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Martina D, Witjaksono MA, Putranto R. Advance Care Planning in Indonesia: Current state and future prospects. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:94-98. [PMID: 37394335 DOI: 10.1016/j.zefq.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023]
Abstract
Indonesia is a low-middle income country in Southeast Asia, as well as the world's fourth most populous and largest archipelagic nation. Indonesia has approximately 1,300 ethnic groups that speak 800 different languages and are typically collectivist and religiously devout. With an aging population and an increasing number of cancer patients, palliative care in the country remains scarcely available, disproportionally distributed, and underfunded. All of these factors (economic level, geographical and cultural landscapes, and palliative care level of development) pose a considerable impact on the adoption of advance care planning in Indonesia. Nonetheless, recent advocacy initiatives promise some hopes in advance care planning in Indonesia. Furthermore, local studies suggested opportunities to implement advance care planning, particularly through capacity building and a culturally sensitive approach to it. This article describes the present situation of advance care planning in Indonesia, including its challenges and opportunities.
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Affiliation(s)
- Diah Martina
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | | | - Rudi Putranto
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Effendy C, Kristanti MS. Open and structured assessment in addressing hospitalized cancer-related problems: The perception of patients and nurses in Indonesia. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2148196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Christantie Effendy
- Department of Medical-Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Lotus Care, Wound and Palliative Homecare Center, Private Clinic, Yogyakarta, Indonesia
| | - Martina Sinta Kristanti
- Department of Basic and Emergency Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Purba CIH, Johnston B, Kotronoulas G. An Exploration of Family Caregivers’ Health Care Needs When Caring for Patients With Cancer in the Resource-Challenged Context of West Java, Indonesia. Semin Oncol Nurs 2022:151369. [DOI: 10.1016/j.soncn.2022.151369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
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Park JY, Pardosi JF, Islam MS, Respati T, Chowdhury K, Seale H. What does family involvement in care provision look like across hospital settings in Bangladesh, Indonesia, and South Korea? BMC Health Serv Res 2022; 22:922. [PMID: 35841023 PMCID: PMC9286761 DOI: 10.1186/s12913-022-08278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Family members provide care whilst staying in the patient's room across a range of cultural settings, irrespective of resource availability in many Asian countries. This has been reported as a contributing factor to the spread of several outbreaks, including COVID-19. Despite these reports, very little is known about the risk of healthcare-associated infection (HAI) transmission related to the involvement of family and private carers in the clinical setting. As a starting point to understanding this issue, this study aimed to provide insights regarding the patient care activities undertaken by family and private carers and the guidance provided to these carers around infection control measures in hospitals located in Bangladesh, Indonesia, and South Korea. METHOD A qualitative study involving 57 semi-structured interviews was undertaken in five tertiary level hospitals across the selected countries. Two groups of individuals were interviewed: (1) patients and their family carers and private carers; and (2) healthcare workers, including doctors, nurses, hospital managers and staff members. Drawing upon the principles of grounded theory, an inductive approach to data analysis using thematic analysis was adopted. RESULTS Five main themes were generated from the analysis of the data: (1) expectation of family carers staying with a patient; (2) residing in the patient's environment: (3) caring activities undertaken by family carers; (4) supporting and educating family carers and (5) communication around healthcare-associated infection and infection prevention and control. CONCLUSION Based on the types of activities being undertaken, coupled with the length of time family and private carers are residing within the clinical setting, coupled with an apparent lack of guidance being given around IPC, more needs to be done to ensure that these carers are not being inadvertently exposed to HAI's or other occupational risks.
