ECHO Hamrahi 4th session 8 March 2022

The 4^th ECHO Hamrahi session took place on 8^th March 2022, the theme being “Frailty and falls in the palliative care setting”.  The session was led by nursing and allied health members of the palliative care teams in Australia and India. There were 30 participants including several newcomers to Hamrahi from sites in the north and north east of India. We enjoyed hearing from Dr Nisha Nadarajan,  palliative care advanced trainee, about her current audit of falls in Eastern Palliative Care service in Melbourne’s western suburbs.

Cachar Cancer Centre continues to be one of the most active sites attending the ECHO Hamrahi program. This time, it looked like the entire nursing team was present, alongside Sarita Chhetri, showing the great support for palliative care development at Cachar!

Following an excellent introductory lecture by Ms Rachel Coghlan, physiotherapist, we moved to hear about two cases which illustrated the importance of assessing frailty and risk of falls in this patient population.

Dr Priyanshu, physiotherapist from Homi Babha, supported by team psychologist and Dr Vidya, discussed the management of an 81-year-old woman with metastatic SCC oesophagus and breast cancer, presenting with multiple symptoms of dysphagia, breathlessness, fatigue and restricted mobility. Her palliative performance scale was 60%. She was increasingly dependent on her son and daughter-in-law for care, with some tensions arising in these relationships as a result. The team discussed her symptom management and the psycho-social care provided by team psychologist and others, to the patient and her caregivers. They presented a comprehensive care plan which summarised the interventions on the psychical, psychological, practical, anticipatory and decision-making domains.

There was active discussion about the types and value of various frailty assessment tools, and their integration into routine clinical care.

The second case presentation was led by Sarah Begley, palliative care clinical nurse consultant in Melbourne, with reflections on management of frailty from Joan Ryan, CNC Sydney, and Rachel Coghlan. Each discussed this from the perspective of a community care setting (Sarah), hospital consultancy (Joan) and from the physiotherapist perspective (Rachel). An interesting point was the judgement required to achieve an acceptable balance between safety and mobility risk reduction, and the patient’s goals and quality of life, which often involves some risk-taking.