PALLIATIVE CARE IN FAMILY PRACTICE AND BENIFITS TO PATIENTS

Dr.S.Abbas Ali
MD,DFM,DNB,MNAMS
PGDHSc (Echocardiogram)
PGDHSc (Ultrasonography)
FCGP, MCCP(Cardiology)


Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of the symptoms slows its progress rather than providing a cure. However, it may occasionally in conjunction with curative therapy, providing that the curative therapy will cause additional morbidity. It aims at improving quality of life, by reducing eliminating pain and other physical symptoms, enabling the patient to ease or psychological and spiritual problems, and supporting the partner and carers.
According to W.H.O. statement
Palliative care is 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, physical, psychosocial and spiritual.
Palliative care neither aims to hasten nor postpone dying. It is characterized concern for symptom relief and promotion of general well-being and spiritual, psychological and social comfort for the person with a life threatening or life illness. The need to maintain quality of life has become increasingly important, just in the dying stages, but also in the weeks, months and years before death. Worldwide increase in life expectancy has led to a corresponding increase in incidence of age-related chronic illnesses and palliative care increasingly cares patients with illnesses other than cancer such as end-stage heart, lung, kidney, disease, motor neuron disease, and dementia. The patient and family are both focus of palliative care, with emphasis placed upon the well-being of family caregivers as well as the patient. In addition, palliative care is no longer restricted to adults and many teams and hospices now exist for children of any age.
With the ageing population, the devastating impact of HIV/AIDS, the growth of non-communicable illnesses such as cancer and the prevalence of other chronic illnesses, it is vital to ensure that the needs of elder people affected by terminal illness both as patients and families and carers are being met.
Unfortunately, the reality is that at this stage this is simply not possible. Not even the most basic palliative care is being provided in India. Less than 1% of the population has access to palliative care. 40% of those seen by palliative care units are over 60.
Key issues are:
• An immediate need to reach out to where palliative care currently does not exist.
• The lack of manpower – a serious barrier to scale up of services.
• Palliative care is presently not recognized as a medical speciality and palliative care is not on the undergraduate medical syllabi.
• A need to develop state policy as well as developing and building a community voice in order to affect change.
• Strengthening of the key institutions who provide and co-ordinate palliative care
• Facilitating coordination



The solution for all these issues is to integrate palliative care with family medicine, because the illnesses which require palliative care are now more than ever illnesses typical of family medicine. They touch many systems and have profound psychosocial ramifications. Most of the care is provided in the community requires co-ordination of many specialities and resources, with the foundation being a strong doctor-patient relationship. Which is central to the role of family physician.
A ‘Family Physician’ is a multi-competent specialist who not only provides the point of first contact, but also provides the continuum of care. The principles of family medicine indicate that there is lot of scope in palliative care.
• Doctor-patient relationship is central to the role of family physician: The chronic nature of the illnesses requiring palliative care and their complex health and psychosocial issues are best addressed in the context of family medicine rather than in any other health care setting.
• The family physician is an expert clinician: In India Family medicine is a post graduate medical qualification which requires three years rigorous training and submission of thesis. Palliative care and elderly care are in family medicine syllabus. So family physician is an expert clinician. He can use his clinical skills and clinical acumen in dealing with presentations of rare diseases or common diseases with unusual presentations requiring palliative care. He can not only provide palliative care (pain and symptom control) but also provides other services like diagnosis and staging, monitoring for adverse drug effects, monitoring of improvements and deteriorations, diagnosis and treatment of intercurrent illnesses, recognition of emergencies, family support, spiritual and emotional support.
• Family physician is a resource to a defined practice population: this is true and he is better option for patient’s requiring palliative care. He is from their own community and near to patient’s house. With 4 or 5 cases of palliative care in his area, he can provide better quality care.
• Family medicine is a community based discipline: Knowledge about and advocacy for services and support for patients and carers are important constructs for the practice of family medicine and for caring of patients requiring palliative care.

BENEFITS:
1. No other specialists except family physician can achieve the palliative care goal, the best quality of life for patients and families by providing relief from pain and other distressing symptoms, integrates the psychological and spiritual aspects of care and offers a support system to help family cope during the patient’s illness and in their own bereavement.
2. Home based palliative care can reduce the costs of treatment; it can reduce the frequency of futile hospital care and decrease the possibility of conflict and litigation between families and health care workers.
3. Effective communication skills are integral part of family medicine and they have very important role on providing of palliative care. There should be multiple counseling sessions of adequate duration in palliative care, only family physician (due to his proximity to patient’s house) can give the satisfaction to family and patient by spending adequate time and opportunity to ask questions and to express their views and emotions. It can resolve the feelings of guilt or remorse of family members and make them to feel that dying as a normal process.