Pengembangan Indikator Kualitas Perawatan Paliatif pada Pasien Kritis sebagai Ukuran Derajat Mutu Perawatan Paliatif di Intensive Care Unit
Heru Suwardianto, Prof. Dr. Christantie Effendy, S.Kp., M.Kes; Dr. Sri Setiyarini, S.Kp., M.Kes
2026 | Disertasi | S3 Kedokteran Umum
Tingginya mortalitas pasien kritis di ICU
menekankan kebutuhan integrasi perawatan paliatif. Namun, indikator kualitas
yang ada sebagian besar dikembangkan di luar negeri dan belum mempertimbangkan
budaya, spiritual, serta karakteristik ICU di Indonesia, maupun diuji validitas
dan reliabilitasnya. Penelitian ini bertujuan mengembangkan indikator kualitas
perawatan paliatif pada pasien kritis di ICU Indonesia yang valid, dan
reliabel.
Penelitian menggunakan desain Exploratory Sequential Mixed Methods. Tahap 1 merupakan penelitian kualitatif
dengan 43 partisipan, dilanjutkan uji face validity menggunakan Modified
Delphi Method dua putaran (putaran 1: 42 ahli; putaran 2: 38 ahli). Tahap 2
meliputi uji validitas konten (n=9), reliabilitas antar penilai (n=4), internal
consistency reliability, dan feasibility study (n=40). Tahap 3
melakukan psychometric testing, termasuk uji validitas konstruk dengan Confirmatory
Factor Analysis (CFA) dan reliabilitas internal menggunakan Amos 29 dan
SPSS 26.
Hasil psychometric testing menunjukkan
bahwa seluruh item instrumen melalui Confirmatory Factor Analysis (CFA)
memiliki factor loading tinggi (0,767–0,998), Composite Reliability (CR) 0,91–0,96,
dan Average Variance Extracted (AVE) 0,79–0,85, mengindikasikan
reliabilitas internal dan validitas konvergen yang sangat baik. Setiap
indikator secara signifikan merepresentasikan domainnya, dan marginal fit
model instrumen (SRMR = 0,000–0,082; CFI = 0,632–1,000) menegaskan bahwa
instrumen PaCE-ICU valid dan reliabel.
Instrumen PaCE-ICU yang
dikembangkan terbukti valid, reliabel, dan sesuai konteks, sehingga dapat
digunakan untuk menilai dan meningkatkan mutu perawatan paliatif pada pasien
kritis di ICU.
The high mortality rate of critically ill
patients in intensive care units (ICUs) highlights the need for integrating
palliative care. However, existing quality indicators are mostly developed
abroad and do not fully consider the cultural, spiritual, and ICU-specific
characteristics in Indonesia, nor have they been comprehensively tested for
validity and reliability. This study aimed to develop valid and reliable
palliative care quality indicators for critically ill patients in Indonesian
ICUs.
This research employed an Exploratory Sequential
Mixed-Method design. Phase 1 involved qualitative research with 43 participants, followed by face
validity assessment using a two-round Modified Delphi Method (round 1: 42
experts; round 2: 38 experts). Phase 2 included content validity
testing (n=9), inter-rater reliability (n=4), internal consistency reliability,
and a feasibility study (n=40). Phase 3 conducted psychometric
testing, including construct validity using Confirmatory Factor Analysis (CFA)
and internal reliability testing with Amos 29 and SPSS 26.
Psychometric testing results indicated that all
instrument items in the CFA had high factor loadings (0,767–0,998), Composite Reliability (CR) of 0.91–0.96, and Average Variance
Extracted (AVE) of 0.79–0.85, reflecting excellent internal reliability
and convergent validity. Each indicator significantly represents its domain,
and the marginal fit of the instrument model (SRMR = 0.000–0.082; CFI = 0.632–1.000)
confirms that the PaCE-ICU instrument is valid and reliable.
The developed PaCE-ICU instrument is valid,
reliable, and contextually appropriate, supporting its use to assess and
improve the quality of palliative care for critically ill patients in ICUs.
Kata Kunci : Intensive Care Units, Perawatan Paliatif, Indikator Kualitas
