Inovasi terapi suportif dalam peningkatan quality of life pada pasien gagal ginjal dengan hemodialisa

Abstract

Background: Indonesia Renal Registry In 2018, the number of new Chronic Kidney Failure patients in Indonesia doubled compared to 2017, namely 30,831. There are slightly more male patients than female patients and the largest proportion of patients is still in the 45 to 64 year old category. Meanwhile, the number of new patients with chronic kidney failure in Banten in 2018 was 1,073. Hemodialysis is a lifelong treatment that often causes adverse effects on patients, especially mental health. Supportive therapy (Supportive Educative System, psychological intervention, and life review) is an alternative therapy that can be given to patients to improve their ability to provide health care, reduce family burdens and increase family coping as well as increase social support so that patients do not experience depression to the point of committing suicide self.Purpose: To find out whether there is an effect of Supportive Therapy (Supportive Educative System, psychological intervention, and life review) in improving the quality of life in kidney failure patients with hemodialysis at the Dompet Dhuafa Bogor Integrated Health Home.Method: Quantitative research using a quasi-experimental method with pre-test post-test with control group. The sample consisted of 50 patients consisting of 25 intervention groups and 25 control groups using purposive sampling technique. This research was conducted for four weeks in July-August. Data analysis used the Wilcoxon test.Results: The supportive therapy mix model, consisting of a Supportive Educative System, psychological intervention, and life review, significantly improved the patient's quality of life. In this study, 17 (34%) respondents were aged 41-50 years, 29 (58%) were women, 48 (96%) were married, 17 (34%) had an elementary school education, 21 (42%) were housewives , 48 (80%) received financing through BPJS, and 20 (40%) had undergone hemodialysis for 1-2 years. Before supportive therapy, the quality of life of the intervention group was moderate (16 [64%]), while that of the control group was moderate (23 [92%]). After therapy, quality of life in the intervention group improved to high (19 [76%]), while in the control group, quality of life remained moderate (19 [76%]). The Wilcoxon test results showed a ρ-value of 0.003, indicating a statistically significant relationship between quality of life before and after supportive therapy in the intervention group. However, in the control group, the ρ-value was 0.157, which was greater than the significance level α (0.05), indicating that there was no statistically significant relationship between quality of life before and after supportive therapy.Conclusion: The mix of supportive therapy models, namely Supportive Educative System, psychological intervention, and life review, seeks to have an impact on improving the patient's quality of life. Research results: Supportive therapy has a significant impact on the quality of life in chronic kidney failure patients on hemodialysis. The mixed supportive therapy model can be applied to patients with health problems that will have a psychological impact. Another factor that can be related to improving the quality of life is family support, and social support is also needed to improve the patient's quality of life.Keywords: Chronic Renal Failure; Haemodialysis; Supportive Therapy Pendahuluan: Indonesia Renal Registry Tahun 2018 Jumlah pasien baru Gagal Ginjal Kronik di Indonesia meningkat dua kali   lipat dibandingkan   dengan   tahun   2017 yaitu sebanyak 30.831.Pasien laki-laki sedikit lebih banyak dibandingkan pasien perempuan dan proporsi pasien terbanyak masih pada kategori 45 sd 64 tahun. Sedangkan jumlah pasien baru Gagal ginjal kronik di Banten tahun 2018 sebanyak 1.073. Hemodialisis merupakan pengobatan seumur hidup yang sering menyebabkan efek buruk pada pasien terutama kesehatan mental. Supportive therapy (Supportive Educative System,  psychological intervention, and life review) merupakan salah satu alternatif terapi yang dapat diberikan kepada pasien  untuk meningkatkan kemampuan dalam memberikan asuhan kesehatan, mengurangi beban keluarga dan meningkatkan koping keluarga serta meningkatkan dukungan sosial sehingga pasien tidak mengalami depresi hingga bunuh diri.Tujuan: Untuk mengetahui apakah ada pengaruh Terapi Suportif (Supportive Educative System,  psychological intervention, and life review) Dalam Peningkatan Quality Of Life Pada Pasien Gagal Ginjal dengan Hemodialisa  Di Rumah Sehat Terpadu  Dompet Dhuafa Bogor.Metode: Penelitian kuantitatif dengan metode quasi eksperimen dengan pre-test post-test with control group. Sampel berjumlah sebanyak 50 pasien terdiri dari 25 kelompok intervensi dan 25 kelompok Kontrol dengan teknik purposive sampling. Penelitian ini dilakukan selama empat minggu pada bulan Juli-Agustus. Analisa data menggunakan uji Wilcoxon.Hasil: Mix model terapi suportif, yang terdiri dari Supportive Educative System, intervensi psikologis, dan ulasan hidup, secara signifikan meningkatkan kualitas hidup pasien. Dalam penelitian ini, sebanyak 17 (34%) responden berusia 41-50 tahun, 29 (58%) perempuan, 48 (96%) menikah, 17 (34%) memiliki pendidikan terakhir SD, 21 (42%) adalah ibu rumah tangga, 48 (80%) mendapatkan pembiayaan melalui BPJS, dan 20 (40%) telah menjalani hemodialisis selama 1-2 tahun. Sebelum terapi suportif, kualitas hidup kelompok intervensi adalah sedang (16 [64%]), sementara kelompok kontrol adalah sedang (23 [92%]). Setelah terapi, kualitas hidup kelompok intervensi meningkat menjadi tinggi (19 [76%]), sementara pada kelompok kontrol, kualitas hidup tetap sedang (19 [76%]). Hasil uji Wilcoxon menunjukkan nilai ρ-value sebesar 0,003, menunjukkan hubungan yang signifikan secara statistik antara kualitas hidup sebelum dan setelah terapi suportif pada kelompok intervensi. Namun, pada kelompok kontrol, nilai ρ-value sebesar 0,157, yang lebih besar dari tingkat signifikansi α (0,05), menunjukkan bahwa tidak terdapat hubungan yang signifikan secara statistik antara kualitas hidup sebelum dan setelah terapi suportif.Simpulan: Mix model terapi suportif  yaitu Supportive Educative System,  psychological intervention, and life review berupaya bisa memberikan dampak untuk peningkatan kualitas hidup pasien. Hasil penelitian terapi suportif memberikan pengaruh bermakna secara signifikan terhadap kualitas hidup pada pasien gagal ginjal kronik dengan hemodialisa. Mix model terapi suportif bisa diterapkan kepada pasien dengan masalah kesehatan yang akan berdampak psikologis. Faktor lain yang bisa berhubungan dengan peningkatan kualitas hidup yaitu dukungan keluarga, dan dukungan social diperlukan juga untuk memberikan peningkatan kualitas hidup pasien.