Indian Journal of Palliative Care最新文献_第5页

Protecting Incapacitated Patients’ Rights and Best Interests 保护无行为能力病人的权利和最大利益

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-11-03 DOI: 10.25259/ijpc_173_2022

Ercan Avci

Contemporary medical ethics requires providing healthcare services in accordance with the patient’s values, preferences and interests based on the rights to self-determination and privacy. Incapacitated patients utilise these rights through substitute decision-makers in light of the substituted judgement and best interest standards. In this context, the article aims to briefly study informed consent and focus on protecting incapacitated patients’ rights and best interests. The article underscores the importance of promoting the autonomy of every patient as much as possible. However, in the case of the lack of decisional capacity and advance directives, surrogates should decide for incapacitated patients based on patients’ known/documented/expressed wishes/ preferences and best interests. Nevertheless, due to the high possibility of the misinterpretation of patients’ values, preferences and interests by surrogates as well as potential financial and social conflicts between patients and their surrogates, in the event of medical procedures with serious consequences, such as life-sustaining support, surrogates should be requested to provide convincing evidence proving that their decisions are in line with the patient’s values, preferences and interests.

当代医学伦理要求在自决权和隐私权的基础上，根据患者的价值观、偏好和利益提供保健服务。无行为能力的患者利用这些权利通过替代决策者在替代判断和最佳利益标准的光。在此背景下，本文旨在简要研究知情同意，并重点关注保护无行为能力患者的权利和最大利益。这篇文章强调了尽可能促进每个病人自主的重要性。然而，在缺乏决策能力和事先指示的情况下，代理人应该根据患者已知/记录/表达的愿望/偏好和最佳利益为无行为能力的患者做出决定。然而，由于代理人很可能误解患者的价值观、偏好和利益，以及患者与其代理人之间潜在的经济和社会冲突，如果医疗程序具有严重后果，如维持生命支持，应要求代理人提供令人信服的证据，证明其决定符合患者的价值观、偏好和利益。

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引用次数: 0

Essential Elements of Home-based Palliative Care Model: A Rapid Review 基于家庭的姑息治疗模式的基本要素:快速回顾

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-11-01 DOI: 10.25259/ijpc_227_2022

Mousami Kirtania, Ajitha Katta

The need for palliative care is increasing due to the rising burden of non-communicable diseases and some communicable diseases. Chronic illnesses demand patient-centred care that focuses on the patient’s individual healthcare needs. Palliative care improves the patients’ and caregivers’ quality of life by providing pain and symptom relief through a holistic approach after the disease is diagnosed. Though there are various models followed in different countries, home-based palliative care is preferred by patients who wish to stay close to their loved ones at their end of life. For providing home-based care, there are certainly important elements that have to be taken care of before planning the implementation because every country has its own healthcare needs, system, and context. India is a developing country where isolated Palliative Care is practiced, hence the situation demands the need of addressing the essential elements that can be included in the protocol of home-based palliative care to enhance the quality of care. Therefore, this study aims to identify a few elements needed to provide home-based palliative care in the Indian context. A rapid review was conducted where seven studies were included that mentioned the elements of home-based palliative care. The electronic databases searched were MedLine, PubMed, and Cochrane databases of systematic reviews. The review was carried out over a period of 8 weeks in June and July 2022. Seven common essential themes were identified; (i) inter-sectoral and inter-professional cooperation, (ii) trust and safety, (iii) holistic management, (iv) non-academic palliative care, (v) spiritual care, (vi) support to caregivers, and (vii) funding and financial support. Our review of effective palliative care models explicates the essential elements for quality home-based care for patients with a terminal illness. The application of the elements must be relevant to the local context due to the huge diversity of the country.

