View/Download PDF Download ---Citations--- BibTeX RIS Buy Reprints PDF Translate this page into: English Arabic Chinese (Simplified) Dutch English French German Greek Hebrew Italian Japanese Korean Persian Portuguese Russian Spanish Turkish Urdu Abstracts 27 (3); 453-470 doi: 10.25259/IJPC_7_2021 PDF Download Citations BibTeXRIS Oral Presentation Umesh Bhadani Organising Secretary, IAPCON 2021, India *Corresponding author: Umesh Bhadani, Organising Secretary, IAPCON 2021, India. umeshbhadani@gmail.com Received: 2021-07-09, Accepted: 2021-07-09, Epub ahead of print: 2021-11-13, Published: 2021-11-24 © 2021 Published by Scientific Scholar on behalf of Indian Journal of Palliative Care 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. OP-01 Quality of Life and Symptom Burden in Patients with Hematological Malignancies Receiving Hematopoietic Stem Cell Transplantation: A Prospective Observational Study Dr. Neethu Susan Abraham All India Institute of Medical Sciences, New Delhi, India E-mail: neethu.march30@gmail.com. Mobile: 6282190748 Background: Hematopoietic stem cell transplant (HSCT) is one of the most intense forms of treatment which can be threatening to life, but can give the hope to cure. Prospective studies which provide valuable information on QOL are important to give the patients a better understanding of the endpoint further. Aims: The aim of the study was to assess the quality of life and symptom Burden of haematological malignancy patients at admission to hospital for HSCT, at 1 month and at 3 months following HSCT using FACT-BMT Scale and r-ESAS. Methods: This prospective observational study was done on haematological malignancy patients who were admitted for HSCT in Dr. B.R.A IRCH, AIIMS. The study subjects were assessed by semi-structured sociodemographic and clinical pro forma and FACT-BMT Scale and r-ESAS at the time of hospital admission for transplantation, on day 30 (~1 month) and day 100 (~3 months) of transplantation. Results: A total of 68 patients were included in this study. The FACT-BMT scores have decreased from baseline to first follow-up and then increased in the third follow-up. The maximum ESAS mean score was for tiredness among all other symptoms at the baseline, 1 month and at 3 months. Conclusion: Symptom burden is the highest in the 1st month after BMT, which comes down later. QOL improves with time. It is very necessary to have assessment of symptom burden to provide good quality of life in such group of patients. OP-02 Empathy Enhancement in Virtual Role Revers Training Jochen Becker-Ebel Yenepoya University, Mangalore and MediAcion, Hamburg E-mail: jochen.becker-ebel@mediacion.de. Mobile: 491794928186 Empathy is the foremost quality of end-of-life and other health professionals and workers. To enhance an adequate level of empathy is crucial for beginners in palliative and healthcare. Role reveres, like in psychodramatic training, has proven to assist in finding this. To high levels of empathy, which should be called better: ‘over-compassion’ will lead to burn-out. Low empathy will ‘professionalise contact,’ but will be experienced as: cold, institutional and uninterested. With the background of training medical doctors and nurses in different states and universities the speaker explains the value crucial teaching methodology by examples. He will offer in his talk real virtual online practise. Maximum participants: 22; minimum time: 30 min. There first 10 min a report will be given from Yenepoya Medical College, Yenepoya Nursing college and Bangalore University (Montfort College) on three different virtual role-revers trainings given between October 2020 and January 2021. The next 15 min a spontan life-example will be given with a volunteer of the group of participants. The last 5 min will be for relecting the process and questions. To be discussed: can virtual empathy training has an effect on the profession of health care and end-of-life care workers? OP-03 Identification of Symptom Clusters in Advanced Head and Neck Cancer Patients Attending Palliative Care Department: An Observational Study Chaitanya Patil Kolhapur Cancer Centre, Kolhapur, Maharashtra, India E-mail: docterchaitanya@gmail.com. Mobile: 9764167788 Background: The primary aim of palliative care is to provide optimum symptom relief and improve the quality of life. Knowledge of symptom clusters will assist us in achieving the goal and so we conducted a study to find symptom clusters among advanced head and neck cancers attending our supportive care clinic. Materials and Methods: A prospective study was conducted among 93 patients with advanced head and neck cancer attending the supportive care clinic at Kolhapur Cancer Centre. The study period was from January 2020 to September 2020. The patient’s demographic information, history of the previous treatment taken, presence of recurrence and metastasis