235Roifah, Meilinawati, Ratnaningsih, Hidayati, Factors that Affect... 235 JNK JURNAL NERS DAN KEBIDANAN http://jnk.phb.ac.id/index.php/jnk Factors that Affect Coping Mechanisms in Chemotherapy Patients with the Approach of Callista Roy Adaptation Theory Ifa Roifah1, Elies Meilinawati2, Tri Ratnaningsih3, RinaNur Hidayati4 1,2,3,4Prodi Keperawatan, STIKes Bina Sehat PPNI Mojokerto, Indonesia Article Information History Article: Received, 29/03/2019 Accepted, 12/08/2019 Published, 12/08/2019 Keywords: Adaptation Theory, Cancer, Chemo- therapy, Coping Mechanisms Abstract © 2019 Jurnal Ners dan Kebidanan Correspondence Address: STIKes Bina Sehat PPNI Mojokerto- JawaTimur, Indonesia P-ISSN : 2355-052X Chemotherapy can cause pain and emotional stress in the patient. This con- dition will make the patient delay the therapy. Strong coping mechanism is required to maintain good conditions. One of the empirical evidence of conceptual model theory is “Holistic Adaptive System” conceptual model theory, proposed by Callista Roy. This model is used in chronic diseases which undergone treatment. This study aimed to analyze factors which in- fluence coping mechanisms in chemotherapy patients by using the Callista Roy adaptation theory approach. The study used cross sectional design. The population was 95 chemotherapy patients at the SumberGlagah Hospi- tal in Mojokerto. The sampling technique used simple random sampling and the sample was 78 respondents. The instrument used coping and adaptation processing scale (CAPS) with an adaptation theory approach. The results of logistic regression showed educational factors (p value 0.031) and work (p value 0.023) had an effect on coping mechanisms, while the chemotherapy cycle factor (p value 0.688) had no effect on coping mechanisms with the theoretical approach of Callista Roy adaptation to chemotherapy patients. The higher the level of education, the better tolerance and control of stres- sors, the workplace environment will provide social support so that coping mechanisms become adaptive. Email: roifahi@yahoo.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v6i2.ART.p235–240 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) https://creativecommons.org/licenses/by-sa/4.0/ 236 Jurnal Ners dan Kebidanan, Volume 6, Nomor 2, Agustus 2019, hlm. 235–240 INTRODUCTION Cancer is a chronic disease that threatens human health both physically and psychologically. One tr ea tment for pr event the ca ncer cell metastases is chemotherapy (Firmana, 2017). Chemotherapy can cause pain that gradually makes the patient’s condition weaken. (CancerHelps, 2014) The condition of patients who are weakened due to chemotherapy can affect the seriousness of patients and it needs a good coping mechanism in adapting to maintain good conditions.(Firmana, 2017) One empirical proof of conceptual model theory “Holistic in Adaptive System”, which was stated by Callista Roy, this model was used in chronic disease which undergoes medication, because theoretically the success of treatment can be achieved by doing adaptive coping mechanism which was an importa nt va riable in the pr ocess of physiology and psychology adaptation to the stimulus that occurs (Kasron, Sahran, & Ohorella, 2016). Dea ths ca used by Non Communica ble Diseases (NCDs), accounting for 70% of the total 56 million cancer deaths are in the second number a s ma ny a s 8. 8 million dea ths (22%) a fter cardiovascular disease 17.7 million deaths (45 %) in the world (WHO, 2017) Data from 2016 non communicaledesiases research on breast tumors survey carried in 34 provinces, 76 districts / cities, with women aged 25-64 years as many as 38,749, the prevalence of positive sadanis 8.1% and had been diagnosed with br ea st ca ncer 0. 