Objectives: Fatigue ranks as a highly prevalent and distressing symptom stated by patients undergoing chemotherapy and/or radiation therapy. It significantly compromises the patients’ quality of life (QoL) and functional performance. The objective of this prospective trial was to evaluate the effectiveness of a multi-component self-help intervention package (MSHIP) targeting fatigue and improving functional performance, QoL and aerobic capacity of patients with cancer undergoing chemotherapy. Materials and Methods: A prospective, open, randomised parallel group trial with follow-up at 3, 6 and 12 weeks was adopted. Patients with cancer admitted for the second cycle of chemotherapy, who fulfilled eligibility criteria, enrolled in the study. Baseline data were collected, and participants were allocated into the MSHIP group and the control group with block randomisation. The outcomes were assessed by the Functional Assessment of Chronic Illness Therapy-Fatigue Scale, the Functional Assessment of Cancer Therapy-General Scale, and 6-min walk distance test. Results: The mean age was comparable between groups (experimental 49.17 ± 8.36 years vs. control 48.22 ± 9.21 years). A substantial difference in fatigue scores (F = 86.45, p < 0.001), functional performance scores (F = 27.95, p < 0.001), QoL scores (F = 13.19, p < 0.001) and aerobic capacity scores (F = 27.95, p < 0.001) between MSHIP group and control group was observed. Conclusion: MSHIP intervention empowers and enables patients with cancer undergoing chemotherapy for self-care activities for the management of fatigue and enhancing functional performance, QoL and aerobic capacity. This economic intervention has proved to be beneficial, and hence, it can be integrated into routine oncology clinical practice for its utilisation.
Objectives:Brainstem dysfunction and brain death are important determinants of End-of-life care (EoLC) decisions in intensive care units (ICUs). In many low- and middle-income settings, withdrawal or withholding of life-sustaining treatment remain ethically and culturally challenging despite high costs and limited critical-care resources. This study reviewed the incidence, causes and outcomes of brainstem dysfunction/brain death and examined relatives' decisions regarding EoL care (EoLC) in a tertiary hospital ICU. Materials and Methods:A retrospective chart review was conducted in the ICU of the University College Hospital, Ibadan, covering March 2020- February 2022. Data were extracted from ICU nurses' spreadsheets and patients' case notes and analysed using IBM Statistical Package for the Social Sciences software. Descriptive statistics were used to summarise demographic variables, causes of brainstem dysfunction, duration of survival after diagnosis and family decisions about EoLC. Results:Among 232 ICU deaths during the study period, 24 (10.3%) were preceded by brainstem dysfunction or death. Males constituted 75% of affected patients. The leading causes were severe head injury (54%) and haemorrhagic stroke (21%). About 58% of patients died within 24-72 h of diagnosis and 37.5% had cardiac arrest before brainstem death. Prognosis was discussed with relatives in only 37.5% of cases. The gag and pupillary reflexes were the most frequently used diagnostic tests (100%), while apnoea testing was performed in 12.5% of cases. Conclusion:Brainstem dysfunction accounted for about one-tenth of ICU deaths, predominantly following trauma and stroke. Limited family counselling and cultural reluctance toward EoL decisions remain major challenges. Strengthening communication, ethical awareness and policy support for EoLC could improve patient management and optimise utilisation of limited ICU resources.