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Affiliation(s)
- J Y Park
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J F Pardosi
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - M S Islam
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - T Respati
- Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - K Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - H Seale
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Martina D, Kustanti CY, Dewantari R, Sutandyo N, Putranto R, Shatri H, Effendy C, van der Heide A, Rietjens JAC, van der Rijt C. Opportunities and challenges for advance care planning in strongly religious family-centric societies: a Focus group study of Indonesian cancer-care professionals. Palliat Care 2022; 21:110. [PMID: 35729537 PMCID: PMC9215088 DOI: 10.1186/s12904-022-01002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Most studies on advance care planning in Asia originate in high-income Asian countries. Indonesia is a middle-income Asian country characterized by its religious devoutness and strong family ties. This study aims to explore the perspectives and experiences of Indonesian healthcare professionals on advance care planning for cancer patients. Methods Focus-group discussions were conducted in July and August 2019 and were analysed using thematic content analysis enhanced by dual coding and exploration of divergent views. Purposive sampling of physicians and nurses actively engaged in cancer care in a national cancer centre and a national general hospital. Results We included 16 physicians and 16 nurses. These participants were open to the idea of advance care planning. We further identified four aspects of this planning that the participants considered to be important: 1) the family’s role in medical decision-making; 2) sensitivity to communication norms; 3) patients’ and families’ religious beliefs regarding the control and sanctity of life; and 4) the availability of a support system for advance care planning (healthcare professionals’ education and training, public education, resource allocation, and formal regulation). Participants believed that, although family hierarchical structure and certain religious beliefs may complicate patients’ engagement in advance care planning, a considerate approach to involving family and patients’ religious perspectives in advance care planning may actually facilitate their engagement in it. Conclusion Indonesian healthcare professionals believed that, for culturally congruent advance care planning in Indonesia, it was essential to respect the cultural aspects of collectivism, communication norms, and patients’ religious beliefs. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01002-6.
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Affiliation(s)
- Diah Martina
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands. .,Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands. .,Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia. .,Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | | | - Rahajeng Dewantari
- Department of Neuro-Psychiatry, Dharmais National Cancer Center, Jakarta, Indonesia
| | - Noorwati Sutandyo
- Department of Hematology and Medical Oncology, Dharmais National Cancer Center, Jakarta, Indonesia
| | - Rudi Putranto
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia.,Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Hamzah Shatri
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia.,Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Christantie Effendy
- School of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Carin van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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Care Dependency of Hospitalized Stroke Patients Based on Family Caregivers’ and Nurses’ Assessments: A Comparative Study. Healthcare (Basel) 2022; 10:healthcare10061007. [PMID: 35742058 PMCID: PMC9222839 DOI: 10.3390/healthcare10061007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023] Open
Abstract
Stroke impacts care dependency, and thus the patient needs home care after suffering a stroke. This study was carried out to investigate similarities and differences between the assessments made by family caregivers and nurses regarding the care dependency level of stroke patients in Indonesian hospitals. This study was a comparative study of the care dependency of stroke patients. Data were collected on the stroke wards on the day of admission using the Care Dependency Scale (CDS). The sample consisted of 118 family caregivers and 21 nurses. The Wilcoxon signed-rank test was performed to determine the mean differences between the paired data collected by family caregivers and nurses. The results of this study show that significant differences exist between the family caregivers’ and nurses’ assessments regarding the care dependency levels of stroke patients. Nurses assigned higher scores to all CDS items than family caregivers did. Significant differences between the family caregivers’ and nurses’ assessments were observed on numerous items of the Care Dependency Scale. This study contributes to efforts to raise awareness of potential differences in perceived care dependency levels of stroke patients. The findings can help nurses plan the patient’s discharge together with family caregivers.
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Charos D, Merluzzi TV, Kolokotroni P, Lykeridou K, Deltsidou A, Vivilaki V. Breast cancer and social relationship coping efficacy: validation of the Greek version. Women Health 2021; 61:947-956. [PMID: 34706626 DOI: 10.1080/03630242.2021.1994101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.