along with different symptoms were noted. Principal component analysis with Varimax and Kaiser Rotation was used to extract the different clusters among the sample. Results: The mean age of the patients was 55.54 A ± 12.64 years with male preponderance. The most experienced symptoms in the past week were pain (92.47%) and sleep disturbances (88.17%). We identified six symptom clusters and there were as follows: Cluster 1 - Fatigue, drowsiness, depression, anxiety and breathlessness; Cluster 2 - Pain and Sleep disturbances; Cluster 3 - Dry mouth and weight loss; Cluster 4 - Facial oedema, Cough, Change in taste, Mouth Sores; Cluster 5 - Diarrhoea only and Cluster 6 - Nausea and Constipation. Conclusion: Advanced head and neck cancer patients had multiple concurrent symptoms which will need extra attention when assessing the patient in a palliative care clinic. Addressing these will help us prepare management algorithms and in turn help in better management of the patients. OP-04 The COVID-19 Pandemic: A New Epoch and Fresh Challenges for Cancer Patients and caregivers - A Descriptive Cross-sectional Study Raghav Gupta Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India E-mail: raghavgupta88@gmail.com. Mobile: 8130622963 Background and Aims: Cancer patients and their caregivers are overwhelmed with features of anxiety and grief. COVID-19 pandemic has added on to the plight by afflicting the cancer care delivery. The descriptive cross-sectional study was conducted to observe the challenges faced by cancer patients and their caregivers and to chalk out strategies to overcome those challenges. Methods: The descriptive cross-sectional study was conducted from June 1 to July 30, 2020. Internal survey questionnaire was developed. After providing verbal instructions to patients and their caregivers who visited pain and palliative care unit, the challenges faced at the level of various domains (physical, logistic, psychological, socioeconomic and spiritual) were noted. Data were analysed using STATA 14 software. Results: Out of 500 cases noted, in 310 cases both patients and caregivers (Group P+CG) were present. In 140 only patient (Group P) and in 50 cases only caregiver came (Group CG). Major challenges encountered were suffering from symptoms such as pain, vomiting, dyspnoea (90%), postponement of cancer treatment (80%), fear of contracting COVID infection due to hospital visit (93.5%), lack of accommodation (70%) and lack of spiritual clarity and hope (50%). Discussion and Conclusion: Major challenges faced by patients were in physical and psychological domain and by caregivers were in socioeconomic domain. It is imperative to recognise the challenges faced. Health-care setups should chalk out strategies to mitigate these challenges so that holistic care could be provided to cancer patients. These will also help in better management for future pandemics also OP-05 Neurodegeneration with Brain Iron Accumulation: A Rare and Unique Challenge in Neuro-palliative Care Sucheta Saha Consultant Rehabilitation Physician, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India E-mail: dr.sucheta.saha@gmail.com. Mobile: 9136172451 Introduction: Neurodegeneration with brain iron accumulation (NBIA) is a rare heterogeneous group of neurologic disorders characterised by abnormal accumulation of iron in the basal ganglia. It is a relentlessly progressive neurodegenerative disorder, without any cure. Neuro-palliation and rehabilitation can play important role in management of this rare disorder. Case Description: An 18-year-old male patient presented to the Physical Medicine and Rehabilitation Out Patient Department of VMMC and Safdarjung Hospital with features of gradually increasing involuntary movement of neck, speech and swallowing difficulties. He was a diagnosed case of NBIA with characteristic ‘Eye of the Tiger’ appearance in MRI. Pharmacotherapy did not show any significant improvement. Injection Botulinum toxin was given for his cervical dystonia and he achieved remarkable improvement in the Fahn- Marsden dystonia scale scoring 2 weeks after the injection. Discussion: Only a handful of cases are reported from India, who received mostly symptomatic treatment. Medications like Baclofen, Trihexyphenidyl has shown some effect. Some cases are also treated with Deep Brain Stimulation without much improvement. In this case, the effect of Botulinum toxin was noticeable and it improved the quality of life of the patient in conjunction with supportive rehabilitation care. It can be used as an effective adjunct to the pharmacotherapy in this rare neurological disorder. OP-06 The Effectiveness of a Nurse Coordinated Home Care Model in Palliative Care Lucy Quadros Tata Memorial Hospital, Mumbai, Maharashtra, India E-mail: lucylady@ hotmail.com. Mobile: 9022478573 Introduction: Home based palliative care (PC) services