由于非传染性疾病和一些传染病的负担日益加重，对姑息治疗的需求正在增加。慢性疾病需要以患者为中心的护理，侧重于患者的个人医疗保健需求。姑息治疗通过在疾病诊断后通过整体方法提供疼痛和症状缓解来改善患者和护理者的生活质量。虽然不同的国家采用了不同的模式，但家庭姑息治疗是希望在生命结束时与亲人保持密切联系的患者的首选。为了提供家庭护理，在规划实施之前，肯定有一些重要的因素必须考虑到，因为每个国家都有自己的医疗保健需求、系统和背景。印度是一个发展中国家，实行的是孤立的姑息治疗，因此，这种情况要求有必要解决可列入家庭姑息治疗方案的基本要素，以提高护理质量。因此，本研究旨在确定在印度提供家庭姑息治疗所需的几个要素。进行了一项快速审查，其中包括七项研究，其中提到了以家庭为基础的姑息治疗的要素。检索的电子数据库为MedLine、PubMed和Cochrane系统评价数据库。该审查在2022年6月和7月进行了为期8周的审查。确定了七个共同的基本主题;(i)跨部门和跨专业合作，(ii)信任和安全，(iii)整体管理，(iv)非学术性姑息治疗，(v)精神护理，(vi)对护理者的支持，以及(vii)资金和财政支持。我们回顾了有效的姑息治疗模式，阐明了为绝症患者提供高质量家庭护理的基本要素。由于国家的巨大多样性，这些要素的应用必须与当地背景相关。

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引用次数: 0

Efficacy and Safety of Celiac Plexus Neurolysis in the Treatment of Chronic Pain Secondary to Oncological Pathology of the Upper Hemiabdomen: A Systematic Review and Meta-Analysis 腹腔丛神经松解术治疗上腹肿瘤病理继发慢性疼痛的疗效和安全性:系统综述和荟萃分析

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-10-21 DOI: 10.25259/ijpc_203_2022

Gloria Melissa Pacheco-Feijoó, Jose Percy Amado-Tineo, Ricardo Plancarte-Sánchez, Carlos Contreras Valdivia, José M. López-Millán

Objectives: The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment t o determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods: This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results: Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control ( P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion: Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory.

目的:腹部肿瘤患者慢性疼痛的处理是复杂的;因此，腹腔神经丛松解术(CPN)是目前确定治疗上腹部肿瘤病理继发慢性疼痛的疗效和安全性的最佳技术。材料和方法:这是一项2000年至2021年间对照临床试验的系统综述，来源为MEDLINE/PubMed、Cochrane、Scopus、Web of Science和Google Scholar。三位独立评估人员分析了书目研究的结果。采用Jadad量表评估研究质量，使用Review Manager 5.3计算研究的平均差值(95%置信区间)和异质性(I2)。结果:共收录文献744篇，其中定性综合文献13篇，定量综合文献3篇。干预后1周至12周，实验组与对照组疼痛强度的降低无明显差异(P >0.05)。与神经松解术相关的不良反应并不严重，也不是短暂的，最常见的不良反应发生率在21%到67%之间(超声内镜下神经松解术为17%，经皮神经松解术为49%)。结论:腹腔神经丛松解术治疗上半腹部肿瘤病理继发的严重慢性疼痛，其镇痛效果与常规药物镇痛相似。这是一种安全的镇痛技术，因为并发症轻微且短暂。

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引用次数: 0

Evaluation of Chemotherapy Induced Peripheral Neuropathy, Sarcopenia and Fatigue in Children with Acute Lymphoblastic Leukaemia and Lymphoma in Tertiary Care Hospital, Dakshina Kannada 在卡纳达邦Dakshina三级医院化疗引起的急性淋巴细胞白血病和淋巴瘤患儿周围神经病变、肌肉减少和疲劳的评价

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-10-21 DOI: 10.25259/ijpc_143_2023

Nishtha Singhal, Stephen Rajan Samuel, Vijaya K. Kumar, Harsha Prasad, M. V. Saraswathy

Objectives: The study aims to assess the proportion and magnitude of chemotherapy-induced peripheral neuropathy (CIPN) and other common complications reported in children with acute lymphoblastic leukaemia (ALL)/ acute lymphoblastic lymphoma (LBL) undergoing chemotherapy. Material and Methods: The study included children between 5 and 18 years old with ALL/LBL undergoing chemotherapy in Tertiary Care Hospitals, Mangalore. The study was conducted using various instruments, including paediatric-modified total neuropathy scale for CIPN, handheld dynamometer for muscle strength, bioimpedance analyser for muscle mass, timed up-and-go test for physical performance, and national comprehensive cancer network (NCCN) guidelines for scoring cancer-related fatigue at 3-time points. The collected data were analysed by IBM Statistical Package for the Social Sciences version 29 using Z-scores with standard deviation for distinct ALL/LBL types. In addition, the Paired t -test compared the baseline outcome to the 3 rd and 6 th time points. Results: The study evaluated 25 children with ALL undergoing chemotherapy based on the UKALL 2003 protocol during their maintenance phase. The study found that 25 children experienced CIPN, with changes in sensory and pin sensibility scores at 3 and 6 months. The study found a significant change in handgrip strength, body mass index, and muscle mass at 3 months, with no significant change in physical performance over time. Fatigue scores increased from baseline to 3 months, with significant changes observed for the 7–12 years age group at 3 months but not for the 5–6 years age group at 6 months. Conclusion: Children with ALL/LBL undergoing chemotherapy experience CIPN and other side effects such as sarcopenia and fatigue. The study highlights the potential benefits of physiotherapy interventions and supportive care strategies aimed at managing the adverse effects of chemotherapy in children with ALL/LBL.