Objectives:Early palliative-care integration is recognised by the World Health Organization, American Society of Clinical Oncology and European Society for Medical Oncology as an essential component of comprehensive oncology care, yet referral practices in many low- and middle-income countries (LMICs) remain inconsistent. At our cancer care department in a private tertiary superspeciality hospital with integrated medical, surgical, radiation oncology and palliative care services, only 7.5% of newly registered patients with Stage IV cancer were being referred to the specialist palliative-care team. The objective of this palliative care quality-improvement project was to raise the referral rate to 25% within the next 6 months through structured, system-level interventions. Materials and Methods:Guided by the National Cancer Grid Enable Quality Improvement in the Patient Care-India programme and the Stanford promoting assessment and improvement of the cancer experience framework, we applied an A3-based Plan-Do-Study-Act cycle. A multidisciplinary team following this methodology refined the problem statement, created a SMART goal, mapped the process using GEMBA walk, performed root-cause analysis using fishbone diagram, formulated key drivers and an impact-effort matrix to prioritise interventions while maintaining a run chart. Key actions included (1) finalising and implementing consensus referral criteria, (2) placing placards in outpatient areas/sending referral criteria on e-mail, (3) ensuring mandatory documentation of treatment intent and referral status in electronic prescriptions and tumour-board reports respectively and (4) bi-monthly compliance audits. The primary outcome was the monthly percentage of patients with Stage IV cancer referred to palliative care, plotted on a run chart from November 2020 to July 2021. Results:During the study period, 537 patients with Stage IV cancer (range 35-72/month) were registered; 66 patients were referred to specialist palliative care (range 4-13/month). In the months of November and December 2020, the baseline referral proportion averaged 7.5%. After sequential implementation of the intervention bundle, referrals rose steadily, and an absolute increase of 10.8% was noted, reaching 18.3% in July 2021 despite pandemic-related limitations. Although the project fell short of its target which was 25%, informal oncologist-palliative-care dialogue and tumour-board documentation of treatment intent and referral status compliance improved. Due to COVID-19-related restrictions, certain activities, e.g. standees, Hindi patient leaflets, could not be implemented. Conclusion:This initiative demonstrates that targeted mentorship, locally tailored referral criteria and seamless workflow prompts, can substantially strengthen palliative care integration in oncology, laying the groundwork for durable culture change and better patient outcomes. Scaling similar QI models across services and institutions will be essential to normalise early palliative care as a core component of high-quality cancer care in LMICs.
Objectives:Cancer is a life-changing diagnosis that can cause a lot of emotional pain for both patients and their families. Alongside medical treatments, it is really important to have supportive methods in place that can help ease stress and improve overall well-being. This study aimed to assess the effectiveness of Laughter Yoga in reducing perceived stress among patients with cancer. Materials and Methods:This study employed a time-series, non-randomised control group design with pre-test and post-test measures, conducted within the oncology department of a tertiary care hospital. A total of 60 cancer patients were assessed for stress levels using the perceived stress scale (PSS-10). Participants in the intervention group received Laughter Yoga sessions 3 times per week, each lasting 30 min, over a period of 30 days. Post-intervention assessments were conducted on the 10th, 20th and 30th days for both the intervention and control groups through face-to-face interviews. Results:The findings revealed that the mean pre-test stress score in the intervention group was 33.6 ± 5.74, which significantly declined to 18.9 ± 7.45 following the intervention. In contrast, the control group maintained a relatively stable stress score of 32.53 ± 5.72. Statistical analysis indicated a significant difference in mean stress levels across various time intervals before and after the intervention (F = 383.4, p = 0.001). Post hoc Bonferroni tests further confirmed significant reductions in stress levels at each follow-up point, day 10, day 20 and day 30 when compared to baseline measurements (p = 0.001). Conclusion:The study demonstrated that Laughter Yoga was associated with a significant reduction in perceived stress among individuals with cancer, highlighting the importance of integrating such adjunctive therapies into oncology centres to better support patients experiencing varying levels of psychological distress.
Spirituality significantly shapes how individuals with cancer cope with illness and find meaning throughout the course of the disease. As cancer continues to impose a global burden, understanding these spiritual experiences is essential for holistic, patient-centred care. This scoping review synthesises existing evidence on the constructs and dimensions of spiritual experiences among adults with cancer. Following Arksey and O'Malley's scoping review framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, a systematic search was conducted using medical subject headings terms and keywords across PubMed, Google Scholar and other sources. Eligible studies included adults with confirmed cancer and examined their spiritual experiences. Qualitative, quantitative and mixed-method studies published in English were included. After screening 1,098 records, 133 studies met the inclusion criteria. Data were charted to summarise study characteristics and derive key themes. Among the 133 included studies, 73 were qualitative, 55 were quantitative and 5 were mixed-method. Research spanned 39 countries and included participants across the cancer progression from diagnosis to survivorship and palliative care. Publication trends indicated a steady increase in interest since 2000. Assessment of qualitative component identified core codes of (1) Relationship/Association with God or a Higher Power, (2) Spiritual Practices and Coping, (3) Inner Strength and Transformation, (4) Meaning-Making and Existential Themes, (5) Spiritual Responses and (6) Community and Interconnectedness. Patients frequently relied on prayer, faith and rituals as primary coping mechanisms. Many described inner transformation, strengthened resilience and renewed life purpose. Existential reflections on mortality and life's meaning were common. Some patients also reported spiritual struggles, including doubt or perceived abandonment, reflecting the multidimensional nature of spirituality. The present scoping review explores the multi-dimensional nature of experiences influencing coping, meaning-making, and emotional well-being across illness trajectories. The six identified categories reflect how patients draw on faith, practices, inner strength and community, while navigating through spiritual struggles. The wide variation in constructs and assessment tools underscores the need for more context-specific and culturally sensitive approaches. Integrating spiritual dimension into cancer care can support more holistic, patient-centred care and direction for future research in this area.