are essential to provide PC effectively. A nurse coordinated (NC) home care model can facilitate this. Objectives: The objective of the study was to determine the feasibility, adherence, effectiveness and acceptability of this model. Materials and Methods: One hundred and three patients with care givers were screened over a period of 16 months, 101 were recruited for the study. The NC visited their homes, administered tools and continued service every month. Follow-up visits were done as per the need. LGPs were identified and were involved in the patient care. Results: Feasibility data were collected from healthcare records in person/phone follow-up. Reduction in score of severe symptoms (>7 out of 10) by >2 points on ESAS scale was seen in 4 out of 7 (57.1% times). This model could reduce doctor visits: Deaths at home - 57, hospital - 14, Respite care - 1 and Hospice Care - 3.99% of the recruited families followed up till the end, 87.5% of the GPs approached participated. FAMCARE-2 showed maximum score on domain satisfied, caregiver burden in ZBI was little/no for 95%, good symptom control on ESAS with mean scores for pain was 2, PPSv2 score was 61-80 for majority times and mean scores on EORTC QLQ-C15-PAL were good. Comparative cost analysis for direct patient care was INR 159,707 (INR 1581.26/patient), compared to private doctor home care costs ~ INR 5000/patient. Conclusion: The nurse coordinated home care model in PC facilitates an interdisciplinary network of care, reduces cost drastically and improves quality of life of patient and family. OP-07 Parents’ Experiences with Prognosis Communication About Their Children Suffering from Advanced Cancer Experience from a Tertiary Cancer Centre in India Jayanthi Iyengar Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India E-mail: jayanthi.iyengar1908@gmail.com. Mobile: 9930284257 J Iyengar, A Ghoshal, MA Muckaden, A Damani, JK Deodhar, G Chinnaswamy, T Vora, KV Ganpathy Background and Aims: It is widely known that knowledge of adverse prognosis affects end-of-life decision-making in parents of children suffering from advanced cancer. Many times, oncologists limit prognostic information to prevent distress; whether this practice reflects patient preferences is not known. This study prospectively examines the perceptions of parents of children, suffering from advanced cancer, on the process of prognoses communication. Methods: Prospective qualitative study and semi-structured interview were conducted to ask parents about their preferences in prognosis communication. The data were analysed using thematic analysis. Results: Four major themes emerged from 14 interviews: (1) prognosis should be informed: subthemes elucidated parents’ preference to be communicated about prognosis in phases as disease progresses, (2) feelings of the parents: while adverse prognosis makes the parent feel helpless/ sad/hopeless, it also gives them an opportunity to revaluate care goals realistically and (3) method of coping: denial, blaming destiny, spiritual beliefs, psychosocial help from hospital and seeking courage from child (4) preparedness: sharing of prognosis information helps to prepare the parents. We found out that there is a need for a cooling off period between the first consultation when prognosis is communicated and subsequent interview to understand perceptions surrounding it. Discussion and Conclusion: The study reveals the need for more openness in prognosis communication from oncologists. In depth knowledge on parent preferences will aid the process. OP-08 Risk Factors Associated with Lifestyle Cancers in India: A Systematic Review Adedolapo Komolafe University of Delhi, New Delhi, India E-mail: dolapo.ajumobi@gmail.com. Mobile: 9711474047 Background and Aims: Lifestyle cancers are becoming major cause of global morbidity and mortality. Evidence suggests that 70-90% of cancers in India are related to lifestyle and can be easily prevented by adapting healthier lifestyles. Thus, this review aimed to examine risk factors of lifestyle cancers in different geographical locations in India. Methods: Three electronic databases, namely; PsychINFO, JSTOR and Medline were systematically screened from December 2017 to February 2018 for literatures on cancer and lifestyle risk factors. The search was limited to India, adults and papers written in English. Results: 2301 articles were identified and ten were reviewed. Smoking and tobacco consumption were strongly related with lung, gastric and oral cancers in South and West India. Furthermore, in West India, Oesophageal cancer was attributed to smoking, alcohol and tea consumption while the consumption of cabbage and sprout was found to the lower the risk of colorectal cancer. In North India, attributions to oesophageal cancer were snuff, smoking, salty tea, hookah, sundried foods and red chilli. No study was found in East