Running head: RESEARCH PROJECT PROPOSAL
Research Project Proposal
Janferp
South University Online
Professor: Marcia Kessack
June 26, 2017
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RESEARCH PROJECT PROPOSAL
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Research Project Proposal
The role that palliative care and palliative care education plays in the well-being
of any individual suffering a chronic illness is undisputed in the medical field, by both
medical practitioners and those receiving the care. However, there is a need to understand
the impact that its timing has on the patient, in terms of enhanced quality of life and
increased satisfaction of the patient. Indeed, it would be highly beneficial to understand
whether the provision of palliative care education early or at the onset of the patient’s
illness will yield better results as opposed to its provision in later stages of the disease.
This should be done or accomplished with the background that palliative care,
traditionally known as the end of- life care, is perceived to offer final comforts for a
person whose illness is not only terminal, but there is little to no hope of recovery.
Further, with the underlying idea that palliative care and its education can be too costly to
implement; it is important to scrutinize if prolonged periods of palliative care education,
started early will add any value to the patient’s quality of life. Previous approaches to
palliative care education may have been satisfactory where a patient is made comfortable
as they approach the end of their with preparation of his or her demise. However, this
might not be enough as this study seeks to verify. The idea is that these patients do not
need to be simply take care of as they approach the ends of their lives, and kept
comfortable with their symptoms. Rather, if they would receive the palliative care early,
or at the onset of their illnesses, they would lead better lives, even as they continue to
manage the illness. They would suffer less symptoms, and thus, live comfortably and
higher-quality lives. Indeed, it would even be possible to change the trajectory of their
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illness if the patient receives the right type, intensity, and approach to early palliative
care.
This study is central to the role of any medical practitioner for various reasons, the
first of which is that it can be the first point of reference in cases that have been
diagnosed with a chronic illness. Indeed, if it is found out that early palliative care will
increase the quality of life, comfort and decrease the symptoms of the disease
significantly, practitioners in the medical field will provide this as the basic approach
towards achieving their objectives. The research, therefore, seeks to verify that in patients
diagnosed with chronic or life-limiting disease, early palliative care education by a nurse
will have a positive impact on patient’s management, measured in improved quality of
life, decreased symptoms and improved patient satisfaction, as compared to no or late
palliative education over 12 months?
Background and Significance of the Problem
The role that palliative care education plays in the treatment of patients with
chronic diseases is so significant that it cannot be ignored. Palliative care education is
easily the most extensive part of the treatment of such illnesses, and as such, its influence
should be studied and analyzed. It is important to note that there is a myriad of reasons
that explain why people might prefer to undertake palliative care education and even the
actual care towards the end of the student life as opposed to earlier stages. Some of these
reasons include lack of appropriate resources and lack of information about the condition
that the patient is suffering from (Venkatesan et al., 2012). However, the worst approach
is one that undertakes to show or bring in palliative care education towards the end of
person’s life simply because of the idea that it is understood to be the end of life care and
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thus, it loses value as early care education. Indeed, the problem is having a population
that introduces palliative care education towards the end of life instead of at the
beginning of the diagnosis of the illness. This difference is important because it will
result in higher rates of survival and receding of chronic diseases. In instances where
palliative care education is provided early, there are higher cases of survival as opposed
to the cases where palliative care education is provided as the end of life care. This
research seeks to find out the lengthening of such care and its education as soon as a
patient realizes that he is suffering a chronic illness.
Statement of the Problem and Purpose of the Study
Palliative care education has been traditionally reserved for the later stages of a
patient’s life where he and his family are prepared for his end of life care. It has been
conventionally employed as a means to ensure that the patient lives a comfortable life as
he prepares for his end of life. The problem is that in instances where a patient is
suffering from a life-threatening disease (or a chronic illness), palliative care education
should be provided early in the trajectory of the disease as opposed to it being an end of
life issue to enhance the quality of their lives. This study seeks to show that early
palliative care education is better than no or later palliative care education as far as
enhancement of patient life is concerned, and thus, the achievement of the objectives of
medical practice.