Objectives:Non-adherence to pharmacotherapy in an ambulatory palliative care setting can negatively affect therapeutic outcomes. Only a limited number of studies have explored the determinants of therapeutic compliance in the Indian palliative care context. This study aims to evaluate therapeutic compliance, assess attitudes toward medication adherence, and the factors influencing it among patients accessing an ambulatory palliative care service in a tertiary care hospital in India. Materials and Methods:One hundred and five adult patients accessing the ambulatory palliative care service and prescribed palliative pharmacotherapy for at least 1 month participated in this observational study. Data were collected using a study questionnaire that included socio-demographic details, the Morisky-Green test and a validated 17-item Likert scale assessing attitudes towards medication adherence. Statistical analysis comprised descriptive statistics, chi-square tests, Fisher's exact test and logistic regression. Results:Adherence to palliative pharmacotherapy was significantly associated with age, with older individuals (>60 years) showing greater compliance with medications compared to the young (p = 0.041, adjusted odds ratio [AOR] = 2.48, confidence interval [CI]: 1.04-5.95). Individuals with lower literacy levels demonstrated greater compliance than those with higher levels of education (p = 0.049, adjusted odds ratio [AOR] = 3.23, CI: 1.01-10.42). Furthermore, women were more compliant towards palliative pharmacotherapy compared to men (p = 0.017, adjusted odds ratio [AOR] = 3.03, CI: 1.22-7.56). Although other factors such as forgetfulness, affordability and assistance to take medications correlated with medication adherence, these were not found to be statistically significant. Conclusion:In the context of Indian palliative care, older age, female gender and lower literacy levels were associated with increased adherence to palliative pharmacotherapy; these demographic associations with compliance with palliative pharmacotherapy warrant further exploration.
Objectives:This study aimed to compare the Malayalam versions of the 9-item Achutha Menon Centre-Caregiver Burden Inventory (AMC-CBI) with the 22-item Zarit Burden Interview (ZBI-22), hypothesising that caregiver burden in palliative home care settings could be measured comparably using either tool. We also tried to identify a global question or brief screening items for caregiver burden based on the performance of the AMC-CBI items relative to the ZBI-22. In addition, we explored how participants understood and interpreted the ZBI-22 items. Materials and Methods:The study used a convergent mixed-methods design comprising a quantitative survey and qualitative interviews. The survey covered 60 adult primary caregivers of palliative care patients receiving home care in rural Kollam, Kerala, who were interviewed telephonically using a structured interview schedule with the ZBI-22 and the AMC-CBI scales and demographic, socioeconomic and caregiving-related details. Analysis was through descriptive statistics, internal consistency assessments using alpha and omega coefficients and validity assessments using agreement methods on z-transformed scores available in the SimplyAgree package for R and Jamovi, including average bias and limits of agreement and Receiver Operating Characteristic (ROC) analyses. Qualitative interviews were conducted telephonically, audio recorded and done by AMC-CBI. Cognitive interviews (n = 7) were conducted with four experts and three caregivers, using a semi-structured guide, to explore item clarity, relevance, redundancy and comprehension of ZBI-22. In-depth interviews (n = 4) were conducted with four additional caregivers (2 cancer, 2 non-cancer cases; one each with low and high burden) to explore caregiving experiences, and transcripts were analysed to compare narrative alignment with ZBI-22 and AMC-CBI items by two independent reviewers. Results:Internal consistency was high for both tools (α and ω > 0.8). Three AMC-CBI items ('lost hope', 'feel sad', and 'financial burden') were selected for a Brief AMC-CBI (ω = 0.787). Both AMC-CBI p = 0.747) and Brief AMC-CBI p = 0.731) strongly correlated with ZBI-22. Agreement analyses with z-scores (Bland-Altman, Deming regression) demonstrated good agreement, though one outlier was noted. ROC analysis showed AMC-CBI ≥12 and Brief AMC-CBI ≥3 as optimal cut-offs. Identity-related strain over a long caregiving duration might lead to discordant classification with ZBI-22 more likely to elicit burden. Qualitative interviews highlighted some item complexity and translation issues in ZBI-22, especially with the word 'duritham'. Reviewers found the AMC-CBI easier to apply during transcript coding. Conclusion:Both tools, the AMC-CBI and Brief AMC-CBI correctly categorised caregiver burden levels in comparison to the ZBI-22, but AMC-CBI was more contextually appropriate. Selecting the full or the Brief AMC-CBI for caregiver burden assessments would be a thoughtful decision that considers the unique requirements and considerations present in palliative care settings. Further studies on the AMC-CBI or its short form for inter-rater reliability assessments and concordance with the ZBI-22 in larger samples would be useful for enhancing the applicability of these tools.
