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

Abstract

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.

Integrated primary palliative care model; facilitators and challenges of primary care/family physicians providing community-based palliative care

“…To overcome these challenges, an integrated community palliative care model was suggested jointly by Indian Association of Palliative Care (IAPC) and Association of Family Physicians of India (AFPI). Subsequently, the associations jointly published a position paper[15] in 2018 emphasising the importance of incorporating primary palliative care into the routine clinical practice of PCP/FP and another paper in 2019[16] deliberating on the competency framework necessary for PCP/FP to provide primary palliative care in the community. The integrated model can have variations in its nature and application, however a systematic review investigating the integrated model identified five core aspects of a successful model.…”

“PALLCARE Seva”—A Beacon Amid the Catastrophic COVID-19 Times: A Cross-Sectional Study from a Rural Oncology Institute in Western Maharashtra

“…One of the crucial recommendations is the joint statement of the Indian Association of Palliative Care and the Academy of Family Physicians of India to integrate palliative care at all levels of healthcare and liaise with general practitioners and family physicians. 26…”

Desafios Para a Rede De Atenção Aos Cuidados Paliativos Na Percepção De Gestores De Saúde

“…Ressalta-se que a educação e o treinamento em CP devem estar disponíveis e acessíveis a médicos, enfermeiros, farmacêuticos, sioterapeutas, terapeutas ocupacionais, fonoaudiólogos, assistentes sociais, capelães e trabalhadores espirituais; e toda equipe multipro ssional e fazer parte do currículo pro ssional nos níveis de graduação e pósgraduação (17) .…”