Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0042-1742613
Brief Communication

Factors Associated with Choosing the Kerala Model of Palliative Care versus Standard Care among Indian Cancer Patients

Prema N. George 
1   Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
,
M.P. Ganesh
2   Department of Entrepreneurship and Management, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
,
Shweta Chawak 
1   Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
,
Mahati Chittem
1   Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Patients who opt for the Kerala Model of Palliative Care (KMPC) report favorable psychological outcomes. Still, not all patients in Kerala prefer this treatment's approach. Hence, this study is aimed to examine the demographical, medical, pain, and psychological factors associated with cancer patients who choose the KMPC versus standard care (SC). Using a cross-sectional design and purposive sampling, 87 patients (SC = 40; KMPC = 47) residing in Kerala, India, responded to questionnaires on pain, anxiety, and depression, and quality of life (QoL). Data analysis was conducted using chi-squared and independent sample t-tests. Findings revealed that KMPC (vs. SC) patients had lower levels of education, were self-employed or homemakers, belonged to a middle or low socioeconomic status, received government aid or were financially self-supported, and were diagnosed for less than 1 year or less than 5 years. KMPC patients reported higher levels of pain, lower levels of anxiety and depression, better overall total QoL, physical health, social health, functionality capacity, and emotional health. These findings suggest the need for community awareness programs regarding the benefits of opting for the KMPC. Patients who chose KMPC reported higher levels of pain than SC patients, highlighting the need for the KMPC to improve its approach to pain management.

Keywords

palliative care - pain management - quality of life - India

^Footnote

✓ SC consists of treatment protocols for a specific illness that are accepted and followed by the treating physician. In the case of this study, SC refers to the standard medical care protocols for the treatment of cancer that are followed by the oncologist.


Reference: Standard of care. National Cancer Institute of health. Accessed September 15, 2021. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/standard-of-care


✓ The hospitals where patients were recruited include:


• Ernakulam General Hospital (total = 46; SC = 17; KMPC = 29)


• Anwar Memorial Hospital (total = 12; SC = 5; KMPC = 7)


• Lakshmi Hospital (SC = 8)


• Government Hospital Aluva (total = 21; SC = 10; KMPC = 11)


Source(s) of Support

The lead author received a Ministry of Human Resources Development (MHRD) fellowship throughout the duration of this study.


Authors' Statement

This manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each of the authors believe that the manuscript represents our honest work.


Authors' Contribution Details (ticked as applicable)

Prema N George was involved in conceptualization, designing, definition of intellectual content, literature search, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing and review. M.P. Ganesh was involved in conceptualization, designing, definition of intellectual content, literature search, data analysis, statistical analysis, manuscript editing and review. Shweta Chawak was involved in definition of intellectual content, manuscript preparation, manuscript editing and review. Mahati Chittem was involved in definition of intellectual content, literature search, manuscript preparation, manuscript editing and review. Shweta Chawak is guarantor for this manuscript.




