Laliu Amri Yasir - Tugas Uts
Laliu Amri Yasir - Tugas Uts
CRITICAL APPRAISAL
THE EFFECTIVENESS OF DIGNITY THERAPY AS APPLIED TO END-OF-
LIFE PATIENTS WITH CANCER IN TAIWAN: A QUASI-EXPERIMENTAL
STUDY
Disusun Oleh:
Lalu Amri Yasir
NIM 22020121410030
MAGISTER KEPERAWATAN
FAKULTAS KEDOKTERAN
UNIVERSITAS DIPONEGORO
TAHUN 2021
Daftar Isi
Halaman Judul
Daftar Isi..............................................................................................................................2
Kata Pengantar.....................................................................................................................3
BA B I Masalah Klinis........................................................................................................4
BAB II Critical Apprasial....................................................................................................5
Daftar Pustaka......................................................................................................................9
Lampiran Journal.................................................................................................................10
Nilai SJR Journal.................................................................................................................18
2
KATA PENGANTAR
Dengan menyebut nama Allah SWT yang Maha Pengasih dan Maha Penyayang,
kami panjatkan puji syukur kehadirat-Nya yang telah melimpahkan rahmat, hidayah,
serta inayah-Nya kepada kami sehingga kami bisa menyelesaikan Laporan Critical
Appraisal.
Laporan ini dibuat sebagai latihan dalam menerapkan materi Critical Appraisal
guna menunjang pemilihan artikel Riset Keperawatan yang tepat untuk digunakan
sebagai tugas ujian tengah semster. Laporan ini disusun secara individu sekaligus untuk
memenuhi tugas Mata Riset Keperawatan.
Penulis menyadari bahwa tanpa bimbingan dari bapak/ibu dosen, penulis tidak
mampu menyelesaikan laporan ini. Untuk itu kami menyampaikan terimakasih kepada
Dosen Pegampu Mata Kuliah Riset Keperawatan dan semua pihak yang telah
berkontribusi dalam pembuatan tugas ini. Penulis menyadari bahwa masih banyak
kekurangan dalam tugas ini, kritik dan saran diharapkan demi kemajuan dan perbaikan
di masa mendatang. Semoga tugas Critical Apprasial ini bermanfaat bagi para
pembaca.
Saya
3
BAB I
GAMBARAN PERMASALAHAN KLINIS
Penderita kanker sering mengalami rasa sakit dan ketidaknyamanan fisik serta
ketidakmampuan dalam memenuhi peran dan tanggung jawabnya. Penderita kanker
selalu merasakan tekanan psikologis, seperti merasa menjadi beban orang lain,
memiliki martabat yang lebih rendah, makna hidup yang lebih rendah, kualitas
hidup yang lebih buruk, dan rasa putus asa, kecemasan, depresi, dan keinginan
untuk mati (Chochinov HM, Hack T, dkk. 2009). Pada tahun 2014 dan 2016, studi
di Amerika Serikat menunjukkan bahwa 63,0% hingga 77,0% dari pasien dengan
kanker menderita tekanan psikologis, masing-masing (Griffiths RR, Johnson MW,
dkk 2016).
Pengembangan perawatan paliatif hospice pada tahun 1990 memiliki tujuan
untuk melindungi martabat pasien akhir hayat dan mengurangi tekanan
psikologis( WHO,2015). Namun, mengambil Taiwan sebagai contoh, hanya 60,9%
dari pasien kanker yang menggunakan perawatan paliatif rumah sakit sebelum
mereka meninggal dalam waktu satu tahun (Promkes RS Taiwan, 2018). Dengan
40,0% pasien akhir hayat dengan kanker yang tidak menggunakan perawatan
paliatif hospice di Taiwan, mengetahui bagaimana membantu mereka menerima
perawatan yang bermartabat, mengurangi tekanan psikologis mereka, dan membuat
mereka merasa hidup mereka masih memiliki makna dan nilai adalah masalah
penting untuk penyedia layanan kesehatan. Penyedia layanan kesehatan sangat
perlu memberikan perhatian dan bantuan terhadap tekanan psikologis pasien ini.
