G M Cancer Research Trust Palliative Care Unit Salt Lake City Medical Center

ESMO Designated Centre of Integrated Oncology and Palliative Care

Contact person Dr G S Bhattacharyya
Address Salt Lake City Medical Center,
DD10, Sector I, Salt Lake,
Kolkata, West Bengal 700064
Country

India

Contact Tel: (+91) 9831011517 -
Web G M Cancer Research Trust Palliative Care Unit Salt Lake City Medical Center
Kolkata G M Cancer Research Trust Palliative Care Unit - Salt Lake City Medical Centre

Centre History:

The center started in 2002, as a Community based Cancer care center with 22 beds. In 2010 the number of beds were increased to 40 and Palliative Care center was formally started to accommodate the extra Palliative Care beds. The center provides Supportive and Palliative care.
The department has 8 published papers in Palliative care with multiple presentations in National and International forums.

Department Profile:

The centre is a multi-disciplinary oncology center with both indoor and outdoor facility and a day care unit. The Department has all 3 major therapeutic areas, Surgery, Medical Oncology and Supportive therapy. The basis of care is Goal directed therapy with continuum of care.
All patients go through a Multi-disciplinary Tumor Board attended by a Multi-disciplinary team, including Palliative Care and Supportive Care specialist, with Nursing support and Psychologist.

There are 2 Surgical Oncologists, 2 Radiation Oncologists, 3 Medical Oncologists including 1 trained in Palliative Care, 1 Physician, 1 Psychologist, 1 Psychiatrist, 3 Nurses, 1 Nutritionist, 1 Radiologist, 1 Ethicist, 5 Volunteers, 1 Hindu Priest and 1 Chaplain. Palliative care starts from Day 1, which includes handling of pain, depression and control of symptoms. Joint rounds are given once in a day and grand rounds are given once in a week. The sharing of responsibility is done on principals of managed care and shared care. This also includes patient support groups formed by volunteers including Specialists.

All major disciplines of oncology care are available in-house with pharmacy, laboratory and imaging. Palliative care assessments are done jointly within the Tumor board and all patients are psychologically assessed and for psychometry. All geriatric patients are assessed for Activity of Daily Living (ADL) and Activity of Instrument for Daily Living (AIDL).

A full-fledged emergency unit running 24 hours a day, is managed by an Emergency Medical officer (trained Interventionist), 4 nurses (all trained for emergency medicine including advanced life saving training) running in 3 shifts per day and an EMT team, the total number of emergency beds is 6. The unit is fully equipped for intensive care along with a step down unit with 4 beds including 2 nurses and 1 doctor.

The unit also works as described above during out of office hours. The rota for on-call are available for physicians, there is real time online telephone communication with the consultant as well as SMS messaging. Arrangements are also there to get the physician who may be required.

A line of communication is opened with the patient care giver, provider and family. The center provides emergency care of inadequately relieved physical and psychological symptoms. The center is a cancer center with an oncology department which provides closely integrated oncology and palliative care clinical services.

Areas of Specialisation:

Geriatric palliative care, multidisciplinary Palliative Care, routine psychometry test, problem oriented medical records and diagnosis, emergency palliative care, clinical trials in palliative care, home care.

Palliative and Supportive Care:

Kolkata G M Cancer Research Trust Palliative Care Unit - Salt Lake City Medical Centre Staff

Palliative care starts from Day 1, which includes handling of pain, depression and control of symptoms. Joint rounds are given once in a day and grand rounds are given once in a week. The sharing of responsibility is done on the principals of managed care and shared care. This also includes patient support groups formed by volunteers including Specialists. All major disciplines of oncology care are available in-house with pharmacy, laboratory and imaging. Palliative care assessments are done jointly within the Tumor board and all patients are psychologically assessed and for psychometry. All geriatric patients are assessed for Activity of Daily Living (ADL) and Activity of Instrument for Daily Living (AIDL). Teaching programs for nurses, resident physicians is undertaken.

For patients who are no longer benefiting from definitive anti-cancer treatment, supportive care and palliative care is continued, usually at home, including hospice, the principals of continuum of care is usually done by volunteers and nurse, sometimes physicians from local areas are interacted with, to provide domiciliary care. Patients who are deemed to be terminal and with life expectancy less than 12 weeks are put on terminal care. The usual care is based on the guidelines laid down by EAPC and AAHPM. The end of life care is administered following guidelines of Center for Advanced Palliative Care (CAPC).

All patients are physically examined and stratified by Performance Status, ADL, AIDL and Carlton’s co-morbidity index. Geriatric patients are assessed by comprehensive geriatric assessment. Nutritional assessment is made by Minnesota assessment scale. Psychometric analysis is done. The patient on arrival in the Out Patients Department first meet the Receptionist and from there directed to a Junior Physician for physical examination and documentation. Then he/she is sent for Psychometric assessments and finally seen by an Onco-physician referred to Tumor Board. The Board after assessments directs the therapy. For admitted patients the same is done but at the bed side. All the above have Standard Operating Procedures which is per Protocol. Patients are evaluated on standard algorithmic protocols for problem shooting and cross consultation for definitive systemic disease is made. Records are put on to problem oriented medical records (POMR) and are used to assess time to time changes.

Inadequately controlled psychological problems or inadequate support is usually handled in following way:
a) General information; b) Interviewing patient with an accompanied person taking notes, discussing the problem and fixing a further date for interview in case of OPD patients. Team members are called for admitted patients at the bed side for re-assessment and all problems are readdressed to find root cause and solutions are made and reviewed the next day, for fixation of responsibilities. These are all recorded as audio and then transcribed. Consent forms are taken for audio recording.

Delivering home care and respite care is available.

For patients who are no longer benefiting from definitive anti-cancer treatment, supportive care and palliative care is continued, usually at home, including the hospice, the principals of continuum of care is usually completed by volunteers and nurse, sometimes physicians from local areas are interacted with, to provide domiciliary care. Patients who are deemed to be terminal and with life expectancy less than 12 weeks are put on terminal care. The usual care is based on the guidelines laid down by EAPC and AAHPM. The end of life care is administered following guidelines of Center for Advanced Palliative Care (CAPC).