Palliative Care: Necessity, Challenges and Actions to be Taken !

What is Palliative Care?

Palliative care is the specialized care given to a patient suffering from long lasting illness or from the fatal illness, during the last days of his/her life.
World Health Organization (WHO) has defined palliative care as “an approach that improves the quality of life of patients and their family members facing the problems associated with life-threatening illness, through the prevention and relief of suffering.”
Palliative care refers to the bunch of the care like relieve from pain, treat the symptoms, preventing from worsening, and also focuses on spiritual and psychological health.
This treatment or care views the person as human, not merely the disease
The aim of palliative care is to provide best possible quality of life both for patient who is near to death and for their families and caretakers
Palliative care is all about improving the quality of life of the patient and those related
Palliative Care accepts death
Patient of many diseases like cancer, Alzheimer, AIDS, etc., seek for palliative care.
In case of professional caregivers, an important aspect of providing palliative care is to work with families and friends of the person near death, to ensure effective communication.

Affirms life and regards death as a normal process
Does not hasten or postpone death
Provides relief from pain and other symptoms
Offers a support system to help patients live as actively as possible right up to their death
Integrates psychological and spiritual care
Intends neither to hasten nor postpone death
Provides a wider support to help the family cope during the patient’s illness and their own bereavement after death.
Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
Will enhance quality of life, and may also positively influence the course of illness

– Source: WHO

Palliative care generally deals with treating symptoms and relieving the pain. However, in case of chronic and long-lasting diseases, some pain is common.
Palliative care treats the pain which may often be missed out during the treatment of chronic disease in the hospital.
This relieves the patient and also decreases the hospital burden.

Palliative care is necessary to improve the quality of life of patient.
With already suffering from life threating disease and stresses related to medical intervention, palliative care makes sure that no such stress occurs and thus improves the quality of life of the patient.
Physical treatment, psychological healing, providing some information about palliative care helps in improving the quality of life of the patient.

Unlike the hospice care, palliative care deals with human as a whole.
Patient are given prime importance and the treatment or care is given accordingly.
Patient are listened and understood.
Along with the physical health, psychological and spiritual heath are also focused.
Palliative care acknowledges death and helps the patient to easily accept it.

Lack of understanding about palliative care in the community
Limited evidences and researches to support and invest in palliative care
Limited funding and under-resourced status
Stringent national policies related to increasing availability of some pain control drugs necessary for palliative care
Lack of advocacy and enough support for palliative care
Quality and uniformity of care at all levels while expanding it to the community level
Lack of trained human resources

Globally, only about 14% of people who need palliative care currently receive it.
Each year, an estimated 40 million people are in need of palliative care, 78% of them people live in low- and middle-income countries.
The need for palliative care has been increasing with the increase in the non-communicable diseases.
Comparing to the past decades, the trend of palliative care has been increasing
A study done in 2011 in 234 countries found that palliative care services were only well integrated in 20 countries, while 42% had no palliative care services at all and a further 32% had only isolated palliative care services.
Apart from the cancer patients, palliative care has been provided to the geriatric patient, people suffering from the HIV/AIDS, Alzheimer, chronic lung diseases etc.
Study conducted in the England in the year 2017 showed that, by the year 2040, the number of people requiring palliative care will grow by 25% considering that age- and sex-specific proportions with palliative care needs remain the same as in 2014. However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4%.

WHO has identified three foundation measures for scaling up provision of palliative care. They are:

Development of national policy is must for strong palliative care. Currently, only handful of countries have concrete national policies for strong palliative care.
Advocacy is necessary for the development of national policy
Presence of national policy will pave the way for budget allocation for palliative care

Training related to what is palliative care and how is it performed
Necessary to reduce stigma and discrimination related to specific diseases like HIV and AIDS
Helps to understand the importance of palliative care.

Pain control is must for effective palliative care
It requires availability and use of pain relievers
Some countries may also need to change laws to make the effective pain relief available

Palliative care is expensive to set up
Support and budget allocation from the government
Community based palliative care can also be set up through community investment in it

As inadequate workforce is the major challenge for palliative care, production of the more human resources is must
Provision of incentives for the workforce
Increase the capacity through trainings
Identify the role of non-physicians and properly mobilize them

Palliative care needs to integrated into the national health policy
It can also be integrated along with the hospital services
Increment in the accessibility and coverage of palliative care is also required at all levels

Researches in palliative care is quite low
Proper research shall provide the stronger evidence for the investment and implementation of the palliative care