6% (Hea lth Resea r ch a nd Development Agency, 2016). According to the Mojokerto Profile 2016 the greatest number in visual inspection of acetid acid (IVA) positive was in Mojoanyar District (13.33%) and for the most breast tumors cases was in Kemlagi District (4.85%) (Mojokerto District Health Office, 2017). Treatment of cancer mostly with chemothe- rapy, data found as many as 58% patients under- went chemotherapy (American Cancer Society, 2016). Side effects on chemotherapy can affect physical or psychological, which are 95% weakness, 90% fatigue, 79% vomit, 75% hair loss, 73% nausea, (Aslam et al., 2014). This will cause negative feelings as well as anxiety on the effects of chemo- therapy that are unpleasant for patients during chemotherapy. Based on a preliminary study on November 20 at the MojokertoSumberGlagah Leprosy Hospital, there were 96 patients from July to December 2017 and there were 28 patients in January to February 13, In 2018 with a total of 124 chemotherapy patients. During interviews with 5 chemotherapy patients, it was found that 2 patients that said they only slept and did not leave the house, often to delay treatment, did not work, and 3 respondents who had been undergoing treatment stated that they were getting used to the usual side effects, maintaining the body in a good condition and continue with the next chemotherapy treatment. This is a positive or negative adaptation because of adjustments in conditions. Adaptation is needed by patients as an effort to deal with physical and psychosocial threats in responding to changes in the effects of chemo- therapy, patients need good coping so that therapy becomes effective(Wahyuni, Huda, & Utami, 2015). The results showed that effective coping mechanisms had an effect on decreasing anxiety, adherence to chemotherapy to improve patients’ psychological prosperity (Lutfa & Maliya, 2008; Sonia, Arifin, & Murni, 2014). This is in line with Roy’s theory which states that constant interaction between individuals and the environment is characterized by internal and external changes, with these changes, individuals must maintain their integrity, which is a continuous adaptation (Nursalam, 2016). In Astuti’s research (2014) said adaptation must be carried out by clients and families in adapting to their conditions (Astuti, 2014). This will help the client’s acceptance of the disease (Roy, 2016). As explained above, Roy’s theory of adaptation can be useful for patients with chronic diseases who are undergoing treatment (Kasron et al., 2016). The process of adaptation and formation of coping mechanisms is influenced by several factors according to the mechanism of coping with the approach of calistaroy adaptation theory. These factors include human, environment, health and nursing, health and environment as individuals such a s a ge, occupa tion, socio-economic sta tus, a djustment, interdependent sick experiences (Kasron et al., 2016). METHODS The study used cross sectional design. The population in this study were 95 chemotherapy patients at the Sumber Glagah Hospital in Mojokerto. The sampling technique used simple random 237Roifah, Meilinawati, Ratnaningsih, Hidayati, Factors that Affect... sampling and the sample size was 78 respondents which criteria are first, the age is over 20 years, second, patients arecommunicable, and last, patients with all types of cancer who undergo chemotherapy. The independent variables in this study were human factors (age and education) and health factor s (chemother a py cycle) the dependent variable in this study was a coping mechanism with the Callista Roy adaptation theory approach. The research began in January to April 2018.The research instrument used coping and adaptation processing scale (CAPS) with an adaptation theory approach. The validity and reliability of this questionnaire were tes ted b efore b eing used with pearsonrs on Correlation Product Moment with r count > r table that is 0,444 and reliability of Chronbach Alp ha 0.8 32 > 0. 