India. Discussion and Conclusion: Non-Hodgkin’s lymphoma, lung, gastric, oral, colorectal, oesophageal and gall bladder cancers have been attributed to lifestyle factors of which smoking and tobacco consumption were common in South and West India while salty tea, hookah, snuff, sundried foods and red chilli were unique to North India. Cabbage, sprouts and Vitamin C were identified having protective properties. It is recommended to organise awareness programmes to help strengthen preventive interventions and reduce cancer incidence. OP-09 Enabling Caregivers The Role of Social Workers and Volunteers Aneka Paul Golden Butterflies Children’s Palliative Care Foundation, Chennai, Tamil Nadu, India E-mail: aneka.sureshp@gmail.com. Mobile: 9004712480 Informal caregivers occupy a unique position within health systems as both providers of care adjunct to health-care professionals and recipients of service in the form of knowledge and skill enhancement. The wellbeing of these informal caregivers is vital to their ability to provide care to their patients; hence, it is in the interest of health systems to provide caregivers with sufficient and timely support. Parents of children with life-threatening or life-limiting conditions are particularly vulnerable to a range of negative physical, mental, emotional, social and financial issues. Golden Butterflies is a volunteer-driven NGO in Chennai, working with child-patients and their families. GB Caregivers Connect - lil lives matter, but YOU matter too was initiated in response to stress perceived among parents/caregivers during telephonic counselling. Therapeutic sessions based on the principles of group work are held once in 2 months. Caregivers connect is a safe space where current and bereaved parents/ caregivers can grieve, vent pent-up emotions, stress and anxiety and relate with one other. A social worker facilitates each session, including a topic for the day such as self-care, self-motivation, resilience and the need to equip oneself with skills and information. Caregivers share challenges and tips, discuss strengths and weaknesses and motivate each other. Individual matters such as patient care, family counselling, financial support and information needs are addressed by the Social Worker to the extent possible. Trained volunteers keep accompanying child-patients and/or their siblings engaged in art and recreational activities in a separate room, so that adults may confer openly. OP-10 Quality of Life After Palliative Whole Brain Radiation in Patients with Brain Metastases Begum Yesmin Nureja Post Graduate E-mail: yesmin.nureja@gmail.com. Mobile: 9789063303 Background: Brain metastasis is the most common cause of intracranial neoplasm followed by brain primary having very poor outcome. Overall outcome ranges from 9 to 17% with a median period of survival ranging from 8.5 to 12 months from primary diagnosis. As radiation therapy contributes to a wholesome amount of palliative care, by meeting the criterion of symptomatic relief, disease control over a period time and also improvement of quality of life. Aim: The aim of the study was to assess symptomatic palliation and improvement in quality of life in patients with brain metastasis treated with whole brain radiation. Materials and Methods: Prospective study, we analysed prospectively 20 patients with whole brain metastasis having various primary sites from August 2019 to July 2020 with symptoms and having multiple lesions were included in the study. The patient was treated with conventional technique (two opposing lateral fields) 300cGy x 10 fractions. We assesses prospectively with EORTC QLQ-30 and QLQ-BN 20 questionnaires at baseline, after 1 month of whole brain radiation and after 3 month of end of treatment. Results: The median survival among patients was found to be 5.5 months (1-12 months). Our study showed differences in symptomatic relief between baseline and 1st month. There was improvement of symptoms in patients with headache (90% vs. 30%), nauseas (80% vs. 20%) and dizziness (40% vs. 10%). All the patients reported to have managed independently with regular day to day activities. Conclusion: In patients with multiple brain metastases, whole brain radiation is effective to palliate the symptoms and there by improve the quality of life even though they have limited life expectancy. OP-11 Empowering Caregivers in the Context of Health Related Suffering Elna Joseph Medical Social Worker Pallium India, Manacaud P.O, Paruthikkuzhy, Thiruvananthapuram, Kerala, India E-mail: elnajosephpalliumindia@gmail. com. Mobile: 9526685949 Introduction: Caregiving in the context of serious illness is a public health concern with many social and economic implications. Approximately 80% of caregivers worldwide are women and they face myriad difficulties in managing the needs of their families. Pallium India launched