Palliative care aims to improve quality of life and reduce suffering for those with serious illnesses through early identification and treatment of pain and other distressing symptoms. It can be provided in hospitals, outpatient clinics, homes, and hospice centers using an interdisciplinary team approach. While palliative care and hospice care both focus on comfort, palliative care can be provided at any stage of illness and with curative treatment, whereas hospice care is for those with less than 6 months to live who are no longer pursuing curative options. Barriers to palliative care include lack of awareness, competency and funding as well as consumer fears and delays in diagnosis.

1. Introduction and Models of
Palliative care
Prof. (Dr.) Smriti Arora
Principal, CON, AIIMS Rishikesh

2. What is Palliative Care ?
• Palliative care is an interdisciplinary medical caregiving
approach aimed at optimizing quality of life and mitigating
suffering among people with serious, complex illnesses.
• Cancers- breast, cervix, lung, oral, throat
• Neurological disorders
• HIV/AIDS
• Cardiovascular disease
• ESRD
• Dementia

3. Palliative care
WHO
• “an approach that improves the quality of life of patients and their
families facing the problems associated with life-threatening
illness, through the prevention and relief of suffering by means of
early identification and impeccable assessment and treatment of
pain and other problems including physical, psychosocial, and
spiritual issues.”

4. Introduction
• Palliative care improves the QoL of patients and their families
who are facing challenges associated with life-threatening
illness, whether physical, psychological, social or spiritual.
• The quality of life of caregivers improves as well.
• Each year, an estimated 40 million people are in need of
palliative care; 78% of them people live in low- and middle-
income countries.
• Worldwide, only about 14% of people who need palliative care
currently receive it.

5. • The global need for palliative care will grow as a result of the
ageing of populations and the rising burden of non-
communicable diseases and some communicable diseases.
• Benefit- Early delivery of palliative care reduces unnecessary
hospital admissions and the use of health services.
• Palliative care involves a range of services delivered by a range
of professionals

6. History of Palliative care
• The concept of palliative care was introduced in India only in the
mid-1980s.
• 1975- the Government of India initiated a National Cancer Control
Program.
• 1984- this plan was modified to make pain relief as one of the
basic services to be delivered at the primary health care level.
• 1980-90- the earliest facilities to deliver palliative care within
cancer centers were established- Ahmedabad, Bangalore, Mumbai,
Trivandrum, and Delhi

7. • 1980- pain clinic and palliative care service under the department of
Anesthesiology, Gujarat Cancer and Research Institute (GCandRI);
1994- Indian Association of Palliative Care (IAPC), Ahemdabad.
• 1986- Professor D’Souza opened the first hospice, Shanti Avedna
Ashram, in Mumbai
• Pain clinics- Kerala, Karnataka
• 1994- Shanti Avedna sadan in Delhi
• 1997- CanSupport was founded in Delhi, Founder- Harmala Gupta,
which provided the first free palliative care, home care support service
in North India.

8. DNIPCare
• NGO, 15th August 2008
• Delhites' National Initiative in Palliative Care
Activities
• Home visits, food to poor and deserving patients
• Medical support
• Providing waterbeds to the prolonged bedridden patients suffering
from bedsores
• Assisting in diagnostic tests
• Counselling

9. PC approach- aims to promote physical,
psychosocial and spiritual well being

11. Goals of palliative care
• Relieve pain and other symptoms.
• Prevent suffering
• Address emotional and spiritual
concerns, of patients and caregivers.
• Honoring patient preferences
• Coordinating care.
• Improving quality of life during illness.

12. Principles of palliative care
• Affirms life and regards dying as a normal process.
• Intends neither to hasten nor postpone death.
• Provides relief from pain and other distressing symptoms.
• Integrates the psychological and spiritual aspects of care.
• Offers a support system to help patients live as actively as possible
until death.
• Offers a support system to help patients’ families cope during the
patient’s illness and in their own bereavement

13. Principles of palliative care
• Is applicable early in course of illness with other therapies to prolong
life.
• Uses team approach to address needs of patients and their families
including bereavement counselling if needed.
• Enhances Q o L and positively influence course of illness

14. PC can be given at
• Hospital
• Community
• Home
• Hospice centre

15. PC team
• Primary care providers
• Specialists PC provider- training is recognized by accrediting body, they have special skill,
knowledge and expertise in management of fatal conditions, grief and bereavement. Timely
involvement of specialist palliative care teams can enhance the care delivered by oncology
teams.
• Family members
• Health care professionals- physicians, nurses, paramedics, physiotherapists, pharmacists
• Volunteers
Skill
• Communication and relationship building, active listening, unhurried communication, patience

