Early palliative care integration in advanced cancer: two institutional quality improvement projects.

Background: Guidelines recommend early palliative care (PC) integration in advanced cancers. This remains a challenge in countries with high cancer burden and limited PC access. We report the quality improvement (QI) journey aimed at improving timely PC integration in patients with advanced gastric, colorectal and lung cancers at two centres in India.

Pragmatic Patient Choice-Driven Radical Treatment Approach (PRAGRAD) for Very Advanced Unresectable Oral Cavity Cancers.

Purpose: The treatment of locally advanced unresectable oral cavity cancers (OCCs) is challenging, with limited consensus on optimal management and poor outcomes. Our clinical practice identified a subset of unresectable OCC patients who respond favorably to aggressive alternate treatment with chemotherapy and radiation therapy. We propose a systematic design for optimal selection method that is patient choice-driven while attempting to managing unresectable OCC with radical therapy approach.

Purple urine bag syndrome: case series.

Purple urine bag syndrome is an uncommon condition that occurs in patients with long-standing indwelling urinary catheters, due to urinary tract infection (UTI) by bacteria producing sulfatase or phosphatase enzymes. This results in the formation of the pigments indigo (blue) and indirubin (red), together providing a purple appearance to urine. Management includes a change of catheter and appropriate antibiotics.

Supportive and Palliative Care Needs of the Older Adults with Stroke and Neurological Diseases: An Estimation using data from Longitudinal Ageing Study in India.

Objectives: The prevalence and burden of neurological diseases are high among the older age group. Stroke and other neurological diseases significantly impair functional capacity and lead to poor quality of life. This study aims to provide a national-level estimate for palliative and supportive care needs among older Indian adults with stroke and other neurological diseases.

Supportive and palliative care needs among older adults in India: an estimation using a nationally representative survey.

Background: One in five people will be older than 60 by the year 2050 in India. This demographic transition demands integration of geriatric and palliative care. The national level burden of palliative and supportive care needs of the older population is largely unknown in India.

A Multicentric Field Test to Study the Validity and Feasibility of the SHS-tool to Screen for Serious Health-related Suffering in Adult Patients with Cancer.

Objectives: The 2017 Lancet Commission reports 'Serious Health-related Suffering' (SHS) as an abyss in healthcare services. It lists 20 common health conditions and 15 symptoms as commonly associated with SHS. In 2015, 80% of SHS prevalence, an estimated 61 million, was noted as from low-middle-income countries.

Rare cause of dyspnoea: phenazopyridine-induced methemoglobinemia.

Methemoglobinemia, due to the oxidation of iron from ferrous to ferric form in the haemoglobin molecule, results in decreased oxygen delivery to the tissues. Phenazopyridine, a commonly used medication for urinary symptoms, is a rare cause of methemoglobinemia. We report an elderly woman with advanced vaginal cancer, who developed methemoglobinemia following the use of phenazopyridine at a dose of 200 mg three times a day for 14 days.

Palliative care outpatients and improved documentation-what matters most? Quality improvement project.

Objective: Patients needs should be regularly assessed. We aimed to improve assessment and documentation of needs from baseline 25% in June 2022 to 75% in December 2022.

Methods: The A3, a structured problem-solving continuous-improvement methodology was used.

Erasmus syndrome: role of specialist palliative care.

Occupational exposure to silica has been seldom implicated to cause systemic sclerosis. Erasmus syndrome is a rare condition where there is development of systemic sclerosis following silicosis. Early diagnosis is essential for appropriate treatment and symptom control.

Palliative care delivery in India during COVID-19 pandemic: role of faith-based hospitals - a qualitative study.

Objectives: The COVID-19 pandemic challenged palliative care (PC) services globally. We studied the ways healthcare professionals (HCPs) working in faith-based hospitals (FBHs) experienced and adapted care through the pandemic, and how this impacted patients with PC needs.

Methods: In-depth interviews were conducted with HCPs from FBHs serving rural and urban population across India.

Osimertinib-induced radiation recall pneumonitis.

Radiation recall pneumonitis (RRP) is a type of radiation induced lung injury that develops in a previously irradiated lung field and is triggered by administration of chemotherapeutic or immunomodulating agents. To our knowledge there is only one report of Osimertinib induced RRP. The predominant symptoms include dyspnea and cough which usually resolve after stopping the inciting agent and with glucocorticoids.

'COVID-19 and palliative medicine: faith-based hospitals in India'.

Objectives: Faith-based organisations (FBOs) in India provide health services particularly to marginalised communities. We studied their preparedness and delivery of palliative care during COVID-19 as part of a mixed-method study. We present the results of an online questionnaire.

Paramedics and serious illness: communication training.

Objectives: The need to empower Ambulance Service staff at the point of delivery of end of life care (EoLC) is crucial. We describe the delivery, outcomes and potential impact of the Serious Illness Conversation project delivered to Welsh Ambulance Service Trust (WAST) staff. Over an 18-month period, 368 WAST staff attended face-to-face teaching, which included serious illness conversation communication skills, symptom control and 'shared decision making'.