Specialty training in Palliative Medicine – Need of the hour

The World Health Organisation (WHO) Global Atlas of Palliative Care at End of Life states that for every 1 adult population there are 377 requiring palliative care at the end of life.1 It is estimated that worldwide 20 million people require palliative careevery year at their end of life and 69% are adults (over 60 years) and 6% children. Amongst adults 78% who require palliative care live in low and middleincome countries; 90% of this burden is constituted by those dying from non-communicable diseases like cardiovascular, cancer and chronic obstructive pulmonary disorders in that order. Of the children who require palliative care, 98% again belong to low and middle-income countries. This WHO report also estimates that about 37.4% of all deaths from all causes need palliative care. Temel and colleagues showed that there is a survival benefit when palliative care is applied early in the disease process at the time of diagnosis itself.2 This also shows that suffering, when it is well addressed can prolong useful life and benefit patients. In India an estimated 6 million may need palliative care and 60% of those dying annually will die of long suffering from advanced illnesses.3 Even today only 1% of people requiring palliative care are receiving it in India.4 This scenario is only going to worsen as more people are living longer with incurable diseases and the majority are noncommunicable ones like cancer. In order to implement the WHO revised definition of palliative care5 for adults and children it is imperative to look at the formidable barriers that are existing and the means to tackle them. The major barriers exist at the level of policy, education, medication availability and implementation. The World Health Assembly has asked all member states to integrate palliative care into routine health care, which is seen as a major boost.6 Despite all these measures there remain barriers that are difficult to overcome. Apart from government policies and medication availability, a major hurdle is from within the medical fraternity itself. With medical care always focusing on cure, the health professionals both doctors and nurses refrain from talking anything connected with death.They also refuse to allow effective palliative care to be provided to their patients under the pretext that they are knowledgeable and are already providing it. Therefore the greatest challenge to implement effective palliative care as envisaged by WHO is, to incorporate palliative Specialty training in Palliative Medicine – Need of the hour