Studi sebelumnya telah menunjukkan bahwa terapi martabat dapat meningkatkan
tekanan psikologis pada pasien akhir kehidupan (Houmann LJ, Chochinov HM,
2014); oleh karena itu, penelitian ini bertujuan untuk mengeksplorasi keefektifan
terapi martabat pada pasien akhir hayat dengan kanker.
BAB II
CRITICAL APPRAISAL
Intervention Terapi martabat selama 4 bulan dari bulan Oktober 2016 s.d Januari
2017
Comparison Kelomok eksperimen yang diberikan intervensi terapi maratabat dan
kelompok kontrol
Outcome Intervensi terpi martabat mencerminkan terjadinya peningkatan
martabat diri pasien, mengurangi keemasan dan depresi secara
signifikan.
B. Critical Appraisal
1. Bukti Ilmiah/Referensi
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M, et al. The
landscape of distress in the terminally ill. J Pain Symptom Manag.
2009;38(5):641e9. https://doi.org/10.1016/j.jpainsymman.2009.04.021
Darmayanti Dwi A., Fitriah, dkk. 2008.Penanganan Masalah Sosial dan Psikologis
Pasien Kanker Stadium Lanjut dalam Perawatan Paliatif. Indonesian Journal Of
Cancer.1, Hal 30-34. https://media.neliti.com/media/publications/69927-ID-
penanganan-masalah-sosial-dan-psikologis.pdf. Diakses pada tanggal 6 Oktober
2021.Pukul 19.30 WITA
Griffiths RR, Johnson MW, Carducci MA, Umbricht A, Richards WA, Richards BD, et
al. Psilocybin produces substantial and sustained decreases in depression and
anxiety in patients with life-threatening cancer: a randomized doubleblind trial. J
Psychopharmacol.2016;30(12):1181e97. ttps://doi.org/10.1177/0269881116675513
Yu-Chi Li, Yin-Hsun Feng, Hui-Ying Chiang, Shu-Ching Ma, Hsiu-Hung Wang. 2019
The Effectiveness of Dignity Therapy as Applied to End-of-Life Patients with
Cancer in Taiwan: A Quasi-Experimental Study. Elselvier: Journal of Asian
Nursing Research
Asian Nursing
Research
14
(2020)
189e195
Contents lists available at ScienceDirect
1
College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
2
Department of Hematology-Oncology, Chi-Mei Medical Center, Tainan, Taiwan
3
Department of Nursing, Chi-Mei Medical Center, Tainan, Taiwan
4
College of Humanities and Social Sciences, Southern Taiwan University of Science and Technology, Tainan, Taiwan
A R T I C A B S T R A C T
L E I
Purpose: The aim of the study was to determine the effectiveness of dignity
N F O therapy for end-of-life patients with cancer.
Methods: This study used a quasi-experimental study design with a
Article history: nonrandomized controlled trial. Dignity therapy was used as an intervention in
Received 21 the experimental group, and general visit was used in the control group. Thirty
August 2019
end-of-life patients with cancer were recruited, with 16 in the experimental group
Received in
and 14 in the control group. Outcome variables were the participants' dignity,
revised form 9
April 2020 demoralization, and depression. Measurements were taken at the following time
Accepted 13 April 2020 points: pre-test (before intervention), post- test 1 (the 7th day), and post-test 2
(the 14th day). The effectiveness of the intervention in the two groups was
K analyzed using the generalized estimating equation, with the p value set to be less
ey than .05. Results: After dignity therapy, the end-of-life patients with cancer
w reflected increased dignity signifi-
or cantly [b ¼ —37.08, standard error (SE) ¼ 7.43, Wald c2 ¼ 24.94, p < .001],
ds whereas demoralization
: (b ¼ —39.55, SE ¼ 6.42, Wald c2 ¼ 37.95, p < .001) and depression (b ¼ —12.01, SE ¼
ca
2.17, Wald c2 ¼ 30.71,
nc
p < .001) were both reduced significantly.
