trend dan issue serta peluang homecare pada pasien...
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Therapeutic advances has converse the clinical course of cancer from fatal illnesses into manageable chronic disease
WHO 2007:
OVER 7 MILLION PEOPLE DIED FROM CANCER
OVER 70% OF PEOPLE WITH CANCER OR AIDS EXPERIENCE SEVERE PAIN
ECCO-ESM0-ESRO, 2013
Oncologists call for radical solution to global cancer
problem:
Forth:
The provision of palliative and terminal care is an essential part of cancer care, and yet it is missing in many of the poorer regions of the world. This will require strong action, coupled with significant training programs, AND THE NEED IS URGENT
“You matter because you are you. You matter to last moment of your life, and we will do all we can, not only to help you die peacefully but to live until you die” Dame Cicely Saunders
Cancer in Indonesia
Number of cancer patients in Indonesia has been increasing . Incidence: 1:10.000, prevalence 1: 43.000
Most cancer patients will die from the disease despite the advances of treatment.
Along with the progress of the disease, causative treatment may fail to change the course of the disesase. Intervention may become inappropriate overtreatment: TERMINAL STAGE
Terminal stage of cancer is characterized by multisymptoms and aspects of suffering
It warrants a comprehensive approach to prevent and relieve suffering and to achieve a better QoL and QoD: PALLIATIVE CARE
Home is the most suitable and preferable place to care of terminally ill cancer patients
Current issues:
It is a long queue for hospital bed
Patients with advanced stage of cancer who do not receive cancer treatment do not need hospitalization
Patients and families may not confidence of being discharged
Effectiveness of hospital bed and Hospital Human resources is questioned
Demand of Palliative Care in all level of Health Care services
Advances in Cancer Treatment VS Poor End of Life Care
Dying and death are difficult and uncomfortable topic to discuss
End of life stage is still not diagnosed
Inappropriately resuscitated
Futile interventions commenced or continued
Health professionals do not discuss where terminally ill patients would like to be cared for and die*
Aggarwal G, 2013
Consequences
Majority of patients die in hospital, the place that might not be as they wish, and may be given unneeded or unwanted treatment
Large number of patients still die distressed with high burden of symptoms *
Unnecessary suffering, undignified died and familly distressing
Patient and family are unaware that death is imminent
Patient and family get conflicting message
Troublesome symptoms
Cultural and spiritual need unmet
Complex bereavement problems
Losses trust in doctor, unsatisfied and complaints about the care
Disadvantages for hospital
Majority of patients die in hospital • may not be as they wish • may be given unneeded treatment • May be given unwanted treatment.
Home Care v.s Hospital Care Roger Woodruff,1999
Advantage of home
Comfort
Privacy
Familiarity
Security
Autonomy
Reduced focus on illness
Close to family and friends
Family involvement of care
Disadvantage of hospital
Rigid timetable
Impersonal care
Loss of control
Investigation of questioned value
Financial cost
Traveling distance for family and friends
Advantage of hospital
Quality of symptom
management
Disadvantage of home
Physical and mental exhaustion
Private life disruption
Social life disruption
Principles of HHC
HHC is not to move hospital home
HHC is for patients with well controlled symptoms
HHC warrant “a qualified” caregiver
Have access to hospital when it is required
Simple medical equipment may be required
HCP visits are mandatory
System includes Primary Health Services
Volunteers are part of team
Home Care? Are family /carer available to provide the necessary level of care?
Can the patient”s needs for assisstance in washing and toileting be met?
Can medication necessary for appropriate medical management be delivered or adminiatered?
Can the patient”s dietery needs be met?
Are appropriate dressing materials available?
Is the neccesary equipment available?
Does the layout of home safe?
Are the financial resources adequate? Income loss due to work off, increased household cost
Is the GP available including after hours and on call
Does the patient feel safe?
Home Care Preparation 1. WHO need to be prepared? • The patient • The family: • The Care giver • Palliative Care team
Send the patients home?
2. Family members
To be with the patient
To be helpful
To receive assurance of the patient’s comfort
To be inform of the latest condition
To be inform of impending death
To ventilate emotion
To receive comfort and support from relatives
To receive acceptance, comfort and support from the hcp
Supports to the family
access to reliable information,
assurance of continuing care
availability of medicines and medical instruments,
training and guidance on aspect of patient’s care, helping to organize the family task,
security in expressing feeling and concerns,
laison to the community support services,
respite from the relentless task of caring
bereavement support.
Areas of training
Administration of medication
Monitoring and and recognizing different aspects of symptoms
Nutrition and hydration
Control of depositions
Hygiene
Changes of position
Dressings
Recognition of dying process
The benefit of palliative care to the hospital
The hospital can stand out as a unique establishment and the forefront of the community
Easing patient transition between care setting
Boosting patient and family satisfaction and hospital loyalty
Reduction in total hospital days Hospital beds will be focused on patients with cancer
treatment Reduced the length of waiting list Increased hospital income generated from PC Improve community relations Ensure continuity of care for patients discharged home
Increasing coordination among HCP
Reducing the burden of time-intensive and complex cases, to improve staff satisfaction and retention
Role of hospital in HC
Family meeting: Care plan
Coordinate the team
Anticipate and prevent symptoms through appropriate and targeted use of medications and other modalities
Prepare medicines and medical/nursing equipment
Prepare the caregivers
Develop relationship and communicate regularly with Community services
Challanges: Family dynamic
Quality of caregiver
Family problems, dispute, culture, communication, decision making
Home condition
GENERAL CONDITION
Distance, traffic jam, flood
The benefit of palliative care to the patient and their family
Increased satisfaction with the care of patients and carers Better awareness of their diagnosis Better performance status and quality of life Improved survival Improved burden and emotional stress: depression, anxiety,
anger Better degree of involvement in care More time spent at home Reduction in hospital days Reduction in cost Increased likelihood of patients dying where they wished
SYSTEM
• Absence of community support •Ineffectiveness of the implementation of two ways Refferal System • Unavailability of Palliative Care in Primary Health Services • Absence of BPJS coverage
Patient and Symptoms
Patient’s condition
intractable symptoms
Unknown previous treatment
Opioiphobia/ inavailability
Limited preparation of drugs
Insufficiency of medical equipment, ec Syringe drivers
Unfamiliar drugs/preparation among nurse
Family’s concerns
Summary
Continuity of care is especially important for patients and their family to avoid unnecessary suffering and to promote QoL
Palliative Care promotes and facilitates continuity of care to avoid needless suffering and burden, eliminate patients and family’s perception of abandonment and ensure that choices and preferences are respected
Home Care is an important model of care for terminally ill patients
Hospital plays an important role in achieving the goal of care for terminally ill patients at home
Nurse role in preparing and providing homecare is essential
Tim Paliatif yth
Kami sekeluraga mengucapkan trimakasih.........................
Papa dan kami sekeluarga sangat terkesan dan sangat nyaman akan perhatian dan perawatan yg diberikan
Papa pulang dengan sangat nyaman, seperti tidur diantarkan oleh pelukan ibunya dan mama, dan didampingi seluruh keluarga tersayang
Trimakasih dokter mengingatkan kami agar memiliki kualitas waktu komunikasi dengan baik dan mengingatkan papah tuk banyak berdialog dengan ALLAH sehingga kematian menjadi kepulangan yang dinantikan dengan indah
Semua merasa bahagia karena memiliki pengalaman akhir yang menyenangkan
Semoga Tim Paliatif dikaruniai kesehatan..............................
WHAT A NICE WAY TO TO PASS AWAY..............................