International Journal of College of Palliative Medicine of Sri Lanka

Nutritional therapy and palliative care in cancer cachexia: a systematic review

Roberto Claudio Correia Filho — 2023-11-11

Introduction: According to evidence-based clinical practice guidelines, nutritional risk screening and nutritional support are essential for all cancer patients with or without cachexia because inadequate nutritional intake is often observed and associated with weight loss. Objective: It was to explore and discuss nutritional therapies and palliative care in cancer cachexia through a systematic review of the literature. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 134 articles were found, and 38 articles were evaluated in full, and 28 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 29 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=51.3%>50%. It was concluded that the preservation of nutritional status may be a relevant concern during the palliative care phase. In overweight and obese patients with advanced cancer, it was observed that almost 50% of patients are at nutritional risk and 13% are malnourished and have worse outcomes. Measures must be proportionate to the nutritional needs and predominant symptoms of each patient, as part of personalized and adapted nutritional treatment.

Cancer-related pain management in hospice settings in Sri Lanka: adequacy, perceptions of patients and experiences of nurses

Manudi Nushara Vidanapathirana — 2024-02-29

Pain debilitates over 75% of patients with advanced-stage cancers and its management is a primary palliative care objective¹. This study aimed to assess the adequacy of cancer-related pain management and identify related patient-perceptions and nursing-experiences at Shantha-Sevana and Sathya-Sai Hospices, Sri Lanka. This was a descriptive study which used expert-developed questionnaires, Brief Pain Inventory, Focus Group Discussions to collect patient data and in-depth interviews to collect nursing data. Adequacy of analgesia was assessed using Pain Management Index [PMI]. Relevant ethical clearance was obtained. Twenty terminally-ill cancer patients and nine nurses took part in the study. Assessment of analgesic adequacy in patients revealed that negative, zero and positive PMI were 40%, 35% and 25% respectively. All patients with negative PMI had moderate-severe pain with none being treated with strong opioids. Adverse patient-perceptions emerged in cognitive and emotional aspects, with pain-related depression being dominant [n=14]. Key patient-perceptions on pain-management were decrease in pain after hospice admission [n=9] and satisfaction with the pain-management provided [n=10]. None of the nurses had received structured training on pain-management for palliative care at basic or recruitment stages. No grading of pain was performed during pain-management. Conclusively, cancerrelated pain is undertreated in hospices and room for improvement exists.

2 nd Annual Academic Sessions -2023

College of Palliative Medicine of Sri Lanka — 2023-09-25

Abstracts of Oral and Poster Presentations

Palliative care: a practice of dignity and morality

Samadhi Wishvanath Rajapaksa — 2023-08-20

Compassionate communities and cities in low and middle-income countries: a systematic review protocol to identify transferrable lessons for implementation in the primary care context

Sashiprabha Dulanjalee Nawaratne — 2023-08-14

Introduction: Compassionate Communities are neighbourhood or village level organizations that addresses the holistic concept of health, physical, psychological, spiritual and social well-being. It is estimated that out of the 40 million individuals who require palliative care each year, 78 per cent reside in low- and middle-income countries. Objective: Compassionate Communities and Cities are based on a health promotion approach to palliative care, with the goal of supporting individuals in solidarity at the end of life. This systematic review aims to analyse Compassionate Communities and Cities initiatives in low- and middle-income countries to identify transferrable lessons for implementation in the primary care context. Methods: A comprehensive, search for studies indexed in Medline, EMBASE, PsycINFO, Web of Science and Scopus databases and grey literature will be conducted using an electronic search strategy. The search strategy will include terms (and synonyms) describing Compassionate Communities and Cities, palliative care and low- and middle-income countries. Article screening will be conducted in two rounds. First, a title and abstract screening will be conducted followed by a full-text screening. Article selection will be conducted by two independent reviewers. Studies or articles fulfilling the inclusion criteria will be evaluated using a data extraction form. Data on objectives, study population, study setting, study characteristics and outcomes will be independently extracted by two reviewers. The reviewers will independently assess the methodological quality of included studies. A narrative synthesis approach will be employed to summarise and explain the extracted data. Results: The systemic review will be carried out and documented in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses. Conclusions: This systematic review will summarise the evidence and provide recommendations for the development and the implementation of Compassionate Communities and Cities approach in other low resource settings.

Reflections on palliative conundrums related to COVID-19 care in a resource-limited setting: a narrative review

Manudi Nushara Vidanapathirana — 2023-08-23

The third wave of the COVID-19 pandemic in Sri Lanka resulted in a rapid rise in incidence and mortality, and overburdened the resources of the free health care sector. This narrative written by a junior doctor who worked at a COVID-19 high dependency unit in Sri Lanka, brings to light the unique palliative care and humanities dilemmas that occur when rising demands of health care surpass the resources of the system. The article will discuss issues of palliation, end-of-life care and family-centred issues in critically ill patients with prolonged hospital stays. It will also discuss the impact of a pandemic on the mental health of front-liners offering both critical and palliative care, which in turn inevitably affects all aforementioned entities. The author suggests strategies to reduce the consequences of these dilemmas on patient care, through improvement of institutional availability of essential health resources based on correct identification of need, equal distribution of frontline work and accessible institution-based services to prevent burnout among health care workers.

