1. Effectiveness of a Hospital Based ‘Therapeutic Community’ Approach in Care for Terminally ill Cancer Patients Singh Naveen Kr., Roy Debabrata, Saini,S

2. Background: Prediction of survival in terminally ill cancer patients is an evolving area largely dependent on evidence-based medicine.

3. Background: Principles of ‘Therapeutic community’ or ‘Fellowshipping’ are now an integral component of palliative care/ Hospice care for terminally ill patients from various afflictions.

4. Background: Documented evidence suggests religious and spiritual forms of coping may provide uniquely meaningful way of dealing with chronic illness and may be more effective at ameliorating affective and cognitive symptoms.

5. Background WHO defines palliative care as the ‘ active total care of patients and their families by a multiprofessional team when their disease is no longer curable and life expectancy is predicted short’. It neither hastens nor postpones death. It integrates psychological and spiritual aspects of care.

6. Objective: Specific objective: Study therapeutic effectiveness of the counseling module ‘ASHA’, Sub objective: To study change in perceived notions on morbidity & QOL among terminally ill cancer patients at HIHT (CRI).

7. Material and Methods: A case series of all eligible study subjects who consented to participate and identified for or undergoing ‘post- surgery 18 months’ radiotherapy follow- up’ (50) were recruited for the study. A well researched group dynamics module for intervention was administered on the study subjects.

8. Material and Methods: A structured 11-question KAP evaluation instrument with open-ended answers was applied pre & post intervention to the study group. Chi square test was applied on respondents pre & post intervention, (providing appropriate / desirable answer for each of the questions) to find level of significance in differences for key parameters.

9. Study design: Prospective with a quasi-experimental component Study tool: A group dynamics module for intervention and a structured KAP evaluation instrument

10. Counseling Module: Curriculum Section 1: IEC/ BCC: Clinico- pathological aspects of cancer- essentials Section 2: Sensitizing on terminal illness & hospice care Section 3: Concept of ‘Fellowshipping’ along with spiritual aspects as a therapeutic modality Introducing principles of ’12 steps’ of living (conceptually similar to AA’s) The road from ‘Denial to Acceptance’ The attendant negative emotions of ‘frustration’, ‘self -pity ‘, ‘anger’ & ‘abnormal behavior/ cognition’ Structured living Perceptions on ‘religiosity’ and ‘spirituality’ Self love & selfishness Salvation- perceived notions Dissolution of mind and ego Contentment and Bliss

11. Results:Association between intervention (Counseling Module) and knowledge score

13. Conclusion: Chi square test on study respondents pre & post counseling for choosing appropriate options for each of the questions, showed significant differences for key parameters. Evidently the counseling module( ASHA) is an effective intervention tool to bring about changes in perceived notions in morbidity and thus enhance QOL.