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Provision of palliative care in National Cancer Grid treatment centres in India: a cross-sectional gap analysis survey
  1. Anuja Damani1,
  2. Naveen Salins2,
  3. Arunangshu Ghoshal1,
  4. Jayeeta Chowdhury3,
  5. Mary Ann Muckaden1,
  6. Jayita Deodhar1 and
  7. CS Pramesh4
  1. 1Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
  2. 2Department of Palliative Medicine and Supportive Care, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  3. 3Tata Trusts, Mumbai, Maharashtra, India
  4. 4Director (Tata Memorial Hospital), Professor of Thoracic Surgery (Surgical Oncology), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
  1. Correspondence to Professor Naveen Salins, Department of Palliative Medicine, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; naveen.salins{at}manipal.edu

Abstract

Objectives This study aimed to identify gaps in palliative care (PC) provision across the National Cancer Grid (NCG) centres in India.

Methods We performed a cross-sectional validated web-based survey on 102 NCG cancer centres (Nov ’17 to April ’18). The survey questionnaire had seven sections collecting data relating to the capacity to provide cancer care and PC, drug availability for pain and symptom control, education, advocacy, and quality assurance activities for PC.

Results Eighty-nine NCG centres responded for this study—72.5% of centres had doctors with generalist PC training, whereas 34.1% of centres had full-time PC physicians; 53.8% had nurses with 6 weeks of PC training; 68.1% of the centres have an outpatient PC and 66.3% have the facility to provide inpatient PC; 38.5% of centres offer home-based PC services; 44% of the centres make a hospice referral and 68.1% of the centres offer concurrent cancer therapy alongside PC. Among the centres, 84.3% have a licence to procure, store and dispense opioids, but only 77.5% have an uninterrupted supply of oral morphine for patients; 61.5% centres have no dedicated funds for PC, 23.1% centres have no support from hospital administration, staff shortage—69.2% have no social workers, 60.4% have no counsellors and 76.9% have no volunteers. Although end-of-life care is recognised, there is a lack of institutional policy. Very few centres take part in quality control measures.

Conclusions The majority of the NCG centres have the facilities to provide PC but suffer from poor implementation of existing policies, funding and human resources.

  • cancer
  • supportive care
  • service evaluation

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Footnotes

  • Presented at Presented as online (only) abstract in ASCO 2018: DOI: 10.1200/JCO.2018.36.15_suppl.e22181 Journal of Clinical Oncology 36, no. 15_suppl.

  • Contributors AD, NS and AG contributed to the study design and contributed to data collection and data analysis. AD, NS, AG, JC, MAM, JD and CSP drafted the article and contributed to the writing of the article.

  • Funding The Tata Memorial Hospital intramurally funded the research.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Ethics Committee at The Tata Memorial Centre approved this study, and it was prospectively registered with CTRI (CTRI/2017/06/008763).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data are available on reasonable request to the corresponding author.

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