IMPLEMENTASI

PALLIATIVE CARE PADA

PELAYANAN DIALISIS
Didik Uji Ranawikarto, S.KM (Undip). Grad Dip Nurs
(Monash)
Instalasi Dialisis RS Margono Soekarjo Purwokerto
IPDI Komisariat Barlingmascakeb

ESRD Option

1. Dialysis: PD, HD
2. Transplantation: :Cadaver, Living, Related,

Unrelated
3. Death

HD

2 X 5 jam per minggu (belum transportasi)

Obat obatan (berbagai jenis)

Fluid Restriction

Food Restriction

High Level of Dependency

Multiple Hospitalization

Transplantasi

Bisa mulai bekerja 3-4 bulan

Dapat bertahan 15-16 tahun
Waktu tunggu untuk mendapatkan donor yg pas?
Keberhasilan: 95%??
Manajemen Post transplant

Dialysis / Transplantation affects a

Person

Socially

Physical

Psychologically

Spiritually

Palliative Care

Suatu pendekatan yang bertujuan meningkatkan

kualitas hidup pasien dan keluarganya dalam

menghadapi penyakit terminal melalui
pegurangan penderitaan akibat penumpukan
symptoms dan nyeri serta masalah bio psiko sosio
spiritual lainnya.

Target (Smith et al, 2015; RHN,

2012)

CKD yang memilih tidak menjalani Dialisis

Pasien yang memburuk kondisinya meski menjalani Dialsisi

Pasien yang memilki multiple diagnosis (misal Ca cervix,

alzheimer dll)

Pasien memilih berhenti dari dialisis

Pasien transplant yg mengalami penurunana fungsi graft dan

tidak menghendaki dialisis.

Pasien Dialysis dengan resiko tinggi mortalitas dan

morbiditasnya.

Model of Quality of Life

Well-being: physical, psychological, social and spiritual

Physical
Functional Ability
Strength/Fatigue
Sleep & Rest
Nausea
Appetite
Constipation
Pain
Social
Financial Burden
Caregiver Burden
Roles and Relationships
Affection/Sexual Function
Appearance

Quality of
Life

Psychological
Anxiety
Depression
Enjoyment/Leisure
Pain Distress
Happiness
Fear
Cognition/Attention
Spiritual
Hope
Suffering
Meaning of Pain
Religiosity
Transcendence

Trajectory/Perjalanan
Penyakit ESRD
(Flecksteiner, 2014)

Implementasi Palliative
Care
Pre Dialysis Education ttg Palliative care/

withdrawal from Dialysis Option

Advance Directives & Advance Care Plan.
Pemenuhan Spiritual Need
Advokasi saat kondisi menurun
Symptom management: Pain, feeding, medication

Two (2) Roads to Death

Confused

Tremulous

Restless

Hallucinations

Normal
Normal

Mumbling Delirium

Sleepy

Myoclonic Jerks

Lethargic
THE
THE USUAL
USUAL
ROAD
ROAD

THE
THE
DIFFICULT
DIFFICULT
ROAD
ROAD

Seizures

Obtunded

Semicomatose
Comatose
Death
Death

Pathway for End of Life

Care

Triggers (RCGP, 2011)

Contoh Implementasi
praktis
Tunda pemberian ESA, IV iron, Vitamn D analog
Hentikan pemeriksaan lab kecuali order dr

Palliative untu manajemen symptom tertentu

Lakukan dialisis hanya untuk fluid oberload

(Isolated Ultra Diltration).

National EoL Care strategy for

England (2008)
Raising the profile
Strategic Commisioning
Identifying people approaching EoL
Care Planning
Voordination of Care
Rapid Access to Care
Delivery of High Quality Service in all location

Strategycont.

Last days of life and care after death

Involving and supporting carer
Education, Training and CPD
Measurement and Research
Funding

Identifying of people approaching

EoL (NHS, 2014)
Significant weight loss > 10% less than 6 month
Albumin <2,5 g/dl
Nausea, vomiting, anorexia
lethargy, insomnia, anxiety, depression
Terjadi bulanan namun 2 minggu terakhir kematian akan

semakin parah
Pasien dg Surprise Question yg berlakuPasien dengan

penumpukan symptoms meski Dialisis

Pasian memilih berhenti dari dialisis.

PC integration to Dialysis
Service (Smith et al, 2015)

Following the Five Cs

1.

Competence

2.

Collegiality

3.

Communication

4.

Continuity of Care

5.

Compassion

Focus discussion on not if, but rather when to switch from

restorative/invasive care to palliation.
Source18

REFERENCES

Please Check, Referensi lengkap tersedia di

Makalah.

Terima Kasih

The single biggest problem with communication

is illusion that it has taken place (G.B. Shaw)