Literature Review
Article 1
Eriksson, G., Bergstedt Wahlström, T., & Melin-Johansson, C. (2014). The need for
palliative care education, support, and reflection among rural nurses and other staff:
RESEARCH PROJECT PROPOSAL
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A quantitative study. Palliative & Supportive Care, 13(2), 1–10.
https://doi.org/10.1017/S1478951513001272
Main purpose and scope: The main purpose of this article is to systematically evaluate
the evidence around the presence of palliative caregivers in rural Sweden, and shed light
on the support that they need in various areas of their operation. Brief Description: The
authors described the roles and positions available for the caregivers in Sweden, and the
commensurate gaps that these people experienced. This provides information on the best
resources to provide the to ensure that palliative care provided is efficient. Numbers of
Participants: The research had 1686 palliative healthcare staff involved in various
institutions of palliative care. These include those in nursing homes, home care, group
residences, registered nurses, assistance nurses, managers, and paramedics. Methodology
Use: The researchers used a sampling method to secure the test subjects, and used a 20
item questionnaire to collect data. Value and Significance: The value in this study is to
show how various service providers, especially those in rural settings can enhance their
palliative care service provision. Possible Bias: Possible biases identified are that the
case in the rural region in Sweden was not compared to other rural areas in the same
country or other countries. Observations: From the research, it is evident that many
caregivers of palliative care do not have palliative training, and many of them needed to
further their education. There are also various shortcomings in terms of education and
other abilities to ensure efficiency. Summary: The main points of this study were that
palliative care is not where it should be, and it can always be enhanced. This is best
achieved through the inclusion of aspects such as informatics, education, further training
and interactions with other professionals.
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Article 2
Venkatesan, P., Harikesavan, K., Kumar, S., Karthikbabu, S., Syed, N., Sisodia, V., &
Jaykumar, S. (2012). Study of Nurses’ Knowledge about Palliative Care: A
Quantitative Cross-sectional Survey. Indian Journal of Palliative Care, 18(2), 122–
127. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477365/
Main purpose and scope: The main purpose of this article is to investigate the
information and knowledge held by nurses as far as palliative care services and analyzing
the challenges experienced is concerned. The authors seek to verify the fact that in the
past nurses, and doctors are not well prepared to deliver effective palliative care in all the
necessary changes and developments in conventional services that provide care for a high
proportion of advanced and terminally ill patients. Brief Description: The authors
described the role that nurse and doctors play in palliative care plays and present the fact
that in most countries, enhancing knowledge and information about palliative care would
be important to enhance life. Numbers of Participants: The number of human subjects
in this study was 363 nurses who are also primary care professionals in a multispecialty
hospital. Methodology Use: The researchers used a self-report questionnaire with 20
items to respond to. Value and Significance: The value in this study is to analyze the
role of changes in the palliative care in the world and the impact it could have. It also
sheds light on the fact that palliative care service providers are usually not well-equipped
with information that will help them make better decisions. Possible Bias: Possible
biases identified are that the research interviewed nurses alone as opposed to the wide of
professionals who are involved in palliative care. Observations: From the analysis or
research undertaken, it is evident that many nurses are not aware of may developments in
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the palliative care field and other related areas, including pain, philosophy, and
psychiatry. All of these are essential to track all aspects of palliative care in all chronic
diseases. Summary: The main points of this study were the emphasis on the importance
of knowledge and information in palliative care. This is enhanced by the increasing needs
and demands of patients with advanced chronic diseases and their families.
Article 3
King, J. D., Eickhoff, J., Traynor, A., & Campbell, T. C. (2016). Integrated oncopalliative care associated with prolonged survival compared to standard care for
patients with advanced lung cancer: A retrospective review. Journal of Pain and
Symptom Management, 51(6), 1027–1032.
