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Can Symptom Relief Be Provided in the Home to Palliative Care Cancer Patients by the Primary Caregivers?: An Indian Study

Chellappan, Sheeba MSc(N); Ezhilarasu, Punitha PhD, MSc(N); Gnanadurai, Angela PhD, MSc(N); George, Reena MD, DNB, Dip Palliative Medicine; Christopher, Solomon MSc (Bio-stat)

doi: 10.1097/NCC.0000000000000098
Articles: Online Only

Background: A large proportion of cancer deaths occur in the developing world, with limited resources for palliative care. Many patients dying at home experience difficult symptoms.

Objective: The objective of this study was to assess the feasibility of a structured training program on symptom management along with an acute symptom management kit for primary caregivers of cancer patients receiving home care.

Methods: Descriptive design was used. Thirty primary caregivers of cancer patients attending the palliative care clinic in Vellore, South India, were provided training on the administration of drugs for acute symptoms. A plastic box with partitions for drugs specific to symptom was provided. On follow-up visits, the usage of the kit, drugs used, and routes of administration were noted. A structured questionnaire with a 4-point scale was used to assess primary caregiver views and satisfaction.

Results: Of primary caregivers, 96.7% used a kit. The common medications used were morphine, metoclopramide, dexamethasone, and benzodiazepines. Seventy-three percent of primary caregivers administered subcutaneous injections at home. Hospital visits for acute symptoms reduced by 80%; 90% were satisfied with the training received; 73% stated it was not a burden to treat the patient at home.

Conclusion: The training program and acute symptom management kit were favorably received and appropriately used by caregivers of diverse backgrounds. Rural backgrounds and illiteracy were not barriers to acceptance.

Implication for Practice: Healthcare professionals should train caregivers during hospital visits, empowering them to manage acute symptoms and provide simple nursing care. This is doubly important in countries where resources are limited and palliative care facilities scarce.

Author Affiliation: Christian Medical College, Vellore, Tamil Nadu, India.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Sheeba Chellappan, MSc(N), Christian College of Nursing, Neyyoor & Post, Kanyakumari Dist, Tamil Nadu, South India 629 802 (

Accepted for publication August 13, 2013.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins