Running head: RESEARCH PROJECT PROPOSAL
Research Project Proposal
Janferp
South University Online
Professor: Marcia Kessack
July 2, 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, regarding 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 disease. They would suffer fewer 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. The purpose of this study is to demonstrate
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
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palliative care education, support, and reflection among rural nurses and other staff:
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
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achieved through the inclusion of aspects such as informatics, education, further training
and interactions with other professionals.
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 researcher interviewed nurses alone as opposed to the wide
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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
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
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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
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
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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
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
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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
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
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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
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
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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
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
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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
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?
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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
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 null hypothesis is that in patients diagnosed with chronic or life-limiting
disease early palliative care education by a nurse will not 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.
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
The theory of self-actualization provided the theoretical foundation of this
research proposal. Abraham Maslow created this theory from his broad theory of the
hierarchy of needs. According to him, self-actualized individuals are the ones who are
psychologically healthy and are therefore at a higher level of the hierarchy of needs.
Also, he contends the notion that self-actualizing people are creative and highly
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demonstrate an ability to resolve contradictions characterized by ultimate contraries such
as life and death. Under self-actualization theory, Maslow he argues that an individual
does not need to transcend the self-actualization needs in a linear, direct and subsequent
stage. He postulates that creative individuals are capable of being self-actualized, free
from their mental health or the lack of it. Maslow describes self-actualization as the
ability surpass the levels of physiological, social and psychological needs and obtaining
personal needs fulfillment regarding the meaning of life (Maslow, 1950).
Self-actualization is said to occur when an individual can exploit his or her
advantages and as well be aware of the limitations. According to Maslow, selfactualization the desire that drives people to realize their full potential and also realize
their biggest limitations or disadvantages and be able to live with them comfortably. A
self-actualized person has reached human existence's apex not physical achievements but
psychological well-being. Self-actualized people display a strong sense of fulfillment
irrespective of their physiological condition or physical health. Abraham Maslow,
therefore, identified some characteristics of self-actualized individuals. They include selfacceptance and acceptance of others, find humor in their mistakes, have a perception of
reality for themselves and others, have a sense of purpose, experience regular moments of
profound joy and happiness, (peak experiences), show compassion and empathy for
themselves and others as well as appreciating the goodness of life.
Self-actualization in person-centered therapy is associated with human potential,
defines human nature and motivates human behavior. Person-centered therapy involves
choosing the direction of motivating a person and individuals who have a negative
attitude about themselves or who are facing difficulties to come to terms with reality are
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assisted to become self-actualized. Self-actualization focuses on individual strengths as
opposed to failings.
Application of Theory to Study Focus
In this project proposal self-actualization will be used to support the research from
the perspective that palliative care education, when offered to chronically ill or diagnosed
patients assists them and their relatives to become self-actualized about their situation
hence play a critical role in determining the quality of patient management and reduction
of symptoms as well as improved their satisfaction. Self-actualization in this research is
directly related to patient satisfaction through palliative care, and the lack of palliative
care is related to a lack of self-actualization. About this research and self-actualization
death is part of living and both death and life provide opportunities for self-actualization
and personal growth. From the characteristics of self-actualized individuals, the project
will identify palliative care as key in instilling these characters or qualities in chronically
ill patients which improve their psychological and physiological condition. This study
will also anticipate that palliative care education provides person-centered therapy to
patients and focuses on identifying their strengths rather than weaknesses which improve
the patients' physical and psychological well-being.
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,
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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.
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
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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.
Extraneous Variables
In a study, extraneous variables are factors that confound the capability of a
researcher to demonstrate causation. There are two kinds of extraneous variable; external
variables and intrinsic variables that included age, gender, and diagnosis. On the other
hand, external factors arise from the research itself. In this research proposal, the
researcher has managed to handle all the intrinsic variables because all the participants
will be of any religion, race or ethnic background along with the level of education. The
educational barrier will not hinder the feedback from the participants as it will be based
on observation.
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Extraneous variables arise from the research itself, and in this research, they are
selection bias and confounding that contribute to overestimate and underestimate of the
real influence of the treatment (Spruyt, 2016). Selection bias is problematic in this
observation research of intervention because of the characteristics of the clinicians,
patients, system, and the context as it will affect the choice of who receives the treatment.
