Challenges in Palliative Care

Palliative Care is a specialised medical care for people suffering from incurable, chronic, progressive and life limiting diseases.

Patient Related

• Patients are often hesitant  due to fear, misconceptions, cultural beliefs and stigma  
• Patients are reluctant to change their doctor who have promised them that disease will be controlled.
• There is a huge communication gap between the doctor, patient and the family leading to following misconceptions:-
• Palliative care is end of life care
• Treatment stops when Palliative care begins
• Palliative care is only for patients dying of cancer
• Palliative care and hospice care is one and the same.

Doctors Related
Lack of awareness/ knowledge about Palliative care amongst most practitioners of medicine.
Some Misconceptions:

• Palliative care is only for cancer patients
• Adequate dose of painkillers (Narcotics) will lead to addiction and respiratory depression.
• Palliative care and Hospice care are same and are meant for dying patients.
• Palliative care speeds up the process of dying

Referral Related

• Fear of upsetting patients, if they find out that their treating doctor is unable to provide holistic care to relieve their physical, emotional, psychosocial, and spiritual problems.
• Seeing referral as an admission of failure
• Not fully understanding the benefits of referral for patients and their families
• Loosing patients and the revenue

Resource Availability
According to national family health survey, Pvt. Medical Sector remains the primary source of health care for 70% of household in urban areas and  63% in rural areas. In spite of this there is –

• Non availability of narcotics in most of the healthcare centres.
• Non availability of Palliative care specialists, and palliative care nurses in Primary Healthcare Centres, District Hospitals, Most of multispeciality/superspeciality hospitals.
• Poor availability of community based/ home care facilities/services specially in North India.

Cost/Insurance Related

• Insurance companies and TPA’s have not included Palliative care in the group of diseases, for cashless treatment.
• Most PSU’s are reluctant to include Palliative Care for reimbursement of bills due to their financial budgets.
• Since most of the patients with chronic progressive diseases have already exhausted their finances, they are unable to afford even affordable Palliative care.