Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abstract
Abstracts
Addendum
Brief Communication
Case Report
Case Series
Commentary
Conference Abstract
Conference Editorial
Conference Proceedings
Current Issue
Editorial
Editorial Commentary
Erratum
General Medicine Original Article
General Medicine, Case Report
General Medicine, Review Article
IAPCONKochi 2019 Conference Proceedings
Letter to Editor
Letter to the Editor
Letters to Editor
Media & News
Narrative Review
Notice of Retraction
Oral Abstracts
Original Article
Palliative Medicine Commentary
Palliative Medicine, Letter to Editor
Palliative Medicine, Letter to the Editor
Palliative Medicine, Original Article
Palliative Medicine, Review Article
Personal Reflection
Perspective
Perspectives
Position Paper
Position Statement
Poster Abstracts
Practitioner Section
Report
REPUBLICATION: Special Article (Guidelines)
Retraction
Review Article
Reviewers 2023
Short Communication
Short Report
Special Editorial
Special Review
Systematic Review
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abstract
Abstracts
Addendum
Brief Communication
Case Report
Case Series
Commentary
Conference Abstract
Conference Editorial
Conference Proceedings
Current Issue
Editorial
Editorial Commentary
Erratum
General Medicine Original Article
General Medicine, Case Report
General Medicine, Review Article
IAPCONKochi 2019 Conference Proceedings
Letter to Editor
Letter to the Editor
Letters to Editor
Media & News
Narrative Review
Notice of Retraction
Oral Abstracts
Original Article
Palliative Medicine Commentary
Palliative Medicine, Letter to Editor
Palliative Medicine, Letter to the Editor
Palliative Medicine, Original Article
Palliative Medicine, Review Article
Personal Reflection
Perspective
Perspectives
Position Paper
Position Statement
Poster Abstracts
Practitioner Section
Report
REPUBLICATION: Special Article (Guidelines)
Retraction
Review Article
Reviewers 2023
Short Communication
Short Report
Special Editorial
Special Review
Systematic Review
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abstract
Abstracts
Addendum
Brief Communication
Case Report
Case Series
Commentary
Conference Abstract
Conference Editorial
Conference Proceedings
Current Issue
Editorial
Editorial Commentary
Erratum
General Medicine Original Article
General Medicine, Case Report
General Medicine, Review Article
IAPCONKochi 2019 Conference Proceedings
Letter to Editor
Letter to the Editor
Letters to Editor
Media & News
Narrative Review
Notice of Retraction
Oral Abstracts
Original Article
Palliative Medicine Commentary
Palliative Medicine, Letter to Editor
Palliative Medicine, Letter to the Editor
Palliative Medicine, Original Article
Palliative Medicine, Review Article
Personal Reflection
Perspective
Perspectives
Position Paper
Position Statement
Poster Abstracts
Practitioner Section
Report
REPUBLICATION: Special Article (Guidelines)
Retraction
Review Article
Reviewers 2023
Short Communication
Short Report
Special Editorial
Special Review
Systematic Review
View/Download PDF

Translate this page into:

Palliative Medicine
Letter to the Editor
27 (
3
); 452-452
doi:
10.25259/IJPC_42_21

Room for Improvement in Kerala’s Palliative Care Delivery

Medical Student, Government Medical College, Kozhikode, Kerala, India
Department of Oncology, MOSC Medical College, Kolenchery, Kerala, India

*Corresponding author: Jeffrey Mathew Boby, Medical Student, Government Medical College, Kozhikode, Kerala, India. jeffreyboby005@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Boby JM, Mathew A. Room for Improvement in Kerala’s palliative care delivery. Indian J Palliat Care 2021;27:452.

Sir,

We read with great interest the work by Lijimol et al. ‘Improving access and quality of palliative care in Kerala:A cross-sectional study of providers in routine practice.’[1] We congratulate the authors for highlighting the palliative care practices in Kerala and take this opportunity to seek clarification on a certain discussion made in the article.

Palliative care is an approach that identifies, evaluates and manages the difficulties, be it physical, psychological, social or spiritual, experienced by patients and family suffering from life-threatening diseases and thereby improving their quality of life. Even though pain mitigation is only one of the components of palliative care, measurement of opioid use by palliative centres is often regarded as a standard for estimating access to palliative care. The standard audit tool for Indian palliative care programs identifies an uninterrupted supply of oral morphine and its documentation as an essential requirement of any palliative care program.

In India, morphine can only be dispensed by an approved provider affiliated with a Recognised Medical Institution (RMI). We feel perplexed by the statement that ‘only 36% of the studied non-government (NGO) and none of the GO PCPs were able to prescribe and provide oral morphine as RMIs. All GO hospitals are deemed RMIs, but mostly, GO PCPs would refer patients to taluks, districts and general hospitals as well the Regional Cancer Centre in Trivandrum for opioids.’The fact that NGO PCP has better access to morphine than government palliative care providers is surprising given that a study done by Rajagopal et al. in 2015 reported that government institutions accounted for only 31% of the total palliative centres in Kerala but distributed 48% of total morphine in the state.[2] Referral of patients to a higher centre would also be an impractical solution as most often the patients are unable to travel to these faraway centres.

Another statement which disturbed us was this – ‘Through this referral network or in-house RMI status, only 57% (57/100) and 55% (55/100) of the GO and NGO PCPs reported ‘always’ or ‘often’ having an uninterrupted supply of oral morphine for their patients.’ Lack of access to adequate morphine in Kerala is especially alarming. We worry that the situation in rest of India would be profoundly appalling. To conclude, we would like to appreciate the effort gone into compiling such a great work assessing the different aspects of palliative care in Kerala, however, we believe that the above statements would benefit from additional insights from the authors.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , . Improving access and quality of palliative care in Kerala:A cross-sectional study of providers in routine practice. Indian J Palliat Care. 2020;26:500-5.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , . Oral morphine use in south India:A population-based study. J Glob Oncol. 2017;3:720-7.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
1,645

PDF downloads
402
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections