|Year : 2014 | Volume
| Issue : 1 | Page : 21-23
Palliative care: Bridging the unmet spiritual, physiotherapy, and emotional aspects in cancer patients
Mukesh Kumar Singhal1, Akhil Kapoor1, Puneet Kumar Bagri1, Kapur Thalor1, Satya Narayan1, Ruchi Mittal2, Raj Kumar Nirban1, Harvindra Singh Kumar1
1 Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner, Rajasthan, India
2 Department of Yoga Sciences, Yoga and Spiritual Medicine Center, Bikaner, Rajasthan, India
|Date of Web Publication||2-Jun-2015|
Mukesh Kumar Singhal
PBM Hospital Campus, Bikaner - 334 003, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Palliative care is a technique to enhance the quality of life of patient suffering from devitalizing illness. This literature review is the work accomplished to pave the strong foundation of palliative care to the needy patients and their families. At the level of hospice care, besides doctors' and nurses' skills, tender care and affectionate support is much more needed then medicines. Materials and Methods: Literature search was performed using the terms "palliative care", "spiritual", "physiotherapy", "cancer patients" and "emotional aspects". The full articles available in English were reviewed. Results: Palliative care is a sophisticated requirement in cancer patients. Most of the available literature has stressed that there is a large gap between the actual demands and provision of palliative care including spiritual, physiotherapy, and emotional aspects in cancer patients. Conclusions: This article discusses various aspects of palliative care and how they influence attitude of the patient and his or her family toward the curing therapy. This provides guidance how nurses and doctor can create non-medication environment for ending suffering and pain for better quality of life by tending them spiritually, physically, and emotionally.
Keywords: Emotionally, palliative care, physiotherapy, spirituality
|How to cite this article:|
Singhal MK, Kapoor A, Bagri PK, Thalor K, Narayan S, Mittal R, Nirban RK, Kumar HS. Palliative care: Bridging the unmet spiritual, physiotherapy, and emotional aspects in cancer patients. Int J Yoga - Philosop Psychol Parapsychol 2014;2:21-3
|How to cite this URL:|
Singhal MK, Kapoor A, Bagri PK, Thalor K, Narayan S, Mittal R, Nirban RK, Kumar HS. Palliative care: Bridging the unmet spiritual, physiotherapy, and emotional aspects in cancer patients. Int J Yoga - Philosop Psychol Parapsychol [serial online] 2014 [cited 2020 Jul 3];2:21-3. Available from: http://www.ijoyppp.org/text.asp?2014/2/1/21/157989
| Introduction|| |
Palliative care is more than just tender loving care.  It is a technique to enhance the quality of life of patient suffering from devitalizing illness. If disease is curable, symptoms are treated to reduce pain bearded by the patient. Cure may involve physical, spiritual or psychological support to the patient and the affected family to relieve them from the illness and deprivation. It is not the end of life care; it focuses on making patient and family members optimistic and enhances their quality of life, no matter what will be the end result of treatment.
For patient suffering from an incurable disease, it's exacting when he or she becomes aware of it. Recovery of that patient and associated members need flawless identification and treatment of all types of problems; economic, emotional, spiritual, physical, and psychological.
Palliative care is generous intimacy and perception. It as applicable to enduring diseases that cause poor quality life, not only for patient bur also for family. It is practiced by multi-dimensional team which encompasses not only doctors, nurses but also counselors, volunteers, family members and professionals. Concept of palliative care in India was introduced late in mid-1980's. In India, the earliest facilities to deliver palliative care within cancer centers were established in some places like Ahmedabad, Bengaluru, Mumbai, Trivandrum, and Delhi in the late 1980s and the early 1990s.  India has a history of palliative care for more than two decades, but it is estimated only 2-3% cancer patients or incurable disease patients have accessed these services. The system in the country taken as a whole seems erratic as only 144 hospices cover entire country, maximum patchy in Kerala.  One of the important steps in the history of palliative care development in India also began from here; forming of Indian Association of Palliative Care (IAPC). In 1986, Professor D'Souza opened the first hospice, Shanti Avedna Ashram, in Mumbai, Maharashtra, and Central India.  The IAPC was registered as Public Trust and Society in March 1994 in Ahmedabad. IAPC held its first international conference at Varanasi in January 1994 (with the assistance of WHO and Government of India) and adopted a constitution. 
- Physical problems such as pain, vomiting, breathlessness and so on
- Psychological problems such as depression, anger or emotional isolation, etc
- Social problems can be monetary affairs due to loss of employment, cost of treatment, social isolation, etc
- Spiritual pain (Why me? Why did God do this to me? Or what is the point of my being alive?).
Palliative care is an essential part of treating cancer or any incurable disease, and it must be made mandatory to reserve beds in each hospital for palliative care and further doctors and nurses must be trained in this special care.
| Spiritual aspects of palliative care|| |
Spiritual pain is a deceptive concept to discuss as this pain is the destruction of reality from self. Spiritual Care is focused care that helps the patient to overcome inner strength naturally during phase of being highly ill. Victor Frankl, a psychiatrist who wrote of his experiences in a Nazi concentration camp, wrote: "Man is not destroyed by suffering; he is destroyed by suffering without meaning."  Patient is highly puzzled in why, how, what happened to me? Pain of disease as well pain of being parted from family and thoughts of afterlife stumps the patient into dilemma of deepest pain. If complete cure is not possible, healing therapy is, of course, the solution by acquiring the illness and maintaining peace in soul and mind. This is possible by rising and touching spiritual being in self. Spiritual care is a peculiaristic exercise to emboss the spiritual beliefs and values to translate mental sickness to harmonious frame of mind.
Hinduism states path to "Moksha" the ultimate path which is the salvation from the cycle of birth, death and rebirth. Hindu ethics is also based on "Karma" that throws light on deeds; good deeds lead rebirth in high domain and bad actions lead to malicious rebirth. Both erotic and ascetic practices increase spiritual knowledge of and union with the divine. 
Buddhism states life is most precious thing and has the highest potential achieve Enlightenment along with "everyone must die".  It believes that we are living in the light of death; remainder life span is decreasing continuously. Wealth loved ones, and even body is unsubstantial. Buddhism focuses on the attainment of peace through physical and mental state is known as "Nirvana," which is the highest level away from sufferings. As per Buddhist belief, mind must be highly alert during the phase near to life end. Hence, patients require exercising positive attitude towards it by gentle chanting, praying and meditation. Buddhism sense of spirituality not only convincing to end sufferings but also to revise external unfavorable procedures. Buddhists believe that suffering is part of life, to be expected and that if a person experiences pain and suffering calmly and peacefully, without becoming emotionally weak, he can reach heights of reality of rebirth by accepting life is suffering.
Christianity states prayer treatment is an efficient choice for doctors and other medical care. In their regard, sufferings and end of life is punishment of the actions did, it is the temporary detachment of soul and body. It provides a culture of relationship with dignity that charts the God's will which will guarantee eternal life with God. The dying person receives a holy water signifying body and blood of Christ. Christians call for love for each other and consider that all of us are part of the body of Christ.
Islamic belief system only God is to be worshiped and served. They consider sin if a person without remembering God and also do not allow the use of anesthetic for death. Islamic followers are supposed to remember God in their pain and suffering and seek patience and peace, ask for forgiveness. They do not consider death a punishment but part of life as an end to one phase and enter new journey.  Jain Patients wish to recite prayers or read religious books/scriptures or listen to religious audio recordings. Decisions on the withdrawal of life support will be made by personal choice with the advice of a spiritual leader.
Birth, death, aging, and sickness are all part of life. Understanding the treatment according to the patient's spiritual belief may help a lot doctors and nurses to fix sickness rapidly. In spite of longer untouched feelings practices on patients, short-term kind understanding can make medicines also result positively sooner.
| Physiotherapy aspects of palliative care|| |
World confederation for physical therapy (WCPT) defines physical therapy as "… providing services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the life-span. Physiotherapy involves the interaction between physiotherapist, patients or clients, families and care givers, in the process of assessing movement potential and in establishing agreed upon goals and objectives using knowledge and skills unique to physiotherapists". 
In general, physical indications implicate pain, fatigue, weakness, vomiting, shortness of breath, nausea. These can be revived using techniques such as physical therapy, nutrients therapy, chemotherapy, radiation therapy (use of X-rays, gamma rays, neutrons, protons) to reduce cancer, cyst, tumors that cause pain and other problems. Need for physical therapy arises from the fact that maximum immature cancer patient deaths are the result of poor nutrition and lack of physical activeness. Therapist can guide family members, directly put into care or act as active teammate of therapy.
