Indian Journal of Palliative Care最新文献

Objectives: Improper pain management is a significant contributing factor and a potential correctable factor for low cure rates of head-and-neck cancer (HNC) patients. This study aims to assess the significance of the Quantitative Improvement Programme (QIP) in evaluating pain levels and its correlation with treatment compliance in recently diagnosed HNC patients undergoing curative treatment at a surgical oncology outpatient department (OPD). The study was conducted from January 2022 to August 2023 at a tertiary cancer care centre in Northeast India.

Materials and methods: This cohort study used secondary data. We implemented the QIP in December 2022. There were 204 patients in the non-implemented group (NIG) (January 2022 to December 2022), and 110 patients were in the implemented group (IG) (January 2023 to August 2023).

Results: The study included 314 HNC patients. The mean age was 57 years, and the male-to-female ratio was 3:1. More than two-thirds (70%) of patients presented with pain. Pain assessment was carried out in 63% (120) of patients in the NIG and 86% (95) patients in the IG and was found to differ significantly (P < 0.0001) between the groups. Treatment abandonment (default before starting treatment) was reported amongst 23% in the NIG, compared to 16% in the IG. 41% (85) of patients in the NIG and 39% (43) in the IG reported non-compliance with treatment (breaks after commencing treatment). There were only 7% of patients from the NIG and 4% of patients from the IG who experienced unfavourable events (relapse, death and treatment failure). Of the various factors analysed, we found age as the single most significant predictor of compliance to treatment (age 18-39 years: Risk ratio [RR] = 2.482, 95% confidence interval [CI]: 0.88, 6.99 [P < 0.08]; age group 40-64 years: RR = 0.54, 95% CI: 0.33, 0.90 [P < 0.01]).

Conclusion: QIP for pain management resulted in efficient pain assessment, enhanced patient compliance and reduced rates of treatment abandonment. The study findings mandate QIP for effective pain management of HNC patients in all cancer centres.

Objectives: Research on palliative care (PC) consultation and its outcomes in the emergency department (ED) within a low-and middle-income country (LMIC) setting is limited. This study aimed to evaluate PC consultation outcomes, symptom burden and management, and referral patterns in patients with advanced cancer referred for specialist PC (SPC) in the ED of an urban tertiary care cancer centre in India.

Materials and methods: Data of adult advanced cancer patients referred for SPC services in the ED between August 2017 and June 2019 were retrospectively screened. Patients' sociodemographic features, clinical characteristics, ED visit-related data, and treatment-related data were documented. Multinomial logistic regression, incorporating significant univariate factors, was performed to analyse the independent predictive factors of consultation outcomes in the ED.

Results: Of the 644 consultations, 366 (56.8%) were discharged home, 166 (25.8%) were admitted to various settings (hospital/respite care/hospice), 74 (11.5%) died in the ED, and 38 (5.9%) were unresponsive upon arrival. Sex, performance status (PS), gastrointestinal and cardiovascular events, pain, cancer progression, and receipt of pharmacological treatment were predictive of consultation outcomes. Male patients and those with poor PS were more likely to be admitted to the ED, whereas patients with poor PS and cancer progression were more likely to die. Discharge rates were higher among females, those with gastrointestinal symptoms and pain, and those receiving pharmacological treatment.

Conclusion: More than 50% of the patients referred for SPC consultations were discharged. In addition, we also identified predictors for each consultation outcome in the LMIC-ED setting. Future research should investigate advanced care planning and survival analyses in comparable ED settings.

[This retracts the article DOI: 10.25259/IJPC_98_21.].

This study sought to explore the unmet palliative care needs of patients diagnosed with Stage B chronic heart failure (CHF) according to the American Heart Association (AHA) and American College of Cardiology (ACC) classifications. We conducted this cross-sectional study between June 1 and August 31, 2020, at Kobe University Hospital. Patients were asked to complete the Integrated Palliative care Outcome Scale (IPOS) along with a customized questionnaire developed by a multidisciplinary team. These tools were filled out by the patients themselves or with help from family members. A total of 101 patients participated in the study, with 55 of them (55%) falling into the Stage B CHF group as classified by AHA/ACC. Among the physical symptoms, 22% reported dyspnea and 20% reported drowsiness as common concerns. Regarding specific problems, 47% identified issues related to exercise, 62% with eating, 26% with finances, and 18% with employment. Notably, financial difficulties were found to be significantly more common among Stage B patients when compared to those in Stages C and D (odds ratio [OR]: 5.22; 95% confidence interval [95% CI]: 1.03-26.5; p = 0.032). Almost 79% of Stage B patients expressed a desire to understand the progression of their disease. In conclusion, stage B CHF patients may face financial difficulties and have unmet informational needs. Therefore, further research is necessary to explore these aspects in greater detail.