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Affiliation(s)
- Dimitrios Charos
- Midwifery Department, University of West Attica, Athens, Greece.,Psychologist, General Anti-Cancer Hospital Agios Savvas, Athens, Greece
| | - Thomas V Merluzzi
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | | | | | - Anna Deltsidou
- Midwifery Department, University of West Attica, Athens, Greece
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Buwana C, Ito Y, Brintnell ES. The Indonesian sociocultural contexts related to daily occupations of children with cancer during hospitalisation: The parents’ perspective. Br J Occup Ther 2021. [DOI: 10.1177/03080226211008716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The sociocultural phenomenon affecting daily occupations of hospitalised children with cancer in a diverse country like Indonesia is thought-provoking and requires exploration. Objective This study aims to explore the sociocultural contexts related to daily occupations of children with cancer during hospital admittance from the parents' perspective. Methods Semi-structured interviews were conducted with parents of children with cancer who had been hospitalised for two weeks or more. The data were collected at the paediatric ward of “Dharmais” National Cancer Center Hospital, Jakarta. The study uses interpretative phenomenological analysis (IPA). Results Nine parents of children with cancer consented to the study. Three interconnected themes emerged as necessary to the sociocultural context among participants. These involve ‘The surrounding human environment as primary encouragement’, ‘Culture and spirituality as the basic standard’ and ‘Activity adjustments as new habits’. Conclusions The themes revealed that the daily occupations of hospitalised children with cancer are strongly encouraged by family and social systems in Indonesia, spiritual aspects of the parents and the occupational changes due to the new settings.
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Affiliation(s)
- Cahya Buwana
- Department of Medical Rehabilitation, “Dharmais” National Cancer Center Hospital, Jakarta, Indonesia
- Department of Occupational Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuko Ito
- Department of Occupational Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - E Sharon Brintnell
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Souza RLAD, Mutti CF, Santos RPD, Oliveira DCD, Okido ACC, Jantsch LB, Neves ET. Hospitalization perceived by children and adolescents undergoing cancer treatment. ACTA ACUST UNITED AC 2021; 42:e20200122. [PMID: 34037109 DOI: 10.1590/1983-1447.2021.20200122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To know the perception of children and adolescents undergoing cancer treatment about hospitalization. METHODS Qualitative research conducted with 13 children and adolescents hospitalized for cancer treatment at a referral hospital in southern Brazil. Semi-structured interviews mediated by the drawing technique were conducted from May to November 2018. Data was submitted to inductive thematic analysis based on the theoretical framework of Brazil's National Humanization Policy. RESULTS Disturbances were detected in the professionals' communication with the hospitalized children and adolescents. The participants felt socially isolated and highlighted the importance of recreational activities during hospitalization. CONCLUSION Infant cancer is complex and needs multidisciplinary care during the treatment, enabling the organization of healthy and welcoming spaces that favor humanization of care.
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Affiliation(s)
- Raíra Lopes Amaral de Souza
- Universidade Federal de Santa Maria (UFSM), Programa de Pós-graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Cintia Flôres Mutti
- Universidade Federal de Santa Maria (UFSM), Colégio Politécnico, Programa de Pós-graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | | | | | | | - Leonardo Bigolin Jantsch
- Universidade Federal de Santa Maria (UFSM), Departamento de Ciências da Saúde. Palmeira das Missões, Rio Grande do Sul, Brasil
| | - Eliane Tatsch Neves
- Universidade Federal de Santa Maria (UFSM), Programa de Pós-graduação em Enfermagem. Santa Maria, Rio Grande do Sul, Brasil
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Rahayu H, Yona S, Masfuri. The social support, spirituality, stress, and family burden of cancer patients in Jakarta hospitals. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2020.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ligita T, Harvey N, Wicking K, Francis K, Nurjannah I. Diabetes self-management: what role does the family play? HEALTH EDUCATION 2020. [DOI: 10.1108/he-12-2019-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper aims to explicate one of the major findings of a research study seeking to understand how Indonesian people with diabetes learn about their disease. The one key finding discussed in this paper is how families influence the learning and self-management processes adopted by Indonesian people with diabetes.Design/methodology/approachA grounded theory methodology was adopted to investigate how Indonesian people with diabetes learn about their disease. Twenty-eight semi-structured interviews were undertaken with Indonesian people living with diabetes, families of people living with diabetes, healthcare professionals and other healthcare providers. Data was analysed by using constant comparative analysis during three coding stages.FindingsThe study explicated the basic social process of how people with diabetes in Indonesia learn about their disease through a generated theory “Learning, choosing, and acting: self-management of diabetes in Indonesia”. This study found family engagement was integral to Indonesian people living with diabetes who were self-managing their disease. Families assisted with seeking information, providing recommendations, selecting and implementing actions, appraising implemented actions, and informing others about their experiences. By acknowledging that family is involved in this process, the healthcare professional can adequately provide health education to both the person with diabetes and their families. Involving families in health education is crucial as family can influence decision making made by people with diabetes in a proper or improper way. Thus, clinicians need to also skilfully recognise difficulties these people encounter by monitoring their self-management progress and by working closely with them and their family members.Originality/valueThis is the first study conducted in Indonesia that specifically investigates the process of how people with diabetes learn about their disease. The involvement of families in this process is a central finding of the study. Families can enhance the overall health and well-being of the person with diabetes, aid in early recognition of aberration to health status and trigger the initiation of interventions to re-establish homeostasis if they are actively engaged and supported by health professionals.
