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"his reference work covers all aspects of the physical, psychological and social care of terminally ill patients. It also examines the social and spiritual aspects of support for patients' families, as well as the education and training of the professionals involved in terminal care."

"When a person suffers from advanced, progressive illness, palliative care ? treatments that improve the physical and psychological quality of life of patients and their families ? can be just as important as treatments that aim to slow or prevent disease progression. Aimed at GPs and trainees, Palliative Care in Clinical Practice offers an accessible and practical introduction to palliative medicine, including a chapter devoted to each of the key areas of symptom management. Clearly and concisely written and fully illustrated throughout, it will be a useful resource for all healthcare professionals who wish to gain an understanding of this important aspect of medicine."

"Obat nyeri umumnya digunakan oleh pasien kanker yang mengikuti pelayanan paliatif dimana pelayanan tersebut mengutamakan peningkatan kualitas hidup pasien. Selain obat nyeri, pasien kanker pelayanan paliatif juga dapat menggunakan obat lain sebagai kombinasi untuk mengatasi gejala lainnya sehingga dapat meningkatkan potensi interaksi obat. Penelitian ini bertujuan untuk menganalisis potensi interaksi obat nyeri dengan obat nyeri dan obat lain pada pasien kanker pelayanan paliatif. Desain penelitian yang digunakan yaitu cross sectional dengan metode retrospektif dan bersifat deskriptif. Sampel penelitian adalah data resep pasien kanker yang mengikuti pelayanan paliatif di RS Kanker Dharmais pada bulan Januari - Desember 2017. Sampel penelitian yang diperoleh sebanyak 273 resep. Hasil penelitian menunjukkan sebanyak 191 resep 69,9 pasien kanker pelayanan paliatif berpotensi memiliki interaksi obat nyeri. Jumlah insidensi interaksi obat nyeri yang ditemukan sebanyak 316 kasus, dengan tingkat keparahan mayor sebanyak 73,5, moderat sebanyak 26,3, dan minor sebanyak 0,2. Kombinasi obat nyeri yang paling banyak mengalami interaksi yaitu fentanil dan morfin sebanyak 61 kasus 19,3. Hasil penelitian ini dapat disimpulkan bahwa potensi interaksi obat nyeri dengan obat nyeri dan obat lain pada pasien kanker cukup tinggi sehingga diperlukan pemantauan terapi dalam peresepan obat nyeri pada pasien kanker yang mengikuti pelayanan paliatif di RS Kanker Dharmais tahun 2017.

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Pain medicines are mostly used in cancer patient with palliative care which give priority to increase patients quality of life. Besides pain medicines, cancer patient with palliative care also used other drug as a combination to overcome other symptomps of cancer which potentially cause drug interaction.

The aim of this study was to analyze the potential of pain medicine interaction in cancer patient. The study design was cross sectional with a retrospective method and descriptive study. The sample of this study was cancer palliative care patients prescription at Dharmais Cancer Hospital in the period of January ndash December 2017. Sample analyzed in this study was 273 prescriptions.

This study found that there were 191 prescriptions 69,9 pain medicine which potentially interact with 316 interaction cases. The most common pain medicine interaction was 61 cases of fentanyl and morphine 19,3. Based on severity, pain medicine interaction consisted of 73,5 mayor interaction, 26,3 moderat interaction, and 0,2 minor interaction.

Based on this study, pain medicine interaction was high occured, so that management therapies are needed in pain medicine prescription in cancer patient with palliative care at Dharmais Cancer Hospital in 2017."

"Perawatan paliatif adalah pendekatan layanan kesehatan yang dapat meningkatkan kualitas hidup pasien dan keluarga. Penelitian ini bertujuan untuk menyelidiki hubungan antara pengetahuan perawat tentang perawatan paliatif dan sikap perawat terhadap pasien dengan penyakit terminal di Dr. RSUPN. Ciptomangunkusumo, Jakarta. Ini adalah penelitian survei deskriptif kuantitatif dengan desain Cross Sectional yang melibatkan semua perawat di bangsal penyakit terminal. Analisis menemukan bahwa ada 148 perawat dengan pengetahuan baik (91,9%) dan 87 perawat dengan sikap baik (54%). Juga, hasil penelitian menunjukkan bahwa tidak ada korelasi yang signifikan (nilai p = 0,070) antara tingkat pengetahuan perawat dan sikap mereka terhadap pasien dengan penyakit terminal.

