CHAPTER - 1

INTRODUCTION

Muzammil pattasseri

THE PAIN AND PALLIATTIVE CARE SOCEITY

Is a registered charitable society established in September 11, 93, it is an organization of medical professional and volunteers, dedicated to the consolation for patients and families. The society endeavors to popularize the concept of palliative care in society on October2005.The first palliative care out-patient clinic in India started functioning in a small room near the department of anesthesia, Medical college Calicut.

DEFINITON OF PAIN AND PALLIATTIVE

The world health organization (WHO) defined palliative care as an approach that improves the quality of patient and their families facing the problem associated with life threatening illness through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, and spiritual

PALLIATIVE CARE
Palliative care is the active total care of patient with life limiting disease, and their families by a multi professional team, when the disease is no longer responsive to

curative care. However in some countries, hospice care denotes community-based palliative care. palliative is derived from the Latin word pallium, a clock , in palliative care symptoms is cloaked with treatments whose primary aim is to promote comfort . However, palliative care extends far beyond physical symptom relief, that patient may come to times with their impending death as fully constructively as they can.

Palliative care is a kind of treatment focused on providing comfort and enhancing the quality of life during the last stage of life. Through extending and saving lives the medicines primary goal, a shift in focus must be affected when caring for patients with a serious and complex chronic illness. In these cases, care must be centered on relieving the symptoms of the diseases, especially in the real pain management. Palliative care is offered simultaneously with all other appropriate medical treatment.

PALLIATIVE CARE IS:

Patients centered rather than diseased.

2 Death accepting but also life-enhancing.

A partnership between the patient and the cares.

 Conceded with healing rather than curing.

EFFECTIVENESS OF PALLIATIVE CARE

Effective palliative care is patient-centered care. Effective palliative care involves:-

1. Individuals firmly expressing their values, goal of care and preference regarding their care. 2. The communications of this wishes and preference to the health care professionals. 3. The health care profession providing treatment consistent with these values, benefits and goal. 4. Proper documentation of these preferences.

PROVIDERS OF PALLIATIVE CARE

Palliative care may be administered by an individual care professional or inter disciplinary team consisting of combination of physician, nurses, social workers, therapist and clergy. Palliative care can be offered in the hospital, long term care facility centers, nursing home, and home or in the outpatient setting.

HIGHLIGHTS OF PALLIATIVE CARE

Affirms the patient life. Relieves symptoms: nausea, fatigue, breathlessness, anxiety, and depression weakness.

Emphasizes effective pain management. Provides the patients with the best quality possible at the end of their life retaining their dignity and respecting their values and preferences.

Providing disease management by offering relief from suffering. Helps to achieve a sense of control. Offers to address any spiritual issues.

Relieves some of the burden placed upon loved ones. Provides support system for family and friends.
5

 Strengthens personal relationship. Establishes a mechanism for warning of potential medical crisis. Earlier intervention leads to better disease management, reduced hospital admission and improved patient comfort and satisfaction.

REHABILITATION
Add life to their days, not days to their life

Palliative is about quality of life and it includes rehabilitation. It seeks to help patients achieve and maintain their maximum potential physically, psychologically, socially and spiritually. However these have become limited as a result of disease explosion.

TEAM WORK
Together everyone Achieve more

Palliative care is best administrated by a group people working as a team. The team is collectively concerned with the total well- being of the patient and family.
6

In practice some or all of the following is involved. Doctors and nurses (the essential core clinical team). Physiotherapist, occupational therapist, other specific therapist. Social workers Volunteers.

As there is overlap of rules, co-ordination is an important part of team work. Conflict inevitable erupts from time to time in a team of highly motivated, skilled professionals. One of the challenges of team work is how to handle conflict constructively and creatively. Volunteers are integral part of most palliative care services, providing added values as a Result of their own life experiences and skills. They also form an important link with the winder community.

CANCER-THE DISEASE AND THE TREATMENT

Cancer is generic term for a large group of disease that can affect any part of the body. Other terms used are malignant tumors and neoplasm.
7

Cancer is an uncontrolled division of cells defying the logic of normal growth and division. This uncontrolled growth affects the function of the body to carry on normal metabolic activities. This manifests as disease. Though the precise causes of this phenomenon have not been conclusively identified, linkages to chemical pollutants, food habit etc have been clearly established. The connection between tobacco smoking and lung cancer has been conclusively proven. Depending on the manner of growth and area affected, cancer has been classified into more than 200 types.