Another kind of selection bias is the healthier volunteer bias that happens when some of
the participants are generally healthier than others. Selection bias results into
confounding that occurs when the independent variable (presentation of early or late
palliative care education that will determine the enhanced life of the patient), and
dependent variable (the patient’s health) predisposes selections into the treatment that
correlate with outcome.
The correlation of these variables with the outcome and the treatment will result
in type 1 errors whereby the outcomes of the treatment will be falsely accredited to the
intervention rather than the confounding treatment. Alternatively, confounding can also
lead to type II error whereby the research will falsely conclude that there are no treatment
effects. For instance, patients in palliative care services are likely to have high comorbid
conditions and organ systems needing treatment. This group is likely to receive early
treatment for cancer conditions unless they are contrasted to other patients who received
early palliative care. Therefore, without accounting for the baseline symptoms and
severity of the condition, then early palliative care could be the source of discomforts.
Before the execution of the research, the Evidence-based Practices Model states
that modifications to the contemporary palliative care practices should be piloted. With
early interventions in palliative and palliative care education there, instrumental variables
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approach will be used to control extraneous variables (Spruyt, 2016). The researcher will
use instrumental variables that will have to meet two conditions. The first condition is
that the variables should be relevant while the second requirement is that they should not
be able to influence the outcome directly on through the effect of the treatment. In this
palliative care research, this will mean that the researcher will be looking for variables
that will predict the choice of the patients in the setting but do not impact the succeeding
outcomes, apart from the onset palliative care versus late palliative care.
Description of the Intervention
PQLI (Palliative Care Quality of Life Instrument) is a type of instrument used to
evaluate the psychometric characteristics of the value of life instrument on terminally ill
patients getting palliative care (Spruyt, 2016). It was viewed to be succinct, quantitative
and simply applicable; more so, it is designed for use by users in palliative care
themselves and based on the current literature. The instrument has items that regarded to
be important to what is perceived as end-of-life care. During the research, as evidenced
from the qualitative evaluation on the description of the patients on the QoL, there is a
necessity to partake in the intervention process because this will provide them with sense
of control over their severe condition. Normally, patients require recognition in the
palliative care and involvement in the intervention choices incorporates the psychosocial
results that they might possess in their lives. When assessing the quality of life in
critically sick cancer patients, the treatment choice is the palliative one, and hence we
regard the significance of the addition of a new measurement when assessing the quality
of life. Lack of a questionnaire in the end-of-life setting and the availability of the unique
needs of the patients was the driving force for such a measurement to be used.
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Test-retest reliability of the participants (N= No. of patients) will be assessed by
relating the tallies documented on two occasions, an average of one week apart
(Spearman rho test). The clinical phase of the patients did no vary between the first and
second completion. Additionally, the state of the patients was steady between the
examination and re-examination. Because of its hierarchical condition, interest reliability
of the rank reports (Selection of Intervention) was determined by applying the Kendall’sW test (Mohanti, 2011).
Two indirect methods will be applied in the evaluating the validity. By assessing
the statistical variance of the questionnaire prior and during the intervention in terms of
Wilcoxon rank test amid the scale of similar subjects. The second method was the
Exploratory factor analysis (Mohanti, 2011). The fundamental principle with direct
oblivion rotation was applied to evaluate the validity of the PQLI.
The purpose of intervention in this research proposal is to bring a change into the
feeling, behaviors, and thoughts of the participants. In this palliative and end-of-life care,
complex intervention will be used (Mohanti, 2011). This is because mixed method
approaches work well within the multiphase model of the intervention evaluation and
development. However, the guidance of generic mixed method will be helpful, but it
presents challenges in the quantitative quasi-experimental design and its use in the endof-life-care have an influence on the application of the mixed methods. A one-day
workshop will be carried out where the nurses in the palliative care hospital participated
in the facilitated groups. After getting the consent of the patients to carry out the research,
instructions will be given on the intervention day and they will be selected based on
program adherence and other physiological factors. The intervention group will ensure
RESEARCH PROJECT PROPOSAL
22
that the research studies the impact of early and late palliative care on the health of cancer
patients.
