Palliative care emphasises the treatment plan as well as the disease's symptoms and stress. This article presents two case studies, an explanation of the advantages of palliative care, and an overview of the global obstacles in addressing its unmet need.

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Palliative care

Palliative care treats a wide range of issues that can include pain, depression, anxiety, fatigue, shortness of breath, constipation, nausea, loss of appetite and difficulty sleeping.

While palliative care units and hospice programmes strive to offer all-encompassing assistance for requirements that emerge during the latter stages of a patient's illness, their technological know-how could be restricted to managing pain.

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Case studies

Case 1

A 75-year-old female with dyspnoea and allergy with so many associated diseases like hypertension diabetes stress and depression was under my treatment for 15 years. She was so restless but always avoided psychiatric evaluation for social stigma.

She always needed medicine for pain and wanted to reduce her weight. Due to obesity, she was unable to walk and do physical exercise hence was not able to reduce weight. She used to take Alprazolam.25 MG at night for sleep. Her phobia of air made her allergic to fans and coolers.

Management

After receiving psychological counselling from me and developing confidence in Jain spirituality, she was able to live peacefully in the company of Sadhus and Aryika Pravachan for six months.

Case 2

A patient with obsessive-compulsive disorder and a history of coronary artery disease was under my treatment and used to take Cad medicine and an anti-depressant for OCD. They were living normally with suppressed desire with son demand for money. He used to wash his hands frequently and got irate when suggested to avoid hand wash. Cad led to cardiac failure.

Management

The treatment began but his non-compliance with medicine resulted in weakness and laziness. Cognitive Behavioral Therapy (CBT)  and spiritual support throughout his remaining life gave him a good end.

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Benefits of palliative care

1. Patients and their families who are dealing with difficulties related to life-threatening illnesses, whether they be psychological, social, spiritual, or physical, benefit from palliative care. Carers' quality of life also gets better.
2. Palliative care is required for an estimated 56.8 million individuals annually, of whom 25.7 million are in their last year of life. 
3. Worldwide, only about 14% of people who need palliative care currently receive it. Adequate palliative care is made unattainable by unduly stringent restrictions on morphine and other critically regulated palliative drugs.
4. To increase access, there is an urgent need for adequate government policies, plans, resources, and training for health professionals on palliative care.
5. The need for palliative care will only increase due to population ageing, the growing prevalence of noncommunicable diseases, and certain communicable diseases.
6. Palliative care provided early on lowers the need for medical treatments and avoidable hospital admissions.
7. Palliative care involves a range of services delivered by a range of professionals who all have equally important roles to play, including physicians, nurses, support workers, paramedics, pharmacists, physiotherapists and volunteers, in support of the patient and their families.
8. Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.
9. Through the early detection, accurate diagnosis, and treatment of pain and other issues, whether they be psychological, spiritual, or physical, it prevents and lessens suffering. To alleviate suffering, problems other than physical symptoms must be addressed.
10. A team approach is used in palliative care to support both patients and carers. This entails attending to practical requirements and offering counselling for grieving. It provides a network of support to enable patients to lead as full lives as possible until their passing.
11. The human right to health specifically recognises palliative care. It needs to be delivered via person-centred, integrated health services that give careful consideration to each person's unique requirements and preferences.

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Role in chronic illnesses

Many different diseases necessitate palliative care. When it comes to chronic illnesses, the majority of persons who require palliative care have chronic respiratory disorders (10.3%), cancer (34%), cardiovascular diseases (38.5%), AIDS (5.7%), and diabetes (4.6%).

A wide range of additional illnesses may also call for palliative care including:

• Drug-resistant tuberculosis
• Congenital abnormalities
• Multiple sclerosis
• Parkinson's disease
• Rheumatoid arthritis
• Kidney failure
• Chronic liver disease
• Neurological diseases

Two of the most common and dangerous symptoms that individuals in need of palliative care encounter are pain and breathing difficulties.

For example, 80% of patients with AIDS or cancer, and 67% of patients with cardiovascular disease or chronic obstructive pulmonary disease will experience moderate to severe pain at the end of their lives. Opioids are essential for managing pain.

Each year an estimated 56.8 million people need palliative care, most of whom live in low- and middle-income countries. For children, 98% of those needing palliative care live in low- and middle-income countries with almost half of them living in Africa.

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Barriers to overcome

The following major obstacles must be removed globally to address the unmet need for palliative care:

1. According to a WHO survey relating to noncommunicable diseases conducted among 194 Member States in 2019: funding for palliative care was available in 68% of countries and only 40% of countries reported that the services reached at least half of patients in need
2. The International Narcotics Control Board found that in 2018, 79 per cent of the world’s population, mainly people in low- and middle-income countries, consumed only 13 per cent of the total quantity of morphine used to treat pain and suffering, or 1% of the 388 tonnes of morphine produced globally.
3. The difference in the use of narcotic drugs for palliative care between high-income and low-income countries is still concerning, even though it was an improvement over 2014 when 80 per cent of the world's population consumed only 9.5% of the morphine used to manage pain and suffering.

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Components of palliative care

Palliative care should be a part of the continuum of care for people with chronic and life-threatening conditions and should be linked to prevention, early detection, and treatment programmes by national health systems. This includes, as a minimum, the following components:

1. Early in the course of an illness, palliative care is most successful. Early palliative care lowers needless hospital stays and medical service utilisation while also improving patients' quality of life.
2. It is necessary to provide palliative care in line with the objectives of universal health coverage.  All people, irrespective work with patients with serious illness.
3. One aspect of providing palliative care services is specialist palliative care. However, to be viable, high-quality, and easily accessible, a palliative care system must be included in primary healthcare, home and community-based care, and supporting carers like family and community volunteers. Healthcare providers have an ethical obligation to provide palliative care.
4. The WHO Essential Medicines List and the WHO Essential Medicines List for children both contain medications used in palliative care, including painkillers. Important international directives and policies on noncommunicable illnesses, people-centred and integrated health services, and universal health coverage all acknowledge the value of palliative care. WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents were released in 2019.
5. Income, disease type or age should have access to a nationally- -determined set of basic health services, including palliative care. The human right of impoverished and marginalised populations to palliative care must be considered by financial and social protection systems.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Sanjay Jain is a practising pain palliative care specialist and psychology counsellor from Sagar, Madhya Pradesh.