The most effective and efficient treatment programmes are:-

1. Provided in a sustained and equitable way. 2. Linked to early detection. 3. Where to evidence based standards of care and a multidisciplinary approach.

DIAGNOSIS
The disease is diagnosed by taking out sample cells from the affected part and subjecting them to examination under the microscope. This method of examination is known as FNAC/biopsy.(FINE NEEDLE ASPIRATION CYCHOGY).

RADIATION
Radiation is an effective and comparatively low cost method of treatment for several types of cancers. Cancer of the mouth, through, lungs and uterus are effectively treated with radiation. Radiation is also resorted to treat cancer that has spread to the bones or the brain.

If radiation has been prescribed for patient, the part of the body that should be subjected to radiation is marked out and the dosage and duration is determined. The patient is then made to lie down on the bed attached to the machine and radiation is passed through the specified area only.

In the normal case, the treatment may last from 2 weeks to 6weeks. In certain case, radiation is applied once a week for 5 or 6 weeks.

CHEMOTHERAPY
Chemotherapy is the treatment of the disease by means of drugs. It is the injunction treatment in the common mens parlance. A variety of medicines are injected to destroy the cancerous cells. Chemotherapy is effective in the treatment of lymphoma and leukemia (blood cancer). And in the treatment of lung cancer and breast cancer, injection with radiation is done. The treatment may involve taking the drug for more than once over span of time.

OBJECTIVES OF THE STUDY

1. To study in detail about the various services provided by Kunnumpuram Pain and Palliative Care Clinic for cancer patients. 2. To study about satisfaction level of patients. 3. To create awareness among people about health.

SCOPE OF THE STUDY

The project aims at studying effectiveness of the pain and palliative treatment for cancer patients.

RESEARCH METHODOLOGY
Research methodology is the procedure use in making systematic observation or otherwise obtaining data, evidence, or information as part of a research project or study. Hear the research method used in descriptive research. Descriptive research includes surveys and fact finding enquiries of different kinds. The major purposes of the state of affairs as it exist at present.

DATA COLLECTION METHOD

The study was mainly conducted by adopting interview schedule method.

10

AREA OF STUDY
Patient residing A R Nagar panchayath, Vengara panchayath, Kannamankalam panchayath andPallikkal panchayath

POLULATION
The total population of the study is 100.

1. DURATION OF THE STUDY

10 /02 /2012

TO

24 /02 /2012

2. SAMPLING
Sampling is the process of selecting a representative portion of the population under study for analysis.

SAMPLING METHOD
The sampling methods used hear is the convenience sampling method.

Convenience sampling method

11

Convenience sampling method is a non probability sampling technique where subjected are selected because of their and proximity to the researcher.

. SAMPLE SIZE
The sample size selected for the study was restricted to 40.

SAMPLE DESIGN
The process of extracting a sample from the respondent is called sampling process. The selection of the sample to conduct the research depends upon the nature and scope of study, along with the objective to be achieved.

TOOLS OF DATA ANALYSIS

The analysis is mainly conducted by using simple statistical tool, percentage. Also charts and tables are used wherever necessary.

. LIMITATION OF THE STUDY

12

1. Resources constrain, home care patients are scattered all over and so faced much difficulty in collecting information from them. 2. Time limitation is one of the major problems of this research. 3. Some of the respondents were not willing to share data completely.

13

CHAPTER-2

REVIEW OF LITERATURE

REVIEW OF LITERATURE
14

P.Hudson&Payne, 2009; Relf, eteal, 2008)

Primary caregivers usually provide primary support for the patients at all levels of need. They may be patents spouse, child, another family members or a friend. Although the primary caregiver may be supported by other caregivers, the generally assume primary responsibility for the coordination and provision of care and support to the patient.

(Christakis&Iwashyna, 2003

Within

Australian

health

policy

standards

it

is

explicitly

acknowledged that the need of primary

Caregivers and family members should be considered as an integral component in the provision of specialist palliative care

(P.Hudson&Payne, 2009). Furthermore, it is deemed best practice for this duty of care to extend into the phases of post- patient death and bereavement (palliative care

Australia, 2005: relf, Machin, &archer, 2008). In recent year, the importance of developing and identifying support intervention for care agencies and research bodies.

Harding &Higginson
15

What is the best way to help caregivers in cancer and palliative care a systematic literature review of intervention and their effectiveness?

