By Romayne Gallagher, MD
IAHPC App Reviewer
Pallikare is an app designed for clinicians in India by clinicians in India. The developer is the Karunashraya—meaning “abode of compassion”—program run by the Bangalore Hospice Trust.
The Pallikare app is free and available for Android phones only. The app is no longer available for IOS phones, likely because Apple’s charge of USD$99 per year is too expensive considering the vast majority of phone users in India use the Android operating system. The app states that it is a quick reference intended for staff in rural areas, hospitals, and primary care who have minimal knowledge in palliative care. It specifically discusses medications available in India, although affordability is likely an issue. The app promotes itself as covering the diagnosis, investigation, and management of eight common symptoms in advanced cancer. There have been over 1,000 downloads of the app, which has garnered several dozen positive reviews.
Karunashraya provides free quality palliative care to advanced stage cancer and noncancer patients. Located in Bengaluru, in central India, the program includes a 73-bed hospice, home care service, and training program for care aides (ages 18-22). To support its multidisciplinary professional and maintenance team in providing the care for no charge, there are many hard-working volunteers supporting care and fundraising.
I do not have an Android phone, so I accessed the app through BlueStacks an android emulator program on my PC that is supposed to render the phone app as it would appear in hand. (This emulator program is advertised as giving access to a wealth of violent games not available on iOS phones. What will they make of someone only accessing palliative care apps!)
Pallikare’s landing page is a required registration that also asks permission to access the phone’s photos and files. This is likely to repel those concerned about privacy, and it is not clear to me why the app needs this access.
I am not familiar with the clinical environment or medical learning in India, but I suspect that there, like many places, clinicians are extremely busy and need on-the-spot, clear, and easily accessible evidence-based information rather than a topic review. The app says it does not replace a textbook, yet its order of presentation, degree of detail, and the necessity to read all the information prior to treatment is very much like a textbook. For example, in constipation treatment there is an accordion button for “bulk forming laxatives” that someone may interpret erroneously as confirmation of their use in treatment. On opening this accordion, however, the recommendation is not to use them. This information should be up front, located in comments at the start of the treatment section.
The icons for the major symptoms are creative and intuitive. The app says it covers eight symptoms but the “skin problems” category alone covers seven skin-related topics, and “miscellaneous” covers an additional seven symptoms/signs.
Reorganization of app content could make this information more visible and the addition of a search function would make an enormous difference. For instance, a search function would allow access to information about managing delirium in last hours to be readily available rather than buried in the section on “death rattle.”
Treatment sections could be arranged in a consistent format permitting swift consultation—such as medication of first choice, second choice, and so on—but no pattern is evident. In the neuropathic pain treatment section, treatment does follow a “first line, second line” progression, but the order is for treatment for noncancer neuropathic pain where greater concern about opioid use disorder may exist.
Lastly, using hyperlinks between sections of the app as opposed to the current written redirection would encourage greater awareness of content and minimize frustration with the user interface. The medical content is consistent with evidence-based literature but there are no references listed.
Pallikare provides credible, useful information on many more symptoms and topics that it advertises. Improving its organization and features would increase the ease of retrieving information and improve access to content that is not easily found.
To learn more about Bangalore Hospice Trust visit the IAHPC Global Directory of Palliative Care Institutions and Organizations.
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