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Palliative care is a health care approach that can improve the quality of life of patients and families. This study aims to investigate the relationship between nurses knowledge about palliative care and nurses attitudes towards patients with terminal illnesses at Dr. RSUPN. Ciptomangunkusumo, Jakarta. This is a quantitative descriptive survey research with Cross Sectional design involving all nurses in terminal disease wards. The analysis found that there were 148 nurses with good knowledge (91.9%) and 87 nurses with good attitude (54%). Also, the results showed that there was no significant correlation (p value = 0.070) between the level of nurses' knowledge and their attitudes towards patients with terminal illness."

"ABSTRAKPengalaman Orang Tua dalam Mengelola Nyeri Anak Kanker yang Menjalani Perawatan Paliatif Nyeri yang dirasakan anak dapat memengaruhi tumbuh kembang anak. Penelitian ini bertujuan untuk memperoleh pengalaman ibu dalam mengelola nyeri yang dirasakan anak kanker yang menjalani perawatan paliatif. Penelitian ini menggunakan metode kualitatif dekskriptif fenomenologi. Pengambilan data melalui wawancara pada orang tua yang memiliki anak dengan diagnosis kanker dimana terdapat 8 partisipan di wilayah Jakarta, Bekasi dan Tangerang yang diambil dengan cara Snowball. Data dikumpulkan melalui in deph interview pada setiap partisipan, sampai data mengalami saturasi. Pengolahan data menggunakan metode analisis collaizi Hasil penelitian mengidentifikasi 8 tema yaitu 1 Dimensi nyeri anak dengan perawatan paliatif, 2 Respon psikologi dan fisik ibu, 3 Respon emosional ibu, 4 Hambatan ibu dalam mengatasi nyeri, 5 . Tindakan ibu dalam mengurangi nyeri, 6 Upaya ibu dalam mengalihkan nyeri, 7 . Memberikan penguatan pada anak saat nyeri dan 8 Usaha dan doa untuk menyenangkan anak. Kesimpulan penelitian adalah nyeri merupakan keluhan yang berdampak pada stres yang dialami ibu yang dapat memengaruhi kehidupan ibu dan anak. Perawat perlu memberikan informasi serta perawatan yang efektif pada anak dan orang tua yang mengalami nyeri kanker. Kata kunciKanker, Nyeri, Anak, perawatan Paliatif.

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ABSTRACTParents voice in managing the pain in children with cancer treated for palliative care Pain experienced by children can adversely affect their growth and development. Paint is a major healt problem for cancer patients and remains an unresolved problem. The study aims to know how the experiences of mothers managing their children rsquo s pain during palliative care following cancer diagnosis. Using qualitative methods within a descriptive phenomenological approach, in depth interviews were conducted with parents mostly mothers of eight children diagnosed with cancer. The data were collected using the snowball sampling method. Analysis of the results identified eight themes 1 The dimensions of pain experienced by children undergoing palliative care 2 Mothers rsquo physical and psychological responses 3 Mothers rsquo emotional responses 4 Barriers encountered by mothers when taking care of their child at home 5 Mothers rsquo interventions to reduce their child rsquo s pain 6 Mothers rsquo efforts to distract their child from pain 7 Giving encouragement when the child is in pain and 8 Mothers rsquo efforts and prayers to make their child comfort. It can be concluded that the child rsquo s pain is the main cause of mothers rsquo stress and pressure and also affects the daily lives of mothers and children. Along with the most effective intervention, nurses need to provide mothers and children with adequate information about cancer pain. KeywordsCancer, pain, child, Paliatif care "

"Perawatan paliatif merupakan perawatan yang dibutuhkan bagi seluruh klien, terutama pada klien dengan penyakit terminal. Dengan diberikannya perawatan paliatif, diharapkan klien dapat mempertahankan atau meningkatkan dukungan secara holistik, seperti dukungan biologis/fisik, psikologis, hubungan sosial, dan spiritualitasnya. Penelitian ini bertujuan untuk mengetahui tingkat pengetahuan mahasiswa keperawatan yang saat ini berada pada tingkat akhir mengenai perawatan paliatif. Desain penelitian yang digunakan pada penelitian ini adalah penelitian deskriptif dengan total 109 responden yang dipilih menggunakan teknik random sampling. Instrumen untuk menilai tingkat pengetahuan mahasiswa dengan Palliative Care Quiz for Nursing (PCQN) yang telah dikembangkan, berisi tentang pertanyaan mengenai perawatan paliatif. Proporsi terbesar kategori tingkat pengetahuan mahasiswa keperawatan berada pada kategori cukup, yaitu 96 atau 88,08%.

