Outcomes of Respite Palliative Care Unit intervention in Patients with Advanced Cancer in an Indian settings: A Retrospective Observational Study

Patients with advanced cancer may exhibit a range of symptoms throughout the disease trajectory. The occurrence of the symptoms in patients with advanced cancer can differ in different palliative care settings. Patients may experience more than one symptom. Most patients with cancer experience symptoms, the prevalence and severity of which vary according to the type, stage, and performance status of the cancer. In advanced cancer, 35–96% of patients experience pain, 32–90% experience fatigue, and 10–70% experience breathlessness. High-quality symptom assessment and management are fundamental to providing holistic, patient-centered care that results in positive outcomes for patients and their families. Despite their universality, most symptoms experienced by patients with advanced cancer cane effectively managed using pharmacological and/or nonpharmacological approaches. Therefore, symptom assessment and management are crucial in palliative care. Palliative care is provided through a range of approaches, each designed to address the unique needs of patients and their families in various care settings. Outpatient palliative care clinics serve patients who can visit, even in the earlier stages of illness, by focusing on symptom management and advance care planning. Hospital-based palliative care involves specialised interdisciplinary teams that manage complex symptoms and provide support in inpatient settings. Community-based and home-based models extend care to patient homes, offer continuity, and reduce hospital visits. Hospice care, typically reserved for patients with limited prognosis, emphasises comfort and dignity at the end-of-life. Respite palliative care offers short-term, temporary care for patients to give their primary caregivers a break from their responsibilities. The definition of respite care remains unaddressed in current studies.

As per the literature, respite care is involved in providing relief or breaking to caregivers from their caregiving activities, and it can be provided across multiple settings and can include in-home respite such as daytime or overnight care; inpatient care in hospices, nursing homes, or hospitals; or day care. Ingleton et al. described respite as both a service and outcome. Services include inpatient care, day care, and home-based care. It is designed to produce a positive effect on caregivers, enabling them to continue their role. Despite the potential advantages of respite care, research on its efficacy has been extremely limited and has not produced a substantial body of empirical evidence on outcomes, either for caregivers or for people receiving respite(8).In India, respite palliative care is a step-down version of in inpatient unit.

Our Respite Palliative Care Unit [RPCU] is a dedicated quasi-9-bedded inpatient facility 80 meters away from our tertiary cancer care centre. The aim is to provide comprehensive care to patients with advanced cancer and their caregivers. Patients registered under the Department of Palliative Medicine with a performance status of ECOG 0–3 and stable vital parameters, and who have uncontrolled physical symptoms, as well as psychosocial and/or spiritual needs, are eligible for admission to the RPCU. It consisted of a multidisciplinary team of palliative care physicians, nurses, psychologists, social workers, rehabilitation therapists, and volunteers. The RPCU focuses on effective evidence-based symptom management, aiming to enhance the comfort and well-being of both patients and caregivers. In addition to physical care, psychosocial and spiritual care is offered to address the emotional, psychological, and existential needs of patients and caregivers. We also focused on engaging patients and caregivers in meaningful activities that support their physical and psychological well-being during RPCU stay.

Recognising the crucial role of caregivers, the RPCU is equally committed to empowerment and support. Caregivers receive hands-on training in essential skills of care, such as wound dressing and timely administration of medications. We also conducted  family meetings to help reduce caregivers ’distress and emotional fatigue. Regular support group meetings were organised to foster peer learning, shared experiences, and emotional solidarity among the caregivers. Through a combination of

education, emotional support, and skill-building activities, the RPCU strives to create a compassionate environment in which both patients and caregivers are supported, empowered, and equipped to navigate their journey with dignity and resilience. This is the first in its kind in the country and started as a service model since 2019. Hence, this study aimed to provide information regarding the clinical outcomes of patients admitted to an RPCU at a tertiary cancer centre.