CanSupport: a model for home-based palliative care delivery in India

Area of Science:

• Palliative Care
• Public Health
• Healthcare Delivery Models

Background:

• Global palliative care access is insufficient, particularly in low- and middle-income countries (LMICs).
• India faces significant disparities in palliative care access, with services primarily offered by scattered non-governmental organizations (NGOs).
• Barriers in LMICs include limited funding, a shortage of trained professionals, and a focus on curative over comfort care.

Purpose of the Study:

• To describe a successful home-based palliative care model implemented by CanSupport, an NGO in Delhi.
• To evaluate the model's effectiveness in providing palliative care services in the Indian context.

Main Methods:

• Retrospective data collection on patient demographics, services, and outcomes for CanSupport patients from 2009-2010.
• Data sources included CanSupport's population registry and direct staff interviews.
• Patient data encompassed demographics, visit frequency, referral sources, pain assessment, morphine administration, place of death, and bereavement support.

Main Results:

• CanSupport served 746 patients between 2009-2010, averaging 10 home visits per patient.
• Most referrals were self-initiated or via helpline (71%), with only 29% from hospitals/physicians.
• Pain management was a key focus, with 31% receiving morphine. 76% of deaths occurred at home, with 6 months of bereavement counseling provided to most families.

Conclusions:

• CanSupport's home-based model demonstrates feasibility and patient-centeredness for end-of-life and chronic care in India.
• The model provides cost-effective care, reducing hospital visit expenses while ensuring trained palliative care evaluation.
• Multidisciplinary teams effectively manage symptoms and offer crucial emotional support to patients and families, offering a scalable solution for LMICs.