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INVITED ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 291-302

Joint position statement Indian association of palliative care and academy of family physicians of India – The way forward for developing community-based palliative care program throughout India: Policy, education, and service delivery considerations


1 Department of Medical Oncology, Christian Medical College Hospital, Vellore, India
2 Department of Palliative Care and Psycho-oncology, Tata Medical Center, Kolkata, West Bengal, India
3 Department of Palliative Medicine, AMRI Dhakuria, Kolkata, West Bengal, India
4 Palliative Medicine, Velindre NHS Trust, Cardiff, Wales, UK
5 Emmanuel Hospital Association, New Delhi, India
6 Deptartment of Medicine, G Kuppuswamy Memorial Hospital, Coimbatore, Tamil Nadu, India
7 MNJ Institute of Oncology and Regional Cancer Center, Hyderabad, Telangana, India
8 Institute of Palliative Medicine, Kozhikode, Kerala, India
9 Department of Distance Education, Christian Medical College Hospital, Vellore, India
10 Academy of Family Physicians of India, Mumbai, Maharashtra, India
11 Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
12 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
13 Makerere University, Kampala, Uganda
14 National Academy of Medical Sciences, Kathmandu, Nepal
15 St Columba's Hospice Chair of Primary Palliative Care, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland

Correspondence Address:
Jenifer Jeba
Department of Medical Oncology, Christian Medical College Hospital, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_99_18

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Purpose: This joint position statement, by the Indian Association of Palliative Care (IAPC) and Academy of Family Physicians of India (AFPI), proposes to address gaps in palliative care provision in the country by developing a community-based palliative care model that will empower primary care physicians to provide basic palliative care. Evidence: India ranks very poorly, 67th of 80 countries in the quality of death index. Two-thirds of patients who die need palliative care and many such patients spend the last hours of life in the Intensive care unit. The Indian National Health Policy (NHP) 2017 and other international bodies endorse palliative care as an essential health-care service component. NHP 2017 also recommends development of distance and continuing education options for general practitioners to upgrade their skills to provide timely interventions and avoid unnecessary referrals. Methods: A taskforce was formed with Indian and International expertise in palliative care and family medicine to develop this paper including an open conference at the IAPC conference 2017, agreement of a formal liaison between IAPC and AFPI and wide consultation leading to the development of this position paper aimed at supporting integration, networking, and joint working between palliative care specialists and generalists. The WHO model of taking a public health approach to palliative care was used as a framework for potential developments; policy support, education and training, service development, and availability of appropriate medicines. Recommendations: This taskforce recommends the following (1) Palliative care should be integrated into all levels of care including primary care with clear referral pathways, networking between palliative care specialist centers and family medicine physicians and generalists in community settings, to support education and clinical services. (2) Implement the recommendations of NHP 2017 to develop services and training programs for upskilling of primary care doctors in public and private sector. (3) Include palliative care as a mandatory component in the undergraduate (MBBS) and postgraduate curriculum of family physicians. (4) Improve access to necessary medications in urban and rural areas. (5) Provide relevant in-service training and support for palliative care to all levels of service providers including primary care and community staff. (6) 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.


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