https://doi.org/10.1016/j.jpainsymman.2016.01.003
Main purpose and scope: The main purpose of this article is to perform a retrospective
analysis of partially integrated onco-palliative care lung cancer clinic to evaluate overall
survival and resource utilization. Brief Description: The authors described lung cancer
as the leading cause of cancer-related death in the U.S. Further, they describe a large
randomized controlled trial in advanced lung cancer found a survival advantage with an
early palliative care (EPC) intervention compared to standard oncologic care. Numbers
of Participants: The number of human subjects in this study was two hundred seven
patients with advanced lung cancer. Methodology Use: The researchers used clinical
trial participation, hospice enrollment and length of stay, and chemotherapy utilization
for collecting and analyzing data. Value and Significance: The value in this study is to
paint an image of the role that palliative care plays in enhancing survival rates of patients
with lung cancer. Possible Bias: Possible biases identified are the provision of care in
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the selected facility. This does not mean that the same impact will be felt in a different
facility. Observations: From the topic and issues written in this study it emerges that
EPC patients had a survival advantage, were more likely to participate in clinical trials
and had a longer median hospice length of stay. Summary: The main points of this
study were that palliative care is not only necessary, but when implemented early, it can
have a bigger impact. Early palliative care or EPC can also be enhanced through
information and informatics.
Article 4
Kwon, J. H., Hui, D., Chisholm, G., Ha, C., Yennurajalingam, S., Kang, J. H., & Bruera,
E. (2013). Clinical characteristics of cancer patients referred early to supportive and
palliative care. Journal of Palliative Medicine, 16(2), 148–155.
https://doi.org/10.1089/jpm.2012.0344
Main purpose and scope: The main purpose of this article is to compare the impact of
the palliative care between early intervention and end of life care. They compared clinical
characteristics between patients referred late in the course of their disease Brief
Description: The authors described palliative care in its changing or evolving forms.
They argue that Palliative care is evolving from end-of-life care to care provided earlier
in the disease trajectory. Numbers of Participants: The number of human subjects in
this study was 695, of which 100 were early referrals. Methodology Use: The
researchers used comparative research method for analyzing the data collected. Value
and Significance: The value in this study is that it tackles an aspect that has been
ignored for a long time. The authors argue that there are no studies on the characteristics,
clinical problems, and outcomes of patients referred early to palliative care. Possible
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Bias: Possible biases identified are the use of cancer patients and the absence of other
chronic diseases. Observations: From the topic and issues written in this study it
emerges that early referrals were younger and shorter disease duration until first palliative
care consultation. Summary: The main points of this study were that early referrals had
better chances at recovering and changing a disease trajectory as opposed using palliative
care as an end of live care.
Article 5
Back, A. L., Park, E. R., Greer, J. A., Jackson, V. A., Jacobsen, J. C., Gallagher, E. R., &
Temel, J. S. (2014). Clinician Roles in early integrated palliative care for patients
with advanced cancer: A Qualitative Study. Journal of Palliative Medicine, 17(11),
1244–1248. https://doi.org/10.1089/jpm.2014.0146
Main purpose and scope: The main purpose of this article is to show how an elaborate
integrated care model ensures that a patient who needs palliative care is well taken care
of. Brief Description: The authors described the idea that palliative care is necessary to
ensure that the patient receives better quality of life and increased awareness of his health
state. This is supported by the need of the patient to survive and improve their lives even
in cases where they have advanced cancer. Numbers of Participants: The number of
human subjects in this study included two qualitative group interviews and one
qualitative individual interview with eight palliative care clinicians. Methodology Use:
The researchers used an interview approach or method for collecting data. In analyzing
the data collected the researchers simply reviewed and identified the major themes and
developed a content-based coding scheme. Value and Significance: The value in this
study is the description of the roles of clinicians and possible roles that can be changed to
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ensure effective achievement of objectives. Possible Bias: Possible biases identified are
the fact that the researchers are also doctors and can sympathize (or empathize) with their
position, or assume its significance to the study in general. Observations: From the topic
and issues written in this study it is evident that the clinician has many roles even into the
palliative care of patients. Summary: The main points of this study include the idea that
clinicians should have a continuing role in the palliative care, and they have roles that
should be integrated into the early palliative care.
Article 6
Dahlhaus, A., Vanneman, N., Siebenhofer, A., Brosche, M., & Guethlin, C. (2013).
Involvement of general practitioners in palliative cancer care: A qualitative study.