目的:本研究旨在评估接受化疗的急性淋巴细胞白血病(ALL)/急性淋巴细胞淋巴瘤(LBL)患儿化疗引起的周围神经病变(CIPN)及其他常见并发症的比例和程度。材料和方法:研究对象为在芒格洛尔三级医院接受化疗的5 - 18岁ALL/LBL患儿。研究使用多种仪器进行，包括儿科改良的CIPN全神经病变量表，手持式肌肉力量测定仪，肌肉质量生物阻抗分析仪，体能计时起跑测试，以及国家综合癌症网络(NCCN)指南，用于在3个时间点对癌症相关疲劳进行评分。收集的数据由IBM Statistical Package for Social Sciences version 29使用不同ALL/LBL类型的标准偏差z分数进行分析。此外，配对t检验将基线结果与第3和第6个时间点进行比较。结果:该研究评估了25名在维持期接受UKALL 2003方案化疗的ALL儿童。研究发现，25名儿童经历了CIPN，在3个月和6个月时感觉和针敏感性评分发生了变化。研究发现，3个月后，婴儿的握力、体重指数和肌肉质量都发生了显著变化，随着时间的推移，身体表现没有显著变化。疲劳评分从基线增加到3个月，7-12岁年龄组在3个月时观察到显著变化，而6 - 6岁年龄组在6个月时没有观察到显著变化。结论:ALL/LBL患儿化疗后出现CIPN及肌肉减少、疲劳等副作用。该研究强调了物理治疗干预和支持性护理策略的潜在益处，这些策略旨在管理ALL/LBL儿童化疗的不良反应。

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引用次数: 0

Impact of Establishing a Pain Clinic in a Rural Cancer Centre Based on the Knowledge and Experience of the Pain of Cancer Patients – A Prospective, Questionnaire-Based Study 基于癌症患者疼痛的知识和经验在农村癌症中心建立疼痛诊所的影响——一项前瞻性、基于问卷的研究

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-10-21 DOI: 10.25259/ijpc_54_2023

Harsimran Singh Walia, Jagdeep Sharma, Mansi Chatterjee Walia, Lalita Gouri Mitra, Atin Goyal, Sofia Jaswal

Objectives: Unrelieved pain significantly affects the quality of life of cancer patients. In rural settings, cancer patients do not have information or knowledge about how to control their pain because of a lack of resources or awareness. We conducted an interventional, questionnaire-based prospective study in a rural tertiary care oncological centre to look for the impact of establishing a pain clinic based on the knowledge and experience of cancer patients regarding their cancer pain. Material and Methods: The patient pain questionnaire was filled by 380 random non-surgical patients complaining of pain who visited our centre for the treatment of cancer. The information generated was used for setting up a pain clinic covering all aspects of cancer pain. After 3 months of starting the pain clinic services, all these patients who visited the pain clinic at least once were again surveyed similarly. Out of 380 patients, we could only follow up with 348 patients and other patients were lost to follow-up. Results: After visiting the pain clinic the mean value of the response for most of the questions decreased suggesting that the responses became more favourable as the knowledge improved and the experience of the pain became less distressing for the patients. The mean value of the responses to all the questions related to the overall knowledge of cancer pain before visiting a pain clinic was 4.22 ± 1.58 and after visiting a pain clinic was 3.83 ± 0.95 which was statistically significant ( P = 0.000). The mean value of the responses to the questions related to the overall experience of the pain before visiting the pain clinic was 3.81 ± 1.42 and after visiting the pain clinic was 2.14 ± 1.05 which was highly significant ( P = 0.000). We found out that the patients who had a higher mean value of the responses (8–10) suggesting the most unfavourable responses benefitted the most and the number of patients having the most unfavourable responses decreased after visiting the pain clinic. Conclusion: In a rural tertiary healthcare cancer centre, the establishment of a pain clinic increased the general understanding and experience of cancer patients regarding their pain and pain management.

