Understanding Long-Term Outcomes of Public Health Strategy in Palliative Care at Micro Level: Impact of Home-Based Palliative Care Services under Local Self-Government Institutions in Kerala, India

Objectives: Palliative care units under Local Self-Government Institutions (LSGIs) are increasing in number in the state of Kerala, India, since the announcement of the Pain and Palliative Care Policy, 2008. Whether these units are functioning with a view to materialise the long-term objectives, following the guidelines stipulated by the Government of Kerala and serve the neediest patients with quality care are a matter of debate. Hence, a microlevel study of the palliative care unit is attempted. The aims of the study were to understand the extent to which the structure and nature of functioning of the Pain and Palliative Care Unit under LSGI comply with guidelines set by the Pain and Palliative Care Policy of the Government of Kerala and to check whether the palliative care services are reaching the needy and, if so, are they provided to patients in good quality. Materials and Methods: The award winning Pain and Palliative Care Unit attached to LSGI is selected for analysis and a hybrid research design is followed. Data are collected from 25 patients and their caregivers selected randomly. Mean score of satisfaction level on the basis of Quality care questionnaire -Palliative care is used. Results: Sample unit complies with the revised guidelines of 2015, Pain and Palliative Care Policy. It serves the neediest patients and the quality of care is satisfactory. Conclusion: The study reaffirms the strength of the public health model in palliative care which can provide quality care to the neediest patients.

A Qualitative Study Using Semi-Structured Interviews: Comparing the Views of Palliative Care Unit Patients and Clinicians on Corneal Donation Discussions

Background: Blindness from corneal opacity accounts for 12% of cases of blindness worldwide. There is a severe shortage of corneas for donation worldwide for transplantation and research purposes. One group of individuals who could potentially be donors are those who die within the inpatient palliative care unit. The aims of the study were to 1. determine the frequency of corneal donation discussion; 2. determine whether inpatient palliative care unit patients and clinicians were aware of the potential for corneal donation discussions and 3. explore the attitudes and beliefs of inpatient palliative care unit patients and clinicians about corneal donation. Methods: An exploratory qualitative study was designed where inpatient palliative care unit patients and clinicians were invited to a semi-structured interview. A total of 46 face to face interviews were undertaken involving inpatient palliative care unit patients (20) and clinicians (26) in three major inpatient palliative care units in South Australia. Results: Very few patient participants were asked about corneal donations during their time in palliative care. Most inpatient palliative care unit clinicians did not bring up the topic as they felt other areas of care took precedence. Inpatient palliative care unit patients thought if inpatient palliative care unit clinicians did not raise the topic, then it was not important. Conclusions: Findings suggest that patients are receptive to discussing corneal donations, but few discussions are occurring. There were some differences between patient and clinician views, such as preference about who raises the possibility of donation and when the discussion might occur.

Use of the PALLIA 10 Score in Patients Enrolled in Phase I Trials at Gustave Roussy Cancer Center

Background Early phase clinical trials usually include patients with advanced disease who have failed standard therapies. Early palliative care for these patients has shown to improve quality of life and even survival. PALLIA 10 score (ranging from 1 to 10) is a tool developed by the French Palliative Care Society to identify the best time to introduce palliative care. Methods We assessed the PALLIA 10 score and other prognostic factors (age, ECOG, Royal Marsden Hospital (RMH) score, LDH and albumin levels, number of prior systemic treatments and metastatic sites) in patients enrolled in phase I trials at Gustave Roussy Cancer Center prospectively during 2 periods of time (cohort 1 (C1) and 2 (C2)). A double-blind assessment of the PALLIA 10 score was done during 15 days by a member of the palliative care unit in C2. A PALLIA 10 > 3 motivated a dedicated palliative care consultation. Results From July 1st 2018 to November 1st 2018 (C1) and from December 1st 2020 to April 16th 2021 (C2), a total of 86 patients were assessed in C1 and 302 in C2. No difference was observed between the two cohorts regarding prognostic factors. Median PALLIA 10 was also similar and very low (median 1, range 1-5 in C1 and 1-8 in C2). On C1 and C2, 12% and 5% of patients had a dedicated palliative consultation. Overall, 77% and 74% of patients in C1 and C2 were still alive beyond 3 months after discontinuation of the trial (p=0.78), followed by at least one subsequent treatment in 63% and 70% of pts. In C2, assessment of PALLIA 10 score was significantly different between palliative care physician (median 5, range 3-8), phase I physician (median 1, range 1 -6) and phase I nurse (median 3, range 1-8) (p<0.001). Conclusion Only a few patients included in phase I clinical trial were referred to the palliative care unit. Median PALLIA 10 score was low when assessed by the phase I physician which suggests the need for a better tool to implement early palliative care in clinical practice and trials.

