Nursing Interventions on Cancer Patients?

Critical Appraisal is a means of which research data is evaluated and examined for the validity and quality of individual studies after the elimination of studies that do not contribute to determining current best evidence (Hamric, Hanson, Tracy, & O’Grady, 2014). This evaluation can be used to eliminate studies that do not meet criteria for meta-analysis. Critical Appraisal is used to help people develop certain skills to make sense of available scientific research evidence based on the validity, results, and relevance.

It consist of a systematic process through which the strengths and weaknesses of a research study can be identified (Young ; Solomon, 2009). The basis for my beginning research has been focused around home care patients and since I have a background of working on an oncology floor I have decided to further explore cancer research for homecare patients. This paper is a review of both quantitative and qualitative research completed in the efficacy of treating cancer patients in the home setting. The burning question is “Do nursing interventions implemented in the home setting improve the quality of life for cancer patients”?

Upon completion of this assignment I hope to gain a general understanding of what a critical appraisal is. In addition, a basic knowledge of the difference between a qualitative and a quantitative review will be established. Cancer is a disease caused by the uncontrolled division and growth of abnormal cells in the body. If a cell is cancerous it is referred to as a malignant cell. According to World Health Organization (WHO) Cancer represents 30% of the burden posed by non-communicable diseases in the Region of the Americas (Luciana, Cabanes, Prieto-Lara, ; Gawryszewski, 2013).

Research articles presented in the paper assess whether or not interventions implemented within the home or outpatient setting have a positive or negative impact on physical endurance and the quality of life of a cancer patient. Loss of physical function is one of the most distressing symptoms of cancer patients’ leading to additional emotional and psychological breakdown (Lowe, Watanabe, Baracos, ; Courneya, 2013). Purpose The purpose of this paper is to take levels of evidence in a meta-synthesis (qualitative) review as well as a meta-analysis (quantitative) review and critically evaluate the information.

The findings for these methods are taken from multiple studies, combined, and analyzed statistically. A meta-synthesis involves integrating qualitative research findings on a specific topic that are themselves interpretive syntheses of narrative information (Polit ; Beck, 2012). Qualitative designs are used best to understand patients’ experiences, attitudes, and beliefs (DiCenso, Guyatt, ; Ciliska, 2005). Meta-analysis is a method of integrating quantitative findings statistically (Polit ; Beck, 2012). Three questions in particular are asked when a quantitative or qualitative study is appraised, they generally are: What are the results?

Are the results of the study valid? How can the results be applied in the identified case? Critical Appraisal: Quantitative Study Quantitative studies are used for evaluating the effectiveness and safety of nursing interventions, the accuracy and precision of nursing assessment measures or diagnostic tests, the strength of causal relationships, and the cost-effectiveness of nursing interventions (DiCenso, Guyatt, ; Ciliska, 2005). The selected quantitative article for critical appraisal is titled “Home-based functional walking program for advanced cancer patients receiving palliative care: a case series”.

This article presented a clearly focused research question related to evaluating how physical activity interventions implemented in the home or outpatient setting impact a cancer patients’ quality of life. The purpose of this study was to examine the initial development and pilot testing of a physical activity intervention in patients with advanced stage cancer receiving palliative care (Lowe, Watanabe, Baracos, ; Courneya, 2013). Researchers wanted to see if a home based walking program would help to decrease the rates of declining physical function in advanced stage cancer patients or add to the quality of life for these patients.

Methods and Results This research study was conducted using qualifying participants in an outpatient or homecare setting receiving palliative care. This was a trial study in which participants were not randomized. Participants meeting study criteria were identified by researchers and consent to participate in the study was obtained by all participants before trial monitoring began. Inclusion criteria required subjects to be age 18 years or older, english speaking, have the cognitive ability to participate, and to have a diagnosis of progressive, incurable and locally recurrent or metastatic cancer and receiving palliative care.

Nine adult cancer patients were chosen for this study all residing either in a palliative home care environment. By the time baseline information was taken three participants dropped out of the program due to hospitalization or feeling overwhelmed, another three left the study due to severe symptoms leaving three remaining participants to complete the program. The sample consisted of two men and one woman with the median age of 55. This physical activity program was monitored over the course of six weeks.

A quasi-experimental pilot study design was used to provide preliminary data of the six week physical activity program among advanced stage cancer patients. The quasi-experimental design can be descriptive or correlational and takes place when the researcher actively manipulates the independent variable to see the effect on the dependent variable (Zaccagnini ; White, 2011). The interventions used was a modified home based functional walking program combined with muscle strengthening excercises. Duration and intensity was individually set for each participant based on baseline results of a physical function test.