1) Carlsson&rollison

Terminally ill patients occurs mostly when the patient lives with a spouse or partner

Given, given &kozachik (2001) Family support in advance cancer No limits stated

16

CHAPTER-3

ORGANIZATION PROFILE

PAIN AND PALLIATIVE CARE CLINIC KUNNUMPURAM

17

This institution was inaugurated by Panchayath member PK KUNJUTY SAHIB on 1 MAY 2004.It is located on the heart of KUNNUMPURAM town, just opposite of Government hospital. As this is one of the satellite centre of PPCC under Calicut MEICAL COLLEGE was praised by World Health Organization (WHO).And the register number is 175/5. Trained persons (doctors, nurses and volunteers) deliver palliative care in this organization.

MISSION
Belief is that individual and families copying with a life threatening illness deserve efficient access to services that use designed to enhance their quality of life and enable them to receive care in the setting of their choice.

AIMS OF PALLIATIVE CARE

1. Affirm life and regard dying as a normal process.

2. Provided relief from pain and other distressing symptom.

3. Integrate the psychological and spiritual aspects of patients care.

14 4. Offer a support system to help patients live as actively as possible until death.

18

The palliative care team provide;-

1. Time for close communication 2. Expert management of pain and other symptoms 3. Help navigating the healthcare system 4. Guidance with difficult and complex treatment choices 5. Emotional and spiritual support for you and your family

AREA OF ACTIVITIES
1. Patient residing A R Nagar panchayath, Vengara panchayath, Kannamankalam panchayath andPallikkal panchayath were recommended to Calicut Medical College, Trivandrum Regional Cancer Centre (RCC) to receive better treatment like radiation, surgery and chemotherapy etc 2. Services are rendered by home care team which comprises doctor and nurses who are ready to serve the patients at any time even if the patients are at home. 3. Water bed is provided for patients who have scarce in their body like abscess. 4. They Provide tour for volunteers. 5. Service for community voluntaries network are available. 6. Medical aids are provided at free of cost for poor cancer patient if they are in need for that. 7. In case of emergency, the patients are provided free wards for their treatment. 8. Easy communication facilities between doctor and patient and nurse and patient and their relatives are provided
19

9. Provide employment opportunities, sheltering, supply food grain etc for weak patients.

The organization depends upon donation for smooth functioning .it donators are:-

Business man and merchants Members in palliative clinic Local governing bodies and other generous people Residence and non-residence of Kunnumpuram Schools and collages

There is an expenditure amounting to more than 45000 rupees per month

Hear almost 68% are cancer patients. Patents are coming from different panchayath. Service are provided to them very effectively they avail their services to panchayath area as whole and partly to nearby areas.

The service is including:-

OP UNIT

- MONDAY

20

HOME CARE

- MONDAY, TUESDAY, WEDNESDAY,

THURSDAY AND FRIDAY

ORGANIZATION MEMBERS

21

1. SECRETARY

E.V SURESH

2. JOINT-SECRETARY

- P.SUBRAMANYAM K.SUBRAMANYAM

3. TREASURER

- PK. MUJEEB

4. CLINIC IN CHARGE

- HYDER

5. PAID STAFF

- ABDULLA MANIMA(Dr) AJMAL (Dr) SUNITH (Nurse) SUNITH (Nurse) GAFOOR

SECRETARY

22

JOINT-SECRETARY

JOINT-SECRETARY

TREASURER

CLINIC-IN CHARGE

PAID-STAFF

PAID-STAFF

VOLUNTEER

23

CHAPTER-4

DATA ANALYSISA AND INTERPRETATION

TABLE NO-4.1

DETAILS OF THE AGE GROUP

24

OPTIONS
Above 56 45-55 35-45 Below 25 25-35 TOTAL

NO:OF RESPONDENT
22 8 6 4 0 40

PERCENTAGE %
55% 20% 15% 10% 0% 100%

SOURCE: - Primary data

INTERPRETATION

From the above table it could be seen that 55%of the patients are the age group of 56 and above, 20%of the age fall in between 45-55, 15% of them fall in between 35-45; 10%of them are below the age25.

