Strengthening Palliative Care in Primary Health Care Through Knowledge Enhancement (SPARK) for Nurses in Yogyakarta: A Randomized Control Trial

Palliative care defines as an approach that improved the quality of life of patients and their family caregivers who are facing problems associated with life threatening (WHO, 2010). The definition is referring to any life-threatening illness such as cancer, dementia, heart failure, and so on. The number of people who needs palliative care is increasing significantly with the increasing number of older people and other degenerative diseases. In fact, more than 75%% people who died from serious health disease were in the developing countries (Spruyt, 2018; WHO, 2010).

In Indonesia, palliative care implementation has just started in 2007 under the ministry of health regulation: SK Menteri Kesehatan No 812/Menkes/SK/VII/2007 (Indonesia, 2007). According to this regulation, palliative care is recommended to be implemented in 5 provinces in Indonesia: Jakarta, Surabaya, Yogyakarta, Makasar dan Bali. It should be applied in all health care settings namely: hospital, primary care, and long term institution. However, the practical implementation in Indonesia has been slowly improved.

The first challenge is due to the insufficiently knowledge of palliative care of health care professionals. In Indonesia, palliative care has started in 2007, but it has just been integrated recently into health care curriculum. Another challenge is that palliative care team usually is formed in hospital based. Meanwhile, most patients who need palliative care are based at home. In the low middle income countries, like Indonesia, community plays an important role in palliative care. Therefore, health care professionals in the Primary Health Centre (PHC) need to be prepared for basic palliative care concept (Putranto, Mudjaddid, Shatri, Adli, & Martina, 2017).

In comparison to other countries in Asian regions, palliative care Indonesia is still slowly developed since Indonesia physician specialist in palliative care has not existed and the scarcity in the drugs regulation (Yamaguchi et al., 2014). Based on the worldwide report in 2015 by the Economist Intelligence Unit (EIU), amongst 80 countries, Indonesia ranked 53rd for palliative care implementation based several indicators: national policies, integration into health care services, hospice services and community engagement (Unit., 2015). Education and training for palliative care for Indonesian health care professional is lacking. Therefore, this should be conducted to accelerate the implementation of palliative care in Indonesia.

The investigators conducted previous study for palliative care implementation in PHC in Yogyakarta from 12 PHCs around Sleman, Kota Yogyakarta and Bantul. It showed that most nurses had not had enough information about palliative care. The concept of palliative care are mixed with other concept such as wound care, homecare and so forth (Unpublished, 2014). Although in Yogyakarta region, palliative care training for nurses and physicians have been performed regularly. However, these trainings were mostly included managerial staff and not the staff who are working directly with the patient. There is a limitation on transferring knowledge from those who attended trainings to those who directly contact with patients.