Supportive Care in Cancer, 21(12), 3293–3300. https://doi.org/10.1007/s00520-0131904-6
Main purpose and scope: The main purpose of this article is to explore general
practitioners' perceptions of their involvement in palliative cancer care and the constraints
they confront. Brief Description: The authors described the role that practitioners play
in palliative care in cancer patients and how these roles should be maintained. Numbers
of Participants: The number of human subjects in this study was 13, all of which were
German general practitioners and selected after purposeful sampling. Methodology Use:
The researchers used a sampling method to secure the test subjects, and used electronic
recordings and transcription to analyze the data collected. Value and Significance: The
value in this study is to show how general practitioners are involved in the provision of
palliative care of their cancer patients, and how these roles should be taken, or advanced.
Possible Bias: Possible biases identified could be in the sampling methods and the small
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sample size, which could limit the perspectives in the general practitioners’ field.
Observations: From the topic and issues written in this study it is evident that doctors
are not only intensely involved in the final phase of their patients' lives, but they are also
aware of the limitations in their medical skills and knowledge and their ability to provide
round-the-clock care. Summary: The main points of this study were that doctors are
currently involved in the palliative care of their patients and that they are not well
prepared for this role.
Article 7
Maloney, C., Lyons, K. D., Li, Z., Hegel, M., Ahles, T. A., & Bakitas, M. (2013). Patient
perspectives on participation in the ENABLE II randomized controlled trial of a
concurrent oncology palliative care intervention: Benefits and burdens. Palliative
Medicine, 27(4), 375–383. https://doi.org/10.1177/0269216312445188
Main purpose and scope: The main purpose of this article is to understand how patients
feel about ENABLE II (Educate, Nurture, Advise Before Life Ends) which was aimed at
enhancing a patient’s quality of life and mood in cancer patients. Brief Description: The
authors described the program which required that the patients evaluate and relay their
perspective of the palliative care they received before and after the program. Numbers of
Participants: The number of human subjects in this study was 72, of which only 53
agreed to engage in an in- depth interview. Methodology Use: The researchers used a
semi- structured interview to collect data and coded the responses into themes for
analyzing the data collected. Value and Significance: The value in this study is to show
that while research can be done on the care providers, it is also important to consider the
patients and the home- based caregivers to share their perspectives on the care received
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from doctors. Possible Bias: Possible biases identified are exaggerations of the homebased caregivers pertaining to the help they receive from doctors. Observations: From
the topic and issues written in this study it emerges that patients assign various aspects of
values to physicians, which include enhanced problem-solving skills, better coping,
feeling empowered, and feeling supported or reassured. Summary: The main points of
this study were that doctors have a major role to play in providing and enhancing
palliative care and that the roles of doctors and home-based caregivers should be merged
and or at least, complementary.
Article 8
Rhondali, W., Burt, S., Wittenberg-Lyles, E., Bruera, E., & Dalal, S. (2013). Medical
oncologists’ perception of palliative care programs and the impact of name change
to supportive care on communication with patients during the referral process. A
qualitative study. Palliative and Supportive Care, 11(5), 397–404.
https://doi.org/10.1017/S1478951512000685
Main purpose and scope: The main purpose of this article is to understand how
oncologists perceive or understand palliative care and how they feel the changing of the
name from palliative care to supportive care will impact the reception and
communication with patients. Brief Description: The authors described palliative care
and in the context of oncology, how it helps to support the patients in the later stages of
cancer. Numbers of Participants: The number of human subjects in this study was 17,
all of whom were oncologists. Methodology Use: The researchers used semi- directed
interviews to collect data from the participants, and used grounded theory and qualitative
methods to analyze the data collected. Value and Significance: The value in this study
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is that it depicts palliative care as not only a basic need or care, but as an essential timesaving application, and symptom control, transitioning to end-of-life care, family
counseling, and improving patients’ ability to tolerate cancer therapies. Possible Bias:
Possible biases identified are that the research interviewed only oncologists, who are
specialists. To overcome this bias, the researcher should have included perspectives from
other professionals who are in the same field or who serve patients treated by oncologists.