6. It can be concluded the instrument was valid and reliable. The instrument consists of 13 questions. The statistical test used in this study was logistic regression. RESULT The Characteristic of chemotherapy patients. Descriptive results of respondents’ charac- teristics are shown in Table 1. The result of analysis showed that 60 % of respondents were in the age of more than 45 years old and 74 % of them were female. The highest level of education for Senior High School is 51% and 78% of respondents are employed. No Variable f % 1 Age of 26-45 years old 31 40 >45 years old 47 60 2 Gender Male 20 26 Female 58 74 3 Education Elementary school 10 13 Junior high school 20 26 Senior High school 40 51 Bachelor 8 10 4 Job Government Employees 5 6 Worker 18 23 Entrepreneur 38 49 Unemployment 17 22 Table 1 The Characteristic of chemotherapy patients in Hospital of Kusta Sumber Glagah Pacet Mojokerto 2018 B SE df Sig 95 % CI Lower Upper Education 0,84 0,39 1 0,031 1,081 5,014 Job 0,97 0,43 1 0,023 1.,44 6,135 Chemotherapy cycle -0,1 0,16 1 0,688 0,693 1,274 Constant -4,9 5,17 1 0,023 Table 2 The Result of Hypothesis Test of Factors That Can Affect Coping Mechanism With The Approach Of Calista Roy Adaptation Test On Chemotherapy Patient Factors That Can Affect Coping Mechanism With The Approach Of Calista Roy Adaptation The results of the hypothesis test use the test logistic regression is shown in Table 2 The test result about the effect of education on coping mechanism with the approach of Callista Royadaptation theory obtained the result of confidence interval was more than 1 p-value 0,031 < 0,05 which meant that partially, education variable affected the coping mechanism with the approach of Callista Roy adaptation theory on chemotherapy patient. The test result about the effect of job on coping mecha nism with the a ppr oa ch of Ca llista Royadaptation theory obtained the result of confidence interval was more than 1 p-value 0,023 < 0,05 which meant that partially that job variable affected coping mechanism with the approach of Callista Roy adaptation theory on chemotherapy patient The test result about the effect of chemotherapy cycle on coping mechanism with the approach of Callista Roy adaptation theory, obtained the result of confidence interval was more than 1 p-value 238 Jurnal Ners dan Kebidanan, Volume 6, Nomor 2, Agustus 2019, hlm. 235–240 0,6881 > 0,05 which meant that partially, chemo- therapy cycle variable did not affect the coping mechanism with approach of Callista Roy adaptation theory on chemotherapy patient The final model of factors that affect coping mechanism with approach of Callista Roy adaptation theory on chemotherapy patient :gˆ(x)=-4,9+ 0,84*education + 0,97*job DISCUSSION T he r esult of fa ctor ana lysis of coping mecha nism which wer e educa tion, job, a nd chemotherapy cycle with the approach of Callista Roy adaptation theory in Kusta Sumber Glagah Pacet Mojokerto hospital. The results of the education effect test on the coping mechanism with Callista Roy’s adaptation theory approach obtained a confidence interval of more than 1 p-value 0.031 <0.05, meaning that partially the education variable had an effect on coping mechanisms with the Callista Roy adaptation theory approach to chemotherapy patients. The results of this study indicate that the majority of respondents graduated from Senior high school education (51%). Education of respondents who are mostly high school and tertiary institutions makes respondents have the ability to solve problems that are more realistic and have the ability to be able to control stressors better so that this affects their coping mechanisms as well. Education could have a different meaning for everyone. Education is generally useful in changing mindset, behavior patterns and decision making patterns. An adequate level of education will be easier in identifying stressors in themselves and outside themselves. Someone with a higher level of education will also have higher cognitive complexity, and vice versa. This has a big effect on attitudes, conception of thinking and individual behavior which further influences coping str ategies tha t get better.(Sijangga, 2010) Therefore someone who is highly educated will be more realistic and active in solving problems(Afiyah, 2017; Tanumidjojo, S., & Yudiarso, 2004). Individual coping skills depend on temperament, perceptions and cognitions and cultural or normative backgrounds in which they are raised.