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Park JY, Pardosi JF, Seale H. Examining the inclusion of patients and their family members in infection prevention and control policies and guidelines across Bangladesh, Indonesia, and South Korea. Am J Infect Control 2020; 48:599-608. [PMID: 31919010 PMCID: PMC7132722 DOI: 10.1016/j.ajic.2019.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although familial involvement during inpatient care is not uncommon in western countries, the types of caring activities that family members in Asian countries provide are significantly different. These activities may place the family member at risk from a health care-associated infection. This study aimed to examine whether the role of patients' families has been accounted for in the infection prevention and control (IPC) guidelines and policy, using examples from Bangladesh (low-income country), Indonesia (middle-income country), and South Korea (high-income country). METHODS The World Health Organization website and Institutional Repository for Information Sharing, Centers for Disease Control and Prevention website, Australian Government Web Archive, Open Grey, Grey Matters, World Bank, and advanced Google search, as well as the Health Department/Ministry of Health websites for each target country and 4 western countries (Australia, Canada, England, and the United States) were searched. Other databases, such as Embase, Medline, CINAHL, Global Health, ProQuest databases, Google scholar, Web of Science, and Scopus were also searched. This was to review the reflection of the cultural influence in IPC policies/guidelines by reviewing those from the global organizations, which are often used as a blueprint for policy development, as well as those from western countries, which hold different cultures in care arrangement. Search was conducted with attention to the key areas: definition and role of carer in the acute health care facility, involvement of patients/family members in IPC activities, patient and family member hand hygiene, and IPC education. RESULTS Ninety-two articles were identified based on the criteria for the study. Only 6 acknowledged that care is provided to hospitalized patients by their family members, and only 1 recommended that family members receive the same level of training as health care workers on IPC precautions. Other guides recommended the provision of information on IPC measures as means of patient involvement in the IPC program. Recognition of family caregivers or inclusion of them in the IPC strategies was not included in the target countries' guidelines. CONCLUSIONS Although health care workers are the primary actors when it comes to providing care in acute health care settings, it is important to expand the IPC guides by considering the role of other caregivers. Policies and guidelines should reflect the cultural influence over healthcare. This is especially true when cultural values strongly influence over healthcare arrangements and the healthcare accommodates these cultural influences in the practice. Further work needs to be undertaken on the level of training/education provided to family members in Bangladesh, Indonesia, and South Korea.
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Affiliation(s)
- Ji Yeon Park
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | | | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Khraisat OM, Alkhawaldeh A, Abuhammad S. Spirituality-focused end-of-life care among paediatric patients: evidence from Saudi Arabia? Int J Palliat Nurs 2020; 25:610-616. [PMID: 31855517 DOI: 10.12968/ijpn.2019.25.12.610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spirituality has been recognised as an essential aspect of patient care. AIM To assess the greatest facilitators that would help to provide spirituality for paediatric end of life. Methods: Two hundred and fifty oncology nurses were surveyed using a spirituality and spiritual care rating questionnaire. FINDINGS The greatest facilitators perceived by nurses were: believe in spirituality as a unifying force that enables one to be at peace with oneself and the world; listening and allowing patients time to discuss and explore their fears; and using art, creativity and self-expression; respect for privacy, dignity and religious and cultural beliefs of a patient. CONCLUSIONS Many nursing-related facilitators to spirituality care were found. They need to be addressed and supported through education and training.
