THE JIMMY S BILIMORIA FOUNDATION launched its PALCARE service on 1 December 2015. The growth of the service prompted the need for guidelines to enable the delivery of standardized and high-quality care across the team.

In November 2016, PALCARE constituted a Clinical Consultative Committee (CCC) comprising of experienced and reputed medical professionals in palliative care, to develop robust, evidence based, clinical guidelines in palliative care for a multidisciplinary team, which are relevant for the care of patients in a home setting in India.

The CCC comprises a cohort of experienced medical personnel in palliative care who have a profound understanding of palliative care services in the Indian context. They include:

1. Dr. R. Akhileswaran chairs the Committee. He is a specialist in Palliative Medicine and Radiation Oncology. He has trained and worked in both specialities in the US, UK, France and India. He currently works full time as a palliative care specialist in Singapore.
2. Dr. Jeremy Johnson has over 25 years’ experience in Palliative Medicine at the Consultant/Medical Director level in the UK, where apart from a busy clinical workload, he was involved in setting up, implementing and developing palliative care services and training programmes. Since 2015, he is the Director of Education and Research at Karunashraya, Bangalore Hospice Trust.
3. Dr. S. Jenifer Jeba is Professor in Palliative Medicine, Department of Medical Oncology, Christian Medical College and Hospital, Vellore. She completed her post-graduation in Radiation Oncology and the Dip Pal Med and MSc Pal Med from Cardiff University, UK, for which she was awarded the “Dame Cicely Saunders Medal”.
4. Dr. P Jayarajan, is PALCARE’s Chief Medical Officer. He has over 10 years’ experience in palliative care, and has worked in Kerala and Mumbai in leadership positions. He has completed the Dip Pal Med from Cardiff University, UK.
5. Ms. Anu Savio Thelly has specialized in both Palliative and Alternative Medicine. She acquired her MSc in Nursing from the Narayana Hrudayalaya College of Nursing in Bengaluru. In 2014, Ms. Thelly received a third prize for the “No Pain for Children – Pediatric Palliative Care Excellence Award” in Rome, Italy.

METHODOLOGY

The CCC was committed to ensure that the PALCARE guidelines were developed with rigor and excellence. No effort was spared to make the end product of a pre-eminent standard.

1. The PALCARE TEAM, led by the CMO, first identified 39 relevant topics under 8 broad categories, comprising 39 specific guidelines, which were approved by the CCC. The list of guidelines appears on the left menu bar.
2. A list of abbreviations used in the guidelines is also available on the left menu bar.
3. The CMO chose a few topics for each monthly session of the CCC. Bringing to bear his decade long experience in palliative care, as also closely examining other guidelines across the globe, he and his team undertook detailed literature review and intensive study of different available guidelines to produce a first cut.
4. This first draft was presented well in advance of each meeting to members of the CCC, who studied each draft in great depth, sought clarifications, commented, changed, added new insights and engaged in rigorous discussion and debate through monthly Skype conferences, till it finally met the CCC’s high level of perfection.
5. Because the members of the CCC are multi-locational, the CCC held meetings by Skype, which lasted several hours at a time. Once a year, the CCC met in person.

CAUTION & DISCLAIMER

• These guidelines have been designed specifically for the PALCARE establishment’s medical team.
• The guidelines are primarily customized for the use of trained medical personnel to care provision at a home-based setting, for patients with incurable diseases more towards end of life, the majority being cancer patients.
• The CCC recognises that the guidelines can only be as the term suggests – a “guide”. They are, therefore, “recommendations” for “most common situations” in a home care milieu in India. The CCC, therefore, recognises that there will be exceptions to common situations, and has advised the PALCARE team that they need to be considered and amended on a case-to-case basis.
• The CCC plans to review the guidelines every couple of years, to ensure that they continue to be relevant and evidence based. The CCC will also add new guidelines as and when it deems necessary.