A.

DEFINISI
 Stress adalah respon tubuh yg tidak spesifik terhadap
setiap kebutuhan tubuh yang terganggu
 Stressor adalah setiap faktor yang menimbulkan stress
 Eustress adalah stress positive yang terjadi ketika
tingkatan stress cukup tinggi untuk memotivasi agar
bertindak (stress positive)
 Distress (stress negative) adalah saat terjadi tingkatan
stress berat atu ringan, tubuh dan pikiran menanggapi
stressor dengan cara negative atau stress yang
mengganggu kesehatan dan sering menyebabkan
ketidakseimbangan antara tuntutan dan kemampuan
untuk menanggapinya
 Bagaimana pandangan individu terhadap stressor dan
pengaruhnya pada situasi mereka.
 Sistem dukungan yang tersedia
 Koping mekanisme yang digunakan.

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Stressor Appraisal Stress

• Eustress
• Disstress

4
Periods of Increased Vulnerability for
Distress
Distress as a psychosocial morbidity
condition
 Consequences of distress as a psychosocial
morbidity condition
• Deterioration of QoL [Parker et al., Psycho-Oncology, 2003]
• Higher levels of pain [Spiegel et al., Cancer, 1994]
• Burden for the family [Pitceathly & Maguire, Eur J Cancer, 2003]
• Longer rehabilitation [Prieto et al., J Clin Oncol., 2002]
• Reduced adherence to treatment [Colleoni et al., Lancet, 2000]
• Less efficacy of chemotherapy (when related to hopelessness)
[Walker et al., Eur J Cancer, 1998]
• Shorter survival expectancy (when related to hopelessness) [Watson
et al., Lancet, 1999; Prieto et al., JCO, 2005; Watson et al, 2005;
Spiegel et al., JCO 2011]
• Risk of suicide (when related to hopelessness and major depression)
[Henriksson et al., J Affect Dis, 1995]
Standards of Care for distress management

• Educational and training programs should be developed

to ensure that health care professionals have knowledge
and skills in the assessment/management of distress
• •Licensed mental health professionals experienced in
psychosocial aspects of cancer should be readily
available as staff members or by referral
• •Quality of distress management program/services
should be included in institutional continuous quality
improvement projects
 Challanges
1. Need for more dissemination
• About 25% use tools among cancer physicians
in their clinical practice to assess emotional
symptoms (low skill confidencs & lack of
training and support 32%; lack of time 57%)
[Mitchell et al., Psycho-Oncology, 2008]
• Only 20% of the NCCN institutions screened all
patients as the guidelines recommend
[Jacobsen and Ransom, J NCCN, 2007]
2. Need for education
 3. Need for communication and relational
skills

• Attitudes
• Behavior
• Compassion
• Dialogue

• Healthcare providers have a profound influence on how patients experience

illness and on their sense of dignity.
• Dignityconserving care has an important effect on the experience of
patienthood.
• The ABCD of dignity conserving care can be applied to teaching, clinical
practice, and standards.
Chochinov, BMJ, 2007
Screeening as part of a process in
psychosocial care