Objectives:Palliative care aims to enhance the quality of life for patients facing terminal or life-threatening illnesses. Unfortunately, many patients encounter difficulties in understanding their condition, treatment processes and available care options due to limited access to clear and relevant information. This often leads to confusion, disrupted decision-making and increased anxiety. This study aimed to explore patient experiences and information needs in the context of palliative care. Materials and Methods:A qualitative descriptive design was employed, involving 20 participants, consisting of 10 palliative patients and 10 family members, to triangulate data sources. Participants were selected through purposive sampling based on predefined inclusion criteria. Data were collected through semi-structured face-to-face interviews and analysed using thematic analysis. Results:Five main themes with 10 subthemes were identified: (1) Sources of information about palliative care: information from physicians and nurses, information from family members and information from friends or community; (2) Alternative sources of health information included the internet (e.g., Google, websites) and educational videos on social media platforms (e.g., YouTube and TikTok); (3) Facilitators in accessing health information: Direct information provided by physicians and support from family members in obtaining information; (4) Barriers in understanding health information: difficulty understanding medical terminology and (5) Expectations for the Use of Digital Technology: easily accessible online health information and Digital applications or platforms for communication with healthcare professionals. Conclusion:Patient experiences in accessing palliative care information are shaped by interactions with doctors, family members and communities, while the internet and social media serve as additional sources. Most patients reported no difficulties due to the support of healthcare providers and their families. However, medical terminology created barriers to comprehension. Patients expressed strong expectations for hospitals to implement digital technologies to enhance access to information and continuity of care.
Objectives: To evaluate the feasibility of implementing telemedicine for cancer pain management through assessment of patient adherence, quality of life, and satisfaction with palliative care. Materials and Methods: Longitudinal open-label randomised controlled trial (n = 170). Participants were randomised to standard care or standard care plus 4-week telemedicine intervention after baseline in-person assessment using Brief Pain Inventory (BPI) (pain), EQ-5D-5L (QoL) and medication details. All participants received standardised World Health Organization-based pain education. Intervention included weekly teleconsultations with voice or video calls, preceded by short message service reminders, for Numerical Rating Scale (NRS)/pain-free interval assessment, medication details and side-effect monitoring. The primary outcome, medication adherence was assessed through pill counts and interviews; secondary outcomes included pain status, QoL and satisfaction through Telehealth Usability Questionnaire (TUQ). Data were analysed using linear mixed models. Baseline characteristics were comparable between the groups. Results: Overall medication adherence was 90.2%. Participants in the intervention group missed significantly fewer pills when non-adherent (4.40 vs. 11.69, p = 0.003). Pain interference improved significantly ( p = 0.036); breakthrough pain frequency reduced (28% vs. 40.9%, p = 0.011 for ≥5 episodes). Quality of life remained stable or improved in the intervention group, whereas it declined in the control group. (EuroQoL-Visual Analogue Scale +2.46 vs. −1.99, p = 0.049). Overall satisfaction was high, with 76.6% positive responses on the Telehealth Usability Questionnaire (TUQ). Conclusion: Structured telemedicine intervention alongside standard care improved medication adherence, functional pain outcomes and QoL over 4 weeks in cancer pain management in a limited-resource setting.