the Ujjwal Project with the support from the Federation of Malayalee Association of America (FOMAA). The project aims to empower the women palliative care beneficiaries including patients and caregivers through cost-effective interventions. Methods: Four assessment parameters were assessed and analysed for women patients/caregivers of palliative care patients using a need assessment tool and urgency matrix and interventions were provided in response. Results: The project team received 74 requests from clinicians and 67 (90.5%) met criteria for support requirements. The major four interventions of the project include the provision of essential/basic amenities, medical support, educational support and/or rehabilitation and reintegration support. Among the 67 identified as eligible, six beneficiaries (9.0%) received assistance in getting basic amenities, 9 (13.4%) received medical support as per their need, 4 beneficiaries (5.9%) received education support and 48 (71.6%) beneficiaries received vocational rehabilitation with cost-effective interventions. Discussion and Conclusion: Project Ujjwal has helped 67 women caregivers so far and the journey is continuing. Pallium India has advanced this novel effort to drastically improve the quality of life of women beneficiaries including caregivers and patients through quality and cost-effective interventions to take control over their lives with the support they need to promote self-esteem and dignity. Keywords: Ujjwal, Empowerment, Empathetic approach, Caregivers, Vocational rehabilitation, Quality of life OP-12 Palliative Care by Faith Based Organisation Hospitals in India Bridging The Gap During Covid-19: A Mixed- Methods Study S. Jenifer Jeba Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India E-mail: jenifermugesh@yahoo.com. Mobile: 9443019383 Background and Aims: Faith Based Organisations (FBO) in India are key health-care providers to marginalised communities. We studied preparedness and delivery of palliative care (PC) during COVID-19. Methods: Mixed-method study undertaken with FBOs providing PC in India using online survey and five semi-structured interviews. Descriptive analysis of survey responses and thematic analysis of interviews was done. Results: Online survey response-rate 46/64 (72%) from hospitals throughout India with 10-2700 (median 100) beds. 30/44 (68%) were in rural or semi- urban areas serving neighbouring villages; 44 provided PC and 52% had dedicated PC teams. PC was offered for cancer and non-cancer conditions; cancer making up > 50% workload for only 15/44 (34%). COVID-19 impact was extensive with interruption of general and PC services for many hospitals. Access to active cancer management was not available for many. COVID-19 induced a mixed community response; fear and stigma, versus inadequate safe-practices for a foreign-disease. PC teams which continued to function though initially fearful, were motivated by visible need from nonavailability of local health services. They responded by adapting services and innovatively addressing wider issues. These were accepted and appreciated by the patients and community because of prior established rapport. PC and community health cooperated, some working collaboratively with government services to provide general community support. Conclusion: FBOs in India despite challenges worked innovatively to deliver PC and bridge gaps in healthcare, providing essential services to marginalised communities during the pandemic. Further interviews with hospital representatives and patients and carers to broaden insights are planned OP-13 Methadone Use for Chronic Pain: A Single-centre Experience D. Arjun Trivandrum Institute of Palliative Sciences, Pallium India, Trivandrum, Kerala, India E-mail: arjundevaraj92@gmail.com. Mobile: 919495548303 Background and Aims: Methadone is new in India and the only available oral strong opioid, other than morphine. Methadone may serve as an effective analgesic among patients with inadequate pain relief on morphine. Methods: Patients prescribed methadone for analgesia from 2018 to 2020 were retrospectively identified from Pallium India’s pharmacy records. Descriptive statistics were generated for demographics, disease characteristics, methadone use patterns and clinical outcomes for the year 2020. Results: Methadone use increased from eight patients (2018) to 35 patients (2020). In 2020, age of patients ranged from 14 to 80 years and 34.3% were women. Primary diagnoses included cancer (91.4%) and traumatic paraplegia (5.7%). Indications for use included neuropathic pain not responding to conventional treatments (62.9%), opioid toxicities with inadequate pain relief (20%), pain in chronic kidney disease (8.6%), adjuvant use (5.7%) and morphine allergy (2.8%). In 2020, six clinicians prescribed methadone across settings (e.g. clinic, inpatient and home care). Common