Data Collection Procedures
The data-collection tool will be TELEform whereby the assessment will be
carried out in six months. Data sources like summary notes and emails will be collected
through discussions and meetings with the caregivers, staff, and patients. For resource
utilization and data quality, descriptive statistics will be used. This tool of data collection
is based on optical recognition, and it will be able to respond to the requirements of
contemporary data processing. Additionally, it is helpful in terms of data quality, work
practice and resource utilization.
Data Analysis Plans
This is an essential part of the research because it will give the reader the analysis
to be conducted in examining the research hypotheses. In this part, this author will
address the assumptions within the study and the exact analytic strategy used in the
research. Also, this author will do the analysis of the quantitative data so as to reach into
a concrete conclusion. The analysis will include finding the mean, mode as well as
deviations.
Ethical Issues
Discuss here.
Limitations of Proposed Study
Discuss here.
Implications for Practice
Discuss here.
RESEARCH PROJECT PROPOSAL
23
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: 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
Maslow, A. H. (1950). Self-actualizing people: a study of psychological health.
RESEARCH PROJECT PROPOSAL
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Personality.
Mohanti, B. (2011). Research focus in palliative care. Indian Journal of Palliative Care,
17(4), 8. http://dx.doi.org/10.4103/0973-1075.76231
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.
Spruyt, O. (2016). Qualitative research in palliative care. Indian Journal of Palliative
Care, 22(4), 367. http://dx.doi.org/10.4103/0973-1075.191739
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/
RESEARCH PROJECT PROPOSAL
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Appendices
Running head: RESEARCH PROJECT PROPOSAL
Research Project Proposal
Janferp
South University Online
Professor: Marcia Kessack
July 2, 2017
1
RESEARCH PROJECT PROPOSAL
2
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, regarding 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 disease. They would suffer fewer symptoms, and thus, live comfortably and
higher-quality lives. Indeed, it would even be possible to change the trajectory of their
RESEARCH PROJECT PROPOSAL
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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
RESEARCH PROJECT PROPOSAL
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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. The purpose of this study is to demonstrate
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
RESEARCH PROJECT PROPOSAL
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palliative care education, support, and reflection among rural nurses and other staff:
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
RESEARCH PROJECT PROPOSAL
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achieved through the inclusion of aspects such as informatics, education, further training
and interactions with other professionals.
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 researcher interviewed nurses alone as opposed to the wide
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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?
RESEARCH PROJECT PROPOSAL
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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
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 null hypothesis is that in patients diagnosed with chronic or life-limiting
disease early palliative care education by a nurse will not 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.
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
The theory of self-actualization provided the theoretical foundation of this
research proposal. Abraham Maslow created this theory from his broad theory of the
hierarchy of needs. According to him, self-actualized individuals are the ones who are
psychologically healthy and are therefore at a higher level of the hierarchy of needs.
Also, he contends the notion that self-actualizing people are creative and highly
RESEARCH PROJECT PROPOSAL
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demonstrate an ability to resolve contradictions characterized by ultimate contraries such
as life and death. Under self-actualization theory, Maslow he argues that an individual
does not need to transcend the self-actualization needs in a linear, direct and subsequent
stage. He postulates that creative individuals are capable of being self-actualized, free
from their mental health or the lack of it. Maslow describes self-actualization as the
ability surpass the levels of physiological, social and psychological needs and obtaining
personal needs fulfillment regarding the meaning of life (Maslow, 1950).
Self-actualization is said to occur when an individual can exploit his or her
advantages and as well be aware of the limitations. According to Maslow, selfactualization the desire that drives people to realize their full potential and also realize
their biggest limitations or disadvantages and be able to live with them comfortably. A
self-actualized person has reached human existence's apex not physical achievements but
psychological well-being. Self-actualized people display a strong sense of fulfillment
irrespective of their physiological condition or physical health. Abraham Maslow,
therefore, identified some characteristics of self-actualized individuals. They include selfacceptance and acceptance of others, find humor in their mistakes, have a perception of
reality for themselves and others, have a sense of purpose, experience regular moments of
profound joy and happiness, (peak experiences), show compassion and empathy for
themselves and others as well as appreciating the goodness of life.