Exercises as a treatment for altered psychological states have been through over the years grounded on the principle, "sound mind and a sound body." Though exercise had been a part of behavioral medicine for treating altered physiological states such as obesity, diabetes, cardiovascular risk modification and smoking according to Martin and Dubbert. 
It demands respect for the individual rights for appropriate physical therapy during any changes in medical reports. Persisting extended care for activeness in patient. Interdisciplinary team must be formed to support pain and enhance the quality of life.
| Emotional aspects of palliative care|| |
After long and serious trauma of illness, burden on the mind is to the same extent as burden on the body. A number of studies in recent years have shown that patients who have their symptoms controlled and are able to communicate their emotional needs have a better experience with their medical care. Emotional problems faced by patients must be sieved by doctor then only he can be called specialist in Palliative care because this is as mandatory as treating illness. Symptoms displaying emotional failure are fear, anxiety, and depression. This can be treated by expertise counseling, family meetings. Kind, soft and generous emotional attachment of doctor or teammate caring results in far better results, in respect to a just medicating process. As per my opinion emotional support is much more necessary than any treatment.
| Future studies|| |
Introduction of palliative care training programs for physiotherapists all over the country and the need of subjective research on past unsuccessful experiences. Also, alteration in professional end-of-Life care is alarming due to the growing number of patients.
| Conclusion|| |
This study shows palliative care improves quality of life of patient and family members, also makes treatment easy. This paper also signifies the urgent need of multiplying palliative care to enhance mental and mechanical capabilities of the patient. Provision of psycho-emotional support is more valuable. Patients who had suffered from long still deserve the best quality of health and hospitals, palliative professionals can provide it. Direct program costs are more than offset by the financial benefit to the hospital system.  The authors conclude that support meetings will be effective in resourcing the arising needs of patients and the experienced palliative care staff, and it can be more satisfactorily done by training, coping strategies, palliative management and financial support body.
| Acknowledgments|| |
The authors would like to thank consultants in Department of Oncology, Dr. Ajay Sharma, Dr. N Sharma and Dr. S L Jakhar and Dr. S. Beniwal. Also, they express gratitude to PG Students of the department: Dr. Daleep Singh, Dr. Sitaram, Dr. Guman Singh, Dr. Murali, Dr. Tanya, Dr. Rajesh, Dr. R Purohit.
| References|| |
palliumindia.org. What is palliative care? Pallium India c2007-2014. Available from: http://www.palliumindia.org/resources/faq. [Last accessed on 2014 Jul 25].
Mohanti BK. Ethics in palliative care. Indian J Palliat Care 2009;15:89-92.
mecc.cancer.gov. Sharma S. Palliative care the Indian scene. Available from: http://www.mecc.cancer.gov/pallative_care_workshop/kumar-indian_scene.pdf. [Last accessed on 2014 Jul 24].
de Souza LJ, Lobo ZM. Symptom control problems in an Indian hospice. Ann Acad Med Singapore 1994;23:287-91.
Khosla D, Patel FD, Sharma SC. Palliative care in India: Current progress and future needs. Indian J Palliat Care 2012;18:149-54.
amazon.com. Frankle VE. Man's Search for Meaning. 1984. p. 14. Available from: http://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl/dp/080701429X. [Last accessed on 2014 Jul 18].
endoflife.northwestern.edu. World Religions: Buddhism. Available from: http://www.endoflife.northwestern.edu/religion_spirituality/buddhism.htm. [Last accessed on 2014 Jul 25].
urbandharma.org. A Buddhist guide to death, dying and suffering. Available from: http://www.urbandharma.org/kusala/dad.html. [Last accessed on 2014 Jul 15].
ispi-usa.org. Guidelines for health care providers interacting with Muslim patients and their families. Available from: http://www.ispi-usa.org/guidelines.htm. [Last accessed on 2014 Jul 10].
Kumar SP, Jim A. Physical therapy in palliative care: From symptom control to quality of life: A critical review. Indian J Palliat Care 2010;16:138-46.
scu.edu. Paulus SC. Palliative care: An ethical obligation. Available from: http://www.scu.edu/ethics/practicing/focusareas/medical/palliative.html. [Last accessed on 2014 Jul 10].