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Palliative care needed for all clients, especially in clients with terminal illness. Given the palliative care, the client is expected to maintain or increase support in a holistic care, such as support for biological/physical, psychological, social relationships, and spirituality. This study aims to determine level of knowledge about palliative care in nursing students. The research design used in this study was a descriptive study with a total of 109 respondents were selected using random sampling techniques. Instruments to assess the knowledge level of students with Quiz for Palliative Care Nursing (PCQN) that have been developed, contains questions about palliative care. The largest proportion category level of knowledge students of Nursing in the category enough, 96 or 88,08%."

"Latar belakang: Terdapat peningkatan kebutuhan layanan paliatif, namun belum semua terjangkau. RSUPN Dr.Cipto Mangunkusumo mengidentifikasi kebutuhan paliatif dengan menggunakan perangkat penapisan, namun belum dilakukan penelitian untuk menilai performanya. Tujuan penelitian: Mengetahui performa perangkat penapisan paliatif dari RSUPN Dr.Cipto Mangunkusumo serta mengetahui titik potong yang optimal untuk perawatan paliatif. Metode: Desain penelitian ini potong lintang, dilakukan di RSUPN Dr.Cipto Mangunkusumo Juli 2019 - Oktober 2019. Pengambilan sampel dilakukan dengan cara consecutive sampling. Keandalan diukur dengan interclass correlation coefficient (ICC). Konsistensi internal dinilai dengan koefisien Cronbach-Alpha. Uji kesahihan kriteria dievaluasi dengan menggunakan uji Pearson. Hasil: Terkumpul 64 subjek, dan terbanyak kelompok usia 51-70 tahun (50%). Kanker merupakan penyakit dasar terbanyak (87,5%). Penyakit komorbid terbanyak adalah penyakit ginjal (17,1%). Sebaran skor paliatif terbanyak pada skor 6 (23,4%). Rata -rata skor adalah 7,51. Mortalitas pasien di RS sebesar 51,6%. Dari kurva sebaran skor paliatif didapatkan nilai AUC 0,687 dengan IK 95% (0,557-0,818). Titik potong optimal untuk menentukan batas konsultasi pada pasien paliatif didapatkan pada skor 8. Seluruh pasien merupakan pasien paliatif menurut pendapat ahli berdasarkan kriteriaWHO. Kesimpulan: Performa perangkat ini cukup baik untuk menilai pasien dalam kondisi terminal dan kompleks. Titik potong optimal pada penelitian ini adalah 8. Diperlukan penelitian lebih lanjut dengan proporsi data yang merata.

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Background: There was an increasing need for palliative services, but not all are affordable. Cipto Mangunkusumo Hospital identified the need for palliation by using a screening score, but no research has been done to assess the performance of this screening device.

Objectives: To determine performance of the palliative patient screening tool questionnaire from Cipto Mangunkusumo Hospital to assess the need of palliative care and to know the optimal cut off point for palliative care.

Methods: The study was cross sectional, and was conducted in Cipto Mangunkusumo Central General Hospital from July 2019-October 2019. Sampling was done by consecutive sampling. The reliability test was measured by the interclass correlation coefficient (ICC). Internal consistency was assessed by the Cronbach-Alpha coefficient. The criterion validity test was conducted by evaluated using the Pearson test.

Results: The total samples collected were 64 samples. The age group was dominated by 51-70 years (50%). Cancer was the most basic disease found (87.5%). Most comorbid diseases were kidney disease (17.1%). The most palliative score distribution was seen at a score of 6 (23.4%). The mean score was 7.51. Patient mortality in the hospital was 33 patients (51.6%). From the palliative score distribution curve, it was found an AUC value of 0.687 with a CI 95% (0.557-0.818). Optimal cut off point was 8. All of patients were palliative according to expert opinion.

