Global Palliative Care

Did you know that 40 million people need palliative care at end of life, but only 10 percent receive it, and that 80 percent of patients who need these services live in limited resource countries? The magnitude of this need drives Dr. Suparna Qanungo, CON Associate Professor and Director for Global Health, who is committed to expanding palliative care on a global scale to those most in need. Along with her collaborators from Clemson (Dr. Kathleen Cartmell), TATA Medical Center, India (Dr. Gaurav Kumar), and Saroj Gupta Cancer Center, India where the pilot project was completed (Drs. GB and Roy), she embarked on a mission to improve the lives of patients needing palliative care in rural underserved areas. Qanungo recently shared about this work implementing a home-based palliative care program for cancer patients in rural India, facilitated by community health workers (CHW). From virtually training CHWs located half a world away to traveling to India to take part in home visits, she is deeply invested in seeing these initiatives succeed.

Dr. Suparna Qanungo, CON Associate Professor and Director for Global Health:

“The extremely limited use of palliative care in low resource settings exacerbates suffering in patients with life-limiting illnesses such as cancer. This is particularly a problem for patients living in rural areas where barriers to care are even more pronounced. These barriers include factors such as distance from a cancer center, lack of healthcare providers in rural communities, restrictive morphine access policies, lack of transportation and treatment costs. For these reasons, most patients living in rural communities never receive palliative care or even basic pain management.

In recognition of the urgent need for palliative care in limited resource settings, the World Health Organization released the Palliative Care Toolkit as a resource that community members can use to deliver palliative care in their own communities. The toolkit provides evidence-based educational materials to manage the physical, emotional and practical challenges of life-threatening illnesses, along with data collection instruments to assess and manage patient needs.

The purpose of this study is to carry out a pragmatic clinical trial to evaluate implementation of a novel intervention that will leverage community health workers to facilitate the delivery of basic palliative care using the WHO Palliative Care Toolkit. The study is being conducted at the Tata Medical Center in Kolkata India, among their patients who reside in the rural regions of 24 Parganas outside of Kolkata, India. With randomization at the patient level, there will be an intervention group which will receive home-based palliative care services facilitated by a community health worker trained in palliative care and a control group which will receive standard cancer-center based palliative care services.

Two specific aims will be evaluated within the study. Aim 1 will be to evaluate implementation of the home-based palliative care intervention within the context of the RE-AIM Framework domains (e.g. Reach, Effectiveness, Adoption, Implementation and Maintenance). Aim 2 will be to evaluate outcomes of this intervention to determine its relative effects compared to a standard control group on diverse patient endpoints, including palliative care needs, symptom burden, quality of life and experience with care.

The role of the community health worker is the following:

• Visit patient/family 1+ times weekly, facilitating basic palliative care (i.e., medication administration, wound care, catheter care)
• Serve as link between patient/family and cancer center using telehealth
• Monitor pain & symptom control
• Educate patient family on disease and symptom management
• Help find community resources to help with practical challenges (i.e. transportation, insurance, nursing care, medication availability, spiritual support services)
• Provide/facilitate emotional support for patient/family
  
  Our long-term goal is to develop a feasible, effective and sustainable model for delivering home-based palliative care for cancer patients in rural underserved areas.”