Effect of Music on Pain in Cancer Patients in Palliative Care Service: A Randomized Controlled Study

This study aimed to investigate the effect of music on pain, anxiety, comfort, and functional capacity of cancer patients who received care in a palliative care unit. The population of this randomized controlled trial consisted of cancer patients hospitalized in the palliative care service between July 2018 and July 2019. The study included 60 patients (30 interventions/30 controls). The patients in the intervention group were given a total of six music sessions, 10 minutes each with the Turkish classical music in maqams of their choice (Hejaz or Rast accompanied by an expert tambour (drum) player). There was a significant difference between the mean total pain scores, anxiety, comfort, and functional capacity scores of the patients in the intervention and control groups before and after music therapy. Music therapy decreased the level of pain. It is demonstrated that Turkish classical music therapy improved the pain, anxiety, comfort, and functional capacity in the palliative care unit.

Admission of a Terminally Ill Lung Cancer Patient With the Accidental Diagnosis of SARS-CoV-2 to a Palliative Care Unit Resulting in a SARS-CoV-2 Outbreak

The COVID-19 pandemic poses challenges for palliative care. Terminal patients cannot wear masks and may demonstrate unspecific symptoms reminiscent of those caused by COVID-19. This report is about a terminally ill patient with lung cancer who displayed fever, cough, and fatigue. During hospital admission screening, the patient tested negative for SARS-CoV-2. When admitting his wife to stay with him, she also had to test for SARS-CoV-2 and displayed a positive test result. Until the positive results were reported, six staff members were infected with SARS-CoV-2, even though they were routinely wearing respirators. This resulted in the palliative care unit having to be closed. Hospitals need strict and adequate testing and re-testing strategies even for intra-hospital transfers. Workers must strictly adhere to recommended respirator practices. Ventilation of patient rooms is essential due to the possible enrichment of particle aerosols containing viruses, as negative pressure rooms are not recommended in all countries.

Physician Attire Influences Patient and Family Perceptions of Care in the Palliative Care Unit in Japan

Background: Physician attire influences perceptions of care. This study was conducted to evaluate the impact of physician attire on perceptions of care by patients and families in a Japanese palliative care unit. Methods: From November 2018 to February 2020, patients and family members admitted to the Palliative Care Unit at Jichi Medical University Hospital were recruited and completed a survey consisting of 4 demographic questions and 15 questions regarding perceptions of care. A 7-point Likert scale (1 = strongly agree, 4 = neutral, 7 = strongly disagree) was used to judge attire (name tag, long sleeve white coat, short sleeve white coat, scrubs, scrub color, jeans, sneakers) addressing patient and overall impact on perception of care. Results: Of 203 patients admitted, 79 were enrolled. Surveys were received from 23 patients and 52 family members. Patients and families want physicians to wear name tags (median, interquartile range) (2, 1-2) and white coats (3, 2-4). Patients want to be addressed by surnames (2, 1.5-4). Patients and family members have neutral opinions about short sleeve white coats (4, 4-4) and scrubs (4, 4-4). Jeans were not liked (4, 4-6) while sneakers are acceptable (3, 2-4). The impact of attire on perceptions of care is significantly (p = .04) greater for patients (3, 2-4) than family members (4, 3-4). Conclusion: Patients and family members prefer their physicians to wear name tags and white coats and address patients by surnames. Physician attire has a significantly greater impact on perceptions of care for patients than family members in a palliative care unit.