Conclusion: This palliative screening tool was quite good for assessing palliative patients in terminal and complex conditions. The optimal cut off point in this study was 8. Further research is needed with an equally proportion samples."

"Pendekatan integrasi antara terapi paliatif dan perawatan penyakit kronik dan atau mengancam jiwa telah banyak digunakan dalam beberapa tahun terakhir. Hingga saat ini, masih banyak yang beranggapan bahwa terapi paliatif hanya ditujukan untuk pasien dengan penyakit berat yang sudah berada di stadium terminal atau akhir hidupnya, namun pada kenyataannya banyak pasien mendapatkan manfaat dari terapi paliatif sedini mungkin. Penelitian ini merupakan uji klinis acak terkontrol yang bertujuan untuk mengetahui manfaat integrasi terapi paliatif pada pasien anak dengan penyakit keganasan. Pasien terdiri dari anak  dengan penyakit keganasan usia 2-18 tahun yang dikonsulkan kepada tim paliatif. Pasien dibagi menjadi dua kelompok secara acak, yakni kelompok kontrol (30 anak) dan kelompok intervensi (30 anak). Intervensi berupa kunjungan rumah, komunikasi dua arah antara tenaga terlatih dengan pasien dan orang tua, dibagi menjadi 6 sesi (1 sesi setiap 2 minggu) yang berfokus pada edukasi penyelesaian masalah, manajemen gejala, perawatan diri sendiri, komunikasi, pembuatan keputusan dan pendampingan rencana perawatan lanjutan. Pasien diikuti dan dilakukan penilaian kualitas hidup dengan kuesioner Pediatric Quality of  Life Innitiative (PedsQLTM) modul kanker 3.0, intensitas gejala dinilai dengan Edmonton Symptoms Assesment Score (ESAS), frekuensi kunjungan unit gawat darurat (UGD) pasien anak dengan penyakit keganasan dicatat selama periode penelitian dan dibandingkan dengan sebelum penelitian. Kelompok intervensi memiliki kualitas hidup lebih tinggi bermakna (81,63) dibandingkan kelompok kontrol (62,39), p<0,001. Ranah kualitas hidup yang paling meningkat secara signifikan adalah ranah nyeri, mual, kecemasan prosedur, kecemasan tata laksana, dan khawatir. Intervensi paliatif dapat menurunkan intensitas gangguan tidur (p=0,003) dan anoreksia pada pasien (p<0,001). Intervensi paliatif dapat menurunkan kunjungan UGD sebanyak 4,77 kali pada pasien anak dengan penyakit keganasan (OR 4,77, 95% IK 1,29-17,65; p=0,018).

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In these last few years, an integrated approach between palliative care and chronic and/or life-threatening conditions care have been widely used. Many people think that palliative care is only intended for those with end stage of disease or in the end of life period. In fact, many patients had benefit from early palliative integration. This study is aimed to know the role of palliative intervention in child with malignancy. A randomized controlled trial comparing patients who were given palliative care (a 3-month home visit) and those who were not (intervention vs control group) was conducted, each group containing 30 patients. Patients consisted of children with cancer aged 2-18 years old who were consulted to palliative team. A two-way communication between a trained health worker and patients with or without their parents were conducted as the intervention (report by proxy or self-report). Interventions were given in 6 sessions (1 session every 2 weeks) focusing on problems solving education, symptoms management, self-care, communication, decision making, and long-term care plan assistance. In the first and twelfth week of the intervention, all patients were assessed with the Pediatric Quality of Life Inventory (PedsQLTM) questionnaire cancer module 3.0. Symptomps intensity were assessed by Edmonton Symptoms Assesment Score (ESAS). Emergency room admissions from the last 3 months were noted before patients were enrolled in the study. During the follow up period, ER admissions were recorded further. Data was analyzed using bivariate analysis, OR calculations were performed to see the effect of interventions on outcomes in this study. A significant difference of quality of life was found between the two groups with average total score in control group 62.39 and intervention group 81.63 (p<0.001). Most significant increased domains were pain, nausea, procedural anxiety, treatment anxiety, and worry. Intensity of sleep disturbance (p=0.003) and anorexia (p<0.001) were decreased significantly in intervention group. Emergency room admissions were reduced by 4.7 times in intervention group (OR 4.77, 95% CI 1.29-17.65; p=0.018)."