Objective: The objective of this study was to validate the 'Functional Assessment of Chronic Illness Therapy-Spiritual-Well-being-Expanded(FACIT-SpEx) Version 4' tool in Malayalam and assess its feasibility among advanced cancer patients receiving palliative care.

Materials and methods: The study was carried out at the outpatient Department of Cancer Palliative Medicine of Malabar Cancer Centre between November 2022 and June 2023. Initially, the FACIT-Sp-Ex version 4 tool with 23 items was translated into the Malayalam language with a forward-backward translation procedure. This was followed by pilot testing in 10 advanced adult cancer patients receiving palliative care who could read and comprehend the Malayalam language. After answering the draft version of the validated tool, patients responded to questions from a Malayalam-translated cognitive debriefing script.

Results: The process of translation and cross-cultural adaptation went on smoothly with very few hurdles. The Malayalam terms used in three items Sp⁷, Sp⁹ and Sp²³ when back translated were found to be different from the source. These issues were resolved with the use of the most suitable translations and closest equivalents available in Malayalam. In the pilot testing, the majority (70%) of the patients were female. The mean age of patients was 45.90 (standard deviation [SD] = 7.62) years. Carcinoma breast (50%) was the most common type of cancer. All the patients knew their diagnosis, while only 80% knew the prognosis. Almost 90% of the patients were receiving some form of palliative anticancer treatment. All patients completed the draft version of the validated tool. The mean spiritual well-being score measured using this validated tool was 71.20 (SD = 15.10). Analysis of the debriefing interviews revealed that the Malayalam version was easy to complete, relevant, and appropriate.

Conclusion: Linguistic validation and cognitive debriefing produced the Malayalam translated FACIT-Sp-Ex version 4 tool conceptually equivalent to the original FACIT-Sp-Ex version 4 tool, and it is feasible for its use.

Objectives: The conventional healthcare system operates on the 'physiological man' and overlooks the 'spiritual man'. Many studies reported on the unmet spiritual needs of terminally ill patients. Despite spiritual care being a predictor of a positive mindset (meaning making) among patients with terminal illnesses, assessing spiritual needs and providing adequate spiritual care is still a distant phenomenon in the healthcare setting.

Materials and methods: With the help of a spiritual needs questionnaire, we analysed the unmet spiritual needs and preferences of 30 terminally ill patients. Specific attention was given to psychosocial, emotional, existential, religious and acceptance of death.

Results: The results show that 72% of terminally ill patients reported a strong desire to have their spiritual needs met. Psychosocial needs scored the highest, while acceptance of dying scored the least. The need to be connected with the family was one of the strongest wishes expressed in the study. Religious needs ranked as the second category of needs. Findings show that the highest needs are intertwined with the patients' culture.

Conclusion: In India, religion and family connections are essential; terminally ill patients expressed the desire that meeting these two aspects makes their lives meaningful even at the end stage. The results warrant a spiritual needs assessment as a deathbed test to make the end-of-life more meaningful.

This systematic review was carried out to appraise the evidence regarding the brassiere-wearing practices and problems faced by breast cancer survivors. An electronic search was carried out across eight databases such as PubMed, Scopus, Web of Science, Science Direct, Google Scholar, Embase, CINAHL and ProQuest. Two researchers independently screened the studies for their eligibility and study quality. A total of 309 studies were assessed for eligibility. After conflict resolution by the third reviewer, five studies were selected for systematic review. All study outcomes in terms of the pattern of brassieres/prostheses, issues and challenges faced by women post-mastectomy were reviewed. It was observed that very few studies were published from various countries all over the world. All the studies were of descriptive type except one, which adopted a prospective randomised crossover design. The brassieres or prostheses, the survivors preferred were homemade made of cotton, cloth, wool, rice, sponge or commercially silicon-made. Weight of the brassiere/prostheses, discomfort, displacement while doing activities of daily living and impaired body image were common issues identified, while the unavailability of size or fit of the brassieres or requirement of alteration in clothes to meet clothing styles were common challenges faced by post-mastectomy women. It was concluded that the post- mastectomy used varied types of brassieres or prostheses with various associated issues and challenges.