16. When does PC start ?

17. End of Life Care
• End-of-life care includes physical, emotional, social, and spiritual
support for patients and their families.
• Goal - to control pain and other symptoms (nausea, vomiting,
dyspnea, delirium) so the patient can be as comfortable as possible.
• may include palliative care, supportive care, and hospice care.
• involves a range of possible decisions, including patients' rights to
choose, participation in clinical trials and choice of medical
interventions, resuscitation, continuance of routine medical
interventions.
• Honor patients preferences

18. Palliative care vs hospice care

19. Hospice care
• Hospice is comfort care without curative intent;
• the patient no longer has curative options or has chosen not to
pursue treatment because the side effects outweigh the
benefits.
• Less than 6 months available

20. Models of Palliative care
• Hospitals
• outpatient clinics,
• inpatient consultation teams,
• acute palliative care units,
• Community-based palliative care
• Hospice care

22. 1. Hospital palliative care
• Outpatient clinics-
• facilitate access to palliative care in the ambulatory
setting
• represent the key point of entry for timely access to
palliative care.
• symptom management, monitoring, education, and
advance care planning.

23. Acute care facility
• Inpatient consultation teams
• PC team provides additional support to patient and family, helps
primary care physician
• provide expert symptom management (pain) and facilitate
discharge planning for acutely symptomatic hospitalized patients.
• Acute palliative care units - Patients with the highest level of
distress and complexity may benefit from an admission to
APCU

24. 2. Community or Home based PC
• Community-based palliative care are more appropriate for patients
with a poor performance status and low to moderate symptom
burden.
• The trend toward delivering PC at home has been recently
accelerated during the COVID-19 pandemic.
• Respite care- for caregivers to avoid burnout, provides temporary
relief for a primary caregiver
• Bereavement services - includes emotional, psychosocial, and
spiritual support provided to individuals and families to assist with
grief, loss, and adjustment after the death of a loved one.

25. • There is evidence for high satisfaction among patients selected into
day-care.

27. 3. Hospice Care
• Ganga Prem Hospice - it provides two crucial aspects :
spiritual support and a holistic and complete medical
treatment that meets the many needs of a dying patient.
• Eminent oncologists and palliative care specialists have
joined with spiritual seekers and holistic therapists to
assist in alleviating the physical and emotional pain of
cancer patients and their grieving families
• Services- completely free ; 15 beds; Food, Laundry,
mortuary, ambulance, library, temple, music room,
meditation room, TV, kitchen, canteen

28. Hospice care
• Home palliative care and inpatient hospice care
significantly improve patient outcomes in the domains of
pain and symptom control, anxiety, insight, and spiritual
wellbeing among HIV/AIDS patients.
• Shanti avedna sadan
• 1986- Mumbai, Goa,
• 1994- New Delhi

29. Shanti Avedna Sadan, New Delhi
• The Institution provides 24 Hour In-Patient Care, for all
Advanced & Terminally ill Cancer Patients, irrespective of
Community, Caste, or Creed.
• It has over 35 Years experience in Hospice and Palliative
Care.
• Intensive Care is given to relieve pain and all distressing
symptoms to bring Peace in Body, Mind and Spirit.

30. • Each of these five models of specialist palliative care serve a
different patient population along the disease continuum.
• Complement one another to provide comprehensive supportive
care.
• Common attributes of these models
• communication and coordination between providers (including
primary care),
• skill enhancement, and
• capacity to respond rapidly to individuals’ changing needs and
preferences over time.

31. Barriers to palliative care
• Consumer
• Fear, mistrust, stigma, discrimination, language barrier, financial constraints,
delayed diagnosis
• Service side
• Lack of awareness, competency, insufficient fundin, not enough
collaborations/ research

32. Conclusion
• Access to appropriate care and support at the end of life is a
basic human right
• Timely, targeted and team based palliative care must be
provided to improve the outcomes
• Palliative care- Adding life to years

34. Thank You

35. References
• https://www.helpguide.org/articles/caregiving/respite-care.htm
• https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-
6963-14-136/tables/3
• https://en.wikipedia.org/wiki/End-of-life_care
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179926/