Estimation of Need for Palliative Care in Urban Field Practice Area of Bengaluru- A Cross Sectional Study

Introduction

Palliative care is defined as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illnesses, through the prevention and relief of suffering by means of early identification, impeccable assessment, and treatment of pain and other problems, physical, psychosocial, and spiritual.”¹ Globally, in the year 2011, around 29 million people died of diseases requiring palliative care.² In India with around 1.2 billion people, every year more than 9.8 million people are dying and most of them die with unbearable pain and with other psychosocial distress. It is estimated that around 60% of them would benefit from palliative care.³ According to the World Health Organization Global Health estimates 2011, around 54.6 million deaths occurred globally, and among those deaths, 66% were due to non-communicable diseases, 25% were due to communicable, maternal, perinatal and nutritional causes, and 9% were due to injuries.¹ In India, due increasing number of old people⁴ and increased burden of non-communicable diseases, there is a growing need for palliative care among people.

Objectives

• To estimate the need for palliative care in urban field practice area of a medical college in Bengaluru.

Materials and Methods

A cross-sectional study was conducted in urban field practice area of a medical college in Bengaluru. Around 741 households were surveyed during November 2021 to December 2021 by using systematic random sampling. Data was collected by conducting house to house survey. Health workers were trained regarding palliative care prior to the data collection. Available member of the households was interviewed about the need for palliative care and the morbidity profile of all the members of the household was collected using Kobo Toolbox. Descriptive statistics was done using SPSS 20.0 version.

Results

Number of people requiring palliative care

Number of households covered = 741

Total population in 741 households = 2557

People identified in need of palliative care = 27

Period prevalence per 1000 =10.5/1000 

Discussion

In the present study, the period prevalence of palliative care needs was found to be 10.5/1000 population, which is higher than the prevalence of around 4/1000 population reported by Global Atlas of palliative care.² Another cross-sectional community based survey conducted by Daya AP et al., showed lesser prevalence of people in need of palliative care.⁵ Studies done in other parts of the world, with better health status of the population reported lower prevalence of people in need of palliative care. The prevalence of need for palliative care was nearly 4/1000 in Spain.⁶ The reasons for lesser prevalence could be because of differences in the geographical location, health-care services availability, health-care seeking behaviour and felt needs of the people.

This study showed higher proportion of need of palliative care among females (59.2%). The study conducted by Daya AP et al., also found a higher proportion of need among females (77%).⁵

According to Global Atlas of palliative care released by the WHO and Worldwide Palliative Care Alliance, the most common disease to be in need of palliative care among adults is cardiovascular diseases (38.5%) and the same was observed in the present study, with cardiovascular diseases (29.6%) being reported as the most common disease in need for palliative care. Daya AP et al., reported chronic heart disease (18.5%) as the second common condition. The other conditions identified in their study were age-related weakness (41%), paralysis (13.5%), post-polio residual paralysis (4.5%), cancer oesophagus (4.5), chronic kidney disease (4.5%), psychosis following head injury (4.5%), mild mental retardation (4.5%) and filariasis of leg (4.5%).⁶

Conclusion

In the present study, 10.5/1000 population were identified to be in need of palliative care. The most common disease condition in need of palliative care was cardiovascular disease (29.6%). The need for palliative care was highest among females (59.2%) and lower socioeconomic class (91%).

Recommendations

Regular health check-ups of Non-communicable diseases (NCDs) to be conducted to reduce the morbidity related to cardiovascular disease from the age of 30. Strengthening of NCD clinics in the primary health care level. Health education programs for the community can be conducted regarding prevention of NCDs and utilizing of the available health services from the Government.

Limitations of the study

Information was collected regarding all family members from any one member of the family present during the time of visit.

The data was collected using interview method which may not reflect the actual number of people in need of palliative care.

Acknowledgment

• The Dean and Director, BMCRI, Bengaluru

• All the faculty and PGs, Department of Community Medicine, BMCRI, Bengaluru.

• Medical Officer, ANM and ASHA of H Siddaiah UPHC