(Maulina & Bahri, 2016) A high level of education can make someone more able to identify stress, understand stress, control stress, be more active and realistic in solving problems. Someone who has a high level of education has a brave mindset in taking a position to overcome problems and not procrastinate. The results of the jobeffect on the coping mechanism with Callista Roy’s adaptation theory approach obtained a confidence interval of more than 1 p-value of 0.023 <0.05 meaning that the work variable partially influenced the coping mechanism with the Callista Roy adaptation theory approach to chemotherapy patients. This research shows that most respondents work (78%). Stuart (2009) states that one source of coping is assetseconomics can help improve individual coping in the face of stressful situations. By working someone has economic assets as a source of coping, so as to improve coping a bilities (Stua r t, 2009). Wor k a s a huma n characteristic to work and carry out role functions in society to sustain life (Kasron et al, 2016). Work can make someone have economic assets as a source of coping, so that being able to improve coping skills becomes more adaptive because it has money to finance the treatment/ chemotherapy process. The test results of the influence of the chemo- therapy cycle on the coping mechanism with the Callista Roy adaptation theory approach showed a confidence interval of more than 1 p-value of 0.6881> 0.05 meaning that the cycles of chemo- therapy variables had no effect on the coping mechanism with the Ca llista Roy ada ptation a ppr oach in pa tients chemothera py. In sick experience by looking at the chemotherapy cycle, in this case the treatment process does not rule out the possibility of physical or psychological changes due to the chemotherapy effects, in the form of fear, stress on the mind, anxiety. This is in accordance with the five types of human reaction phases with the disease, in these phases not always regularly, it can be surpassed quickly or gradually, depending on the patient’s psychologica l condition, under sta nding of psychological conditions, not only by the sufferer but also the presence support of people in the lives of patients in the healing process (Smart, 2013). Most of the respondents had undergone chemotherapy for 1-6 times, this was closely related to the adaptive coping of the respondents, where respondents were accustomed to under going treatment and able to adapt to the side effects that appeared after chemotherapy, besides positive beliefs, the ability to control good emotions, social 239Roifah, Meilinawati, Ratnaningsih, Hidayati, Factors that Affect... support, and high spirituality values in respondents can support the formation of adaptive coping for respondents (Anggeria & Daeli, 2017; Maulina & Bahri, 2016).The physical and psychological effects caused by the administration of chemotherapy are related to a decrease in ability in functional status while undergoing chemotherapy. The longer the duration of chemotherapy, the more cancer cells will experience damage and death, as well as healthy cells in the body, after several periods, one to three weeks healthy cells recover but suffer significant da ma ge tha t will decr ea se functiona nd the endurance of the patient’s body will also decrease this will continue in the next chemotherapy(Ogce & Ozkan, 2008; Ogce, Ozkan, & Baltalarli, 2007) The chemotherapy cycle is more often able to ma ke r espondents become a ccustomed to undergoing treatment and able to adapt to the side effects that arise after chemotherapy so that this can make responding coping more adaptive than fewer chemotherapy cycles. The longer a person suffers from an illness, the more experience various stressors due to his illness and that experience can be used as an anticipatory effort in dealing with the stressors experienced by these patients so that patients can adapt to their conditions. CONCLUSION Results of logistic regression analysis it was found that the factors that affect the coping mechanism with Callista Roy adaptation theory approach on chemotherapy patients are Education (p-value 0,031) and job (p-value 0,023). The logit form of the final model is gˆ(x)=-4,9+ 0,84*education + 0,97*job. SUGGESTION Social support and family support need to be improved to improve cancer coping mechanisms. Health