To evaluate medical costs associated with palliative care (PC) and hospice care (HC) compared with usual care among patients with terminal cancer, while accounting for variations in cost definitions and models of care. A systematic review and meta-analysis of observational studies were conducted. Literature searches were performed in PubMed, Scopus, and ProQuest (January 2010-July 2025). Eligible studies compared the medical costs of palliative or hospice care with usual care in adult terminal cancer patients. Care models were defined according to study-specific criteria. Data were pooled using a random-effects meta-analysis, and heterogeneity was assessed using the I2 statistic. Eighteen studies were included. PC was associated with lower medical costs than usual care (standardised mean difference [SMD] -0.31; 95% confidence interval [CI] -0.35--0.27; p < 0.00001), while HC showed greater cost reductions (SMD -0.64; 95% CI -0.67--0.62; p < 0.00001). The overall pooled effect favoured palliative-oriented models (SMD -0.54; 95% CI -0.57- -0.52). However, substantial heterogeneity (I2 up to 100%) likely reflects differences in cost components, care models and health system contexts. PC and HC reduce medical costs and support integration into routine oncology and end-of-life care.
Hypercalcaemia of malignancy (HCM) is a recognised paraneoplastic complication of advanced cancer, with HHM being mediated predominantly by parathyroid hormone-related protein (PTHrP) secretion. While commonly observed in squamous cell carcinomas, it is exceedingly rare in gallbladder adenocarcinoma, with only isolated case reports described in the literature. We report a man in his 50s with metastatic gallbladder cancer who presented with colicky abdominal pain, constipation, fatigue, low mood, delayed responses and insomnia. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders- 5 th Edition criteria. Laboratory evaluation revealed severe hypercalcaemia with a corrected serum calcium of 18.92 mg/dL, suppressed parathyroid hormone of 7.83 pg/mL and markedly elevated PTHrP of 701.3 pg/mL, consistent with HHM. His condition improved with intravenous hydration, bisphosphonates and calcitonin, along with multidisciplinary palliative care addressing psychological, emotional and spiritual concerns. This case highlights the need to recognise hypercalcaemia as a potential cause of delirium, even in rare malignancies, as timely diagnosis may facilitate prompt symptom management and prevent potentially life-threatening complications.
As psychosocial treatments become increasingly important in palliative care, dignity therapy (DT) emerges as a promising intervention. This systematic review aims to synthesize and critically evaluate the evidence on DT interventions in adults with cancer by integrating findings from randomised controlled trials (RCTs), quasi-experimental, qualitative, and mixed-methods studies. The search terms 'Dignity Therapy' AND 'Cancer' were used to identify RCTs, quasi-experimental, mixed methods and qualitative studies related to DT implemented in adult cancer patients from Scopus and Web of Science databases on 20th November, 2024. Critical Appraisal Skills Programme checklists were used to assess the risk of bias in the studies. Twenty studies were included after a two-stage screening process, out of which 7 were RCTs, 6 were quasi-experimental studies, 5 were qualitative studies and 2 were mixed-method studies. These studies demonstrate that DT enhances dignity, reduces psychological distress and improves family dynamics, particularly in culturally adapted formats. Quantitative findings demonstrate significant improvements in dignity-related outcomes (p < 0.01; d = 1.04-2.45), anxiety (d = 1.73), depression (d = 0.94) and physical symptoms including nausea and insomnia (p < 0.05). Qualitative themes reveal core therapeutic mechanisms: Legacy creation, meaning-making, communion, being heard and cultural adaptation reinforcing DT's psychosocial value. DT was effectively delivered by diverse providers, with family-integrated approaches showing promise in collectivist cultures. The geographical scope restricts generalisability to other cultural settings. High attrition rates (up to 44.2%) and small sample sizes weaken statistical power, and the absence of long-term follow-up data obscures DT's sustained effects. The lack of standardised outcome measures also introduces subjectivity, particularly in qualitative analyses, potentially biasing results. This systematic review concludes that while the report underscores DT's promise in palliative care, mixed findings and methodological gaps highlight the need for more robust, inclusive research to solidify its therapeutic role.
