessed by KPS, was greater in the CT group (+15 points) than in the fluoroscopy group (+12 points). Complications were significantly lower in the CT group (20%) compared to the fluoroscopy group (46.7%, P = 0.019), with diarrhoea and hypotension being the most common.

Conclusion: Both CT and fluoroscopy-guided CPN provide effective pain relief in pancreatic cancer. However, CT-guided CPN is associated with significantly greater pain reduction, especially in patients with neuropathic pain features, lower complication rates and better functional outcomes. Pain phenotyping using LANSS enhances procedural decision-making and supports a personalised approach to palliative care in pancreatic malignancy.

Chemotherapy-related oral side effects such as xerostomia, dysgeusia and oral pain can occur during or soon after treatment in patients with cancer. With the right guidelines, a structured approach and proper training for dental specialists, we can significantly improve the management of oral symptoms and enhance the overall oral health of patients. This scoping review aims to map and assess the dental care interventions to improve symptoms related to the oral cavity in patients with cancer receiving oral chemotherapy. The updated methodological guidance by JBI will be followed for this scoping review. This review will consider quantitative studies on the oral care interventions available to improve symptoms related to the oral cavity in patients with any type of cancer aged 18 years or older receiving oral chemotherapy. MEDLINE (PubMed), EMBASE, CINAHL (EBSCOhost), Scopus, Cochrane and Google Scholar searches will be conducted by two reviewers who will independently screen the articles in two stages and extract the data. The third reviewer will resolve the disagreements between reviewers. Studies in English published from the beginning to the present will be considered. The piloted data extraction process to gather relevant information from the selected studies will be used. The results will be presented using narrative synthesis, and the reporting will be done according to Preferred Reporting Items for Systematic Reviews and Meta-analyses - Scoping Review guidelines. Our review aims to synthesise interventions designed to improve the symptoms related to the oral cavity in patients undergoing oral chemotherapy. This will be the first review to consolidate information from several databases on this topic.

Facial pain associated with oncologic pathologies in pediatric patients presents significant diagnostic and therapeutic challenges with a considerable impact on quality of life. In this context, chemical neurolysis of the sphenopalatine ganglion emerges as a promising therapeutic option. We present the case of a 9-year-old girl with embryonal rhabdomyosarcoma who experienced severe facial pain resistant to conventional treatment. The pain was described as continuous, disabling, and neuropathic in nature, affecting basic functions such as eating and sleeping. Pharmacological management with opioids and adjuvants was insufficient, with high opioid requirements and minimal relief. A diagnostic sphenopalatine ganglion block was performed using a transnasal approach, yielding temporary but complete analgesia. Based on this response, percutaneous chemical neurolysis via the infrazygomatic route was carried out under fluoroscopic guidance using absolute alcohol. Following the intervention, pain intensity decreased from 10/10 to 4/10 at 24 hours and to 0/10 at 7 days, with sustained complete pain relief at 3-month follow-up. This was accompanied by a substantial improvement in quality of life and complete discontinuation of opioid use. No complications were observed during or after the procedure. This case highlights the efficacy and safety of chemical neurolysis of the sphenopalatine ganglion as an innovative therapeutic option for refractory facial pain in pediatric patients with head and neck oncologic diseases, particularly when conventional measures fail.

Objectives: The objective is to assess the effectiveness of a structured compassion fatigue (CF) Educational Self-Help Module in improving the professional quality of life (ProQOL) among nurses. CF is a decline in a caregiver's ability to empathise and be compassionate, resulting from prolonged, continuous and repeated caregiver stress. It is a recently recognised but significant problem in the nursing field worldwide.

Materials and methods: An experimental single-group pre-test and post-test design was employed with a quantitative evaluative approach. Of the 528 eligible nurses, 42 were randomly selected using a computer-generated random numbers and 39 completed the intervention. Data were collected using a socio-demographic pro forma and the ProQOL Scale for Health Workers (ProQOL Health, Version 1), measuring compassion satisfaction (CS), perceived support (PS), burnout (BO), secondary traumatic stress (STS) and moral distress (MD). A validated, 4 h educational self-help module was delivered, with follow-up reinforcement through daily WhatsApp messages and weekly self-study materials. ProQOL scores were assessed at baseline, day 30 and day 60. Statistical analysis was performed using the Friedman test and the Wilcoxon signed-rank test.

Results: Significant improvements were observed post-intervention in CS (from 22.67 ± 3.48 to 26.62 ± 2.96) and PS (from 20.90 ± 4.07 to 26.97 ± 4.04). Concurrently, BO, STS and MD scores significantly declined. The number of participants classified as resilient increased from 2.6% to 17.9% by Day 60.

Conclusion: The CF Intervention Module effectively enhanced nurses' professional well-being by increasing positive ProQOL components and reducing CF-related vulnerabilities. The study supports the integration of self-help modules into staff development programmes to improve emotional well-being, reduce BO, and ultimately enhance patient care outcomes.

Objectives: In Thailand, family physicians play a central role in palliative care, which often includes the withdrawal of mechanical ventilation (WMV) as part of life-sustaining treatment cessation. However, the rationale behind these decisions varies significantly among practitioners. This study examines key factors that influence Thai family physicians' decisions to discontinue mechanical ventilation for terminally ill patients.

