Continuity of palliative care to improve the quality of life
Dr Firuza Patel - Chandigarh Hospice, Punjab, India
I’ve started the palliative care service in Chandigarh and this is a service which we believe in two things: one we believe that there should be a continuity of care and that palliative care should be integrated with radiotherapy or medical oncology. So therefore we have a palliative care OPD clinic which runs in the radiotherapy department. We also run a home care team which is for patients who are too sick to come to the hospital. The team, doctor, nurse and a social worker, go and visit them at home and this is in the tri-city of Chandigarh, Mohali and Panchkula because our vehicle can go just that far. When the patients are too sick to be looked after at home, or for patients who have come from out of Chandigarh and we need to monitor their morphine doses and all, we admit them to the hospice.
So the same team of doctor and nurse also visit the patient in the hospice so therefore we believe that this is a continuity of care that the patient sees the same doctors from the time they were on active anti-cancer treatment to the time they come into the hospice.
How have you measured quality of life?
We wanted to know that we always say that palliative care improves the quality of life but where is the evidence for it? So her thesis was that we did the quality of life assessment on the first day the patient was referred to the palliative care clinic. Then after giving them palliative care for a week or ten days when they revisited the clinic, or about seven days later, we reassessed the quality of life again. We realised that when we saw all the domains together the score had tremendously improved, it was about the total score improved from 35 to now 85. Then we tried to see that is there any particular setting where this improvement is better? Is it in the OPD or is it in the home care or is in the hospice? Our finding was that the patients in the hospice benefitted the most, probably because they got the majority of the time they had nursing staff and the doctors looking after them. The second was those who visited the OPD because again they were probably visiting the doctors every day if they needed it. And the home care ones were the ones who came last. So we found that the improvement was best in the patients that were treated in the hospice followed by the OPD and then in the home care setting.