er
de
Conclusion: Clinical nurses could be adopting dignity therapy to relieve
pr psychological distress and improve spiritual need in end-of-life patients with
es cancer. Future studies might be expanded to looking at patients vis-a`-vis
si end-of-life patients without cancer to improve their psychological
o distress. These results provide reference data for the care of end-of-life patients
n with cancer for nursing professionals.
ne © 2020 Korean Society of Nursing Science. Published by Elsevier BV. This is an
o
open access article under the CC BY-NC-ND license
pl
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
as
m
s
psychologica
l distress
terminal
care
https://doi.org/10.1016/j.anr.2020.04.003
p1976-1317 e2093-7482/© 2020 Korean Society of Nursing Science. Published by Elsevier BV. This is an open access article under
the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
190 Y.-C. Li et al. / Asian Nursing Research 14 (2020) 189e195
psychological distress in end-of-life patients [7]; therefore, the therapy found it helpful [20], and in 2014, a study in the United
present study aimed at exploring the effectiveness of dignity
therapy in end-of-life patients with cancer.
Dignity therapy
Methods
Study design
Participants
Sample size
Study process
1. Tell me a little about your life history; particularly the parts that you either
remember most or think are the most important? When did you feel most alive?
2. Are there specific things that you would want your family to know about you, and
are there particular things you would want them to remember?
3. What are the most important roles you have played in life (family roles,
vocational roles, community-service roles, etc.)? Why were they so impor- tant
to you, and what do you. think you accomplished in those roles?
4. What are your most important accomplishments, and what do you feel most
proud of?
5. Are there particular things that you feel still need to be said to your loved
ones or things that you would want to take the time to say once again?
6. What are your hopes and dreams for your loved ones?
7. What have you learned about life that you would want to pass along to
others? What advice or words of guidance would you wish to pass along
to your (son, daughter, husband, wife, parents, others)?
8. Are there words or perhaps even instructions that you would like to offer
your family to help prepare them for the future?
9. In creating this permanent record, are there other things that you would like
included?
Intervention
Measurements
Basic information
(r ¼ 0.80, p < .001) and DS-MV (r ¼ 0.78, p < .001). Breast 1 (6.3) 1 (7.1)
Gastric 0 (0.0) 1 (7.1)
Leukemia 1 (6.3) 0 (0.0)
Statistical analysis Bladder 0 (0.0) 1 (7.1)
Prostate 0 (0.0) 1 (7.1)
This study analyzed demographic and disease characteristics Esophageal 0 (0.0) 1 (7.1)
Disease status 4.74 .057
with descriptive statistics. The homogeneity analysis of the two
Initial 3 (18.8) 8 (57.1)
groups was conducted using the c2 test and the independent t test. diagnosis
The effectiveness of the interventions among the two groups was Recurrence 13 (81.2) 6 (42.9)
tested using the generalized estimating equation with the p value Treatment type 4.81 .091
Radiotherapy 1 (6.2) 5 (35.7)
set to be less than .05. Data analysis was carried out using SPSS
Chemotherapy 9 (59.3) 7 (50.0)
AMOS 19.0 (IBM. Corp., Armonk, NY, USA). Symptomatic 6 (32.5) 2 (14.3)
Questionnaire
Ethical consideration
The experimental group had a mean PDI-MV score of 65.63 In the results of generalized estimating equation analysis, in
(SD ¼ 26.63), while the control group had a mean score of 86.43 comparing the experimental and control groups, the participants'
(SD ¼ 20.88), and the difference was statistically signi ficant dignity (b 20.08, p .013) and demoralization (b 14.63,
(t ¼ ¼
2.36, p .026). The experimental and control groups had mean p .037) both ¼ —illustrated¼ statistically significant difference.