Self-actualization in person-centered therapy is associated with human potential,
defines human nature and motivates human behavior. Person-centered therapy involves
choosing the direction of motivating a person and individuals who have a negative
attitude about themselves or who are facing difficulties to come to terms with reality are
RESEARCH PROJECT PROPOSAL
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assisted to become self-actualized. Self-actualization focuses on individual strengths as
opposed to failings.
Application of Theory to Study Focus
In this project proposal self-actualization will be used to support the research from
the perspective that palliative care education, when offered to chronically ill or diagnosed
patients assists them and their relatives to become self-actualized about their situation
hence play a critical role in determining the quality of patient management and reduction
of symptoms as well as improved their satisfaction. Self-actualization in this research is
directly related to patient satisfaction through palliative care, and the lack of palliative
care is related to a lack of self-actualization. About this research and self-actualization
death is part of living and both death and life provide opportunities for self-actualization
and personal growth. From the characteristics of self-actualized individuals, the project
will identify palliative care as key in instilling these characters or qualities in chronically
ill patients which improve their psychological and physiological condition. This study
will also anticipate that palliative care education provides person-centered therapy to
patients and focuses on identifying their strengths rather than weaknesses which improve
the patients' physical and psychological well-being.
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,
RESEARCH PROJECT PROPOSAL
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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.
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
RESEARCH PROJECT PROPOSAL
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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.
Extraneous Variables
In a study, extraneous variables are factors that confound the capability of a
researcher to demonstrate causation. There are two kinds of extraneous variable; external
variables and intrinsic variables that included age, gender, and diagnosis. On the other
hand, external factors arise from the research itself. In this research proposal, the
researcher has managed to handle all the intrinsic variables because all the participants
will be of any religion, race or ethnic background along with the level of education. The
educational barrier will not hinder the feedback from the participants as it will be based
on observation.
RESEARCH PROJECT PROPOSAL
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Extraneous variables arise from the research itself, and in this research, they are
selection bias and confounding that contribute to overestimate and underestimate of the
real influence of the treatment (Spruyt, 2016). Selection bias is problematic in this
observation research of intervention because of the characteristics of the clinicians,
patients, system, and the context as it will affect the choice of who receives the treatment.
Another kind of selection bias is the healthier volunteer bias that happens when some of
the participants are generally healthier than others. Selection bias results into
confounding that occurs when the independent variable (presentation of early or late
palliative care education that will determine the enhanced life of the patient), and
dependent variable (the patient’s health) predisposes selections into the treatment that
correlate with outcome.
The correlation of these variables with the outcome and the treatment will result
in type 1 errors whereby the outcomes of the treatment will be falsely accredited to the
intervention rather than the confounding treatment. Alternatively, confounding can also
lead to type II error whereby the research will falsely conclude that there are no treatment
effects. For instance, patients in palliative care services are likely to have high comorbid
conditions and organ systems needing treatment. This group is likely to receive early
treatment for cancer conditions unless they are contrasted to other patients who received
early palliative care. Therefore, without accounting for the baseline symptoms and
severity of the condition, then early palliative care could be the source of discomforts.
Before the execution of the research, the Evidence-based Practices Model states
that modifications to the contemporary palliative care practices should be piloted. With
early interventions in palliative and palliative care education there, instrumental variables
RESEARCH PROJECT PROPOSAL
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approach will be used to control extraneous variables (Spruyt, 2016). The researcher will
use instrumental variables that will have to meet two conditions. The first condition is
that the variables should be relevant while the second requirement is that they should not
be able to influence the outcome directly on through the effect of the treatment. In this
palliative care research, this will mean that the researcher will be looking for variables
that will predict the choice of the patients in the setting but do not impact the succeeding
outcomes, apart from the onset palliative care versus late palliative care.