Objectives: This study aimed to assess chemotherapy-related symptom toxicities, nutritional status, psychological distress and palliative outcomes among adult cancer patients in a tertiary care centre in India. Materials and Methods: This cross-sectional observational study selected 254 adult cancer patients undergoing chemotherapy at a tertiary care hospital. Eligible patients were selected for the study. Patients with histologically confirmed malignancies were enrolled, irrespective of cancer histology or prior chemotherapy cycles. Patients with diagnosed severe psychiatric disorders (e.g., schizophrenia, bipolar disorder or major depressive disorder affecting decision-making capacity), those receiving exclusive palliative care or those unwilling to provide informed consent were excluded. A face-to-face interview lasting 10–15 min was conducted after obtaining informed consent, using validated tools such as the National Cancer Institute -PRO-CTCAE ® , full Mini-Nutritional Assessment (MNA), National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) and palliative outcome scale (POS) to assess chemotherapy-related toxicities, nutritional status, distress and palliative care needs. The data were analysed with Jamovi v2.6. Sociodemographic and clinical variables were documented. Descriptive statistics employed frequencies and percentages. Inferential analyses presented continuous data as mean ± standard deviation or medians (Shapiro–Wilk normality tested) and categorical data as proportions. Associations between age, body mass index (BMI), MNA, POS and distress were examined using non-parametric Spearman’s ρ correlations ( p < 0.05 significance). Results: Among 254 chemotherapy patients (71.3% female; mean age 58.5 ± 12.5 years), breast cancer predominated (63%), with 83.9% below the poverty line and 83.1% having comorbidities (diabetes 42.2%, hypertension 36.5%). PRO-CTCAE ® revealed moderate-severe toxicities: Alopecia (36.2%), decreased appetite (18.1%) and fatigue (17.3%). Distress affected 64.6% (DT ≥ 4). Significant malnutrition prevalence (57.1%) was observed, with 36.2% of patients additionally identified at malnutrition risk. Patients exhibited a moderate palliative care burden, with a Palliative Outcome Scale (POS) median score of 2 per item and a mean total score of 19.4 ± 4.7. Spearman’s ρ showed BMI-POS (ρ = −0.230, p < 0.001) and MNA-POS (ρ = −0.150, p = 0.017) were inversely correlated. There were no age associations (all p > 0.05). Conclusion: Chemotherapy patients exhibited high malnutrition (57.1%), distress (64.6%) and toxicities (alopecia 36.2%). BMI and nutritional status showed weak inverse correlations with palliative burden (ρ = −0.230, p < 0.001; ρ = −0.150, p = 0.017). These validated tools (PRO-CTCAE ® , MNA, DT, POS) reveal substantial unmet needs. The absence of multivariable analysis limits confounder adjustment. Targeted nutritional interventions, distress management and symptom control should be explored in future intervention studies to potentially improve quality of life in socioeconomically vulnerable Indian cohorts.
Objectives: Do Not Intubate/Do Not Resuscitate (DNI/DNR) decisions are made when a patient has declined resuscitation, has a poor prognosis or if the patient will not survive intubation with sufficient quality of life. The DNI/DNR discussion is always a complex communication process. The primary objective of the study was to describe the reflections on the experience during conversations on DNI/DNR with the family members of the patients referred for palliative care and conversations through a focus group discussion (FGD) with other medical specialty trainees to improve learning through self-reflection. Materials and Methods: This is a qualitative study. A qualitative reflective study of DNI/DNR conversations was made. Reflections on various experiences during the conversation were carried out using the Gibbs reflective tool. FGD with six other speciality post-graduate trainee doctors was audio recorded after informed consent, transcribed verbatim and thematically analysed. Results: Reflections on self-experience during DNI/DNR conversations were summarised under the following: (i) Difficult conversation, (ii) lack of communication and denial, (iii) influence of financial background and (iv) emotional burden on healthcare workers. Themes identified included factors influencing DNI/DNR conversations (patient demographics and disease onset, early initiation of discussions, empathic communication, and rapport building), emotional burden on healthcare workers, and the need for multiple discussion sessions. Conclusion: The analysis revealed that every conversation differs depending on the patient and his or her family members’ perspectives. Reflections on various conversations help to identify flaws and improve one’s communication skills. Communication skills might improve by practising self-reflection, attending communication skill classes and observing seniors.
