Background: End-of-life care (EOLC) has not been discussed widely in Low-Middle Income Countries, especially in India. Considering the growing number of cancer patients needing EOLC, there is a strong need to evaluate the current status, nature and type of EOLC services offered in India. This study attempts to understand the EOLC services in the Indian cancer setting.
Methods: In this descriptive survey, the centers offering palliative care services and cancer hospitals were extracted from the databases of 1) Indian Association of Palliative care 2) Pallium India 3) Jeet Association for Support to Cancer Patients 4) National Cancer Grid and 5) Director of Drug Control, Govt of India. The lists was collated, and the duplicates were removed. The final number of centers identified were contacted through email, telephone, and social media and the data was obtained using a structured interview schedule.
Results: A total of 1294 centers were identified and screened. Centres not functional (48), not willing (6), no/invalid contact information (68), no service for cancer (152), no palliative care service (188) were excluded. Of the eligible centers (N=736), 373 were contacted, of which 232 (62.1%) centers offer EOLC services for cancer patients. Among these, 81 responded to survey and 67.1% of the centers reported having dedicated EOLC professionals (97.6%-physicians, 98.8%-nurses, 68.3%-Social workers, and 62.2%-Psychologists). Of all, 22% reported difficulty in availing medications, 37.8% did not have adequate financial stability for functioning, and 74.4% stated need for financial support from the government. Overall, 82.9% practice DNR requests and 50% practice living will request.
Discussion: Nearly two-third of the centers offer EOLC services. Availability of medicines, financial constraints, last-mile connectivity and need for professional training are the major concerns in EOLC in Indian cancer setting. The findings would aid in the development of guidelines for a nation-wide model of care in India.