care providers emphasize caring-based services and comprehensive health services. REFERENCES Afiyah, R. K. (2017). Dukungan Keluarga Mempengaruhi Kemampuan Adaptasi (Penerapan Model Adaptasi Roy) Pada Pasien Kanker Di Yayasan Kanker Indonesia Cabang Jawa Timur. Jurnal Ilmiah Kesehatan (Journal of Health Sciences), 10(1). American Cancer Society. (2016). Cancer Treatment & Survivorship Facts & Figures 2016-2017. American Cancer Society, 44. https://doi.org/10.3322/ caac.21235 Anggeria, E., & Daeli, V. A. (2017). HUBUNGAN MEKA- NISME KOPING DENGAN KUALITAS HIDUP PADA PASIEN TERMINAL DENGAN KANKER SERVIKS DI RSU. VINA ESTETICA MEDAN TAHUN 2016. J UMA NTIK (Jurnal Il mi ah Penelitian Kesehatan), 3(1), 29–43. Aslam, M. S., Naveed, S., Ahmed, A., Abbas, Z., Gull, I., & Athar, M. A. (2014). Side Effects of Chemotherapy in Cancer Patients and Evaluation of Patients Opinion about Starvation Based Differential Chemotherapy. Journal of Cancer Therapy, 5(July), 817–822. https://doi.org/10.4236/jct.2014.58089 Astuti, I. W. (2014). Penerapan Teori Adaptasi Roy dan Symptom Management Humphreys Pada Asuhan Keperawatan Pasien Kanker Ovarium Post Operasi Sit or edukti f Den gan Kem ot er a pi. J urnal Keperawatan Maternitas, 2(1), 35–43. Retrieved from https://simdos.unud.ac.id/uploads/file_ penelitian_1_dir/1592c172b76ac272df4a284 216569c31.pdf CancerHelps. (2014). Bebas Kanker Itu Mudah (Y. Indah, Ed.). Jakarta. Firmana, D. (2017). Keperawatan Kemoterapi. Jakarta Selatan: Salemba Medika. Health Research and Development Agency. (2016). Riset PTM tahun 2016. Kasron, Sahran, & Ohorella, U. B. (2016). Teori Keperawatan dan Tokohnya. Jakarta Timur: CV. Trans Info Media. Lutfa, U., & Maliya, A. (2008). Faktor-Faktor Yang Mempengaruhi Kecemasan Pasien Dalam Tindakan Kemoterapi Di Rumah Sakit Dr.Moewardi Surakarta. Berita Ilmu Keperawatan, 1(4), 187–192. Retrieved from http://journals.ums.ac.id/index.php/BIK/ article/view/3733/2403 Maulina, R., & Bahri, T. S. (2016). MEKANISME KOPING PASIEN KANKER YANG MENJALANI KEMO- TERAPI DI RSUD dr. ZAINOEL ABIDIN BANDA ACEH. Jurnal Ilmiah Mahasiswa Fak ult as Keperawatan, 1(1). Mojokerto District Health Office. (2017). Profil Kesehatan Kabupaten Mojokerto Tahun 2016. Mojokerto District Health Office. Nursalam. (2016). Metodologi Penelitian Ilmu Kepe- rawatan (4th ed.). Jakarta: Salemba Medika. Ogce, F., & Ozkan, S. (2008). Changes in functional status and physical and psychological symptoms in women receiving chemotherapy for breast cancer. Asian Pac J Cancer Prev, 9(3), 449–452. Ogce, F., Ozkan, S., & Baltalarli, B. (2007). Psychosocial stressors, social support and socio-demographic variables as determinants of quality of life of Turkish breast cancer patients. Asian Pacific Journal of Cancer Prevention, 8(1), 77. 240 Jurnal Ners dan Kebidanan, Volume 6, Nomor 2, Agustus 2019, hlm. 235–240 Roy, S. C. (2016). Coping and Adaptation Processing Scale (CAPS):Short Form(15-Item) nformation for Users. Retrieved from https://www.bc.edu/content/ dam/files/schools/son_sites/theorist/pdf/CAPS- Short Form User Manual 3-3-16.pdf Sijangga, W. N. (2010). Hubungan antara strategi coping dengan kecemasan menghadapi persalinan pada ibu hamil hipertensi. Universitas Muhammadiyah Surakarta. Smart, A. (2013). Kanker Organ Reproduksi. Jogjakarta: Aplus Books. Sonia, Arifin, & Murni, 2014. (2014). Hubungan mekanisme koping dengan kepatuhan kemoterapi pada penderita keganasan yang mengalami ansietas dan depresi. 37(April 2014), 2–7. Stuart, G. W. (2009). Principles And Practice Of Psychiatric Nursing 9th Edition. Canada: Mosby Elsevier. Tanumidjojo, Y., S., L. B., & Yudiarso, A. (2004). Stres dan Perilaku Koping Pada Remaja Penyandang Diabetes Mellitus Tipe I. Anima, Indonesian Psychological Journal, 19(4), 399–406. Wahyuni, D., Huda, N., & Utami, G. T. (2015). Studi Fenomenologi: Pengalaman Pasien Kanker Stadium Lanjut yang Menjalani Kemoterap. Jurnal Online Mahasiswa (JOM) Bidang Ilmu Keperawatan, 5(2), 1041–1047. WHO. (2017). World Health Statistics 2017: Monitoring Health for The Sustainable Development Goals. In World Health Organization. https:/ /doi.org/ 10.1017/CBO9781107415324.004.