NUST08011 Nursing Care And Decision Making

Summary:

Chemotherapy is often the choice of treatment for the cancer patients with higher severity scale, however the consequences of the chemotherapy has to be taken into account whole discussing the impact on their overall health and wellbeing. This research study by the Wright et al., (2014), emphasizes on the effect of chemotherapy to the terminally ailing cancer patients and as attempted to compare the standards of subsequent medical care experience received by the terminally ill cancer patients in the advanced stages of cancer. The design of the study has been secondary analysis incorporating prospectus multi-institutional and longitudinal study of the cancer patients who were going through advanced stages of the disease. The setting incorporated for the study had been 8 outpatient oncology clinics within the context of United States. The sample population selected for the study included 386 adult cancer patients at least one chemotherapy regimen, the sampling had been done on the basis of selecting patients who are terminally ill or will subsequently die in the near future. The primary outcome of the study had been to discover the intensive medical care that the advanced cancer patients receive in the very last weeks or months of their life (Wright et al., 2014). Along with that the primary focus of the study had also been on the place of death for the cancer patients are receiving chemotherapy for example if it is in the palliative unit or Intensive Care Unit. The secondary outcome of the study included discovery of survival rate, late hospital referrals and whether the patients died in the preferred place of the patient.

Strengths of the study: 

While discussing the strength of this research paper it has to be mentioned that the outcome measurement for the study had been very usefully subdivided into two different sections, for example the primary outcome only emphasized on the palliative treatment and location of death for the patients and whether they both have been in accordance to the preference of the patient. The secondary outcome however concentrated on the three separate variables, survival, late hospice referrals and attainment of patient preferences regarding the place of death. Hence, it can be stated that the research article had been incorporated all details regarding the care and experience received by a cancer patient in their end of life phase (Hui et al., 2014).

Another considerable strength of the study is the fact that this research article had collected extensive data after almost a decade of the previously published literature conducted on a similar context. This research study has been able to feel the gaps left behind by the previous literature on the relation of emergency department visits by cancer patients and the treatment they received by incorporating the chemotherapy received depending on the advancement stage of the cancer. This research study has very successfully differentiated between the dying patients and patients that are terminally ill but yet have 6 or months of time. The data on performance status, physical functioning, quality of life, and many other psychosocial factors of the cancer patients in the end of life phase will be helpful in designing palliative care plans that will have the minimal chances of further complication arising for such patients and ensuring most comfortable and desired experiences received in the last few weeks of life (Guldin et al., 2012). this research study is more representative of the dying patients in contrast to the earlier studies where no discretion have been undertaken to differentiate the stages of cancer of the patient depending on the time left; hence it can be hoped this study will be fertile ground for further research that will help in designing evidence based care plans suitable for different terminally ill cancer patients in different stage of severity.

Limitation: 

However, there are a few limitations of this study; and the most important one is the fact that research study failed to attain any information regarding the nature of the patient decisions after enrolments or the timeframe of those decisions being made, which considerably minimized the extensive detail being considered in the study (Wright et al., 2014). Another highly significant limitation of this study is the fact that authors failed to collect information regarding the baseline preferences of the study subjects regarding the time or preferences of hospice or the preferred or desired place of death. According to the most of the studies, the dying patients and their family members or caregivers often prefer short hospice stays and care provided in intensive care units, although authentic information about the preferences of the patents who had been involved in this study had been neglected in the study. The authors also failed to adjust a number of cofounders that could have potentially altered the results of the study. For instance, factors like disease duration, and pervious chemotherapy experiences have not been associated with the observed confounders linked to the propensity score weightage; which can have a profound effect on mortality of the patients. Lastly, the sampling of the study had been very narrow incorporating only the patients who had died during the completion of the study, hence, the results generated cannot be applied to the scenario of the patients who are terminally ill yet have longer time left for them. Hence, it can be said that study results, despite being very detailed and definite, cannot be generalized into bigger sample populations and settings, hence the transferability or external validity of the study is very limited (Wright et al., 2014).

Nursing implications: 

It has to be understood in this context that the palliative care is a crucial aspect of health care and there are countless policies and protocol employed to guarantee that the best interests of the patents are being safeguarded and the personal desires expressed by the patients are being respected at all terms. However, in such cases, the personal desires and preferences can differ from the care needs or care pattern decided for the patient after enrollment. For instance, for the sample population decided for this research paper included the cancer patients receiving chemotherapy in the ending phase of their life and the data collected discovered that the adverse consequences of this therapy in the palliative stage results into further complications like cardiopulmonary disorders and speeds up the process of death for the patients (Greer et al., 2013). Hence, this research study has discovered information that questions the efficacy of chemotherapy in the very last weeks of life and whether is promotes attainment of patient goals. Hence, it can be hoped that based on the findings of the study the palliative oncology nursing staff can device better policies and protocols that will help in attainment of better patient goals (Alonso-Babarro et al., 2013).

References: 

Alonso-Babarro, A., Astray-Mochales, J., Domínguez-Berjón, F., Gènova-Maleras, R., Bruera, E., Díaz-Mayordomo, A. and Centeno Cortes, C., 2013. The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients. Palliative medicine, 27(1), pp.68-75.

Greer, J.A., Jackson, V.A., Meier, D.E. and Temel, J.S., 2013. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: a cancer journal for clinicians, 63(5), pp.349-363.

Guldin, M.B., Vedsted, P., Zachariae, R., Olesen, F. and Jensen, A.B., 2012. Complicated grief and need for professional support in family caregivers of cancer patients in palliative care: a longitudinal cohort study. Supportive care in cancer, 20(8), pp.1679-1685.

Hui, D., Kim, S.H., Roquemore, J., Dev, R., Chisholm, G. and Bruera, E., 2014. Impact of timing and setting of palliative care referral on quality of end?of?life care in cancer patients. Cancer, 120(11), pp.1743-1749.

Smith, T.J., Temin, S., Alesi, E.R., Abernethy, A.P., Balboni, T.A., Basch, E.M., Ferrell, B.R., Loscalzo, M., Meier, D.E., Paice, J.A. and Peppercorn, J.M., 2012. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of clinical oncology, 30(8), pp.880-887.

Wiener, L., Weaver, M.S., Bell, C.J. and Sansom-Daly, U.M., 2015. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clinical oncology in adolescents and young adults, 5, p.1.

Wright, A.A., Zhang, B., Keating, N.L., Weeks, J.C. and Prigerson, H.G., 2014. Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ, 348, p.g1219.

Wright, A.A., Zhang, B., Keating, N.L., Weeks, J.C. and Prigerson, H.G., 2014. Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ, 348, p.g1219.