Pelayanan paliatif

1. Pelayanan paliatif dokter
keluarga
dr. Rohmania Setiarini

2.  Palliative derives from the Latin Pallium
which means to cloak.
 Palliation means to cloak over, to not
address the underlying causes, but to
eliminate the effects.

3. What is Palliative Care?
 The World Health Organization describes
palliative care as "an approach that
improves the quality of life of patients and
their families facing the problems
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."

4. WHO Definition of Palliative
Care
Palliative care:
provides relief from pain and other
distressing symptoms;
affirms life and regards dying as a normal
process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual
aspects of patient care;
offers a support system to help patients live
as actively as possible until death;

5.  offers a support system to help the family cope during
the patients illness and in their own bereavement;
 uses a team approach to address the needs of patients and
their families, including bereavement counseling, if
indicated;
 will enhance quality of life, and may also positively
influence the course of illness;
 is applicable early in the course of illness, in conjunction
with other therapies that are intended to prolong life,
such as chemotherapy or radiation therapy, and includes
those investigations needed to better understand and
manage distressing clinical complications.
WHO Definition of Palliative Care
(cont.)

6. PRINCIPLES
 Focus on quality rather than quantity of life
 Life affirming but death accepting
 Effective communication at all levels
 Respect for autonomy and choice
 Effective symptom management
 Holistic, multi-professional approach
 Caring about the person and those who
matter to that person

7. Who receives Palliative Care?
Individuals struggling with various diseases
Individuals with chronic diseases such as
cancer, cardiac disease, kidney failure,
Alzheimer's, HIV/AIDS and Amyotrophic
Lateral Sclerosis (ALS)

8. Cancer and Palliative Care
 It is generally estimated that roughly 7.2 to 7.5
million people worldwide die from cancer each year.
 More than 70% of all cancer deaths occur in
developing countries, where resources available for
prevention, diagnosis and treatment of cancer are
limited or nonexistent.
 More than 40% of all cancers can be prevented.
Others can be detected early, treated and cured. Even
with late-stage cancer, the suffering of patients can
be relieved with good palliative care.

9. Palliative Care and Cancer Care
 Palliative care is given throughout a
patient’s experience with cancer.
 Care can begin at diagnosis and continue
through treatment, follow-up care, and the
end of life.

10. Palliative Care and Cancer
 "Everyone has a right to be treated, and die, with
dignity. The relief of pain - physical, emotional,
spiritual and social - is a human right," said Dr
Catherine Le Galès-Camus, WHO Assistant
Director-General for Noncommunicable Diseases
and Mental Health. "Palliative care is an urgent
need worldwide for people living with advanced
stages of cancer, particularly in developing
countries, where a high proportion of people with
cancer are diagnosed when treatment is no longer
effective."

11. SYMPTOM PATIENTS (%) SYMPTOM PATIENTS (%)
Pain 84 Edema 28
Easy fatigue 69 Taste change 28
Weakness 66 Hoarseness 24
Anorexia 66 Anxiety 24
Lack of energy 61 Vomiting 23
Dry mouth 57 Confusion 21
Constipation 52 Dizziness 19
Early satiety 51 Dyspepsia 19
Dyspnea 50 Dysphagia 18
Weight loss 50 Belching 18
Sleep problems 49 Bloating 18
Depression 41 Wheezing 13
Cough 38 Memory problems 12
Nausea 36 Headache 11
Most Common Symptoms of Patients with Advanced Cancer
Walsh D, Donnelly S, Rybicki L. Support Care Cancer 2000;8:175-179.

12. Who Provides Palliative Care?
 Usually provided by a team of individuals
 Interdisciplinary group of professionals
 Team includes experts in multiple fields:
 Doctors
 Nurses
 social workers
 massage therapists
 Pharmacists
 Nutritionists

13. Palliative Care Patient Support
Services
Three categories of support:
1. Pain management is vital for comfort and
to reduce patients’ distress. Health care
professionals and families can collaborate to
identify the sources of pain and relieve them
with drugs and other forms of therapy.

14. Palliative Care Patient Support
Services
2. Symptom management involves treating
symptoms other than pain such as nausea,
weakness, bowel and bladder problems,
mental confusion, fatigue, and difficulty
breathing

15. Palliative Care Patient Support
Services
3. Emotional and spiritual support is
important for both the patient and family in
dealing with the emotional demands of critical
illness.

16. What does Palliative Care Provide to
the Patient?
 Helps patients gain the strength and peace
of mind to carry on with daily life
 Aid the ability to tolerate medical
treatments
 Helps patients to better understand their
choices for care

17. What Does Palliative Care
Provide for the Patient’s Family?
Helps families understand the choices
available for care
Improves everyday life of patient; reducing
the concern of loved ones
Allows for valuable support system

18. Approaches to Palliative Care
A palliative care team delivers many forms of
help to a patient suffering from a severe illness,
including :
 Close communication with doctors
 Expert management of pain and other symptoms
 Help navigating the healthcare system
 Guidance with difficult and complex treatment choices
 Emotional and spiritual support for the patient and their family

19. Critical Elements of Palliative
Care
 These are taken from the Health and
Welfare Canada, Palliative Care Services
Guidelines, Ottawa, 1989
1) Death is seen as a natural part of life and is
acknowledged rather than seen as a failure
or something which must always be fought
against to the very end.

20. 2)The unit of care is both the patient and the
loved ones; although death is personal, its
meaning and impact are wider. The family
must be integrally included in planning and
care.

21. 3. Palliative care upholds the basic dignity and
worth of humankind whether living or
dying. People who are dying are still living
and have the right to be in control of their
lives, including refusal of treatment or the
continuation of it.

22. 4. The primary intent of care is palliative or
“comfort oriented”. The relief of distressing
symptoms, especially physical is
paramount.

23. 5. The needs of the terminally ill are often
diverse and best met by a variety of skills
from professional disciplines, volunteers
and the family.

24. 6. Coordination and consistency of care are
essential among the disciplines and between
facilities.

25. 7. Creation of “home” – wherever that may be
is necessary for proper care.

26. 8. Grief support for the family (loved ones)
following death is an essential part of care
for the dying.

27. 9. Support for caregivers is essential to their
ability to continue working effectively in an
area of pain, death and loss.

28. Palliative Care Is Effective
Researchers have studied the positive effects
palliative care has on patients. Recent
studies show that patients who receive
palliative care report improvement in:
 Pain and other distressing symptoms, such as
nausea or shortness of breath
 Communication with their doctors and family
members
 Emotional and psychological state