Impact of Experiential Learning Method on the Knowledge, Attitude,

and Coping Mechanisms of Cancer Patient’s Companions at the Java

Branch of the Indonesian Cancer Foundation

Yulis Setiya Dewi, Nuzul Qur’aniati and Titis Eka Apriliyanti

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Experiential Learning Method, Knowledge, Attitude, Coping Mechanism.

Abstract: Cancer is a chronic disease that has caused 8.2 million mortalities around the world and 347,792 mortalities

in Indonesia. A good knowledge, a positive attitude, and a constructive coping mechanism are main factors

of a supportive companion. This research aimed to understand the impact of experiential learning methods on

the knowledge, attitude, and coping mechanisms of cancer patient’s companions. The research was designed

with a pre-experimental approach using a one group pre-post test. The population were the companions of

cancer patients at the East Java Branch of the Indonesian Cancer Foundation with a sample of 27 respondents

who were selected using a purposive sampling method. The Wilcoxon Signed Ranks Test was used to analyze

the data with a value of p < 0.05. The significancy of knowledge was 0.000, attitude was 0.012, and coping

mechanism was 0.109. This indicated that experiential learning methods increase knowledge and attitude. The

use of experiential learning methods is effective to increase the knowledge of good and positive attitudes of

companions and may improve support for cancer patients to aid successful treatment.

1 BACKGROUND

For chronic diseases such as cancer, family support is

very effective. This is in accordance with the

statement that family support relates to attitude,

action, and acceptance of family against sufferers of

the illness (Friedman, 2010). Based on preliminary

studies that researchers conducted on September 15,

2015 at the East Java Branch of the Indonesian

Cancer Foundation using 10 companions or families

of cancer patients. obtained 60% had low level of

knowledge, 50%, had negative attitudes, and 70% had

unconstructive coping mechanism. Less knowledge

about cancer treatment, attitude, and non-constructive

coping mechanisms will have a negative impact on

the pattern of family support, which can influence

levels of motivation, success, and life expectancy as

well as compliance of therapy in cancer patients who

need to continue the treatment process over long

periods (Eom et al., 2013). This is proven by research

by Rankin (2012) who states that a family's emotional

physiology and upheaval is linked to stress and grief

and can interfere with the treatment of people with

cancer.

Prevelent cases of cancer are estimated to account

for 8.2 million deaths worldwide (International

Agency for Research on Cancer, 2012). The annual

number of new cases is projected to rise from 14.1

million in 2012 to 21.6 million in 2030 (World Health

Organization, 2017). Cases of cancer in Indonesia,

based on the research of basic health prevalence of

cancer in Indonesia, reached 1.4% or approximately

347,792 people (Badan Penelitian dan

Pengembangan Kesehatan, 2013). The estimated

number of cancer sufferers in East Java province,

according to the Cancer Foundation Indonesia Branch

in East Java, is around 61,230. Based on the results of

preliminary studies, there are 30 cancer patients who

occupy the Foundation with various types of cancer,

such as breast cancer, rectal cancer, cervical cancer,

and cancer of the eye. Breast cancer is the most

prevelant cancer at the the East Java Branch of the

Indonesian Cancer Foundation, which accounted for

60% of sufferers in 2014.

The impact of cancer requires patients to receive

and handle ongoing treatment over a long period of

time. Treatments such as radiotherapy and

chemotherapy have side effects; chemotherapy drugs

do not only kill cancer cells but also attack healthy

Dewi, Y., Qur’aniati, N. and Apriliyanti, T.

Impact of Experiential Learning Method on the Knowledge, Attitude, and Coping Mechanism of Cancer Patient’s Companions at the Java Branch of Indonesian Cancer Foundation.

DOI: 10.5220/0008331707170724

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 717-724

ISBN: 978-989-758-336-0

717

cells especially cells that divide rapidly, e.g. hair

cells, bone marrow, skin, mouth, throat, and the

digestive tract, which consequently causes hair loss,

bleeding, weakness in the body, fatigue, infection,

aphthous ulcers, difficulty swallowing, nausea,

vomiting, and decreased appetite (Aslam et al., 2014).