FIGURE -4.1

DETAILS OF THE AGE GROUP

25

10% 15% 55%

ABOVE 56 45-55 35-45 BELOW25

20%

TABLE NO: 4.2

26

GENDER OF PATIENTS

OPTIONS
Female Male TOTAL

NO:OF RESPONDENT
16 24 40

PERCENTAGE %
40% 60% 100%

SOURCE: - Primary data

INTERPRETATION The above tables shows that60% of the patients are male and remaining 40% of the patients are female

FIGURE NO -4.2

27

GENDER OF PATIENTS
70%

60%
60%

50%

40%
40%

30%

20%

10%

0% male female

28

TABLE NO: 4.3

FACILITIES PROVIDED FOR THE CLINIC

OPTIONS
Home care Out patient TOTAL

NO:OF RESPONDENT
40 0 40

PERCENTAGE %
100% 0% 100%

SOURCE: - Primary data

INTERPRETATION

100% of patients are getting home care facility

FIGURE-4.3
29

FACILITIES PROVIDED FOR THE CLINIC

home care out patient

100%

30

TABLE NO: 4.4

REASON FOR NOT GOING TO THE CLINIC FOR TREATMENT

OPTIONS
Health problem Personal problem Expensive TOTAL

NO:OF RESPONDENT PERCENTAGE%

32 8 0 40 80% 20% 0% 100%

SOURCE: - Primary data

INTERPRETATION The above table shown that 80%of the patient are not going to the clinic for treatment because of the health problem, and remaining 20% of them because of the personal problem.

31

FIGURE-4.4

REASON FOR NOT GOING TO THE CLINIC FOR TREATMENT

80%
80%

70%

60%

50%

40%

30%

20%

20%

10%

0%
0% health problem personal problem expencive

32

TABLE NO: 4.5

SATISFACTION OF THE PATIENTS WITH ENVIRONMENT OF THE CLINIC

OPTIONS
Satisfied Partly satisfied Dissatisfied TOTAL

NO:OF RESPONDENT
40 0 0 40

PERCENTAGE %
100% 0% 0% 100%

SOURCE: - Primary data

INTERPRETATION:100% of patients are satisfied with the environment of the clinic.

33

FIGURE-4.5

SATISFACTION OF THE PATIENTS WITH ENVIRONMENT OF THE CLINIC

0%

satisfied partly satisfied dissatisfied

100%

34

28

TABLE NO: 4.6

MENTAL RELIEF OF THE PATIENT

OPTIONS
Yes always getting To some extend Not getting TOTAL

NO:OF RESPONDENT
40 0 0 40

PERCENTAGE %
100% 0% 0% 100%

SOURCE: - Primary data INTERPRETATION:The above table shown that 100% of the patients are always getting mental relief.

35

FIGURE-4.6

MENTAL RELIEF OF THE PATIENT

0%

yes always getting to some extent not getting

100%

TABLE NO: 4.7

36

RELIEF OF THE PATIENTS FROM PAIN AND OTHER PHYSICAL PROBLEM

OPTOINS
Partly relief Full relief No relief TOTAL

NO:OF RESPONDENT
40 0 0 40

PERCENTAGE %
100% 0% 0% 100%

SOURCE: - Primary data

INTERPRETATION:The above table shown that 100% of the patients said that they are getting partially relief, from pain and other physical problem

FIGURE-4.7

37

RELIEF OF THE PATIENTS FROM PAIN AND OTHER PHYSICAL PROBLEM

100%
100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

0%

0% partly relief full relief no relief

38

TABLE NO: 4.8

REASON FOR GETTING THE CARE FROM THE CLINIC

OPTION
Poor class Very poor class Middle class Well-off TOTAL

NO:OF RASPONDENT
18 6 10 6 40

PERCENTAGE %
45% 15% 25% 15 100%

SOURCE: - Primary data INTERPRETATION:The above table shows that 45% of the patients are belonging to poor class, 15% of the patients are belonging to very poor class, 25% of the patients are belonging to middle class remaining 15% of the patients are belonging to well-off family.

FIGURE-4.8

39

REASON FOR GETTING THE CARE FROM THE CLINIC

15% 45%

poor class

25%

very poor class middle class well-off

15%

TABLE NO: 4. 9
40

RECIVING MEDICINES AT FREE OF COST

OPTIONS
Always To some extent never TOTAL

NO:OF RESPONDENT
40 0 0 40

PERCENTAGE %
100% 0% 0% 100%

SOURCE: - Primary data

INTERPRETATION;The above table shown that 100% of the patients always receiving medicines at free of cost.