¼ — Con-
DS-MV scores of 52.44 (SD ¼ 24.26) and 66.93 (SD ¼ 14.78), ¼
cerning time effects, in comparison with the pre-test, the partici-
respectively; there was no statistically significant difference be- pants' dignity at post-test 1 and 2 (b ¼ 8.93, p ¼ .002; b ¼
tween the two groups (t¼ 1.94, p ¼.063). The experimental and 12.58,
control groups had mean PHQ-9 scores of 13.00 (SD ¼ 6.85) and p ¼ .027, respectively), demoralization at post-test 1 and 2
14.86 (SD¼6.40), respectively; there was no statistically significant (b ¼ 6.36, p ¼ .025; b ¼ 9.35, p < .032, respectively), and depression
difference between the two groups (t¼ 0.76, p ¼.451) (Table 2). At at post-test 2 (b ¼ 9.35, p < .032) all showed change effect over time
the three measured time points, the means of PDI-MV, DS-MV, and significantly. Concerning group and time interaction effect, in
PHQ-9 decreased gradually in the experimental group, indicating comparison with the control group, the study found the experi-
dignity in this group was increased gradually, while mental group's dignity (b ¼ - 32.18, p < .001; b ¼ - 37.08, p < .
demoralization and depression were decreased gradually. The 001,
control group showed an opposite result. The changes of respectively), demoralization (b ¼ —29.55, p < .001; b ¼ —39.55,
measurements between the three time points for the two groups p < .001, respectively), and depression (b ¼ —8.07, p < .001;
are shown in Figure 2. b ¼ 12.01, p < .001, respectively) at post-test 1 and 2 all showed
—
statistically significant difference.
Effectiveness of dignity therapy The study results showed the participants showed increase in
dignity and reduction in demoralization and depression after dig-
Table 3 shows the effectiveness of dignity therapy on dignity, nity therapy. Furthermore, as time progressed, statistically signifi-
demoralization, and depression in end-of-life patients with cancer. cant differences were still noted on the 7th day (post-test 1) and
the 14th day (post-test 2) after dignity therapy.
Figure 2. The results of repeat measures.
194 Y.-C. Li et al. / Asian Nursing Research 14 (2020) 189e195
Note. DS-MV ¼ Demoralization Scale Mandarin Version; GEE ¼ generalized estimating equation; PDI-MV ¼ Patient Dignity Inventory Mandarin Version; PHQ-9 ¼ Patient
Health Questionnaire-9; SE ¼ standard error.
a
Reference: control group.
b
Reference: pre-test.
c
Reference: control group × pre-test.
d
Experimental group (post-test 1 e pre-test) e control group (post-test 1 e pre-test).
e
Experimental group (post-test 2 e pre-test) e control group (post-test 2 e pre-test).
Discussion
rewrite the texts themselves. Generative documents should main-
tain the patient's usual tone of speech so that it feels genuine when
The results of this study revealed that dignity therapy had sig-
read by family members and as if it came from the patient.
nificant effects in increasing dignity and reducing demoralization
In our research, it was observed that complete dignity therapy
and depression in end-of-life patients with cancer in Taiwan. Since
success required repeated interviews with patients, transcriptions,
the development of dignity therapy by a Canadian researcher in
and editing of the manuscript. All of this process necessitated
2005 [1], other countries have been testing the effectiveness of the
timetabled personnel and time, determining whether the clinical
therapy; for example, in 2014 in Denmark [20], 2014 in the United
work could be loaded. In previous studies, most of the results of
States [22], 2014 and 2017 in Portugal [23,24], and 2016 and 2017 in
dignity therapy were performed by physicians and were not per-
Spain [30,31].
formed by clinical nurses. This study was carried out by nurses
The results of the aforementioned studies are similar to those
throughout the process, and the results showed effectiveness. The
of this study, thereby demonstrating the effectiveness of dignity
result indicated clinical nurses could also use assessment tools to
therapy on enhancing patient dignity. The studies in Portugal
understand psychological distress of end-of-life patients with
found differences in depression, where the experimental group on
cancer and use dignity therapy to assist them in mitigation.