Observations: From the topic and issues written in this study it appears that the
provision of palliative care is not only important to the patients and the oncologists, but it
is also unchanged by the changes in the terminology and title. Further, these changes in
terminology did not make it easier to interact with the patients. Summary: The main
points of this study were the emphasis on the importance of palliative care, and the fact
that it should be incorporated into the cancer treatment schedule.
Research Questions, Hypothesis, and Variables
The relationship between various variables will be tackled through an analysis of
research questions, which will culminate to the description of the differences between
early and late palliative care education provision.
The research question is: In patients diagnosed with chronic or life-limiting
disease, how does early palliative care education by a nurse, as compared to no or late
palliative education impact a patient’s management (improve quality of life, decrease in
symptoms, improve patient satisfaction) over 12 months?
The research hypothesis is that in patients diagnosed with chronic or life-limiting
disease early palliative care education by a nurse will have a positive impact on patient’s
RESEARCH PROJECT PROPOSAL
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management, measured in improved quality of life, decreased symptoms and improved
patient satisfaction, as compared to no or late palliative education over 12 months.
The independent variable presentation of early or late palliative care education
that will determine the enhanced life of the patient.
The dependent variable is the health of the patients, which is determined by the
palliative care and measure by enhancing quality of life, and decreased symptoms.
The operationalizing variables of variable will be done through the qualitative
information and quantitative data received from research materials and secondary
sources.
Theoretical Framework
Overview and Guiding Propositions
As required by the middle-range theory, there is a reality of the research question
that has little to no abstract foundation. Indeed, the middle-range theory requires that
there are more real-life phenomena add that the research can be directly applied to
practice. Further, the middle-range theory also requires that there are a combination or
several studies and professions. Additionally, middle-theories should be developed from
information received and observed from actual practices in various fields. This means
that they should have a concrete basis.
Application of Theory to Study Focus
Indeed, the idea holds that with more and fast accurate information, patients will
survive longer and they might start getting better from the palliative care they receive.
Under the middle range theory, these are real life events that can be enhanced by the
research and its findings. These results are meant to corroborate the idea that in the
RESEARCH PROJECT PROPOSAL
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presence of early palliative care education, there are increased chances of patient
survival, and increased comfort as opposed to late palliative care education. This theory
or hypothesis is derived from actual observations from nursing practice.
Methodology
Sample/Setting
The research will involve sampling from a pool of people who have interacted
with either form of palliative care education and who can honestly share their experiences
about these approaches to palliative care. The idea is to show that the impact of the early
or late (or no) palliative care education is felt by the people who are in the community,
and the patients can easily attest to this. Further, previous articles or secondary data that
will be used will need to be sampled to find the sources that directly relate to quantitative
data sources. The samples will be representative samples thus they will be selected in a
manner that represents the population of study. This type of sample was select because it
provides credible or valid results that reflect on the traits within the population selected.
Sampling Strategy
The sample will be chosen randomly. According to Cormack (2016 ), the method
of randomly selecting the sample is the best, because it represents the population of
interest and also eliminates sampling bias. The sampling frame for this study is the cancer
patients admitted to the oncology unit where this author works, and a hospice care agency
in the area. The patients and nurses within the unit and the agency will be included in
this study at random, as data will be collected to determine if early palliative education
makes a difference in patients with chronic or life-limiting disease’s quality of life.
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All the participants will be of any race, religion, or ethnic background along with
education of level. Education will not be a factor as the feedback expected will be based
on observation. However, the researcher will perform a random sampling strategy that
will be aimed at a pool of participants of religious, gender and racial diversity.
Research Design
The design of this research is quantitative quasi-experimental design to show the
relationship between the variables (Grove, Burns, & Gray, 2013).). According to
Cormack (2016), qualitative researchers are required to use a small, selected sample
centered in-depth nature of the study and the necessary data analysis. As per, Grove et al.
(2013) when using two variables, it is advised that the researcher a use at least 60
participants. Therefore, a minimum of 50 participants and a maximum of 100 will be
surveyed in this study.
