Pengambilan keputusan do not resucitate pasien end of life ditinjau dari perspektif keluarga
Abstract
The goals of decision making process about Do Not Resuscitate orders (DNR) are supporting the autonomy of patient or family and preventing futile medical interventions. Families can experience challenges and difficulties when making decision about DNR. The exploration of the decision-making process involving family is therefore crucial.
This study aimed to explore in-depth the decision making of DNR among End of Life (EoL) patients within inpatient area from the perspective of family caregiver. A qualitative descriptive phenomenology study was conducted that recruited 6 family caregivers, within purposive sampling. Data collection used in-depth interviews with face to face and video calls, and data analysis followed the Colaizzi’s method.
Twelve major themes emerged from interview finding of family caregiver: decision making made through family counselling, inadequate information communication, consideration of patient health status, family’s beliefs and values, family accompaniment, time allocation, knowledge, trust in health workers, financial consideration, information provision, and needs of second opinions.
The findings of this study highlighted providing communication and sharing information were ineffective and inadequate. Several barriers factors were also found related to culture and religious beliefs and values, lack of knowledge and formal training, time constrains, caring experience, and financial consideration.
Conclusion thus suggest need to inprove their ability to provide adequate information, to sharing and to perform an effective communication. Assessing appropriate and providing standards of operational procedure is essential to be done in order to improve communication styles and facilitate a shared decision making, partculary in DNR decision making for EoL patients.
References
Bailey FA, Allen RS, Williams BR, Goode PS, Granstaff S, Redden DT, et al. Do-not-resuscitate orders in the last days of life. J Palliat Med. 2012;15(7):751–9.
Huang Y chen, Huang S jean, Ko W je. Survey of Do-not-resuscitate Orders in Surgical Intensive Care Units. Journal of the Formosan Medical Association [Internet]. 2010;109(3):201–8. Available from: http://dx.doi.org/10.1016/S0929-6646(10)60043-5
Mockford C, Fritz Z, George R, Court R, Grove A, Clarke B, et al. Do not attempt cardiopulmonary resuscitation (DNACPR) orders: A systematic review of the barriers and facilitators of decision-making and implementation. Resuscitation [Internet]. 2014; Available from: http://dx.doi.org/10.1016/j.resuscitation.2014.11.016
Gibbs AJO, Malyon AC, Fritz ZBM. Themes and variations: An exploratory international investigation into resuscitation decision-making. Resuscitation [Internet]. 2016 Jun;103:75–81. Available from: http://10.0.3.248/j.resuscitation.2016.01.020
Saczynski JS, Gabbay E, McManus DD, McManus R, Gore JM, Gurwitz JH, et al. Increase in the proportion of patients hospitalized with acute myocardial infarction with do-not-resuscitate orders already in place between 2001 and 2007: A nonconcurrent prospective study. Clin Epidemiol. 2012;4(1):267–74.
Suryani S, Welch A. The Application of Colaiizi’s Method in Conducting Research Across Two Language.
Stiggelbout AM, Pieterse AH, de Haes JCJM. Shared decision making: Concepts, evidence, and practice. Patient Educ Couns [Internet]. 2015;98(10):1172–9. Available from: http://dx.doi.org/10.1016/j.pec.2015.06.022
ÇUVALCİ B, HİNTİSTAN S. Dnr Order and Elderly. Middle Black Sea Journal of Health Science. 2017;3(December):41–8.
Roze AL, Sharma N, Heyland DK, You JJ. Strategies for effective goals of care discussions and decision-making : perspectives from a multi-centre survey of Canadian hospital-based healthcare providers. 2015;1–10.
Wallace CL. Family communication and decision making at the end of life: A literature review. Palliat Support Care. 2013;13(3):815–25.
Virdun C, Luckett T, Davidson PM, Phillips J. Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important. Palliat Med [Internet]. 2015 Oct;29(9):774–96. Available from: https://search.proquest.com/docview/1716273550?accountid=48290
Yuen JK, Reid MC, Fetters MD. Hospital do-not-resuscitate orders: Why they have failed and how to fix them. Vol. 26, Journal of General Internal Medicine. 2011. p. 791–7.
Ruiz-Garcia J, Diez-Villanueva P, Ayesta A, Bruña V, Figueiras-Graillet LM, Gallego-Parra L, et al. End-of-life care in a cardiology department: Have we improved? Journal of Geriatric Cardiology. 2016;13(7):587–92.
Mrayyan M SA. Do Not Resuscitate: An Argumentative Essay. J Palliat Care Med. 2016;06(02).
Afandi D. TINJAUAN PUSTAKA Kaidah dasar bioetika dalam pengambilan keputusan klinis yang etis. 2017;40(2):111–21.
Amestiasih T, Nekada CDY. Hubungan Pengetahuan Perawat Tentang Do Not Resuscitation ( Dnr ) Dengan Sikap Merawat Pasien Di Icu Rsud Panembahan Senopati Bantul. Jurnal Keperawatan Respati Yogyakarta. 2017;4(2):138–41.
Moordiningsih, Faturochman. Proses Pengambilan Keputusan Dokter (Physician Decision Making). Jurnal Psikologi. 2004;33(2):1–8.
Truglio-Londrigan M, Slyer JT, Singleton JK, Worral PS. A qualitative systematic review of internal and external influences on shared decision-making in all health care settings. JBI Database System Rev Implement Rep. 2014;12(5):121–94.
Kementerian Kesehatan. Peraturan Menteri Kesehatan Republik Indonesia Nomor 37 Tahun 2014 Tentang Penentuan Kematian Dan Pemanfaatan Organ Donor. 2014. Jalan H.R. Rasuna Said Blok X.5 Kav. 4-9; Jakarta Selatan 12950; Jakarta, Indonesia; p. 6–7
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