This causes side effects in cancer patients prompting

a sense of worry, anxiety, and fear (Purba &

Prawitasari, 2006). People with cancer feel worried

and anxious affecting aspects of cognitive, emotional,

and physiological wellbeing, and so support is needed

from the family (Etty, 2004). The support from

families, friends or relatives who can be a good

listener and respected the patient’s opinion can help

individuals cope with feelings of worry, anxiety, and

fear.. A family environment can help an individual to

develop close connections and feel safe and

comfortable so that the emotions of each family

member can flow positively (Kalsum, 2009). People

with cancer are given support in the form of

emotional support, family support and informational

support to improve the quality of their lives

(Henriksson & Arestedt, 2013). Those who receive

support from family feel cared for and loved, and

those who feel worthless can share the burden, gain

confidence, and cultivate expectations to ward off, or

reduce, stress (Grant et al., 2013)

The Minister of Health of the Republic of

Indonesia Regulation No. 65 of 2013 has explained

that community development is a process of

providing continuous information to individuals,

families and groups (clients) and continuously

following the development and the process of helping

to change aspects of knowledge, to an attiude of being

willing, and from being willing to being able to

perform (Kementerian Kesehatan RI, 2013).

According to Adams, Kayes, and Kolb (2004) a

learning model is a process obtained through gaining

a combination of experiences (transforming

experiences). Experiential learning methods can

increase awareness and ability by integrating

previous experiences with new knowledge, because

the best learning process for leaning information is to

experience it (De Porter, 2000).

The theory of planned behavior described by

Ajzen (2005), states that specified behavior is formed

from three main factors: 1) personal factors including

personality traits, values, emotions, life and

intelligence owned; 2) social factors including age,

gender, and education; and 3) the information

consists of experience, knowledge, and the media.

One knows the stimulus or the objective of health,

then makes an assessment or opinion of what is

known. The next process is expected to carry out or

practice what is known or what has been responded

to (considered good) or it can also relate to overt

behavior (Notoatmodjo, 2007). Grasping experiences

through the transformation of experience is aimed at

the information factor. This is in the form of changing

behavior because the concerned wants to adjust to the

existing norms and stages of behavioral change,

which are: concrete experience, observation and

reflection, the formation of abstract concepts, and

generalization and testing of concepts in new

situations (Arjanto, 2012). This research aimed to

know the impact of experiential learning methods on

the knowledge, attitude, and coping mechanisms of

cancer patients’ companions.

2 METHODS

The study design was pre-experimental. The

population in this study were the companions

(relatives) of cancer patients in the East Java Branch

of the Indonesia Cancer Foundation in 2015, with a

population of 30 people. The main inclusion criteria

entailed an age of 18–64 years, a companion within a

nuclear family of cancer patients in the East Java

Branch of the Indonesian Cancer Foundation, stage

two of cancer, complementary cancer patients, having

good vision and hearing, and an ability to read and

write. After the inclusion criteria were selected, a

population of 29 people were obtained. Determining

the large samples in the research and obtaining large

samples of geochemical calculation results amounted

to 27 people. The sampling technique used in this

research was purposive sampling, a type of non-

probability sampling.

The independent variable in this study was a

method of experiential learning, while the dependent

variable, i.e. the knowledge, attitudes, and the coping

mechanisms of cancer sufferers, were measured with

research instruments, in this case, questionnaires to

measure the initial data and final data following the

intervention. The intervention of experiential learning

methods included phases of 30–45 minutes. The first

phase was a concrete experience of consideration and

describes the experience of respondents as well as the

delivery of the material. The second phase is the

reflective observation in which a review has been

conducted or studied with a question and answer

discussion. The third phase is the phase of abstract

conceptualitation, explaining the new concept of

integration experience and education. The fourth

phase is the last active experimentation phase of

concept planning and testing using the new

experience gained.

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Data analysis was conducted using the Wilcoxon

Signed Rank Test then the conclusion was drawn

along with the data processing and presentation of

results with the degree of significance p ≤ 0.05. This

research passed an ethical review and was deemed

eligible with the registration number

415/EC/KEPK/FKUA/2016.

3 RESULTS

The results indicated that nine respondents (33.3%)

were aged 54–64 years and three respondents

(11.1%), were aged 18–29 years. Most respondents

(14) (51.9%) were female. Respondents’ average

education level were the same, i.e. ten (37.0%)

respondents were educated at primary level and very

few (four) had attained a higher education level

(14.8%). Based on job characteristics, 37% of

respondents were categorised as private employees.

Revenue of respondents was about 1–2

million/month. Some respondents came from outside

the city of Surabaya but were still from East Java

(51.9%), while the rest came from outside Java Island

(48.1%) (see Table 1).

Table 1: Distribution of respondents’ characteristics of cancer patients at the East Java Branch of the Indonesian Cancer

Foundation December 2015–January 2016.