目的:未缓解的疼痛显著影响癌症患者的生活质量。在农村地区，由于缺乏资源或意识，癌症患者没有关于如何控制疼痛的信息或知识。我们在一家农村三级保健肿瘤中心进行了一项介入性的、基于问卷的前瞻性研究，以寻找建立一个基于癌症患者关于癌症疼痛的知识和经验的疼痛诊所的影响。材料与方法:随机抽取380例因癌症就诊的非手术疼痛患者填写患者疼痛问卷。所产生的信息被用于建立一个涵盖癌症疼痛各个方面的疼痛诊所。开始疼痛门诊服务3个月后，所有至少访问过一次疼痛门诊的患者再次接受类似调查。380例患者中，我们只能随访348例，其余患者失访。结果:在访问疼痛诊所后，大多数问题的回答的平均值下降，这表明随着知识的提高和疼痛体验对患者的痛苦减轻，回答变得更加有利。就诊前对癌症疼痛总体知识的回答均值为4.22±1.58，就诊后对癌症疼痛总体知识的回答均值为3.83±0.95，差异有统计学意义(P = 0.000)。就诊前和就诊后总体疼痛体验相关问题的回答均值分别为3.81±1.42和2.14±1.05，差异有显著性意义(P = 0.000)。我们发现，在疼痛门诊就诊后，反应均值较高(8-10)的患者受益最多，反应最不利的患者数量减少。结论:在农村三级医疗癌症中心，疼痛门诊的建立增加了癌症患者对疼痛和疼痛管理的总体了解和经验。

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引用次数: 0

Can Artificial Intelligence aid communication? Considering the possibilities of GPT-3 in Palliative care 人工智能能帮助沟通吗?考虑GPT-3在姑息治疗中的可能性

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-10-18 DOI: 10.25259/ijpc_155_2023

Rajashree Srivastava, Shikha Srivastava

Objectives: This article reviews the developments in artificial intelligence (AI) technologies and their current and prospective applications in endof-life communications. It uses Open AI’s generative pre-trained transformer 3 (GPT-3) as a case study to understand the possibilities of AI-aided communication in Palliative Care. Material and Methods: Open AI’s GPT-3 was taken as a case study where responses were generated through the GPT-3 beta playground (Davinci engine) and were scrutinised by six mental health professionals (MHPs) working in a palliative care setting in India. They were tasked to evaluate the responses generated by the AI (the identity was not revealed until a part of the study was completed) in a simulated palliative care conversation with another MHP posing as a patient. The aim was to undermine whether the professionals were able to detect that the responses were indeed generated by a machine and did they approve or disapprove of the responses. Results: The GPT-3 playground with the right prompts produced remarkable, often surprising texts and responses that imitated human interaction. However, glitches such as redundancy were noticed along with strongly held opinions in certain questions related to faith, death, and life after death. Conclusion: AI-assisted communication in palliative care could be used to train professionals in the palliative care field using it as a simulation in training. It could also be used as a therapeutic intervention for the purpose of engagement and philosophical dialogue after certain modifications. However, it would have its own limitations such as it cannot replace a human agent just yet.

目的:本文综述了人工智能技术的发展及其在生命终末通信中的应用现状和前景。它使用Open AI的生成预训练转换器3 (GPT-3)作为案例研究，以了解AI辅助通信在姑息治疗中的可能性。材料和方法:以Open AI的GPT-3作为案例研究，通过GPT-3 beta游乐场(达芬奇引擎)生成响应，并由在印度姑息治疗环境中工作的六名精神卫生专业人员(MHPs)进行审查。他们的任务是评估人工智能(直到研究的一部分完成才透露其身份)在与另一位冒充患者的MHP进行模拟的姑息治疗对话中产生的反应。其目的是破坏专业人员是否能够检测到这些回答确实是由机器产生的，以及他们是否同意或不同意这些回答。结果:GPT-3操场与正确的提示产生显著的，经常令人惊讶的文本和反应，模仿人类的互动。然而，在与信仰、死亡和死后的生活有关的某些问题上，人们注意到诸如冗余之类的小故障以及强烈的观点。结论:人工智能辅助临终关怀沟通可作为临终关怀专业人员培训的模拟手段。在经过一定的修改后，它也可以作为一种治疗干预，用于参与和哲学对话的目的。然而，它也有自己的局限性，比如它还不能取代人类代理人。

