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Pelayanan Perawatan Paliatif dan Akhir Kehidupan

Presentasi untuk BIMTEK Pelayanan Perawatan Paliatif dan Akhir Kehidupan

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Pelayanan Perawatan Paliatif dan Akhir Kehidupan

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  1. BIMTEK PELAYANAN PERAWATAN PALIATIF DAN PERAWATAN AKHIR KEHIDUPAN dr. Ika Syamsul Huda MZ, SpPD, MPH Ketua Tim PerawatanPaliatif RSUP dr. Kariadi Semarang

  2. CURICULUM VITAE Nama : dr. H. IkaSyamsul Huda MZ, MPH, Sp.PD, FINASIM Tempat/Tgl. Lahir : Semarang, 09 September 1968 Alamat : Jl. Panda Raya 77i Palebon, Pedurungan, Semarang. No. Hp : WA 083838240991 Keluarga : Istri : EmyPoerbandari Anak : 1. Missy Savira : 2. Qori El-Hafizh Pendidikan : - Program PendidikanDokterSpesialisPenyakitDalam UniversitasDiponegoro, Tahun 1998 - Magister ManajemenRumahsakit UniversitasGadjahMada, Tahun 2010 Pekerjaan : Staf KSM PenyakitDalam RSUP dr. Kariadi Ketua Tim PerawatanPaliatif RSUP dr. Kariadi AnggotaPerhimpunanDokterPaliatif Indonesia (PERDOPIN) Anggota Masyarakat Paliatif Indonesia (MPI)

  3. PALLIATIVE CARE End-of-life care

  4. Mapping levels of palliative care development in 198 countries: the situation in 2017 INDONESIA: Isolated Palliative Care Provision Prof. David Clark, dkk 2019

  5. INDONESIA: Isolated Palliative Care Provision A country in this category is characterized by the development of palliative care activism that is still patchy in scope and not well-supported; sources of funding that are often heavily donor-dependent; limited availability of morphine; and a small number of palliative care services that are limited in relation to the size of the population. Prof. David Clark, dkk 2019

  6. Capacity to Deliver Palliative Care (%)

  7. MYTHS ABOUT PALLIATIVE CARE

  8. PALLIATIVE CARE IS REQUIRED FOR A WIDE RANGE OF DISEASES http://www.who.int/en/news-room/fact-sheets/detail/palliative-care

  9. POPULASI PENDERITA KANKER DI INDONESIA (2015)

  10. PELAYANAN KESEHATAN Promotif Preventif Kuratif Rehabilitatif Suportif Paliatif

  11. HISTORY OF PALLIATIVE CARE PALLIATIVE Palliare(Bahasa Latin) = to cloak, cover jubah, mantel dr. Balfour Mount Born 14 April 1939 Urological surgeon Father of Canada's palliative care movement Dame Mary Cicely Saunders(22 Juni 1918 - 14 Juli 2005) TOTAL PAIN MODERN HOSPICE (1960) http://www.case-stories.org/total-pain-and-social-suffering/

  12. Butterflies are known as a symbol of transformation, hope, life, and spirit. Hospices across the country hold butterfly releases to help those who are grieving, remember and honor their loved ones. Another way hospice helps care and nurture their families and the communities they serve. https://www.facebook.com/NHPCO/posts/butterflies-are-known-as-a-symbol-of-transformation-hope-life-and-spirit-hospice/10155750819413907/

  13. TOTAL PAIN

  14. WHODefinition of Palliative Care Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. http://www.who.int/cancer/palliative/definition/en/

  15. Z51.5 Palliative care ICD-10 Version:2016https://icd.who.int/browse10/2016/en#/Z51.5

  16. Quality of Life (QoL) Kualitashidup (QoL) didefinisikansebagaipersepsiindividutentangposisimerekadalamkehidupandalamkonteksbudaya dan sistemnilai di mana merekahidup dan dalamkaitannyadengantujuan, harapan, standar, dan kekhawatiranmereka. Iniadalahkonsepluas yang dipengaruhisecarakompleks oleh kesehatanfisikseseorang, keadaanpsikologis, tingkatkemandirian, hubungansosial, dan hubunganmerekadenganciri-cirimenonjoldarilingkunganmereka.

  17. DasarAcuan KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR : 812/Menkes/SK/VII/2007 TENTANG KEBIJAKAN PERAWATAN PALIATIF MENTERI KESEHATAN REPUBLIK INDONESIA Padatanggal : 19 Juli 2007 Dr. dr. SITI FADILAH SUPARI Sp.JP (K) http://dinkes.surabaya.go.id/portal/files/kepmenkes/skmenkes812707.pdf

  18. KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR : 812/Menkes/SK/VII/2007 TENTANG KEBIJAKAN PERAWATAN PALIATIF MENTERI KESEHATAN REPUBLIK INDONESIA http://dinkes.surabaya.go.id/portal/files/kepmenkes/skmenkes812707.pdf

  19. LINTASAN SAKIT ILLNESS TRAJECTORY Department of Health, Western Australia. Palliative Care Model of Care. Perth: WA Cancer & Palliative Care Network, Department of Health, Western Australian; 2008.

