Development of Standard Operating Procedures in Palliative Care: A Qualitative Approach

Abstract

Introduction: Cancer remains a leading cause of death globally and in Indonesia. In advanced stages where curative treatment is limited, palliative care becomes essential for reducing suffering and improving quality of life. However, standardized protocols for palliative care delivery remain limited, particularly in resource-constrained settings like North Sumatra. Objective: This study addresses the critical gap in contextualized Standard Operating Procedures (SOPs) for palliative care in Indonesia.

Materials and Methods: A qualitative approach employing the initial stages of the Borg & Gall Research and Development model was utilized. Data were collected through semi-structured in-depth interviews with eight purposively selected informants (four advanced cancer patients and four healthcare professionals) and direct observations in four referral hospitals in North Sumatra. Data saturation was achieved after six interviews, confirmed by two additional interviews. Thematic analysis followed Braun and Clarke’s six-stage framework, with triangulation, member checking, and peer debriefing ensuring trustworthiness.

Results: Six main themes emerged: (1) family and environmental support, (2) pain management, (3) improving quality of life, (4) role of healthcare professionals, (5) access to health services, and (6) hope in palliative care. Observations revealed significant limitations in trained personnel, medication availability, and service standardization, particularly in rural areas. Findings align with international frameworks (WHO, ASCO, ESMO) while highlighting unique cultural and systemic challenges in Indonesia.

Conclusion: SOPs for palliative care must be contextually designed, incorporating local cultural values, healthcare infrastructure realities, and international best practices. Specific recommendations include standardized pain assessment protocols, structured family involvement frameworks, multidisciplinary care pathways, and strategies for resource-limited settings. Continuous training and policy support are essential for sustainable implementation.