Variable

Category

Number

Percentage

Ages

18–29

11.1%

30–41

29.6%

42–53

25.9%

54–64

333%

Gender

Female

519%

Male

481%

Level of Education

Primary School

37.0%

Junior High School

222%

Senior High School

25.9%

Higher Education

14.8%

Occupation

Swasta

37.0%

Wiraswasta

296%

Buruh

14.8%

Tidak Bekerja

18.5%

Earning

< 1 million Rupiahs/month

25.9%

1–2 < 1 million Rupiahs/month

55.6%

> 2 < 1 million Rupiahs/month

185%

Area of Origin

Surabaya

East Java

519%

Java Island

Outside Java Island

48.1%

Table 2: Distribution of cancer patient accompanied by respondents at the East Java Branch of the Indonesian Cancer

Foundation December 2015–January 2016.

Variable

Category

Number

Percentage

Time having cancer

<1 year

63.0%

< 5 Years

37.0%

Treatment

Surgery

25.9%

Radioteraphy

29.6%

Chemoteraphy

63.0%

Cancer

Ca. Cervix

29.6%

Ca. mamae

7.4%

Ca. colon

7.4%

Ca. rectal

11.1%

Ca. Uterine

3.7%

Ca. prostat

3.7%

Ca. endometrium

3.7%

Ca. Oculi

3.7%

Ca. nasofaringeal

11.1%

Ca. Cerebri

14.8%

Hepatoma

3.7%

Impact of Experiential Learning Method on the Knowledge, Attitude, and Coping Mechanism of Cancer Patient’s Companions at the Java

Branch of Indonesian Cancer Foundation

719

Seventeen patients, accompanied by their

families, had been diagnosed with cancer for <1 year

(63.0%). Furthermore, 17 patients received

chemotherapy that (63.0%). Cervical cancer was the

most prevalent, with 29.6% of patients (see Table

2).The result of the research showed that before

undergoing experiential learning, the knowledge of

the respondents in the pre-test was low (51.9%).

However, after experiential learning was delivered,

the results from the post-test showed that most people

(19) had good knowledge (70.4%) (see Table 3).

Some respondents (16 people) had a negative attitude

(59.3%), but after performing the experiential

learning method, post-test results showed that most

had a positive attitude (77.8%) (see Table 4). The

results of the pre-test from those participants provided

with experiential learning showed that (16) had

destructive coping mechanisms (59.3%). After being

provided with the experiential learning method, the

post-test results determined that 17 people

demonstrated a constructive coping mechanism

(63.0%) (Table 5).

Table 3: Distribution of respondents based on their

knowledge before and after experiential learning is

provided at the East Java Branch of the Indonesian Cancer

Foundation December 2015–January 2016.

Knowledge

Category

Pre-test

Post-test

Freq

Percent

Freq

Percent

Good

22.2%

70.4%

Enough

25.9%

29.6%

Low

51.9%

Total

100%

Table 4: Distribution of respondents based on attitude

before and after they were provided with experiential

learning at Yayasan Kanker Indonesia Branch of East Java

December 2015–January 2016.

Attitude

Category

Pre-test

Post-test

Freq

Percent

Freq

Percent

Positive

40.7%

77.8%

Negative

59.3%

22.2%

Total

100%

Table 5: Distribution of respondents based on coping

mechanisms before and after they were provided with

experiential learning at Yayasan Kanker Indonesia Branch

of East Java December 2015–January 2016.

Coping Mechanism

Category

Pre-test

Post-test

Freq

Percent

Freq

Percent

Constructive

40.7%

63.0%

Destructive

59.3%

37.0%

Total

100%

Table 6: Statistical test results using the Wilcoxon Signed

Rank Test, showing the influence of experiential learning

methods on knowledge, attitudes, and coping mechanisms

of cancer patients at the Indonesian Cancer Foundation East

Java Branch December 2015–January 2016.

No.

Category

P value

The influence of experiential learning

methods on knowledge

0.000

The influence of experiential learning

methods on attitute

0.012

The influence of experiential learning

methods on coping mechanism

0109

Based on the Wilcoxon Signed Rank Test

statistics test, experiential learning method increases

the knowledge and attitudes of respondents, which is

significant with the probability of knowledge that is

(p) = 0.000 and attitude (p) = 0.012, but regarding

coping mechanisms do not have a significant

influence at (p) = 0.109 (see Table 6).

4 DISCUSSIONS

4.1 Effect of Experiential Learning

Methods on the Knowledge of

Cancer Companions at the East

Java Branch of the Indonesian

Cancer Foundation

The study showed that, based on the Wilcoxon Signed

Ranks Test, experiential learning methods improve

knowledge of family who accompany cancer patients.