Materials and methods: We conducted an online survey from December 2021 to January 2022, employing a customised questionnaire. Its content validity and reliability were affirmed, achieving Cronbach's alpha scores of 0.81 and 0.88 in separate sections.

Results: Among 164 respondents, 123 (75%) had previously participated in WMV decisions. Key influencing factors included the involvement of family or surrogate decision-makers (SDMs), physicians' experience with end-of-life care and patients' explicit opposition to ventilator support. Urgent requests from families or SDMs and the imminence of patient mortality were also pivotal. A consensus on the ethical appropriateness of WMV was observed. Notably, physicians with over 3 years of experience in palliative care were significantly more likely to discontinue ventilation (odds ratio [OR] = 5.30; P = 0.001), a likelihood further increased by formal training in this area (OR = 8.97; P < 0.001).

Conclusion: The decisions of Thai family physicians to cease mechanical ventilation in terminally ill patients are strongly influenced by family or SDMs' input, their own experiential background and the expressed wishes of the patients regarding ventilator assistance.

Objectives: The aim of this study was to explore the experiences, motivations and challenges faced by palliative care volunteers in Bangladesh.

Materials and methods: Qualitative semi-structured interviews were conducted with volunteers in two community-based palliative care projects. Interviews were recorded, transcribed and coded using thematic analysis.

Results: Ten volunteers provided insights into their experiences. The following major themes were identified, including motivation and impact, training and roles, challenges, support system, and future directions. Volunteers were highly motivated and developed deep and trusting relationships with the patients and family members. Volunteers identified the importance of receiving support from the palliative care team and other volunteers, to motivate and sustain them. Volunteers were active in addressing myths and barriers to acceptance of palliative care with patients and their families. The impact for volunteers extended beyond personal satisfaction, as they began to feel that palliative care was so important that it should be widely available and needed to be implemented nationally.

Conclusion: Recruiting palliative care volunteers from the same community as patients may enhance palliative care programs by helping healthcare providers to understand the unique needs and perspectives of the local community. Integrating volunteers into the palliative care team provides them with support to cope and sustains them in their volunteer role. Incorporating the voices of volunteers into palliative care advocacy activities should be considered, as they bring a unique perspective on the importance of palliative care for their community and country.

Objectives: This study aims to investigate the impact of psychological distress, quality of life (QoL) and unmet supportive care needs on the burden experienced by cancer caregivers in Oman. Given the limited research in the Omani community, there is a need to explore these factors comprehensively. This study aims to assess the prevalence of psychological distress, QoL and unmet supportive care needs among cancer caregivers while identifying associated factors.

Materials and methods: A cross-sectional study involving 144 informal cancer caregivers was conducted. Psychological distress, QoL and unmet supportive care needs were assessed using the depression anxiety stress scales, the Caregiver QOL Index-Cancer and the Supportive Care Needs Survey-Partners and Caregivers Survey, respectively. Interrelationships were examined using hierarchical multivariable linear regression.

Results: Caregivers demonstrated significant levels of stress, anxiety and depression, with rates exceeding clinical cut-offs at 77.8%, 68.1% and 71.5% respectively. The mean QoL score was 78.99, with 74.3% scoring between fair and poor QoL. In addition, 86.8% reported experiencing 5 or more unmet care needs, primarily within the psychological/emotional and healthcare domains. There was significant but weak evidence suggesting that gender and patient age might influence anxiety scores, with male caregivers and older cancer patients exhibiting a decreased risk of high anxiety scores among caregivers.

Conclusion: The study highlights the significant psychological distress, diminished QoL and prevalence of unmet supportive care needs among cancer caregivers in Oman. These findings emphasise the urgent need for tailored support systems to address their specific needs. Implementing initiatives aimed at alleviating the psychological challenges encountered by cancer caregivers is crucial.

Objectives: Palliative care education empowers nurses to provide compassionate, competent end-of-life care. It enhances communication, emotional resilience and patient-centred practices, improving the quality of life for patients with life-limiting illnesses. Structured training, such as the End-of-Life Nursing Education Consortium (ELNEC) course, strengthens clinical skills, reduces burnout and ensures dignified, holistic care in diverse healthcare settings. The present study explores the experience of nurses trained in the ELNEC palliative care course, which significantly improves their professional capabilities and attitudes towards end-of-life care.

Materials and methods: This phenomenological study explored nurses' experiences after completing the ELNEC Palliative Care Value-Added Course. Using purposive sampling, seven hospital-based nurses were interviewed online. Data were analysed using Colaizzi's method. Ethical approval was obtained, and participant confidentiality was ensured. Findings reflect the course's impact on practice, communication and emotional preparedness in end-of-life care.

Results: Seven female nurses aged 22-26 participated in this phenomenological study. Thematic analysis using Colaizzi's method revealed enhanced patient-centred care, empathetic communication, emotional competence and professional resilience as major outcomes of ELNEC training. Participants advocated curriculum integration and emphasised practical exposure to strengthen value-added palliative care education further.

Conclusion: ELNEC training enhances nurses' end-of-life care skills, communication and confidence, improving patient outcomes and professional satisfaction. Emphasising comprehensive, simulation-based learning further strengthens their capabilities in delivering compassionate, high-quality palliative care.