Yoong et al., (2013) in their qualitative article ‘Early palliative care in advanced lung cancer: a qualitative study’ focus on determining the importance and role of early ambulatory palliative care interventions for patients who have been diagnosed with lung cancer. The authors argue that over the last one decade, palliative care has grown in significance and utilization especially for patients with advanced forms of illness as well as their caregivers. This is within the context that palliative care has continually been associated with improved management and control of symptoms, improved quality of life and better moods, effective utilization of available health resources, reduced healthcare costs, patient satisfaction, and caregiver satisfaction as well as increased chances of survival for the patient (Greer et al., 2012).
Apparently, many centers that offer cancer management incorporate some elements of palliative care that essentially include acute inpatient care services and inpatient care consultative services. However, there is a lacking element of outpatient palliative care services within the same fold. This implies that even within the knowledge that early palliative care can afford patients and families better responses in the management of their illnesses, the lacking frameworks to facilitate the early palliative care within ambulatory settings has been lacking across most of these cancer management units (Greer, Jackson, Meier & Temel, 2013). The integration of palliative care frameworks within these care settings has positive influence on the patient’s and family’s understanding of the illness and its prognosis and therefore aiding the timely transition towards hospice care. Similarly, it helps reduce the need for utilization of chemotherapy towards the end of life as patient gradually gather knowledge and innate skill to manage their illness through more appropriate and less demanding non-pharmaco-therapeutic approaches (Yoong et al., 2013).
The researchers thus has three major objectives in their study; on one hand to establish the core elements that define early palliative care visits, establish and determine how these elements scan be afforded timely and thirdly to make a comparative analysis of the palliative care content and the related oncologic documentation at each critical point of time within the line of disease progression and clinical deterioration. In this case, the ideal situation for the researchers was to level out the role of palliative care against, and with, that of the oncologic visits (Tappen, 2011).
Therefore, the researchers intended that at the end of their study, they would be in a good position to determine whether incorporating palliative care within ambulatory settings would help improve the patient/family management of the illness and subsequently the quality of life of the patient. With this information, the researchers were of the intention that the results would then guide clinical practice decisions so that they can adopt the use of palliative care within ambulatory settings (Melnyk & Fineout-Overholt, 2015). The decision would then be made based on these results as to the effect that palliative care should not just be restricted to hospice care when the illness has progressed to a state and where the patient’s cognitive capabilities have been significantly reduced and self-care is at a state of decline.
The researchers, basing their arguments on the results of the randomized trial designed for this study are of the view that early palliative care visits help bridge the gap that oncologic visits fail to cover. This is essentially in respect to the fact that palliative care has its emphasis on the management of symptoms, coping strategies and cultivating a sense of prognostic awareness and illness understanding in a timely and responsive manner (Yoong et al., 2013). Oncologic visits on the other have their primary focus on the treatment of cancer as well as management of the related medical complications.
This information then leads to the PICOT question ‘For cancer patients in their early days of diagnosis (P), does the integration of palliative care within the oncologic visits (I) as compared to standard oncologic visits procedures (C) strengthen the coping ability and illnesses understanding of the patient and their caregivers (O)? (Charmaz & McMullen, 2011)
References
Charmaz, K., & McMullen, L. M. (2011). Five ways of doing qualitative analysis: Phenomenological psychology, grounded theory, discourse analysis, narrative research, and intuitive inquiry. Guilford Press.
Greer, J. A., Jackson, V. A., Meier, D. E., & 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), 349-363.
Greer, J. A., Pirl, W. F., Jackson, V. A., Muzikansky, A., Lennes, I. T., Heist, R. S., & Temel, J. S. (2012). Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non–small-cell lung cancer. Journal of Clinical Oncology, 30(4), 394-400.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Tappen, R. M. (2011). Advanced nursing research: From theory to practice. Sudbury, MA: Jones & Bartlett Learning.
Yoong, J., Park, E. R., Greer, J. A., Jackson, V. A., Gallagher, E. R., Pirl, W. F., & Temel, J. S. (2013). Early palliative care in advanced lung cancer: a qualitative study. JAMA internal medicine, 173(4), 283-290.