¼
Day 4 (median - 4.00, p < .001) and Day 15 (median
¼ - 4.00, ¼p .010)
Concerning the limitations in this study, the participants were
showed a decrease in depression scores [23]. Their results for
end-of-life patients with cancer, with the study group self-chosen
depression were similar to those of our study. Demoralization is
owing to respect for the patient's wish, so this study did not
an emerging diagnosis that has gained some attention in the past
apply randomization or double-blinded techniques. Initial differ-
decade [12]. A previous study has shown that for end-of-life pa-
ence in the PDI-MV score of the two groups, which might represent
tients with cancer undergoing dignity therapy, the incidence of
group difference, needs to be mentioned as a limitation of the
demoralization decreased from 53.9% to 12.1% (p ¼ .002) [24]. The present study. Although this study indeed followed the patient's
results are similar to those of our study, in which dignity therapy
wish to join either the experimental or control group, dignity
had significant effects on reducing demoralization; however, in
therapy is a unique, personalized, and short-term psychotherapy
previous studies on dignity therapy, few studies have examined
and cannot be shared with other patients, so cross-subject
demoralization as an outcome variable. It is suggested that this be
contamination did not occur. This study had a small sample size,
explored in future studies.
so the results cannot be generalized; consequently, we recommend
Although all the participants in this study had family to
further studies be designed with larger sample sizes in Taiwan.
accompany them during the dignity therapy, in Taiwan, almost
80% of patients are cared for by care workers. Based on the
experience of this study, some suggestions are made as follows. If Conclusion
the patient wishes to accept dignity therapy, the dignity therapist
must contact the family member who is expected to accompany Dignity therapy is a relatively newly developed spiritual treat-
the patient and introduce the therapy to him/her. A date needs to ment. To date, published studies have been conducted only in
be arranged with the patient and family member for an interview. Western countries. Our study results indicated that dignity
Dignity therapy is best conducted from 10 am to 12 noon, 3 pm to therapy could enhance dignity and reduce demoralization and
5 pm, and 7 pm to 8 pm, with each session lasting 60 minutes to depression in the population of end-of-life patients with cancer in
match the maximum duration of physical strength and attention in Taiwan. This study was only conducted in a medical center in
the patients. Patients could tell a sad story or an ugly story if they Southern Taiwan; in addition, this study only recruited those
wish; however, the dignity therapist must let patients understand diagnosed with end-of- life cancer. Future studies could examine in
how words can help and hurt people at the same time and that the detail whether there are regional and cultural differences and
dignity therapy session is not to be used to hurt family and whether the therapy could be promoted among other end-of-life
relatives. Events or phrases that hurt family and relatives such as patients or patients suffering from other illnesses such as
“I hate you,” “I hope you die,” and “I hope you will suffer from amyotrophic lateral sclerosis, cerebral stroke, or renal failure.
retribution” are not to be recorded in the generativity document
and are not to be conveyed by the dignity therapist. In terms of Conflict of interest
editing the text, as per previous studies [1,20] and the experience
of this study, editors should not No conflict of interest has been declared by the authors.
Y.-C. Li et al. / Asian Nursing Research 14 (2020) 189e195 195
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bukti sebagai berikut:
<ahref="https://www.scimagojr.com/journalsearch.php?
q=10600153312&tip=sid&exact=no" title="SCImago Journal & Country Rank"><img
border="0" src="https://www.scimagojr.com/journal_img.php?id=10600153312" alt="SCImago
Journal & Country Rank" /></a>