The Indian Association of Palliative Care (IAPC) issued a position statement for palliative care during the Coronavirus pandemic. Ubiqare Health has been providing palliative care service at home in Bangalore during this pandemic and fully relates to this position statement. For your convenience, we are providing an abridged version of it on our website.

Coronavirus disease 2019 (COVID-19) has challenged the health-care systems of India and across the world. The high infectivity along with the rapid and progressive nature of the illness and associated morbidity and mortality poses unique difficulties. Shortage of personal protective equipment (PPE), disinfectants, high burden of suffering combined with inadequate health-care resources and medical technology, and reliance on informal cares pose added challenges to the health-care system. As a result, many patients with severe COVID-19 who are reliant on the public health-care system are unable to access the limited supply of designated hospital beds or intensive care resources or hospital beds and are therefore dying at home, often in difficult circumstances. Moreover, resource allocation for COVID-19 has increased the suffering and death of patients with other life-limiting conditions.

Palliative care focuses on effective symptom control, promotion of quality of life, holistic care of physical, psychological, social, and spiritual health, and complex decision-making, all of which play a major role in the alleviation of this widespread suffering. Essential skills of sensitive, effective, empathetic communication, discussion, and review of care plans, providing all help ensures a comfortable and dignified death. Furthermore, it is imperative to support colleagues and families in coping with the direct or indirect impact of the COVID-19 pandemic.

How is this position statement relevant to doctors not working in palliative care?

The purpose of the position statement is to:

1) Guide health-care professionals caring for COVID-19 patients

2) Provide palliative care input into government decisions and policies concerning COVID-19

3) Support the ongoing provision of palliative care in India

4) Optimize preparedness of the palliative care services to respond to COVID-19 pandemic.

You can read the full statement and the associated details here: https://rb.gy/sxblig

Key Takeaways From the Statement

Patients with life-threatening illnesses such as cancer or end-stage organ failures are faced with challenges related to the interruption of disease directed management, adaptations in management guidelines, and lack of availability/access to supportive and palliative care. IAPC has guided adapting policies and processes to ensure adequate and safe care provision for these patients.

Acknowledging the current status of health care and palliative care in India, it is important to have clear guidance and understanding about the judicious resource allocation, ways to realign the palliative care provision in hospitals, home-based palliative care services, nursing care services, and telehealth services. Telehealth is becoming very important in the current scenario of pandemic. The Ministry of Health and Family Welfare, Government of India, has provided a guideline on telehealth. There are some restrictions and may need further modifications to appropriately adapt to the current pandemic situation. This can help and improve symptom management of patients more practicable in home settings, thus avoiding unnecessary hospital visits. Telehealth can also be used as a source for identifying, assessing, and providing adequate psychological, social, and spiritual issues that contribute to increased distress. It can be used to teach self-care and address issues such as stigma and isolation. In addition to this, palliative care providers also play a vital role in supporting the family members during and after the death of a patient in the form of bereavement support.

Another important but less addressed issue that may need special attention is the care of children and adolescents who are dealing with cancer or other chronic life-limiting illnesses. The pandemic situation has caused an immense impact on them and their families. These recommendations may help in guiding the palliative care providers to understand, assess, and adapt the processes involved in the care of such children and adolescents.

The number of available palliative care providers in India is limited and will not fulfill the increased need for palliative care during this pandemic situation. The role of generalists in providing palliative care to different groups of patients is essential and should be promoted and supported. These recommendations may be used to guide policymakers and health-care professionals to adopt the principles of palliative care to improve the quality of care provision for those in need.

Disclaimer: This is a reproduction of original content published in Indian Journal of Palliative Care. We do not claim copyright ownership to it. This is an abridged form of the original content. One can read the full content on the website of Indian Journal of Palliative Care.