Disertasi

Penerapan Epidemiologi Forensik Sebagai Upaya Peningkatan Mutu Praktik Berbasis Bukti di Bidang Kedokteran Forensik dan Medikolegal: Studi Mixed-Method tentang Penentuan dan Pelaporan Kausalitas Probabilistik pada Kasus Kompleks Kedokteran Forensik di Indonesia. = Application of Forensic Epidemiology as a Quality Improvement Tool of Evidence-Based Practice in Forensic Medicine: Mixed-Method Study Regarding the Determination and Reporting of Probabilistic Causation in Complex Forensic Medical Cases in Indonesia.

Pendapat ahli yang disampaikan dalam proses hukum harus dapat dipertanggungjawabkan secara ilmiah, yang dikenal dengan evidence-based practice (EBP). Dalam kedokteran forensik, EBP belum diterapkan secara eksplisit, termasuk di Indonesia. Salah satu pendekatan potensial untuk merumuskan pendapat ahli berbasis bukti disebut dengan INFERENCE (INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements). Selain itu, belum ada pedoman universal untuk membuat laporan patologi forensik. Salah satu pedoman yang potensial bernama PERFORM-P (Principles of evidence-based Reporting in FORensic Medicine-Pathology version). Penelitian ini menggunakan metode campuran (mixed-methods) melalui lima tahapan yang saling terkait yaitu (1) survei potong lintang untuk mengetahui karakteristik dokter forensik Indonesia dan praktiknya saat ini, (2) proses adaptasi dan validasi kedua alat tersebut melalui review oleh Kolegium Ilmu Kedokteran Forensik Indonesia, (3) studi pre-post intervention satu kelompok untuk menilai validitas dan reliabilitas pendapat ahli kedokteran forensik yang diformulasikan menggunakan i-INFERENCE (Indonesian-INFERENCE) dan dilaporkan menggunakan i-PERFORM-P (Indonesian-PERFORM-P), (4) studi kasus analitik menggunakan i-INFERENCE, dan (5) diskusi kelompok terfokus untuk mengeksplorasi kepuasan pelanggan terhadap i-INFERENCE dan i-PERFORM-P. Seluruh penelitian ini dilaksanakan di Jakarta (secara luring dan daring) sejak bulan Desember 2017 sampai Juli 2022. i-INFERENCE dan i-PERFORM-P dapat meningkatkan validitas pendapat ahli kedokteran forensik. Kedua alat tersebut berpotensi untuk digunakan dalam setting Indonesia dengan beberapa tambahan/klarifikasi dalam pedoman pengguna. Keduanya juga mendapat sambutan yang umumnya positif, baik dari pengguna potensial (dokter forensik Indonesia) maupun oleh konsumen (jaksa dan hakim) meskipun diperlukan upaya lebih dalam menggunakannya. Peserta membayangkan bahwa kedua alat tersebut akan sangat berguna dalam kasus yang rumit. Dengan adanya i-INFERENCE dan i-PERFORM-P dokter forensik Indonesia diharapkan lebih siap dalam menganalisis dan melaporkan kasus yang kompleks, serta implementasi EBP dapat ditingkatkan.
Kata kunci: i-INFERENCE, i-PERFORM-P, kedokteran forensik, patologi forensik, praktik berbasis bukti.



Expert opinions presented in legal proceedings should be scientifically accountable, which is known as evidence-based practice (EBP). In forensic medicine, EBP has not been explicitly applied, including in Indonesia. One potential approach to formulate evidence-based expert opinions is called INFERENCE (INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements). Additionally, there is also no universal guideline for making forensic pathological reports. One prospective guideline is the PERFORM-P (Principles of Evidencebased Reporting in FORensic Medicine-Pathology version). This study uses a mixed-method through five interrelated phases, i.e., (1) a cross-sectional survey to determine the characteristics of Indonesian forensic doctors and their current practice, (2) the adaptation and validation process of the two tools through a review by the Indonesian College of Forensic Medicine, (3) a one-group pre-post intervention study to assess the validity and reliability of forensic medical expert opinions formulated using i-INFERENCE (Indonesian-INFERENCE) and reported using i-PERFORM-P (Indonesian-PERFORM-P), (4) an analytic case study using i-INFERENCE, and (5) a focused group discussion to explore customer satisfaction towards i-INFERENCE and i-PERFORM-P. This study was conducted in Jakarta (online and offline) from December 2017 until July 2022. i-INFERENCE and iPERFORM-P can increase the validity of forensic medical expert opinions. Both tools can potentially be used in the Indonesian setting with some additions/clarifications in the user manuals. They also received a generally positive reception, both by potensial user (Indonesian forensic medical doctors) and by consumers (public prosecutors and judges) albeit the extra effort that is needed in using them. Participants envision that both tools will be most useful in complex cases. By obtaining the i-INFERENCE and the i-PERFORM-P, Indonesian forensic medical doctors are better equipped in analyzing and reporting complex cases, and the implementation of EBP can be improved.
Keywords: evidence-based practice, forensic medicine, forensic pathology, iINFERENCE, i-PERFORM-P.