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引用次数: 0

Medication Considerations in a Cancer Patient with a Jejunostomy Tube (J-tube) 肿瘤患者空肠造口管(j管)的用药考虑

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-10-13 DOI: 10.25259/ijpc_145_2022

Meenakshi V. Venketeswaran

引用次数: 0

Using Social Constructivist Learning Theory to Unpack General Practitioners’ Learning Preferences of End-of-Life Care: A Systematically Constructed Narrative Review 运用社会建构主义学习理论解读全科医生临终关怀学习偏好:系统建构的叙事回顾

Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-09-29 DOI: 10.25259/ijpc_50_2023

Shrikant Atreya, Soumitra Shankar Datta, Naveen Salins

General practitioners play a vital role in providing community-based palliative care to patients reaching end of life. In order for GPs to upgrade their skills at end-of-life care delivery, it is imperative that training programs be aligned to their learning needs and preferences. A narrative review was conducted using the electronic databases PubMed, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane from 01/01/1990 to 31/05/2021. 23 articles (of 10037 searched) were included for the review. Following themes were generated: Value attributed to end-of-life care learning, experience and reflection as a departure point for learning, learning as embedded in the clinical context; autonomy to decide upon their learning needs and learning preferences, learning as a transformative process; and learning as embedded in social interaction and interpretation. Training programs that are aligned to the preferences of GPs will encourage a larger clientele of GPs to access them.

全科医生在为临终病人提供基于社区的姑息治疗方面发挥着至关重要的作用。为了提高全科医生在临终关怀服务方面的技能，培训项目必须与他们的学习需求和偏好保持一致。使用PubMed、CINAHL、PsycINFO、EMBASE、Scopus、Web of Science和Cochrane等电子数据库对1990年1月1日至2021年5月31日的文献进行述评。检索到的10037篇文章中有23篇被纳入综述。产生了以下主题:生命末期护理学习的价值，作为学习出发点的经验和反思，嵌入临床环境的学习;自主决定自己的学习需求和学习偏好，将学习视为一个变革的过程;学习是嵌入在社会互动和解释中。与全科医生的偏好相一致的培训项目将鼓励更多的全科医生客户来接受培训。

引用次数: 0

Development and Validation of Total Pain Scale for Evaluation of Total Pain in Cancer Patients. 癌症患者全身疼痛量表的开发和验证。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-07-01 Epub Date: 2023-07-11 DOI: 10.25259/IJPC_256_2022

Suraj Pal Singh, Rajeev Aggarwal, Rajeev Kumar Malhotra, Varun Shekhar, Vikram Partap Singh, Sushma Bhatnagar

Objectives: Cancer pain has all the components of total pain such as physical, social, psychological, and spiritual. These components contribute to the overall pain experience in cancer patients. Many instruments have been developed till date to assess the effect of pain in cancer patients but none of the instruments include all components of total pain. In this article, we describe the development and validation of the total pain scale (TPS) for the evaluation of total pain in cancer patients with pain. This study aimed to develop and validate a questionnaire for the evaluation of total pain in cancer patients with pain.

Material and methods: This study included a review of existing pain questionnaires for cancer pain for item pool generation. Items were generated in the Hindi language by six stakeholders to create 23 items to develop TPS. TPS was applied to 300 Hindi-speaking cancer patients. Bivariate correlation was used to reduce the number of items as well as construction of the domain followed by factor analysis to finalise TPS. Confirmatory factor analysis (CFA) was performed for testing the validity and reliability of TPS.

Results: TPS is an 18-item scale composed of four domains (physical, social, spiritual and psychological domain). The internal consistency of TPS and its subscales was found to be very good (a = 0.84-0.88). CFA and structural equation modeling Goodness of fit has confirmed that model 4 is the best fit as it yielded a lesser root-mean-squared error of approximation value of 0.062 and a greater comparative fit index, Tucker-Lewis index value of 0.944. The convergent and divergent validity of TPS and its domain was good.

Conclusion: This study reports TPS to be a brief (18-item), valid, and reliable questionnaire in the Hindi language for assessment of all components of total pain in cancer patients with pain.