Description of the Intervention
PQLI (Palliative Care Quality of Life Instrument) is a type of instrument used to
evaluate the psychometric characteristics of the value of life instrument on terminally ill
patients getting palliative care (Spruyt, 2016). It was viewed to be succinct, quantitative
and simply applicable; more so, it is designed for use by users in palliative care
themselves and based on the current literature. The instrument has items that regarded to
be important to what is perceived as end-of-life care. During the research, as evidenced
from the qualitative evaluation on the description of the patients on the QoL, there is a
necessity to partake in the intervention process because this will provide them with sense
of control over their severe condition. Normally, patients require recognition in the
palliative care and involvement in the intervention choices incorporates the psychosocial
results that they might possess in their lives. When assessing the quality of life in
critically sick cancer patients, the treatment choice is the palliative one, and hence we
regard the significance of the addition of a new measurement when assessing the quality
of life. Lack of a questionnaire in the end-of-life setting and the availability of the unique
needs of the patients was the driving force for such a measurement to be used.
RESEARCH PROJECT PROPOSAL
21
Test-retest reliability of the participants (N= No. of patients) will be assessed by
relating the tallies documented on two occasions, an average of one week apart
(Spearman rho test). The clinical phase of the patients did no vary between the first and
second completion. Additionally, the state of the patients was steady between the
examination and re-examination. Because of its hierarchical condition, interest reliability
of the rank reports (Selection of Intervention) was determined by applying the Kendall’sW test (Mohanti, 2011).
Two indirect methods will be applied in the evaluating the validity. By assessing
the statistical variance of the questionnaire prior and during the intervention in terms of
Wilcoxon rank test amid the scale of similar subjects. The second method was the
Exploratory factor analysis (Mohanti, 2011). The fundamental principle with direct
oblivion rotation was applied to evaluate the validity of the PQLI.
The purpose of intervention in this research proposal is to bring a change into the
feeling, behaviors, and thoughts of the participants. In this palliative and end-of-life care,
complex intervention will be used (Mohanti, 2011). This is because mixed method
approaches work well within the multiphase model of the intervention evaluation and
development. However, the guidance of generic mixed method will be helpful, but it
presents challenges in the quantitative quasi-experimental design and its use in the endof-life-care have an influence on the application of the mixed methods. A one-day
workshop will be carried out where the nurses in the palliative care hospital participated
in the facilitated groups. After getting the consent of the patients to carry out the research,
instructions will be given on the intervention day and they will be selected based on
program adherence and other physiological factors. The intervention group will ensure
RESEARCH PROJECT PROPOSAL
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that the research studies the impact of early and late palliative care on the health of cancer
patients.
Data Collection Procedures
Data Analysis Plans
Ethical Issues
Discuss here.
Limitations of Proposed Study
Discuss here.
Implications for Practice
Discuss here.
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: 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].
RESEARCH PROJECT PROPOSAL
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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
Maslow, A. H. (1950). Self-actualizing people: a study of psychological health.
Personality.
Mohanti, B. (2011). Research focus in palliative care. Indian Journal of Palliative Care,
17(4), 8. http://dx.doi.org/10.4103/0973-1075.76231
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.
Spruyt, O. (2016). Qualitative research in palliative care. Indian Journal of Palliative
Care, 22(4), 367. http://dx.doi.org/10.4103/0973-1075.191739
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/
RESEARCH PROJECT PROPOSAL
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RESEARCH PROJECT PROPOSAL
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Appendices
Running head: RESEARCH PROJECT PROPOSAL
Research Project Proposal
Janferp
South University Online
Professor: Marcia Kessack
July 2, 2017
1
RESEARCH PROJECT PROPOSAL
2
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, regarding 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 disease. They would suffer fewer symptoms, and thus, live comfortably and
higher-quality lives. Indeed, it would even be possible to change the trajectory of their
RESEARCH PROJECT PROPOSAL
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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
RESEARCH PROJECT PROPOSAL
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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. The purpose of this study is to demonstrate
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
RESEARCH PROJECT PROPOSAL
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palliative care education, support, and reflection among rural nurses and other staff:
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
RESEARCH PROJECT PROPOSAL
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achieved through the inclusion of aspects such as informatics, education, further training
and interactions with other professionals.
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 researcher interviewed nurses alone as opposed to the wide
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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
RESEARCH PROJECT PROPOSAL
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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
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 response...
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