This research supports the theory that the learning

process will change a person’s knowledge level

(Efendi, 2009). The learning process provides

knowledge for the companions of cancer patients,

resulting in changes to information processes,

decision-making, and emotions that eventually occur

within the process of cognitive control in the brain to

perform mechanisms of learning and adaptation

(Nursalam, 2014).

The results showed respondents who have less

knowledge before being provided with experiential

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

720

learning may have an elementary schooling level,

with minimal exposure to information from

magazines, newspapers, the Internet, and other

information sources. This theory, proposed by

(Notoatmodjo, 2003), states that the basic concept of

education is a process of learning, which means that

in education there are relationships, developments,

and change toward more advanced, mature, better

individuals, family, and society, where a higher level

education may improve one’s ability to receive

information so that more and more knowledge is

owned; with poor education it is difficult to receive

information.

The knowledge level of respondents mostly

improved after being provided with experiential

learning because it is appropriately applied to

individuals who have poor knowledge; the

experiential learning model defines learning as a

process obtained through a combination of

experiences (grasping experience) by transforming

experiences (transformation of experience) (Adams

et al., 2004). Grasping experiences can occur directly,

i.e. through the senses and indirectly, i.e. in the form

of symbolic forms, such as concepts. The experiential

learning model describes two methods of obtaining

information with concrete experience and abstract

conceptualization, and two experience transformation

capital that is reflective observation and active

experimentation.

Experience has an important role in the

construction of knowledge. Madnesen and Sheal

argue that meaningfulness of learning depends on

methods of learning. Learning by reading only allows

10% of meaning, listening allows 20%, observing

allows 30%, listening and observing allows 50%,

communicating reaches 70%, and learning by doing

and communicating can reach 90% of (Suherman,

2008). Learning activities relating to active real

experiences can optimize achievement of learning

objectives. Experiential learning is an educational

process, centered on learners and is activity-oriented.

Experiences have an important role in the formation

of cognitive knowledge in the mind. People reflect on

the experience of new knowledge. It is stated that if

new concepts can be integrated with existing concepts

in cognitive structure, new concepts can be imagined

or can be associated with the realistic world. The

knowledge gained can the be applied to other

situations (Sharlanova, 2004).

There are three characteristics in the experiential

learning model: (1) learning is best accepted as a

process, in which concepts are obtained and modified

through experimental activities and not stated in the

form of products; (2) learning is a continuous process

based on experience; and (3) the learning process

requires conflict resolution (Wirta & Rapi, 2008). The

benefits of applying learning based on experience are

as follows; (1) provide the appropriate range of

learning methods, (2) provide a close link between

theory and practice; (3) clearly formulate the

importance of reflecting and stimulating the feed

turning about what has been learned; (4) supporting

the combiniation of teaching styles so that learning

becomes more effective (Adams et al., 2004).

Using the experiential learning method,

respondents are invited to share what they know and

learn gradually from the concrete experience,

reflection, observation, abstraction,

conceptualization, and active experimentation phase,

so that respondents who have less knowledge gain

much more experience before or are exposed to

information to improve their knowledge (Suherman,

2008). The experiential learning method makes it

easier for respondents to learn significantly from the

experiences of others, whereas in the concrete

experience phase until the abstract phase

conceptualization which is the stage for the

respondent is required to think in real or mind (mind

on) develop a new concept in integrating experience

previously obtained with knowledge just received

from the education presented by the researchers

(Sharlanova, 2004). The theory suggested by Ajzen

(2005) also describes perceived behavioral control as

a function based on control beliefs, that are beliefs

based on individuals’ previous experiences of a

behavior, the information the individual possesses

about a behavior, or that acquired by observing

knowledge that belongs to self, as well as others

known to the individual.

4.2 Effect of Experiential Learning

Methods on the Attitude of Cancer

Supervisors at the East Java

Branch of the Indonesian Cancer

Foundation

The results showed that respondents’ attitudes of

cancer patients found a strong correlation with

significant differences according to the Wilcoxon

Signed Ranks statistical test. It means that

experiential learning methods improved the attitudes

of the respondents.