Publication History

Article published online:
14 March 2022

© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Are M, McIntyre A, Reddy S. Global disparities in cancer pain management and palliative care. J Surg Oncol 2017; 115 (05) 637-641
    CrossrefPubMedGoogle Scholar
  • 2 Vijay D. Community Palliative Care in Kerala and Nadia District, West Bengal Voices, Narratives and Experiences. Paper presented at: Indian Association of Palliative Care Conference; 2019; Kochi Kerala
    Google Scholar
  • 3 Azeez EPA, Anbuselvi G. Is the Kerala model of community-based palliative care operations sustainable? Evidence from the field. Indian J Palliat Care 2021; 27 (01) 18-22
    CrossrefPubMedGoogle Scholar
  • 4 Philip RR, Venables E, Manima A, Tripathy JP, Philip S. “Small small interventions, big big roles”- a qualitative study of patient, care-giver and health-care worker experiences of a palliative care programme in Kerala, India. BMC Palliat Care 2019; 18 (01) 16
    CrossrefPubMedGoogle Scholar
  • 5 Chittem M, Norman P, Harris PR. Relationships between perceived diagnostic disclosure, patient characteristics, psychological distress and illness perceptions in Indian cancer patients. Psychooncology 2013; 22 (06) 1375-1380
    CrossrefPubMedGoogle Scholar
  • 6 Freyd M. The graphic rating scale. J Educ Psychol 1923; 14: 83-102
    CrossrefGoogle Scholar
  • 7 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
    CrossrefPubMedGoogle Scholar
  • 8 Thomas BC, Devi N, Sarita GP. et al. Reliability and validity of the Malayalam hospital anxiety and depression scale (HADS) in cancer patients. Indian J Med Res 2005; 122 (05) 395-399
    PubMedGoogle Scholar
  • 9 Chawak S, Chittem M. Are you satisfied with your care? A study examining the relationship between psychological factors and satisfaction with the medical consultation among Indian cancer patients. In: Pradhan R, Kumar U. eds. International Handbook of Advances in Emotion, Wellbeing, and Resilience: Theoretical Perspectives and Practical Applications. New Jersey: Apple Academic Press; 2021: 129-143
    Google Scholar
  • 10 Cella DF, Tulsky DS, Gray G. et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 1993; 11 (03) 570-579
    CrossrefPubMedGoogle Scholar
  • 11 Thomas BC, Pandey M, Ramdas K, Sebastian P, Nair MK. FACT-G: reliability and validity of the Malayalam translation. Qual Life Res 2004; 13 (01) 263-269
    CrossrefPubMedGoogle Scholar
  • 12 Singh DP. Quality of life in cancer patients receiving palliative care. Indian J Palliat Care 2010; 16 (01) 36-43
    CrossrefPubMedGoogle Scholar
  • 13 Thomas BC, Thomas I, Nandamohan V, Nair MK, Pandey M. Screening for distress can predict loss of follow-up and treatment in cancer patients: results of development and validation of the Distress Inventory for Cancer Version 2. Psychooncology 2009; 18 (05) 524-533
    CrossrefPubMedGoogle Scholar
  • 14 Mathew A, George PS, Ramadas K. et al. Sociodemographic factors and stage of cancer at diagnosis: a population-based study in South India. J Glob Oncol 2019; 5: 1-10
    CrossrefPubMedGoogle Scholar
  • 15 Philip RR, Philip S, Tripathy JP, Manima A, Venables E. Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers. BMC Palliat Care 2018; 17 (01) 26
    CrossrefPubMedGoogle Scholar
  • 16 Cea ME, Reid MC, Inturrisi C, Witkin LR, Prigerson HG, Bao Y. Pain assessment, management, and control among patients 65 years or older receiving hospice care in the U.S. J Pain Symptom Manage 2016; 52 (05) 663-672
    CrossrefPubMedGoogle Scholar
  • 17 Daniel S, Venkateswaran C, Hutchinson A, Johnson MJ. 'I don't talk about my distress to others; I feel that I have to suffer my problems...' Voices of Indian women with breast cancer: a qualitative interview study. Support Care Cancer 2021; 29 (05) 2591-2600
    CrossrefPubMedGoogle Scholar
  • 18 Vallath N, Rajagopal MR, Perera S, Khan F, Paudel BD, Tisocki K. Access to pain relief and essential opioids in the WHO South-East Asia Region: challenges in implementing drug reforms. WHO South-East Asia J Public Health 2018; 7 (02) 67-72
    CrossrefPubMedGoogle Scholar
  • 19 Ramasubbu SK, Pasricha RK, Nath UK, Rawat VS, Das B. Quality of life and factors affecting it in adult cancer patients undergoing cancer chemotherapy in a tertiary care hospital. Cancer Rep (Hoboken) 2021; 4 (02) e1312
    CrossrefPubMedGoogle Scholar
  • 20 Lynch T, Connor S, Clark D. Mapping levels of palliative care development: a global update. J Pain Symptom Manage 2013; 45 (06) 1094-1106
    CrossrefPubMedGoogle Scholar