目的：癌症疼痛包括身体、社会、心理和精神等全部疼痛成分。这些成分有助于癌症患者的整体疼痛体验。迄今为止，已经开发了许多仪器来评估癌症患者疼痛的影响，但没有一种仪器包括完全疼痛的所有成分。在这篇文章中，我们描述了总疼痛量表（TPS）的开发和验证，用于评估癌症疼痛患者的总疼痛。本研究旨在开发和验证一份用于评估癌症疼痛患者全身疼痛的问卷。材料和方法：本研究包括对现有癌症疼痛项目库生成疼痛问卷的回顾。六个利益相关者用印地语生成了项目，创建了23个项目来开发TPS。TPS应用于300名讲印地语的癌症患者。双变量相关性用于减少项目数量以及领域构建，然后进行因子分析以最终确定TPS。结果：TPS是一个由物理、社会、精神和心理四个领域组成的18项量表。TPS及其分量表的内部一致性非常好（a=0.84-0.88）。CFA和结构方程建模拟合优度已经证实，模型4是最佳拟合，因为它产生了较小的均方根误差（近似值为0.062）和较大的比较拟合指数（Tucker Lewis指数值为0.944）。TPS及其域的收敛和发散有效性良好。结论：本研究报告TPS是一份简短（18项）、有效和可靠的印地语问卷，用于评估癌症疼痛患者全身疼痛的所有成分。

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引用次数: 0

Mapping of Palliative Care Services and Challenges in Implementation of National Program for Palliative Care in Puducherry. 普杜切里国家姑息治疗方案实施过程中的姑息治疗服务和挑战。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Indian Journal of Palliative Care

Pub Date : 2023-07-01 Epub Date: 2023-01-18 DOI: 10.25259/IJPC_146_2022

Mayank Sharma, Sonali Sarkar, S Adinarayanan, Gunaseelan Karunanithi

Objectives: The purpose of this study was to map ongoing palliative care services and describe the characteristics of providers, recipients, level of care, and approach. Second, it seeks to investigate the difficulties encountered in implementing NPPC in the Puducherry district of UT Puducherry. This study aims to review the challenges in its implementation.

Material and methods: The study using both quantitative and qualitative design, including geospatial mapping of organisations, describing service delivery characteristics and exploring challenges faced in implementing NPPC, was conducted from July 2021 to January 2022. In-depth interviews were conducted with seven healthcare providers, four patients and three caregivers, as well as key informant interviews with six doctors in administration.

Results: Thirteen organisations providing palliative care to population of Puducherry district of union territory Puducherry and neighbouring districts of Tamil Nadu were identified. Mapped organisations were primarily concentrated in urban areas. Morphine was available only at three medical colleges, providing outpatient palliative care services. Non-governmental organisations provided only home-based palliative care services and the hospices provided both in-patient and home-based services. Key barriers perceived by the health system were difficulty in procuring morphine, inadequate personnel and inadequate funding. Few barriers perceived by patients/family were stigma faced in community, psychological challenges and poor quality of care.

Conclusions: Palliative care services are mainly available in urban areas and through private hospices. There is a need to implement palliative care program through the public health system to improve the accessibility in the rural areas.

目的：本研究的目的是绘制正在进行的姑息治疗服务图，并描述提供者、接受者、护理水平和方法的特征。其次，它试图调查在UT Puducherry的Puduchery区实施NPPC时遇到的困难。本研究旨在审查其执行过程中的挑战。材料和方法：该研究于2021年7月至2022年1月进行，采用了定量和定性设计，包括组织的地理空间地图，描述了服务提供特征，并探讨了实施NPPC面临的挑战。对七名医疗保健提供者、四名患者和三名护理人员进行了深入访谈，并对六名管理医生进行了关键线人访谈。结果：确定了13个为联邦领地普杜切里区和泰米尔纳德邦邻近地区的居民提供姑息治疗的组织。地图组织主要集中在城市地区。只有三所医学院提供吗啡，提供门诊姑息治疗服务。非政府组织只提供家庭姑息治疗服务，收容所同时提供住院和家庭服务。卫生系统认为的主要障碍是难以采购吗啡、人员不足和资金不足。患者/家庭认为的障碍很少是社区中面临的耻辱、心理挑战和护理质量差。结论：姑息治疗服务主要在城市地区和私人收容所提供。有必要通过公共卫生系统实施姑息治疗计划，以提高农村地区的可及性。

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引用次数: 0