This study will use a survey method. The survey method is preferred because it
has a standard measurement approach. However, this method has its shortcomings, which
are centered around inflexibility, validity and reliability threats. Secondary data will also
be used by incorporating research by other scholars and researchers to complement ideas
generated by the researcher. The survey approach attempts to collect data from members
of a large population on one or more variables. This research design was found to be
appropriate because it provided detailed data directly from the field to meet the research
objectives. The survey design is accurate and has greater efficiency. It was more relevant
for the purpose of finding the experiences and perceived benefits of introducing palliative
care education at the early stages of an illness.
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Extraneous Variables
Description of the Intervention
.
Data Collection Procedures
Data Analysis Plans
.
Ethical Issues
Discuss here.
Limitations of Proposed Study
Discuss here.
Implications for Practice
Discuss here.
Assignment 2 Grading
Criteria
Maximum
Points
Earned
Points
Comments
Does not justify well how student arrived at number of
participants to use – needs to reference the calculator used
and how attrition is accounted for and still have significance
in the study.
Sample discussion
includes justification for
number of subjects and
criteria for
inclusion/exclusion.
5
1
Where is your source showing this is an
appropriate sample size? What calculator
did you use that took into account that this
sample size would still show significance of
greater than or equal to 0.05%?? IRB will
not approve this study without the
calculator and calculations being
referenced.
Please amend this and turn back in
for re-grading.
Inclusion/exclusion criteria must be spelled out in more
detail – see my comments.
RESEARCH PROJECT PROPOSAL
Setting discussion
includes an overview and
rationale for setting
location
Sampling Strategy is fully
explained and appropriate
to the study focus.
Research Design is
described in detail and is
appropriate to answer the
research question.
18
5
5
10
10
Student describes the setting where the study will be
conducted very well.
Very well described in this section
Research Design is well stated and explained.
5
5
See my comments throughout the paper
Followed APA guidelines
for writing style, spelling
and grammar, and citation
of sources.
5
Total:
30
5
Please correct the errors found throughout the paper and
resubmit for grading.
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References
Bliss, J., & While, A. (2007). District nursing and social work: palliative and continuing
care delivery. British Journal of Community Nursing, 12(6), 268–72.
https://doi.org/10.12968/bjcn.2007.12.6.23775
Cormack, D. (2016). The research process in nursing. Oxford [u.s.]: Blackwell Science.
Eriksson, G., Bergstedt Wahlström, T., & Melin-Johansson, C. (2014). The need for
palliative care education, support, and reflection among rural nurses and other staff:
RESEARCH PROJECT PROPOSAL
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A quantitative study. Palliative & Supportive Care, 13(2), 1–10.
https://doi.org/10.1017/S1478951513001272
Grove, Susan, Nancy Burns, Jennifer Gray. The practice of nursing research: appraisal,
synthesis, and generation of evidence, 7th Edition. W.B. Saunders Company, 2013.
[South University].
King, J. D., Eickhoff, J., Traynor, A., & Campbell, T. C. (2016). Integrated oncopalliative care associated with prolonged survival compared to standard care for
patients with advanced lung cancer: A retrospective review. Journal of Pain and
Symptom Management, 51(6), 1027–1032.
https://doi.org/10.1016/j.jpainsymman.2016.01.003
Kwon, J. H., Hui, D., Chisholm, G., Ha, C., Yennurajalingam, S., Kang, J. H., & Bruera,
E. (2013). Clinical characteristics of cancer patients referred early to supportive and
palliative care. Journal of Palliative Medicine, 16(2), 148–155.
https://doi.org/10.1089/jpm.2012.0344
Murray, M. (2007). Crossing over: transforming palliative care nursing services for the
21st century. International Journal Of Palliative Nursing, 13(8), 366-376.
Shima, Y. (2010). Introduction to palliative care for the oncologist-history and basic
principles of palliative care. Cancer & Chemotherapy, 37(10), 1849–1853.
Venkatesan, P., Harikesavan, K., Kumar, S., Karthikbabu, S., Syed, N., Sisodia, V., &
Jaykumar, S. (2012). Study of Nurses’ Knowledge about Palliative Care: A
Quantitative Cross-sectional Survey. Indian Journal of Palliative Care, 18(2), 122–
127. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477365/
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