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Affiliation(s)
- Omar Ma Khraisat
- Assistant Professor, Nursing College, Al-Ahliyya Amman University, Jordan
| | | | - Sawsan Abuhammad
- Assistant Professor, Nursing School, Jordan University of Science and Technology, Jordan
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The experience of caring for an advanced lung cancer spouse: Vulnerable journey of caregiving. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Krisdiyanto BF, Dahlia D, Waluyo A. On home-based care decision making: The will of the family of palliative cancer patients. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kilic ST, Oz F. Family Caregivers' Involvement in Caring with Cancer and their Quality of Life. Asian Pac J Cancer Prev 2019; 20:1735-1741. [PMID: 31244294 PMCID: PMC7021632 DOI: 10.31557/apjcp.2019.20.6.1735] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Cancer is a chronic disease and a major health problem. It affects both patients and their family
caregivers multidimensionally. The family caregivers may be affected by not only the disease process but also hospital
policies, economic difficulties, accessibility and communication of health care service and can be in need of help.
This process may affect their quality of life. However, there have not been enough studies on quality of life of family
caregivers of patients with cancer in Turkish culture. Therefore, this study aimed to evaluate the quality of life of
family caregivers of patients with cancer in Turkey. Objectives: The purpose of study was to evaluate the quality of
life of family caregivers with cancer patients in Turkey. Methods: Participants consist of the family caregivers who
volunteered to take part in this descriptive study from 11 hospitals (n =378) which has a daily chemotherapy units
and located within the boundaries of Ankara, Turkey. ‘Sociodemographic Characteristic Form’ and ‘Quality of Life
Scale-Family Version were used as data collection tool. The Kruskal-Wallis and Mann-Whitney U, tests were used
for data analysis. Resultes:It is found that there are statistically significant difference among the factors of gender,
employment status, income level, and whether caregivers reside with their patients. Family caregivers’ quality of life is
negatively affected during the caregiving process (p < 0.05). Conclusion: The results indicate that family caregivers’
quality of life are negatively affected to care process. The results of this research are important as they highlight the
need to also consider family caregivers’ quality of life when caring for patients, and study highlight possible areas in
which support can be provided for family caregivers of cancer patients in Turkey.
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Affiliation(s)
- Sevcan Toptas Kilic
- Hacettepe University Faculty of Nursing, Psychiatric Nursing Department, Ankara, Turkey.
| | - Fatma Oz
- Near East University, Faculty of Nursing, Mersin, Turkey
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Kristanti MS, Effendy C, Utarini A, Vernooij-Dassen M, Engels Y. The experience of family caregivers of patients with cancer in an Asian country: A grounded theory approach. Palliat Med 2019; 33:676-684. [PMID: 30916614 PMCID: PMC6537031 DOI: 10.1177/0269216319833260] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Strong family bonds are part of the Indonesian culture. Family members of patients with cancer are intensively involved in caring, also in hospitals. This is considered "normal": a societal and religious obligation. The values underpinning this might influence families' perception of it. AIM To explore and model experiences of family caregivers of patients with cancer in Indonesia in performing caregiving tasks. DESIGN A grounded theory approach was applied. The constant comparative method was used for data analysis and a paradigm scheme was employed for developing a theoretical model. SETTING/PARTICIPANTS The study was conducted in three hospitals in Indonesia. The participants were family caregivers of patients with cancer. RESULTS A total of 24 family caregivers participated. "Belief in caregiving" appeared to be the core phenomenon. This reflects the caregivers' conviction that providing care is an important value, which becomes the will power and source of their strength. It is a combination of spiritual and religious, value and motivation to care, and is influenced by contextual factors. It influences actions: coping mechanisms, sharing tasks, and making sacrifices. Social support influences the process of the core phenomenon and the actions of the caregivers. Both positive and negative experiences were identified. CONCLUSION We developed a model of family caregivers' experiences from a country where caregiving is deeply rooted in religion and culture. The model might also be useful in other cultural contexts. Our model shows that the spiritual domain, not only for the patient but also for the family caregivers, should be structurally addressed by professional caregivers.
