Dr Jenifer Jeba S is a Professor (Palliative Medicine) at the Christian Medical College and Hospital, Vellore, India. Here, she explains how palliative care and family medicine physicians in India have come together to meet the huge unmet palliative care need for people with advanced illness throughout India.
This initiative was supported by Dr Mary Ann Muckaden, former President of Indian Association of Palliative Care (IAPC), and Dr Raman Kumar, President, Academy of Family Medicine Physicians of India (AFPI).
The Indian National Health Policy (NHP) 2017 lists palliative care as an essential healthcare service. Unfortunately, less than one per cent of the population has access to pain relief and palliative care. Why this gap? Could it be lack of awareness, reduced opportunities for formal training, difficulties with opioid access, dearth of professional capacity or all of these?
The IAPC and AFPI have joined hands to respond to the haunting need for greater access to pain relief and palliative care. A task force consisting of palliative care specialists, community and family medicine physicians from within and outside India, met at the Indian Association of Palliative Care Conference (IAPCON) Coimbatore 2017, where they brainstormed on integration, networking, and bringing specialists and generalist physicians under one umbrella. The task force group published a Joint Position statement (April 2018) that highlighted steps to empower primary care physicians and advocate development and promotion of community-based palliative care throughout India through policy, education and service delivery.
Six key task force recommendations
- Integrated palliative care into all levels of care including primary care with clear referral pathways, networking between palliative care specialists and family medicine physicians and generalists in community settings, to support education and clinical services.
- Implement the recommendations of NHP 2017 to develop services and training programmes for upskilling of primary care doctors in the public and private sector.
- Include palliative care as a mandatory component in the undergraduate (MBBS) and postgraduate curriculum of family physicians.
- Improve access to necessary medications in urban and rural areas.
- Provide relevant in‑service training and support for palliative care to all levels of service providers including primary care and community staff.
- Generate public awareness about palliative care and empower the community to identify those with chronic disease and provide support for those choosing to die at home.
The way forward
There is work in progress to formulate and incorporate essential palliative care competencies into the family medicine post-graduate curriculum. This will go a long way in empowering this group of professionals in the delivery of primary palliative care and across India. A presentation on this is planned in the IAPCON Kochi, 2019 conference by Dr Atreya Shrikant. Many members of the task force and others have taken on this venture and conduct workshops/seminars to educate and offer support for family physicians and general practitioners in their region. This promotes the integrated model of care between palliative care specialists and generalists. SPICT-LIS has been identified as a useful proactive tool for use by generalists to identify patients with advanced life-limiting conditions who need palliative care.
We hope to create awareness, teach and propagate use of this tool, so generalists feel confident to identify and provide palliative care for those in need.
I would like to personally acknowledge the ongoing support of international palliative care colleagues:
Dr Scott A Murray, Emeritus Professor of Primary Palliative Care, University of Edinburgh, Scotland; Dr Dan Munday, Consultant in Palliative Medicine, Advisor to Nepalese Association for Palliative Care; Dr Mhoira Leng, Medical Director of Cairdeas International Palliative Care Trust and Senior Advisor for Palliative Care to Makerere University in Uganda; Dr Nikki Pease, Consultant in Palliative Medicine, Velindre NHS Trust, Cardiff, Wales; Dr Alan Barnard, Senior Lecturer, Palliative Medicine, School of Public Health and Family Medicine, University of Cape Town.
- Contact Dr Jenifer Jeba S by email.
- Indian Association of Palliative Care (IAPC).
- Academy of Family Medicine Physicians of India(AFPI).
- Joint Position statement.
- SPICT-LIS. Website providing information and resources on Supportive and Palliative Care Indicators Tool (SPICT™).
- IAPCON Kochi, 2019 – 26th International Conference of the IAPC: 8 to 10 February 2019.