  20. MODEL BARU PERAWATAN PALIATIF http://www.jpalliativecare.com/articles/2010/16/3/images/IndianJPalliatCare_2010_16_3_107_73639_f1.jpg

  21. PATIENTS ARE ‘APPROACHING THE END OF LIFE’ WHEN THEY ARE LIKELY TO DIE WITHIN THE NEXT 12 MONTHS. https://web.archive.org/web/20101130194228/https://www.gmc-uk.org/static/documents/content/End_of_life.pdf

  22. THE END OF LIFE

  23. People are ‘approaching the end of life’ if they are likely to die within the next 12 months. People “at the end of life” people who are imminently dying and might be in the last few hours or days of life. https://www.dyingmatters.org/sites/default/files/user/10Questions.pdf

  24. End-Stage IndicatorsEnd-Stage Indicators • Cancer Diagnoses • Disease with distant metastases at presentation OR • Progression from an earlier stage of disease to metastatic disease with either: • a continued decline in spite of therapy • patient declines further disease directed therapy

  25. INTEGRASI PERAWATAN PALIATIF PALLIATIVE CARE KERJASAMA TIM

  26. TIM PERAWATAN PALIATIF RUMAH SAKIT • Dokter • Perawat • Fisioterapis • Farmasis • Rohaniawan • Pekerjasosial Multidisipliner Kolaborasi Koordinatif

  27. PROVIDING A PALLIATIVE APPROACH TO CARE

  28. Identify if the patient would benefit from palliative care earlier in their illness trajectory Three triggers that suggest that patients could benefit from a palliative care approach: The Surprise Question: ‘Would you be surprised if the patient were to die in the next year?’ General indicators of decline: deterioration, advanced disease, decreased response to treatment, choice for no further disease modifying treatment. Specific clinical indicators related to certain conditions.

  29. Bear in mind that even doctors with long experience tend to over-estimate prognosis.

  30. Unplanned hospital admission(s). • Performance status is poor or deteriorating, with limited reversibility. (eg. The person stays in bed or in a chair for more than half the day.) • Depends on others for care due to increasing physical and/or mental health problems. • The person’s carer needs more help and support. • Progressive weight loss; remains underweight; low muscle mass. • Persistent symptoms despite optimal treatment of underlying condition(s). • The person (or family) asks for palliative care; chooses to reduce, stop or not have treatment; or wishes to focus on quality of life.

  31. Cancer • Functional ability deteriorating due to progressive cancer. • Too frail for cancer treatment or treatment is for symptom control.

  32. Tool SPICT-App https://www.spict.org.uk/spictapp/ https://www.spict.org.uk/

  33. Contoh: • HCC BCLC stage D • Hepatitis C • Asites grade 2 • Paliative Care

  34. Assess the person’s current and future needs and preferences across all domains of care. Screening Tools • Edmonton Symptom Assessment System (ESAS-r) • Palliative Performance Scale (PPSv2) https://www.ontariopalliativecarenetwork.ca/en/node/31896

  35. Edmonton Symptom Assessment System: (revised version) (ESAS-R)

  36. www.victoriahospice.org/sites/default/files/pps_english.pdf

  37. CONTOH KASUS Pasiensangatlemahdantetapberadadikursibeberapa jam sehari. Sisawaktu, diasedangditempattidur. Diamemilikipenyakitlanjutdanmembutuhkanbantuan yang hampirlengkapdenganperawatandiridanmakanan. Iamengalamipenurunanasupanmakanan, denganbeberapacamilankecil yang kebanyakantetapbelumselesai. Diamemilikiasupancairan yang cukup. Pasienmengantuk(DROWSY) tapitidakbingung(CONFUSED). BERAPA PPS PASIEN TERSEBUT?

  38. https://eprognosis.ucsf.edu/pps.php?p=palliative

  39. Family Meeting INFORMATION BREAKING BAD NEWS FAMILY SUPPORT ADVANCED CARE PLANNING

  40. VALUES • WISHES • BELIEFS • PREFERENCES • GOALS NILAI – HARAPAN – KEYAKINAN - PREFERENSI - TUJUAN

  41. BREAKING BAD NEWS • PersiapkandanRencanakan • CariTahuApa yang PasiendanKeluargaTahudanIngintahu • DukunganEmosi (Support Mental PasiendanKeluarga) • MembuatRekomendasi • Resolusikonflik

  42. Memberikaninformasisesuaikebutuhanpasiendankeluarga. • Berikanpasienkesempatanuntukmembahasharapan-harapannya, ataudisisi lain menghargaiuntuktidakmembahasnyajikapasientidakmenginginkannya. • Berikaninformasisecarabertahapsesuai yang diinginkanpasien. • Gunakanbahasayangjelasdanmudahdimengertisertamenghindaripenggunaanistilah-istilahmedis. • Menjadipendengar yang baikdantanyakankembaliuntukmemperjelasmaksudpernyataannya.

  43. • Jelaskanmengenaiketidakpastiandanketerbatasandariprognosisdanmasaakhirkehidupan. • Hindarimemberikanbatasanwaktukecualikondisipasiensudah terminal • Perhatikanjugahal-hal yang diperlukanolehpelakurawat. Pertimbangkanpertemuanterpisahantarapasiendenganpelakurawatbiladibutuhkan. • Berikaninformasidanpendekatan yang konsistenkepadasetiapanggotakeluargapasien, pasiendantimpaliatif yang merawat. • Minimalkanpenggunaankata-kata ‘meninggal’ dan ‘sekarat’ dalamdiskusi.

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