Objectives:Cancer and its treatment modalities, such as chemotherapy and radiotherapy, adversely affect physiological stability and psychological well-being, leading to symptoms like pain, anxiety, depression, and stress. Mind-body interventions such as guided imagery (GI) and mindfulness meditation (MM) may help alleviate these symptoms. This study aimed to evaluate and compare the effectiveness of GI and MM on selected bio-physiological and psychological parameters among patients with cancer. Materials and Methods:A quasi-experimental pretest-posttest control group design was adopted among 148 patients with stage II and III cancer undergoing chemotherapy or radiotherapy in a tertiary care hospital in South India during 2023-2024. Participants were assigned to GI (n=49), MM (n=49), and control (n=50) groups. Interventions were administered for 15 minutes twice daily over four weeks. Physiological parameters (heart rate, respiratory rate, systolic and diastolic blood pressure, salivary amylase) and psychological variables (pain, depression, anxiety, and stress) were assessed at baseline and post-intervention. Data were analyzed using repeated measures ANOVA, one-way ANOVA, Wilcoxon signed-rank test, and Bonferroni post hoc test, with significance set at p<0.05. Results:Both GI and MM groups showed statistically significant improvements in physiological and psychological parameters compared to the control group (p<0.001). Significant reductions were observed in heart rate, respiratory rate, blood pressure, salivary amylase levels, pain, depression, anxiety, and stress. MM demonstrated relatively greater improvement in psychological outcomes, while GI showed comparable effectiveness in physiological stabilization. Conclusion:Guided imagery and mindfulness meditation appear to be effective, feasible, and low-cost non-pharmacological interventions that improve physiological relaxation and psychological well-being among patients with cancer. Integration of these interventions into palliative and oncology nursing practice can enhance holistic patient care.
Objectives: For end-stage kidney disease (ESKD) patients on maintenance haemodialysis (MHD), end-of-life care (EOLC) and dialysis discontinuation are established in Western nations, but family perspectives in the intensive care unit (ICU) remain understudied in developing nations like India. This study examined families’ perceptions of EOLC, dialysis withdrawal and life-sustaining drug discontinuation for MHD patients in our ICU, where the Kidney Supportive Care (KSC) team was part of the Primary Medical Board (PMB). Materials and Methods: A cross-sectional survey examined family input for MHD ICU patients undergoing EOLC and dialysis discontinuation assisted by KSC team (palliative care expert, nephrologist and intensivist). We gathered baseline data, ICU admission causes, 24 h pre-death symptoms and withdrawal advice and used Statistical Package for the Social Sciences 21 for statistical analysis. Results: 23/98 MHD patients (82.6% male, mean age 57 ± 12.09 years) underwent EOLC. ICU admissions were mostly for infection (47.8%). The most prevalent pre-death symptom was agitation (86.9%). Haemodynamic decline (82.6%) and disease progression (69.5%) drove withdrawal. All patients underwent dialysis withdrawal and had ‘Do Not Resuscitate orders instituted. The rate of ventilator and inotrope withdrawal was 80% and 50%, respectively. 74% of families attended, and 20% received spiritual leader visits during EOLC. All participating family members reported no guilt and provided positive feedback for KSC team engagement during EOLC. Conclusion: Our study highlights complete agreement of families on dialysis withdrawal and providing EOLC support in our ICU setting for ESKD patients. It also emphasises the need for a dedicated PMB with the KSC team for a better EOLC, which provides family satisfaction and avoids redundant interventions.
