Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers

BMC Palliative Care

Rekha Rachel Philip¹  Sairu Philip¹  Jaya Prasad Tripathy²  Abdulla Manima³  Emilie Venables⁴ 

[1] Department of Community Medicine, Government T.D Medical College;International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office;Malappuram Initiative in Palliative Care;Medical Department, Médecins Sans Frontières;

关键词: Home-based care;    Palliative care;    Community-based care;    Care-givers;    Chronic disease;    Cancer;   

DOI  :  10.1186/s12904-018-0278-4

来源: DOAJ

【 摘 要 】

Abstract Background The well lauded community-based palliative care programme of Kerala, India provides medical and social support, through home-based care, for patients with terminal illness and diseases requiring long-term support. There is, however, limited information on patient characteristics, caregivers and programme performance. This study was carried out to describe: i) the patients enrolled in the programme from 1996 to 2016 and their diagnosis, and ii) the care-giver characteristics and palliative care support from nurses and doctors in a cohort of patients registered during 2013–2015. Methods A descriptive study was conducted in the oldest community-based palliative clinic in Kerala. Data were collected from annual patient registers from 1996 to 2016 and patient case records during the period 2013–2015. Results While 91% of the patients registered in the clinic in 1996 had cancer, its relative proportion came down to 32% in 2016 with the inclusion of dementia-related illness (19%) cardiovascular accidents (17%) and severe mental illness (5%).Among patients registered during 2013–15, the median number of home visits from nurses and doctors in 12 months were five and one respectively. In the same cohort, twelve months’ post-enrolment, 56% of patients died, 30% were in continuing in active care and 7% opted out. Those who opted out of care were likely to be aged < 60 years, received one or less visit annually from a doctor or have a serious mental illness. 96% of patients had a care-giver at home, 85% of these care-givers being female. Conclusions The changing dynamics over a 20-year period of this palliative care programme in Kerala, India, highlights the need for similar programmes to remain flexible and adapt their services in response to a growing global burden of Non Communicable Diseases. While a high death rate is expected in this population, the high proportion of patients choosing to stay in the programme suggests that home-based care is valued within this particular group. A diverse range of clinical and psycho-social support skills are required to assist families and their caregivers when caring for a cohort such as this one.

【 授权许可】

Unknown