Manajemen Gejala pada Pasien

Kanker Stadium Lanjut :

Ta n t a n g a n d a n P e l u a n g

Ns. Nurul Huda M. Kep Sp Kep MB.,PhD

Dipresentasikan pada Webinar Nasional Unoiversitas Hang Tuah Pekanbaru

23 Maret 2024
Agenda Epidemiology kanker
Barriers dalam pemberian asuhan
keperawatan kanker

Style
Solusi dalam menghadapi
barriers
Epidemiology
 Cancer Incidence

Indonesia menempati
10 juta kasus urutan ke-8 di Asia
kematian akibat Tenggara..
kanker pada tahun

2020 2022
2020 2022 2040

Kanker di seluruh dunia angka kejadian penyakit kasus kanker diperkirakan

telah meningkat menjadi kanker di Indonesia meningkat menjadi 28,4
19,3 juta kasus dan 2020. sebesar 136 orang per juta kasus.
100.000 penduduk
Overview
Pasien dengan kanker stadium lanjut
mengalami gejala dan kekhawatiran fisik,
emosional dan psikososial akibat penyakit,
perawatan dan prognosis mereka

Kualitas hidup pasien kanker dipengaruhi oleh

berbagai jenis gejala yang mereka hadapi pada
saat diagnosis, selama, dan setelah pengobatan.

Penilaian QOL pada pasien kanker sangat

penting untuk merancang intervensi guna
meningkatkan hasil dalam domain sosial,
keuangan, psikososial, dan fisik dari QOL
pasien

Seiring dengan meningkatnya harapan hidup

pasien kanker, kualitas hidup yang berhubungan
dengan kesehatan dan perawatan yang mereka
dapatkan menjadi semakin penting
penyakit komorbid tekanan psikologis

penurunan fungsi
polifarmasi
organ

Kompleksitas
komplikasi Penanganan Kanker masalah nutrisi

kurangnya dukungan kelemahan kognitif

sosial

fungsi organ yang terganggu

kualitas hidup
 Milestone diagnose kanker
Kualitas Hidup

Permasalahan social
dan spiritual

Permasalahan
Permasalahan Psikologis
Fisik
Perjalanan penyakit
Diagnosa kanker dan pengobatan
 Penilaian Kualitas Hidup
Digunakan untuk merancang intervensi keperawatan yang berhubungan dengan :

Domain Sosial

Domain Keuangan

Domain fisik dan

psikologis

Domain Spiritual
Sebagian besar pasien kanker memerlukan dukungan fisik, psikologis, sosial, dan spiritual
Kebutuhan Pasien Kanker

Physical support

.
 Psychological support

Social support

Spiritual Support
 Pencegahan

Peran Perawat Penilaian

Penatalaksanaan
However, some barriers are still exist
which caused the delayed intervention
Barriers &
solutions
 Barriers

Akses pengobatan Peran tim Pengelolaan

Pengaruh agama dan Komunikasi efektif
yang tidak merata interdisiplin nutrisi
budaya
inequitable access to treatment
Inequitable access to care is especially problematic in the cancer care
01 sector, as early diagnosis and timely access to cancer treatment are
linked with better health outcome
.

cancer incidence is as much as four times higher among structurally

02 vulnerable populations, who are also more likely to be diagnosed with
advanced cancers and have worse cancer-related outcomes

There is less use of cancer control screening, prevention strategies, or

03 primary care services for people living in poverty

For this reason, cancer is diagnosed at a later stage, resulting in worse

04 patient outcomes, a reduced quality of life, and at a higher cost to the
healthcare system
 research and innovation
equal acces

information quality of life

Hak-Hak yang Harus

quality, expertise, and integrated supportive &
Dipenuhi pada Pasien
outcomes palliative care
Kanker
specialised
survivorship & rehabilitation
multidisciplinary care

shared decision-making
reintegrartion
 The influence of religion and different cultural systems

Some people view the act of suffering At this time, spiritual care is crucial
as something that individuals must for the patient and their family.
endure and that only god will
determine when and how an individual
should die.

It is important for health care Spiritual care involves religious

providers to be aware that leaders from different religions
there is great variation within
cultures

Therefore, health care

providers must be open
Some cultures and religions minded to the fact that their
view talks about death as perspectives on various
taboo, advanced care directives may
be different from the patients
and their families
 3. Effective Communication

Communication is
essential in patients
with advanced cancer.
We can use “NURSE”
to ensure that we are
demonstrating empathy

Building the relationship and trust through open communication will help the patient feel that their beliefs are
respected and that the nurse team is doing their best to respect the wishes and allow the patient to die with dignity.
 • The “N” stands for “name the emotion”, which
shows the family that you are recognizing the
way that they are feeling.
NURSE

• “U” stands for “understanding in an open and

compassionate way”. “R” stands for “respect
for the person experiencing the emotion”.
• “S” stands for “communicate support”.
• “E” stands for “explore the emotional
experience of the other person”

