Palliative Care is an UMBRELLA of CARE that includes the active total care of patients with life- limiting illnesses such as Cancer, HIV, etc. as well as their families. It is not an alternative to curative care but complementary to total patient management. Thus the principal aim is to provide “Holistic Care†to take care of all realms of suffering simultaneously which includes Physical, Psychological, Emotional, Social and Spiritual in order to improve the Quality of Life of patients and their families.
The Palliative Care Services started at B K L Walawalkar Hospital in 2010. Here we focus mainly on Cancer patients, as the number of people suffering from this disease is increasing in Konkan region. In line with our principle of providing ‘Comfort Care’, we believe in integrating Palliative Care into Good Clinical Practice at the time of diagnosis; and continuing all through the trajectory of illness, assuming larger proportions as the disease progresses.
The palliative care service is team based where the team is collectively concerned with the total well-being of the patient and family. This multidisciplinary team makes the complete care of patient possible.
Palliative Care Services Includes
- Assessment and management of Pain and other symptoms.
- Nursing, wound care and medication.
- Psychosocial support for patient.
- Care of the relatives.
- Training in Palliative Care for nurses, volunteers, and other healthcare professionals.
- Improve performance status and the overall Quality Of Life.
At Walawalkar Hospital, We provide care at two different levels
During curative treatment phase
From the time of diagnosis of disease, throughout the curative treatment Palliative Care service continues to work for patients and their caregivers.
The emphasis is on helping patient to understand his disease, treatment being offered, their implications on his life, to support him throughout his efforts to cope with disease, improve his compliance to treatment and help his family to manage through this phase.
Thus the whole process of Cure and Care is achieved through the partnership between the Caring Team and the patient and his family.
When no longer curative treatment is possible
When the disease reaches to an advanced stage and when any curative treatment is no longer possible or has very little effects on well-being, Palliative Care service assumes greater role in assisting patient and his family. At this stage, Care implies broader support and encompasses:
- Illness Management
- Physical Aspects
- Psychological care and Counseling
- Social aspects
- Spiritual care
- Care at the end of life/ Death management
- Loss, Bereavement
Statistics
All the patients who are registered under Cancer Department are extended Palliative Care Service.
Following graph can give an overview of number of patients availing Palliative Care facilities
Other Activities
Along with primary physical and psychosocial care, we have started various activities that would have positive effects on well-being and overall quality of life. Some notable of them are:
Social Help and Rehabilitation
Support groups for patients and caregivers
With the goal of helping patient achieve good coping style, we have started Support Groups for Cancer patients and their relatives. Having disease alters all facets of one’s life and people start feeling vulnerable. Thus the basic idea is that people facing similar problems come together to form a group and thoughts and feelings are shared within the group. It is seen that participants benefit from talking with others who have similar problems, which may make them feel less isolated, different, alienated and alone. In fact merely attending the group without any active participation also may help reduce patient’s negative thoughts and feelings. This group is led by patients and caregivers with our team members being only facilitator.
Group sessions for Physiotherapy, Relaxation training
Along with primary treatment regime, efforts are being taken to help patients manage the side- effects, other complications and improve psychological state. Patients are exposed to certain techniques that break the vicious cycle of anxiety- which intensifies pain and, in turn, causes more anxiety. Again these activities are carried out in group setting so that the patient would not feel left out or different from others
Physiotherapy/ Occupational therapy interventions help patients increase their daily life functioning and gain better control over Activities of Daily Living. They include various neck exercises, hand movements, jaw exercises and such other interventions.
Relaxation techniques include relaxation exercises, Progressive Relaxation Training, Controlled Breathing, Autogenic training, Visualization, Imagery, Meditation and repetitive prayer etc.
Education and training
To spread awareness among staff and other population regarding Palliative Care, various training programs and lecture series are arranged at regular time intervals. Some of them include Lecture on Pain Management by Dr. P. M. Jain, an expert on Pain Management who is propagating Pain as the 5th vital sign in patient assessment. Another noteworthy program is Awareness program on Palliative Care conducted by Palliative Care Dept. of Tata Memorial Hospital which is an apex cancer institute in South- East Asia. The program was to sensitize the nursing staff towards Palliative Care.
Also in order to increase awareness about Cancer and its prevention, we have compiled Cancer Awareness Booklet and pamphlets for Oral Self Examination and Breast Self Examination.
Phone Follow-up to ensure continuity of care even at home
One’s home environment is instrumental in giving sense of control and mastery over things. Many a times hospital setting creates fear and apprehensions in one’s mind. Thus when no active treatment is possible, patients are sent back to home. They are given telephone numbers of Palliative Care team members so that they can contact any of our team members as per their needs. So Continuity of Care is ensured even at home. Patients and caregivers are ensured that they are always being cared and supported.
Research Activity
Research findings help to validate assumptions and hypothesis. With this view, we have started research on Effect of Pain Management and Psychological interventions on perceived Quality of Life of patients. Pain is assessed using Edmonton Symptom Assessment Scale. Quality of Life is measured by using FAACT scale. Both these scales are administered before and after pain management interventions and psychological interventions to see the difference between two sets of scores.
Our Palliative Care Team
Palliative Care Service at B K L Walawalkar Hospital is the result of initiative taken by Dr. S. Banavali. It’s because of his passionate efforts and valuable guidance that Palliative Care Service is functioning today in the service of our patients. Palliative Care Team consists of professionals from various disciplines who are dedicated to achieve the goal of total quality care in patient management.