Objectives: Morphine is the cornerstone of pain management in a palliative care setting. Nausea with or without vomiting usually occurs when patients are initiated on morphine for the 1^st time or when the dose is substantially increased.

Materials and methods: A total of 90 patients fulfilling the inclusion criteria were randomly allocated into two groups of 45 each. Group M received a tablet of metoclopramide 10 mg orally 3 times a day; Group H received a tablet of haloperidol (2.5 mg) orally at night. All the patients were provided NCI CTCAE V4.3 NAUSEA AND VOMITING SCALE and asked to mark their response from day 1 to day 7. At the follow-up visit on the 7^th day, the form was collected, and data were analysed.

Results: In Group M and Group H, the mean nausea score was between 1 and 2 and the difference was statistically insignificant. In Group M, the maximum vomiting score was 1.28 on day 5, while in Group H, the maximum score was 2 on day 5. The difference between the two groups was statistically significant.

Conclusion: Metoclopramide and haloperidol are equally efficacious in preventing nausea, but metoclopramide was found to be more effective with lesser side effects than haloperidol for morphine-induced vomiting in cancer patients when used prophylactically.

Objectives: The prevalence and burden of neurological diseases are high among the older age group. Stroke and other neurological diseases significantly impair functional capacity and lead to poor quality of life. This study aims to provide a national-level estimate for palliative and supportive care needs among older Indian adults with stroke and other neurological diseases.

Materials and methods: The Longitudinal Ageing Study in India (LASI), a national-level survey of older adults, was used as a representative sample to estimate palliative and supportive care needs. The supportive and palliative care indicator tool income setting (SPICT-LIS) was used to identify palliative care needs in older adults with stroke and other neurological diseases. A total of 31,902 older adults aged 60 years and above were identified from the LASI data, and among them, 1458 older adults with stroke and other neurological diseases were selected for the analysis. The SPICT-LIS indicators were compared with the selected LASI data. Both univariate analysis and multivariate logistic regression were performed to determine the association between supportive and palliative care needs and background characteristics of older adults.

Results: The analysis showed that 63.6% of older adults with stroke and other neurological diseases in India have supportive and palliative care needs. In regression analysis, the burden of supportive and palliative care needs was observed to be high among older adults who were in the underweight, overweight/obese category, who experienced ill-treatment, and who had diabetes and hypertension. In contrast, the burden of supportive and palliative care needs was observed to be low among older adults with stroke and neurological diseases who belonged to richer and richest economic quintiles, those receiving at least one social support scheme, those engaged in social activity and those performing physical activity.

Conclusion: The palliative care needs among the older adult population with stroke and other neurological diseases in India are high. The findings of this study underscore the importance of screening for supportive and palliative care needs among patients with stroke and other neurological diseases to identify these unmet needs. The workforce trained in the provision of generalist and specialist palliative care will be required to meet this need, and the population of older adults is estimated to double in the next three decades.

Chronic kidney disease (CKD) is a widespread health issue impacting millions globally. Recognizing the potential benefits of yoga in enhancing physical and mental well-being, this research aims to develop and validate a yoga module tailored for CKD patients, with a specific focus on improving their general health. The yoga module was meticulously crafted through an extensive review of traditional and contemporary literature, incorporating postures, breathing techniques and meditation practices deemed safe and beneficial for CKD patients. Content validity was established through input yoga experts with over 7 years of experience. The study spanned from January 2020 to December 2021. The final version of the yoga module retained 83.33% of the proposed yoga techniques, incorporating modifications suggested by experts. The content validity index for the entire yoga module averaged 0.83. This work establishes the viability, validity and practicality of a yoga module designed for CKD patients. With 35 out of 42 items retained, the module exhibited significant health improvements after 12 weeks of practice. The findings position yoga therapy as a potentially effective complementary treatment for CKD patients, offering improvements in general health and quality of life and potentially slowing disease progression.