El-Bar et al (2013).
It is important for health care providers to not use
code words or euphemisms while speaking

Vagueness must also be avoided

Euphemism and vagueness may result in families feeling

uncomfortable and not confident about the treatment that their
loved one will be receiving

In order to prevent uncertainty and promote understanding, it is

best to have the patient and the interdisciplinary team speak in
person, face-to-face.
 4. The role of an interdisciplinary team

 an interdisciplinary team will result in better care for the patient and
their family
 Patients in advanced cancer stage usually have more than one
comorbidity, and therefore require more than one healthcare
provider to meet their healthcare needs.
 Moreover, the advanced and incurable disease trajectory of a loved
one in may bring forward a time of worry and sorrow for the patient,
family, and healthcare professionals.
 Thus being a time of need for emotional and spiritual support.
Healthcare workers are
prone to compassion

fatigue and burn out

Therefore, during times of
stress, the involvement of a
religious provider may help
with relieving stress for not
only the patient and family,
but also for the healthcare
professionals who are also
experiencing stress
.
Hence, an interdisciplinary
team which involves multiple
healthcare providers are
very important to ensuring
that the patient, their family,
and health care
professionals are provided
with all the available support
 5. Oral Intake
many families have a hard
time grasping the fact that the
appetite of their loved one is
continuing to decline which
will result in a low to none oral
intake
it is important for both the
patient and family to know that
the body naturally forms
substances called ketones
which help to eliminate the
feeling of hunger, thus having
the patient feel more
comfortable without food than
with it
This natural mechanism
helps the body to stay more
comfortable and prevent or
alleviate symptoms of
congestion which are usually
experienced by patients
approaching EOL
.
 In some instances, if the patient’s wishes were to prolong the
life, or the proxy has difficulties coping with lack of oral intake,
the decision can be made to place a feeding tube, but, it must
be understood that a feeding tube is not the solution.

 Hence, healthcare providers must take the time to educate to

the best of their ability, the risks and benefits in relation to the
placement of a feeding tube if they wish to have their life
prolonged.

 This emphasizes the importance of education and having

advanced directives in place.
 Decision-making and who we are to listen to
Health care providers must be aware
that it is their right to ensure that the
patient is aware of and involved in the
process of making decisions about
his/her care.
Your Text Here
Health care provider must make sure
that the patient is aware of and has
agreed with the chosen options
regarding his/her care
Your Text Here
Cognitive impairment(s), and rapid
decline in health, can result in failure
to communicate and/or inability to
understand and appreciate the
information received
Factors such as religion, inability to
understand, reluctance to acknowledge
incurable illness and unrealistic
expectations to have life prolonged, may
determine whether or not a patient can be
a candidate for receiving palliative care.
It is therefore crucial for health care
providers to discuss the disease
trajectory and explain the benefits of
palliative care and whether the patient
may require this kind of care
regardless of whether their stay is at
home, in acute care or long term care
setting
 Transition to palliative care

Text 1 Text 2 Text 3 Text 4

It is important for the Most patients find palliative care provides Health care providers in
patient and family to themselves in acute health services for palliative care make an
also understand that care if their condition is individuals with life- approach towards
their loved one may not deteriorating, or in threating illnesses improving the quality of
be conscious and alert palliative care if EOL where remission can no life for a patient, by
as they are can be close. longer be achieved, all make sure that the
approaching death. attempted interventions patient is kept
have failed, and comfortable both
prognosis is short term physically and
emotionally during a
period of time where
they’re nearing death
Fostering successful integration of palliative care
Health care
professional (HCP) HCP who does not
may be responsible for recognize the end stage
why a patient is not of the disease and has
transferred to palliative limited knowledge about
care. palliative care may
advise the patient to
continue with acute care
management.
many patients die a lot of people don’t More hours teaching
without receiving the know what to do or for medical school must
benefits of palliative can’t recognize that enforce the fact that
care. people are dying” palliative care should
be initiated at earlier
stages of illness
 Caregiver burden
It has been found that most individuals would prefer to die
at home surrounded by their loved ones, but statistics
show that almost 70% of patients deaths occur in the
hospital.
Contents .
Title
many of the family members who are caring for their loved
one are of seniors who are not only untrained and
unsupported, but are also trying to take care of their own
health concerns. As a result, many families choose to send
their loved one to hospital.
Contents .
Title
Therefore, Health Links is another way to improve care for
Contents patients with complex conditions by bringing together
Title Contents different health care providers
Title

Helping to alleviate pain symptoms will result in less

suffering, ICU admissions, non-beneficial healthcare
interventions and emergency room visits.
These reductions, along with the reduction in burden placed on the family including stress
and finances, makes palliative care a preferred option for improving the quality of care for
individuals
THANK YOU