Progress in Primary Palliative Care in India

INTRODUCTION Timely integration of palliative care into caring for patients with chronic life-threatening illnesses has been shown to alleviate pain and symptoms, reduce unnecessary hospital visits and futile interventions, and facilitate early transition to home care, thus reducing the financial burden on families and health systems. The recent Lancet Oncology commissioned a team across the globe to explore palliative care interventions as a solution to mitigate the human crisis of cancer. Teams from LMICs worked to develop palliative care solutions better aligned with the local cultural needs of palliative care patients. In view of poor governmental support in low- and middle-income countries, nongovernmental organizations and community volunteers actively participated in advocacy, fund-raising, improving access to palliative care and community empowerment. This enabled continuity of care and enhanced patient autonomy, reducing out-of-pocket expenses and supporting patients in remaining at home as their preferred place of care. Furthermore, they also used innovative strategies to deliver palliative care to remote and difficult-to-reach areas. Some of these innovations included opioid dispensation to patients at home through faxed opioid prescriptions, video-based, and smartphone-based consultations. PROGRESS IN PRIMARY PALLIATIVE CARE IN INDIA Active collaboration among government, healthcare systems, policymakers, and researchers will strengthen national palliative care infrastructure, expand the workforce, and ensure the sustainability of palliative care and equitable access to essential medicines and community-based care to people with cancer in LMICs. WONCA special interest group on palliative care and cancer, where India is highlighted as a national example of primary palliative care development. In 2017, the Indian Association of Palliative Care joined hands with the Academy of Family Physicians of India to expand primary palliative care in the community. Subsequently, the associations jointly published a position paper emphasizing the importance of primary palliative care in the community. This paper was published in 2018. The paper identified gaps in palliative care provision in the country and offered recommendations for developing a community-based palliative care model. In 2019, a body of National and International experts in palliative care and primary care published a competency framework that deliberated on the competencies required for family physicians to provide primary palliative care. The National Board approved the competency framework of examinations for integrating primary palliative care into the postgraduate family medicine curriculum [Exemplar 1].Exemplar 1: Milestones achieved in developing primary palliative care in India