Trend dan Issue serta Peluang Homecare pada Pasien Kanker

Maria A. Witjaksono

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

PERJALANAN PENYAKIT

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

YOUR PATIENTS ARE WHEN THEY ARE HOME

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.

Die at home in missery

THE PLACE FOR END OF LIFE CARE IS IMPORTANT THE MAGIC OF HOME

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

Who Which patient? Where When How? Home Care Preparation Support

Send the patients home?

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

2. Others

24 hours on call services

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..............................

THANK YOU