FIGURE-4.9
41

RECIVING MEDICINES AT FREE OF COST

100%
100%

90%

80%

70%

60%

50%

40%

30%

20%

0%
10%

0%

0% always to some extent never

42

TABEL NO: 4.10

WELFARE FACILITIES FOR THE POOR PATIENTS

OPTONS

NO:OF RESPONDENT

PERCENTAGE %

Free rice Financial support Support for education of children No getting TOTAL SOURCE: - Primary data

20 4 6 10 40

50% 10% 15% 25% 100%

INTERPRETATION:The above table show that 50% of the patients said that they are getting free rice,10% of patients said that they are getting financial support ,15% of the patients said that they are getting educational support for their childrens education, and 25% of the patient said that they are not getting welfare facilities.

FIGURE-4.10
43

WELFARE FACILITIES FOR THE POOR PATIENTS

25% 50%
free rice financial support support for education of chidren no getting

15% 10%

44

TABLE NO: 4.11

SATISFACTION OF THE PATIENTS WITH THE PRESENT WELFARE FACILITIES

POTIONS
Satisfied Partially satisfied dissatisfied TOTAL

NO;OF RESPONDENT
36 4 0 40

PERCENTAGE%
90% 10% 0% 100%

SOURCE: - Primary data

INTERPRETATION:-

The above table shows that 90%of the patients are satisfied with the present welfare facilities and the remaining 10% of the patients are partially satisfied with the present welfare facilities.

FIGURE-4.11
45

SATISFACTION OF THE PATIENTS WITH THE PRESENT WELFARE FACILITIES

90%
90%

80%

70%

60%

50%

40%

30%

20%

10% 0%

10%

0% satisfied partially satisfied dissatisfied

46

TABLE NO: 4.12

REASON FOR SELECTING PALLIATIVE

OPTIONS
Monitory benefit Home care facility TOTAL SOURCE: - Primary data

NO:OF RESPONDENT
30 10 40

PERCENTAGE %
75% 25% 100%

INTERPRETATION:The above table shown that75% of the patients selected the palliative care because it is more beneficial to them on monitory basis and the remaining 25% of the patients selected it for its home care facility.

FIGURE-4.12
47

REASON FOR SELECTING PALLIATIVE CLINIC

25%

monitory benefit home care facility

75%

48

TABLE NO: 4.13

RESPONSE OF THE PATIENTS WHEN VOLUNTEERS ASK ABOUT THEIR PROBLEMS

OPTIONS
Yes ,I tell every thing Only some information TOTAL

NO:OF RESPONDENT
40 0 40

PERCENTAGE %
100% 0% 100%

SOURCE: - Primary data

INTRPRETATION:The above table shown that 100%of the patients tell everything when volunteers ask about their problems.

FIGURE-4.13
49

100%
100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

0%
0% yes,I tell everything only some information

TABLE NO: 4.14

50

APPROACH OF DOCTORS, NURESES, VOLUNTEERS TOWARDS THE PATIENTS

OPTIONS
Caring TOTAL

NO:OF RESPONDENT
40 40

PERCENTAGE %
100% 100%

SOURCE: - Primary data

INTERPRETATION:-

The above table shown that doctors, nurses, volunteers have a tendency to care them.

FIGURE-4.14
51

APPROACH OF DOCTORS, NURESES, VOLUNTEERS TOWARDS THE PATIENTS

100%
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% caring

52

TABLE NO- 4.15

SERVICE PROVIDED BY PAIN AND PALLIATTIVE CARE CLINIC KUNNUMPURAM

OPTIONS
Excellent satisfactory good Non -satisfactory TOTAL SOURCE: - Primary data

NO:OF RESPONDENT
28 6 6 0 40

PERCENTAGE %
70% 15% 15% 0% 100%

INTERPRETATION:The above table shown that 70%of the patients said that the service provided by the clinic is excellent, 15% of the patients are of the opinion that the services provided by the clinic are good and satisfactory respectively.

FIGURE-4.15
53

SERVICE PROVIDED BY PAIN AND PALLIATIVE CARE CLINIC KUNNUMPURAM

15%

15%

Excellent satisfactory good

70%

54

CHAPTER 5

SUMMERY , FINDINGS, SUGGESTIONS & CONCLUTION

55

SUMMERY

The first chapters include the introductions of pain and palliative care clinic. This include definition of pain and palliative, needs of palliative, effectiveness of palliative, highlights of palliative, and cancer disease, objectives of palliative, scope of palliative, research methodology The second chapter includes review of literature of pain and palliative care clinic. It contains important information of famous people. The third chapters include organization profile of the Kunnumpuram pain and palliative care clinic. It gives all information with organization The forth chapters include data analysis of Kunnumpuram pain and palliative care clinic. The fifth chapters include findings, suggestion, conclusion, summary, annexure, bibliography.