Quality of Life among family caregivers of advanced cancer patients attending the palliative care clinic at National Cancer Institute, Maharagama - Sri Lanka: an observational descriptive cross-sectional study

Marylou Dharmakan — 2023-08-25

Introduction: Caregivers of advanced cancer patients under palliation have many challenges. This is associated with a decline in their quality of life. Objectives: This study was conducted to determine the quality of life among family caregivers of advanced cancer patients attending the palliative care clinic of the National Cancer Institute (NCI) Maharagama. Methods: A total of 266 caregivers of advanced cancer patients under palliation participated in the study conducted. Patient’s data and Socio demographic data were collected. The assessment of the quality of life was done using the World health organization quality of life shortened version WHOQOL-BREF. Results: Majority of patients in this study was between 61-70 years and were male, while most of caregivers were between 41-50 years and were female. The mean scores of the physical, psychological, environmental and social domains in the QOL were 74.8%, 63.53%, 62.67% and 56.67% respectively. The mean score of the total QOL was 64.43. The QOL in every domain was lower than 75% while they were greater than 50%. Conclusion: The quality of life of the family caregiver was most affected in the social domain, followed by the environmental, psychological and physical domain. Family caregiver quality of life should be assessed and this will be a positive step towards cooperating support towards caregivers.

A description and comparison of palliative care services in a developed country and a developing country: England and Sri Lanka and lessons to learn

Weerasingha Navarathnage Sachintha Dilhani — 2023-08-15

Introduction: Palliative care is an essential element of any comprehensive and integrated healthcare system, and access to palliative care is a fundamental human right. The proportion of people in need of palliative care is rising globally. Objective: To describe and compare the palliative care service delivery system to support patients who need palliative care in England and Sri Lanka. Methods: Description and comparison based on expert consultation, reviewing governmental policy, web sites, other documents, and relevant scientific literature. Results: England has a long history of evolution in palliative care, and the country has a well-established palliative care delivery system. Sri Lanka is a developing country with a short history of palliative care initiatives compared to England. However, Sri Lanka has a robust healthcare system in which the integration of palliative care services has already been implemented. Numerous effective initiatives used in England in delivering palliative care services successfully could be adapted and utilized to strengthen the palliative care delivery system in Sri Lanka. Conclusion: Although England has a well-developed and comprehensive palliative care delivery system, compared to Sri Lanka, both countries still showcase the need for further improvement in services. Specific palliative care initiatives applied in England could be incorporated to strengthen and improve the services in Sri Lanka.

Putting community-based palliative care into practice through primary health care: policy, education and service delivery considerations for Sri Lanka

Sashiprabha Dulanjalee Nawaratne — 2023-08-25

Introduction: Palliative care services must be expanded in all settings, most notably at the primary health care level. Objective: This paper aimed to stimulate a discussion on how to promote the deployment of community-based palliative care services that address the holistic palliative care needs of the people through primary health care in Sri Lanka. Methods: A literature search was conducted using key databases using search terms concerning palliative care and primary health care. In addition, government and international websites were searched to identify reports, guidelines, policy documents, and global and country-specific reports on palliative care in the primary healthcare context. Articles and documents produced in English and Sinhala from the year 2000 onward were collected, analyzed, and presented narratively. Results: Following its recognition by National Health Policy 2016-2025, several others (National Strategic Framework for Palliative Care Development, National Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases, National Elderly Health Policy, National Strategic Plan on Prevention and Control of Cancer, Primary care policy, HIV/AIDS policy, Mental Health Policy, etc.) had identified palliative care as a priority area. National Cancer Control Programme has conducted various training and refresher programs, developed publications and training materials, and supportive guidelines and circulars on Palliative Care targeting different categories of primary health care workers. The Palliative Care and End of Life Care Taskforce and the College of Palliative Medicine of Sri Lanka have also developed several publications. Limited home-based palliative care is delivered at present through Public Health Nursing Officers. Primary preventive health services involvement in palliative care provision at present was negligible. Conclusion: Despite many positive factors, there is still much to improve in policy, education, and service delivery on palliative care. By incorporating both primary palliative care and public health palliative care strategies in primary care, Sri Lanka has the potential to greatly improve community-based palliative care

End-of-life care in dementia: a literature review on the global context

Nimali Wijegoonewardene — 2023-08-15

Introduction: Management of dementia has become a major public health problem. For patients with advanced, progressive and incurable illnesses, End-of-life care (EOLC) helps living well as much as possible until death. In dementia, EOLC has important implications for the patient, family and society. Objective: It was realize a literature review attempted to explore the EOLC in dementia in the global context. Methods: The literature review was carried out in mid-2022. Google Scholar was searched for relevant articles. ‘End-of-life care’ and ‘dementia’ were used as the keywords. Forty-six articles identified as relevant, were reviewed. Findings were compiled under identified broad headings. Results: Importance of EOLC in dementia, planning EOLC, scales used in evaluating EOLC, perceptions of patients and family including preferences, priorities, quality and satisfaction on EOLC, enablers for good EOLC, barriers & challenges in EOLC and improving EOLC for dementia patients were the broad headings identified. Often family members had limited knowledge about the disease and were unprepared for decision-making. Preferences of the patients and their family carers or healthcare providers sometimes differed. Communicative, relational and organizational challenges were present during care. Communication on advance care planning improved satisfaction with care. Psycho-social aspects of care is an important aspect. Knowledge on dementia has to be improved among all parties involved. Early decisions on palliative and EOLC options should be taken. Conclusion: Care providers and family should consider patient preferences when deciding and planning EOLC. Patient views need to be obtained early in the course of the disease.

Palliative medicine under the light of regenerative medicine and nutrology: a new paradigm

Idiberto José Zotarelli Filho — 2023-03-16