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Affiliation(s)
- Martina Sinta Kristanti
- Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
- School of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Christantie Effendy
- School of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adi Utarini
- Department of Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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19
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Herlianita R, Yen M, Chen CH, Fetzer SJ, Lin ECL. Perception of Spirituality and Spiritual Care among Muslim Nurses in Indonesia. JOURNAL OF RELIGION AND HEALTH 2018. [PMID: 28647910 DOI: 10.1007/s10943-017-0437-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.
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Affiliation(s)
| | - Miaofen Yen
- Department of Nursing, National Cheng Kung University (NCKU) and Hospital, Tainan City, Taiwan, ROC
| | - Ching-Huey Chen
- Department of Nursing, Chang Jung Christian University, Tainan City, Taiwan, ROC
| | - Susan J Fetzer
- Department of Nursing, University of New Hampshire, Durham, NH, USA
| | - Esther Ching-Lan Lin
- Department of Nursing, National Cheng Kung University (NCKU) and Hospital, No. 1, University Rd., Tainan City, 70101, Taiwan, ROC.
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20
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Ruben MA, Blanch-Hartigan D, Shipherd JC. To Know Another’s Pain: A Meta-analysis of Caregivers’ and Healthcare Providers’ Pain Assessment Accuracy. Ann Behav Med 2018; 52:662-685. [DOI: 10.1093/abm/kax036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mollie A Ruben
- School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA
| | | | - Jillian C Shipherd
- National Center for PTSD, Women’s Health Sciences, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Lesbian, Gay, Bisexual, and Transgender (LGBT) Program, Veterans Health Administration, Washington, DC
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21
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Partanen E, Lemetti T, Haavisto E. Participation of relatives in the care of cancer patients in hospital-A scoping review. Eur J Cancer Care (Engl) 2018; 27:e12821. [PMID: 29337413 DOI: 10.1111/ecc.12821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 11/29/2022]
Abstract
The purpose of the review was to describe what kind of research has been conducted concerning relatives' participation in the care of cancer patients in hospital and how relatives have participated in the care. Data (n = 9) were identified through a manual search and by searching the electronic databases (n = 8) Cinahl, PubMed and Cochrane Library and analysed with deductive content analysis. According to the review, participation in the concrete care appeared as taking care of comprehensive care and the quality of care, helping with daily activities and helping the healthcare professionals. Emotional support appeared as protecting, supporting and visiting the patient and discussing with the patient. Participation in decision-making appeared as acting as an advocate for the patient, participating in the discussion concerning the decision-making and participating in the discussion concerning the decisions of end of life. According to the review, research concerning this topic seems to be rare. While hospital periods are shortening and homecare is increasing, the role of relatives as a supporter of the cancer patient is becoming even stronger. In the future, more research should be conducted how the patients experience participation and what are their wishes.
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Affiliation(s)
- E Partanen
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - T Lemetti
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - E Haavisto
- Department of Nursing Science, Hospital District of Satakunta, University of Turku, Turku, Finland
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22
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Schröders J, Wall S, Hakimi M, Dewi FST, Weinehall L, Nichter M, Nilsson M, Kusnanto H, Rahajeng E, Ng N. How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis. PLoS One 2017; 12:e0179186. [PMID: 28632767 PMCID: PMC5478110 DOI: 10.1371/journal.pone.0179186] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/07/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health. METHODS Our review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data. RESULTS On the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension. CONCLUSIONS Our findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.