Previous surveys of patients with advanced stage cancer presented findings with a median survival of 104 days. Findings of this quantitative study revealed that post intervention scores showed that all three participants showed worsening symptoms and fatigue scores by the end of the six week home-based walking program. Two of the three participants passed away within 90 days of completing the program. Although study results demonstrated challenges associated with physical activity interventions in advanced stage cancer patients, no definitive proof was uncovered showing improvement in the quality of life for advanced stage cancer patients.

Critical Appraisal: Qualitative Study Quanlitative study designs are well-suited for helping to understand the illness experience (DiCenso, Guyatt, ; Ciliska, 2005). The selected qualitative study article for critical appraisal was titled “Early support visits by district nurses to cancer patients at home: A multi-perspective qualitative study”, posed a clearly focused research question. Multi-perspective study can be defined as combining multiple viewpoints, representations and roles. Many palliative care patients spend most of their final days at home with caregivers and some support healthcare staff.

It is said that nurses make frequent support visits to patients, yet there is still very little known about what is actually provided by visiting nurses to homecare palliative patients and their caregivers. The purpose of this qualitative study was to address limitations of previous studies of reported practice by taking a multi-perspective approach, along with views of nurses, patients, and caregivers and directly observing and reporting findings (Griffiths, Ewing, ; Rogers, 2012). Participants were studied in focus groups.

This study was developed to help present findings that explored how district nurses early support visits to advanced stage cancer patients is both described and carried out. Previous studies identified have been limited to the reports of practice by nurses. With this study researchers were able to observe interactions between nurse, patient, and caregivers during home visits in order to record findings. This observation by researchers was then used to identify how home visits were conducted and what they entailed. Methods and Results

This research study was completed using a focus group design method. The study sample included a total of 77 participants, 10 palliative care patients (seven women, three men), nine caregivers (five spouses, four daughters), and 58 nurses. Of these 58 nurses 28 were leaders and 30 were staff nurses. The age range of the 10 patients was 53-85 with a median age of 72. All of the patients had a diagnosis of various advanced staged cancer. Data was collected by experienced qualitative researchers that worked as community nurses.

The setting for this study took place in the North West (urban), and South East (rural) regions of England. Prior to data collection ethical approval was granted and participants provided written consent. Each focus group session lasted from 60-90 minutes. Researchers began recruitment by making observations of visits, with each patient receiving two observation visits. Patients and caregivers were interviewed both before and after observations in order to retrieve needed background information for research. Upon collection and analysis of data audio recordings were used during home visits.

Findings revealed that the nurses that participated in this study showed great value for palliative care. There were four types of visits described: assessment of physical care needs, assessment and delivery of practical help, and two cross cuttig themes of information giving and enabling talk. Detailed observations of these visits with interviews were presented from the nurses in the assessment of physical care needs and while nurses reported carrying out early support visits there was difficulty in articulating the content covered in these visist.

In the assessment and delivery of practical help it was noted by nurses that physical needs dominated visits but this was mostly a review of what patients needed as far as equipment, etc. Research findings show that this particular study can be applied to patient care by educating support staff that early support visits could potentially play a part in reducing costly hospital admissions. Patients also reported a decrease in stress levels with support from visiting nurses. Overall this multi-perspective approach provided new insights about support visits by district nurses.

Conclusion Qualitative and quantitative research methods make different contributions to knowledge (DiCenso, Guyatt, ; Ciliska, 2005). Critical appraisal is an essential part of evidenced-based research and its methods help to form a portion of the systematic review process. It is the analysis of findings that allows the reader to form an opinion about the validity and reliability that such research can be used in patient practice. This process enables the reader to assess the study’s usefulness and whether or not the findings are trustworthy (Young ; Solomon, 2009).

Teamwork is an essential part to providing palliative home care and nurse play a vital role (Griffiths, Ewing, ; Rogers, 2012). Although earlier studies have found that physical activity interventions in early stage cancer patients present positive results, that has not been confirmed in patients with advanced stage cancer and further research will be required. Overall I found that the results presented in the quantitative study were not valid due to lack of identifiable evidence shown.

While reviewing the qualitative study I found that the sample size was not large enough to provide a definitive answer as to whether this study provided valid results. When referring to the burning question I think that it has been shown that to a certain point nursing interventions implemented in the home such as adding physical activity and nursing support visits to cancer patients’ agenda can positively affect the patient’s quality of life. When searching for effective interventions researchers must always remember to incorporate patient preferences in their studies because this will help to enhance both recruitment and adherence.