Research using the experiential learning method

regarding the companions of cancer patients supports

the theory proposed by Azwar (2009), which states

that health education is a form of persuasion in

changing attitudes, by entering ideas, thoughts, or

facts through communication messages, with the

Impact of Experiential Learning Method on the Knowledge, Attitude, and Coping Mechanism of Cancer Patient’s Companions at the Java

Branch of Indonesian Cancer Foundation

721

message intentionally delivered to open opportunities

for expected changes in attitude. Regarding the

experiential learning methods in the reflective

observation phase, learners review what has been

done or learned. Listening skills, giving

attention/sharing, finding differences, and applying

ideas, so forming a discussion can help to obtain

results of reflection. Learners observe the activity

carefully using the five senses or feelings and then

reflect on the obtained results. At this stage, learners

discuss the results of the reflection.

Attitude is a disposition of positive or negative

responses to a behavior. Attitudes toward behavior

are determined by the belief about the consequences

of a behavior; these are called behavioral beliefs

(Ajzen, 2005). Behavioral beliefs associate behavior

with the results that can be obtained from the

behavior. Attitudes toward behavior are determined

by individual evaluations of behavior-related results

and with the strength of the relationships of both

(Ajzen, 2005).

In general, the more individuals that evaluate a

behavior will produce positive consequences then the

individual will tend to favor the behavior; if more

individuals evaluate negatively then the individual

will be unfavorable towards the behavior (Ajzen,

2005). After the experiential learning method

intervention, resondents have mostly positive attitude

changes because good knowledge is the cause of

better attitude changes. This will lead people to have

cognition for considering good, bad, or personal

maturity. According to Notoatmodjo (2003), factors

that can affect the level of knowledge is information,

for which more information can affect or increase

one's knowledge. Knowledge raises an awareness so

that eventually one will behave in accordance with

the knowledge they possess. The experiential learning

method allows respondents to get real information

from other people's experiences and the stages of

respondents to integrate experiences that have been

previously obtained using educational knowledge

submitted by researchers. This supports the statement

of Azwar (2009) who states that the influence of other

people can affect attitude and, generally, individuals

tend to have a compromising attitude towards the

more important person.

4.3 Effect of Experiential Learning

Methods on the Coping

Mechanisms of Companions at the

East Java Branch of the Indonesian

Cancer Foundation

The results of the study indicated that the coping

mechanisms of respondents regarding cancer does not

achieve any significant data between the pre-

experiential learning method and the post-test; in this

study, the experiential learning method was not

proven to improve the constructive coping

mechanism of respondents.

The results before the experiential learning

method found that most respondents have a

destructive coping mechanism. This is because one of

the impacts of cancer for families are a sad feeling

such as the fear of losing something, There are

difference response of adaptation in every people.

The psychological reactions of rejection will arise at

the beginning of the diagnosis. This can be felt by the

clients and their family and is a defensive response

enabling one to avoid reality. This refusal can be

expressed openly, for example, by doubting the truth

of the diagnosis by conducting another medical

examination (called a "second opinion") (FKUI,

2013).

The change in some respondents who

demonstrated a constructive coping mechanism, after

being provided with experiential learning, was

prompted by physical health, according to Mu’tadin

(2002). A healthly condition plays an important role

in coping with stress. Individuals required energy

rather than positive beliefs or views when dealing

with stress or problems they encounter. The

individual must feel confidence and positive thinking

that a problem will be resolved. Problem-solving

skills include the ability to seek information, analyze

a situation, and identify the problem with the goal of

generating alternative actions. Respondents who are

active and able to carry out each stage are found to

have a constructive coping mechanism.

5 CONCLUSIONS

The level of knowledge of the companion of cancer

patients increased after the provision of experiential

learning method. The level of knowledge of

respondents about the treatment of cancer patients

was mostly good because the method of experiential

learning makes it easier to learn significantly from the

experience of others.

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

722

The positive attitudes of patients with cancer

increased after the provision of experiential learning

methods. Positive attitudes of respondents in the

treatment of cancer sufferers are mostly good because

the experiential learning method provides a real

concept of the experience of others and integrates the

experience possessed with new knowledge.

The constructive coping mechanisms of sufferers

with cancer did not improve following the provision

of experiential learning methods. The coping

mechanism of respondents in the care of cancer

patients in part were not constructive because of the

psychological reactions of rejection during the phase

of adaptation of various respondents.

As suggested, it is expected that the board of the

East Java Branch of the Indonesian Cancer

Foundation can learn experiential learning methods

within the health education provided for the

companions of cancer patients. It is suggested that the

nursing profession should study and develop the use

of experiential learning methods as an alternative to

educational media when providing counseling. There

is a need for further research relating to the

relationship between the counselor and patient with

cancer (father, mother, child,

grandmother/grandfather). The level of adaptation

regarding the coping mechanism of each respondent

is different, so the time of the research should be

added so that the results are representative and

satisfactory.

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