- BUSINESS REQUIREMENTS DOCUMENT (BRD)
1.1 Background & Rationale
Chronic, life-limiting illnesses such as cancer, advanced organ failure, neurological disorders, and geriatric conditions contribute significantly to pain, suffering, and reduced quality of life. A large proportion of patients requiring palliative care remain unidentified or receive fragmented care.
The Government of India mandates integration of Palliative Care services at Health & Wellness Centres (HWCs) to ensure early identification, basic symptom management, psychosocial support, and timely referral.
Integrating Palliative Care into the mAAM application will:
- Enable early identification of palliative care needs
- Standardize symptom assessment at CPHC level
- Support continuity of care across facility and home-based settings
- Strengthen referral and counter-referral pathways
1.2 Scope of Palliative Care Services in mAAM
Phase 1 (As per GoI Operational Guidelines):
- Identification of patients requiring palliative care
- Pain assessment and basic pain relief
- Symptom screening (breathlessness, nausea, constipation, fatigue, anxiety)
- Psychosocial and caregiver support
- Referral to higher facility / palliative care unit
- Follow-up and continuity of care
Phase 2 (Future scope):
- Specialist palliative care documentation
- Advanced pain management workflows
- Integration with home-based palliative teams
1.3 Target Users & Roles
Role | Responsibilities |
ASHA / MPW | Community identification, referral to HWC |
CHO (Primary User) | Screening, symptom assessment, basic management, referral, follow-up |
Staff Nurse | Support assessment and follow-up |
Medical Officer | Advanced management, referral decisions |
Specialist Palliative Team | Care outside mAAM |
PRODUCT REQUIREMENTS DOCUMENT (PRD)
Palliative Care Services
CPHC Services – mAAM Application
- Module Overview
Objective
Enable identification, basic symptom management, psychosocial support, referral, and follow-up for patients requiring palliative care at CPHC level, as per GoI guidelines.
Primary User
- Community Health Officer (CHO)
Secondary Users
- Staff Nurse
- Medical Officer (view & referral)
- Beneficiary Eligibility
Criteria | System Behaviour |
All age groups | Screening allowed |
Any gender | Same workflow |
Chronic / life-limiting illness | Eligible for palliative care screening |
- Palliative Care — Entry & Consent
3.1 Entry Conditions
Palliative care screening can be initiated if any one applies:
- Known chronic / life-limiting illness
- Persistent pain or distressing symptoms
- Referred by ASHA / MPW
- Trigger during NCD / OPD / home visit
3.2 Consent
Field | Type | Rules |
Consent Given | Radio | Yes / No |
Type of Consent | Dropdown | Verbal / Written |
Consent Scope | Auto | “Palliative care assessment & support” |
System Rules
- Consent is mandatory
- If consent = No → Exit module
- Screening for Palliative Care Need
To be enabled if: Entry conditions met
Data Field | Field Type | Validation / Logic |
Chronic illness present | Checkbox | Optional |
Persistent pain | Checkbox | Optional |
Severe weakness / fatigue | Checkbox | Optional |
Breathlessness | Checkbox | Optional |
Functional dependence / difficulty in activities of daily living (ADL) | Checkbox | Optional |
Psychological distress | Checkbox | Optional |
Screening Outcome | Auto | Suspected / Not suspected |
Referral Required | Auto | Yes if Suspected |
Logic:
If any one symptom is selected → Screening Outcome = Suspected
- Pain Assessment
To be enabled if: Screening Outcome = Suspected
Data Field | Field Type | Value / Options | Validation |
Pain present | Radio | Yes / No | Mandatory |
Pain severity | Dropdown | Mild / Moderate / Severe | Mandatory if Yes |
Pain duration | Dropdown | <1 week / ≥1 week | Optional |
- Symptom Assessment (Basic)
Symptom | Field Type | Options |
Nausea / vomiting | Checkbox | Yes |
Constipation | Checkbox | Yes |
Anxiety / restlessness | Checkbox | Yes |
Sleep disturbance | Checkbox | Yes |
- Basic Management (CHO Level)
Data Field | Field Type | Validation |
Basic symptom relief provided | Radio | Yes / No |
Psychosocial support provided | Radio | Yes / No |
Caregiver counselling provided | Radio | Yes / No |
Remarks | Text | Optional (250 chars) |
No advanced pain management or specialist treatment at HWC level.