starting doses were 2.5 mg twice daily (34.3%), 5 mg twice daily (14.3%) and 1 mg twice daily (14.3%). Initial doses ranged from 1 to 20 mg/day and were titrated after 5-7 days as needed. The maximum prescribed dose was 27.5 mg/day. No laboratory or electrocardiogram screening/monitoring was performed. Nor were any adverse effects noted. Discussion and Conclusion: At our centre, methadone use increased dramatically from 2018 to 2020, likely driven by increased clinician experience and comfort. Our findings demonstrate the feasibility of building local expertise in methadone prescribing and the role of methadone as a critical pain relief medication. OP-14 Physician Perceived Confidence in Palliative Medicine after Attending an Online Training Programme Deepak Varughese Pallium India, Trivandrum, Kerala, India E-mail: deepakvarughese@gmail. com. Mobile: 918778497207 Introduction: With increased life expectancy and a changing epidemiological profile, the need for palliative care is increasing in India. However, the availability of specialist palliative care services is limited. Short online courses in palliative care principles may be effective in bridging this gap. This study examined physician confidence in several palliative care domains following attendance one such online course. Methods: The course was conducted on the Zoom Platform. Sessions were held once a week for 19 weeks. Each session was 90 min and included a faculty lecture followed by a case presentation. We conducted a retrospective pre-post-test study. All participants who attended the course in the past year were contacted electronically and asked to rate their confidence in specific palliative care domains before and after the course. We used Wilcoxon Signed-Ranked Test to compare median scores reported as pre- and posttaking the course. Data were analysed in SPSS V23. Results: Among the 125 people who had participated in the online course, 95 completed the online survey. There was a statistically significant improvement in confidence in the management of pain (P < 0.01), gastrointestinal (P < 0.01) and respiratory (P < 0.01) symptoms. There also was a statistically significant improvement in confidence in the use of morphine (P < 0.01) and in discussing psychosocial issues with the family (P < 0.01). Discussion: Our study provides preliminary evidence in the ability of online training to increase physician confidence in core palliative care practice principles. Further research is needed to determine the impact of this training on practice and patient outcomes. OP-15 Correlation of Palliative Performance Scale with Survival of Cancer Patients Admitted in A Palliative Care Unit Sachin Bansal Bhagwan Mahaveer Cancer Hospital, Jaipur, Rajasthan, India E-mail: bansalspmc2006@gmail.com. Mobile: 9828370236 Background and Aim: The palliative performance scale (PPS) was first introduced in 1996 for measurement of the performance status in palliative care. PPS is a reliable and validated tool used to measure functional performance; higher scores indicate higher functionality. Estimating survival is challenging in the terminal phase of advanced stage of cancer. Patients, families and healthcare organisations would benefit from more reliable prognostic tools. The aim of this study was to correlate survival with PPS for admitted patients in palliative care unit (PCU) in a tertiary care cancer hospital. Methods: This retrospective analysis is an observational study based on hospital data of 74 patients for the advanced stage cancer who died in hospital between year May 2018 and February 2020. The complete information of each patient enrolled in study including age, gender, date of death, diagnosis, data regarding performance status (Intake, consciousness, ambulation, self-activity and extent of disease affecting daily activity) and survival days, was obtained. Results: Median survival time was significantly better in patients with PPS more than 60 as compared to those with PPS 40-60 and minimum in those with PPS <40 as indicated by the Kaplan-Meier survival analysis. Strong correlation was seen between PPS and survival time as indicated by correlation coefficient value of 0.6. As PPS value increases survival time also increases significantly. Conclusion: In our limited sample, we found that if PPS is less than 40% then median survival is less than 5 days in advanced cancer in patients. OP-16 Integrated Palliative Care Outcome Scale: Translation and Adaptation for Use in India Tushti Bhardwaj Dr. Bhim Rao Ambedkar College, University of Delhi, New Delhi, India E-mail: tushti.p@gmail.com. Mobile: 9711474047 Background and Aims: Over three decades of palliative care growth though India could give various models of palliative care delivery to the world but unfortunately, we lack indigenous evidence of our complex interventions. India needs valid i