FINDINGS
56

1. The 55% of the patients are coming in the age group of 56 and above. 2. 100% of the cancer patients are home care patients. 3. 80% of the patients are not going to clinic because of the health problem. 4. 100% of the patients are getting mental relief from the clinic. 5. 100% of the patients are getting only partial relief from pain and other physical problem. 6. 45% of the patients are coming under poor class. 7. 100% of the patients are receiving medicine at free of cost. 8. 50% of the patients are getting the free rice 9. 90% of the patients are satisfied with the present welfare facility provided by the clinic. 10. 75% of the patients are selecting palliative care because it is more beneficial to them on monitory basis. 11. 100% of the patients tell everything when the volunteers ask them about their problems. 12. 100% of the patients said that the approach of the doctor, nurses and volunteers are caring. 13. 70% of the patients said that the services provided by the Kunnumpuram Pain and Palliative care clinic are excellent.

57

SUGGESTION

1. It is suggested to increase in the number of OP days

2. More volunteers are needed to work for the organization. So it is suggested to take initiative increasing the number of volunteers.

3. Kunnumpuram Pain and Palliative conducting weakened class for every relative of patients.

4. Volunteers should make regular home visit for giving psychological assistance to the patients.

5. Community volunteers should try to identify problem of the chronically ill people in their area and should organize appropriate intervention.

6. They should study about the problem of very poor patients and give more facilities for the financial support of the families and education of their children

CONCLUSION
58

The project report found that generally the services provided in Pain and Palliative Care Clinic Kunnumpuram was satisfactory, Pain and Palliative Care Clinic giving almost care for the mental relief of the cancer patients. A volunteer in Pain and Palliative clinic deserves special appreciation for their sincere efforts at the center.

However for improved performance of the Pain and Palliative Clinic Kunnumpuram, active workers should be included in the organization body and other less active fund providers.

59

BIBILIOGRAPHY

BIBILIOGRAPHY
60

BOOKS Research Methodology by (C.R.KOTHARY.) Introducing Palliative care :Robert Twycross

WEB SITE www.painandpalliativecare.com

INSTITUTION

Kunnumpuram Palliative clinic profile. Kunnumpuram Pain and Palliative Care Clinic Guide.

61

ANNEXURE

FOR CANCER PATIENTS

62

(QUESTIONNAIRE FOR PATIENTS)

Name Age Gender a) Male : : : b) Female

Marital status:

a) Married

b) Unmarried

c) divorced

1. What health problem do you have? Specify.. 2. What are the facilities provided by the clinic to you?

a) Home care

b) Out patient

3. Why are you not going to clinic for treatment?

a) Health problem

b) Personal problem c) Expensive

4. Are you satisfied with the environment that the clinic have?

a) Satisfied

b) Partly satisfied

c) Dissatisfied

5. Are you getting any mental relief from the clinic?

a) Yes, always getting b)To some extent

63

c) Not getting

6. Are you getting complete relief from pain and other physical problem?

a) Full relief

b) Partly relief

c) No relief

54 7. You are getting treatment here because you belong to?

a) Well-off

b)Middle class

c)very poor class

8. Do you receive medicines free of cost?

a) Always

b) To some extent

c) never

9. What other facilities are you getting from this clinic?

a) Free rice

b) Financial help for your family

c) Education support for your children

10. Are you satisfied with the present welfare facilities provided by this clinic? a) Satisfied b) partly satisfied C) dissatisfied

11. What is the reason for selecting pain and palliative care?

a) Monitory benefits

b) Home care facility

64

c)

Relief from pain and other physical problem

12. When volunteers ask you about your problem, do you tell everything? b) No I dont tell c) Only some information

a) Yes I tell everything

13. How is the approach of doctors, nurses and volunteers?

a) Caring

b)Not caring

c)Harsh

14. How do you rate due services provided by Kunnumpuram Pain and Palliative care society?

a) Excellent

b) Satisfactory

c)Good

d)Non-satisfactory

65