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Affiliation(s)
- Julia Schröders
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stig Wall
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mohammad Hakimi
- Centre for Reproductive Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lars Weinehall
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Mark Nichter
- School of Anthropology, College of Social and Behavioral Sciences, The University of Arizona, Tucson, United States of America
| | - Maria Nilsson
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hari Kusnanto
- Department of Family Medicine, Community Medicine and Bioethics, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ekowati Rahajeng
- Center for Public Health Research and Development, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta, Republic of Indonesia
| | - Nawi Ng
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
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23
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Parás-Bravo P, Paz-Zulueta M, Alonso-Blanco MC, Salvadores-Fuentes P, Alconero-Camarero AR, Santibañez M. Association among presence of cancer pain, inadequate pain control, and psychotropic drug use. PLoS One 2017; 12:e0178742. [PMID: 28594871 PMCID: PMC5464574 DOI: 10.1371/journal.pone.0178742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 05/18/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant use of psychotropic drugs among such patients, the association among pain, inadequate pain control, and psychotropic drug use has not been fully determined. This study examined the prevalence of cancer pain and inadequate pain control and the association with psychotropic drug use. MATERIALS AND METHODS In this cross-sectional study, we investigated 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Adjusted odds ratios (ORs) were estimated together with their 95% confidence intervals (95% CIs) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics, and antidepressants). RESULTS The mean patient age was 61.17 (standard deviation ± 13.14) years; 57.5% were women, 42.5% men. Pain was present in 18.4% of patients and inadequate pain control in 54.2%. We found a statistically significant association between the presence of cancer pain and anxiolytic use (adjusted OR, 3.15; 95% CI, 1.49-6.68) and hypnotic use (adjusted OR, 5.19; 95% CI, 1.77-15.25). Inadequate pain control was associated to a greater extent with the use of those drugs: adjusted OR for anxiolytic use, 4.74 (95% CI, 1.91-11.80); adjusted OR for hypnotic use, 6.09 (95% CI, 1.74-21.32). By contrast, no association was found between pain and antidepressant use (adjusted OR, 0.99). CONCLUSION The presence of pain and (to a greater extent) poor pain control were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appeared to be no association between pain and antidepressant use.
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Affiliation(s)
| | - María Paz-Zulueta
- Department of Nursing, University of Cantabria, Santander, Spain
- * E-mail:
| | | | - Paloma Salvadores-Fuentes
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Division of Physical Therapy, University “Rey Juan Carlos”, Madrid, Spain
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24
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The role of Indonesian patients' health behaviors in delaying the diagnosis of nasopharyngeal carcinoma. BMC Public Health 2017; 17:510. [PMID: 28545416 PMCID: PMC5445307 DOI: 10.1186/s12889-017-4429-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With an estimated 13,000 newly diagnosed patients per year, nasopharyngeal carcinoma (NPC) is one of the most common types of cancer in males in Indonesia. Moreover, most patients are diagnosed at an advanced stage of the disease. This study aimed to explore the health behaviors of patients diagnosed with NPC and the possible causes of patient delay in NPC diagnosis. METHODS A qualitative research method was used to gain better insight into patient behaviors. Twelve patients were interviewed using semi-structured interview guidelines. All interviews were recorded, transcribed verbatim and analyzed according to a standard content analysis framework. RESULTS Most patients had limited knowledge regarding NPC and its causes. Fifty percent of the patients had a delay of six months from the onset of symptoms to diagnosis. The main reason for this delay was the lack of awareness among the patients, which was influenced by their environment, economic status, family, culture, and religion. The perceived barriers to seeking medical help included direct non-medical costs not covered by health insurance, complex and time-consuming insurance and referral systems, and negative experiences in the past. Health insurance did motivate people to seek medical help. CONCLUSION This study provides additional insight into patients' motivations to delay seeking medical help and can facilitate the design of NPC education programs. To improve awareness of the abovementioned causes for delay, community-based education programs are highly warranted and should focus on the recognition of NPC symptoms and possible solutions to overcome the main barriers at an earlier disease stage.
