Introduction:Collusion is frequently encountered but least studied entity in palliative care services in India. Impact of collusion is manifold and identifying it requires good communication skills. Once identified, it gives an indication for existing healthy versus developing unhealthy collusion to be dealt within families.Objective:The objective of this study was to identify the prevalence of collusion and its clinical and psychological correlates among patients and caregivers in a palliative cancer care.Materials and Methods:We describe systematic identification and unraveling of collusion across multiple levels in a palliative cancer care eventually drafting an algorithm to unravel the collusion. Patients and families were recruited from in-patient palliative care services after obtaining written informed consent. Qualitative interviews were conducted using collusion questionnaire, EQ5D, Visual Analog Scale, and NIMHANS psychiatric morbidity screen.Results:Among 62 cancer families interviewed, we identified that 71% collusion exists between doctor and patient, 61.3% between doctor and caregiver, and 75.83% between patient and caregiver. Around 50% collusions were unraveled systematically. Collusion was more prevalent in patients with rapid progression of illness (<6 months), patients with poor coping skills, and preference of being interviewed alone.Conclusion:This statistics suggests that collusion goes unnoticed in terminal illnesses and communication skills play a major role in identifying and dealing with collusion. This also unearths need to formulate interview techniques and structured assessment tools or questionnaire in palliative cancer care which are sparse.

The worst thing we can do is abandon someone who is hurting. Attitudes which promote death rather than affirm life are the ultimate abandonment. ' -Dame Cicely Saunders. The second wave surge of the COVID-19 pandemic in India has presented a challenge to urgently mitigate the immense suffering. The rapid spread due to the variant, airborne transmission, and flaunting of prevention guidelines has resulted in fear and panic. The rapid deterioration in severe COVID infection results in total suffering, which is physical, emotional, social, financial, and spiritual for both the person and family. Compounding this is the overwhelmed health-care system resulting in a lack of vaccinations, oxygen, hospital and ICU beds. All these lead to despair, anguish, and hopelessness. How can we mitigate this immense suffering? There is a need for a more effective integration of palliative care with COVID care at all levels. A recent BMJ article outlines palliative care for patients with serious COVID-19. [1] This integration must result in a better quality of life and recovery as the immediate goal and also better quality of death if it is inevitable. This is wartime and the need of the hour is for all palliative care teams to prioritise this need and be involved in effective palliative care integration with COVID care, in addition to their primary area of responsibility. In the context of severe COVID infection, the acute shortages of hospital and ICU beds can only be addressed by making the bed at home functional. Desperate families need to be supported and empowered to take care of their loved ones at home by both COVID care and palliative care joining hands and adhering strictly to all personal protection measures. This can be done by effective use of the subcutaneous route (SC) for symptom control coupled with simultaneous ongoing specialist COVID care support including oxygen provision as possible.https://jpalliativecare.com/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.