- Referral Management
Auto-enabled if:
- Severe pain
- Multiple symptoms
- CHO assesses need beyond HWC scope
Data Field | Field Type | Validation |
Referral Required | Auto | Yes |
Referred To | Dropdown | PHC / CHC / District Hospital |
Reason for Referral | Dropdown | Pain control / Symptom management / End-of-life care |
Referral Date | Auto | System generated |
Please note: If the assessments are yielding yes for referral, a single alert note should appear before the Submit button if the CHO has still selected no for referral. Also the page doesn't move forward without registering a referral.
- Follow-Up
Data Field | Field Type | Validation |
Follow-up date | Date | Mandatory |
Symptom improvement | Radio | Yes / No |
Pain Severity | Dropdown | Mild / Moderate / Severe |
Referral completed | Radio | Yes / No |
- Case Closure (Only in the case of no follow up; For follow up yes: Only date and remarks field needed)
Closure Reason | Logic |
Under care | Follow-up ongoing |
Referred | Referral accepted |
Death | Sync with beneficiary status |
- Appendices
Functional Decline Assessment Table (Katz ADL) for the Section 4-Screening for Palliative Care Need
- Data Capture Table (UI / Formस्तर)
Field Name | Field Type | Options / Values | Mandatory | Logic |
Bathing | Radio | Independent (1) / Dependent (0) | Yes | As per Katz definition Sum of all fields Based on score If score < 6 |
Dressing | Radio | Independent (1) / Dependent (0) | Yes | |
Toileting | Radio | Independent (1) / Dependent (0) | Yes | |
Transferring | Radio | Independent (1) / Dependent (0) | Yes | |
Continence | Radio | Independent (1) / Dependent (0) | Yes | |
Feeding | Radio | Independent (1) / Dependent (0) | Yes | |
Total Score | Auto-calculated | 0 – 6 | Auto | |
Functional Status | Auto | Independent / Partial Dependence / Severe Dependence | Auto | |
Functional Decline Flag | Auto | Yes / No | Auto |
- Clinical Definition Mapping (as per Guidelines)
(From Annexure II – ADL table)
Activity | Independent (Score = 1) | Dependent (Score = 0) |
Bathing | Bathes self or needs help in only one part | Needs help in >1 part or getting in/out |
Dressing | Dresses self completely | Needs partial/full assistance |
Toileting | Uses toilet independently | Needs help / uses bedpan |
Transferring | Moves in/out of bed/chair independently | Needs assistance |
Continence | Full control over bladder & bowel | Partial/total incontinence |
Feeding | Eats independently | Needs assistance / tube feeding |
- Functional Decline Classification Logic
Total Score | Category | Functional Status | System Interpretation |
6 | Fully Independent | No decline | Normal |
4 – 5 | Mild Decline | Partial Dependence | Monitor + counselling |
2 – 3 | Moderate Decline | Functional Dependence | Needs intervention |
0 – 1 | Severe Decline | Highly Dependent | High priority / palliative care |
- System Logic formAAM
Trigger Points and System behaviour
- If any ADL = Dependent → Functional difficulty exists
- If Total Score ≤ 5 → Functional Decline = YES
- If Score ≤ 3 → Flag as High-Risk Elderly
Condition | System Behaviour |
Any ADL = Dependent | Mark “Functional dependence = Yes” |
Functional dependence = Yes | Screening Outcome → Suspected |
Score ≤ 3 | Auto-suggest Referral |
Score ≤ 1 | Tag: Bed-bound / Palliative candidate |
- Suggested UI Output (for App)
Display to CHO:
- Total Score: X/6
- Functional Status: ___
- Risk Level: Low / Moderate / High
- Suggested Action:
- Independent → Routine follow-up
- Moderate → Rehab + caregiver support
- Severe → Referral + palliative care