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25
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Kristanti MS, Setiyarini S, Effendy C. Enhancing the quality of life for palliative care cancer patients in Indonesia through family caregivers: a pilot study of basic skills training. BMC Palliat Care 2017; 16:4. [PMID: 28095837 PMCID: PMC5240385 DOI: 10.1186/s12904-016-0178-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 12/23/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palliative care in Indonesia is problematic because of cultural and socio-economic factors. Family in Indonesia is an integral part of caregiving process in inpatient and outpatient settings. However, most families are not adequately prepared to deliver basic care for their sick family member. This research is a pilot project aiming to evaluate how basic skills training (BST) given to family caregivers could enhance the quality of life (QoL) of palliative care cancer patients in Indonesia. METHODS The study is a prospective quantitative with pre and post-test design. Thirty family caregivers of cancer patients were trained in basic skills including showering, washing hair, assisting for fecal and urinary elimination and oral care, as well as feeding at bedside. Patients' QoL were measured at baseline and 4 weeks after training using EORTC QLQ C30. Hypothesis testing was done using related samples Wilcoxon Signed Rank. A paired t-test and one-way ANOVA were used to check in which subgroups was the intervention more significant. RESULTS The intervention showed a significant change in patients' global health status/QoL, emotional and social functioning, pain, fatigue, dyspnea, insomnia, appetite loss, constipation and financial hardship of the patients. Male patient's had a significant effect on global health status (qol) (p = 0.030); female patients had a significant effect on dyspnea (p = 0.050) and constipation (p = 0.038). Younger patients had a significant effect in global health status/QoL (p = 0.002). Patients between 45 and 54 years old had significant effect on financial issue (p = 0.039). Caregivers between 45 and 54 years old had significant effect on patients' dyspnea (p = 0.031). CONCLUSIONS Basic skills training for family caregivers provided some changes in some aspects of QoL of palliative cancer patients. The intervention showed promises in maintaining the QoL of cancer patients considering socio-economic and cultural challenges in the provision of palliative care in Indonesia.
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Affiliation(s)
| | - Sri Setiyarini
- School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Christantie Effendy
- School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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26
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Rochmawati E, Wiechula R, Cameron K. Current status of palliative care services in Indonesia: a literature review. Int Nurs Rev 2016; 63:180-90. [DOI: 10.1111/inr.12236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Erna Rochmawati
- School of Nursing; University of Adelaide; Adelaide South Australia Australia
- School of Nursing; Universitas Muhammadiyah Yogyakarta; Indonesia
| | - Rick Wiechula
- School of Nursing; University of Adelaide; Adelaide South Australia Australia
| | - Kate Cameron
- School of Nursing; University of Adelaide; Adelaide South Australia Australia
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Effendy C, Vissers K, Osse BHP, Tejawinata S, Vernooij-Dassen M, Engels Y. Comparison of problems and unmet needs of patients with advanced cancer in a European country and an Asian country. Pain Pract 2014; 15:433-40. [PMID: 24666769 DOI: 10.1111/papr.12196] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with advanced cancer experience problems and unmet needs. However, we assume that patients with advanced cancer will have more problems and unmet needs in a country with a lower economic status than in an economically stronger country. We studied whether patients with advanced cancer in Indonesia have more problems and unmet needs than a similar group of patients in the Netherlands. METHODS We performed a cross-sectional survey. We compared the data for 180 Indonesian and 94 Dutch patients relating to 24 items of the Problems and Needs in Palliative Care-short version questionnaire. We performed descriptive and χ(2) analysis with Bonferroni correction. RESULTS The prevalence of most physical problems, including pain, was similar in the 2 groups. In Indonesia, financial problems were the most common: 70 to 80% vs. 30 to 42% in the Netherlands. In Indonesia, 25 to 50% of the patients reported psychological and autonomy problems versus 55 to 86% in the Netherlands. The Indonesian group had many more unmet needs for each problem (> 54%) than the Dutch group (< 35%). CONCLUSION Apparently, economic and cultural differences hardly influence physical problems. Nonetheless, fewer Indonesian patients reported psychological and autonomy problems than Dutch patients. This difference contradicts our hypothesis. However, we found more unmet needs for professional attention in Indonesia than in the Netherlands, which is compatible with our hypothesis. These simple comparative data provide interesting insights into problems and unmet needs and give rise to our new hypothesis about cultural influences. This hypothesis should be studied in more depth.
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Affiliation(s)
- Christantie Effendy
- School of Nursing, Medical Faculty, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Bart H P Osse
- Arentz en Osse Huisartsenpraktijk in Deventer, Deventer, the Netherlands
| | - Sunaryadi Tejawinata
- Center of Development for Palliative and Pain Relief, Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.,Department of Primary and Community Care, Radboud University Nijmegen Medical Centre and Kalorama Foundation, Beek-Ubbergen, the Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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