Wagner, E. H., Ludman, E. J., Aiello Bowles, E. J., Peinfold, R., Reid, R., Rutter, C., & Chubak, J. (2013, November 25). Nurse Navigators in Early Cancer Care: A Randomized, Controlled Trial. Retrieved from http://jco.ascopubs.org/content/early/2013/11/25/JCO.2013.51.7359.full.pdf+html
PICO question
In patients who have been diagnosed with breast, colorectal and lung cancer, are nurse navigator interventions more effective than the routine/normal care in improving quality of life and patient experience?
Part 1
The results are valid based on the fact that concept of bias was eliminated in the study process by selecting patients who were actually diagnosed with the three types of cancers thus upholding the credibility of the research. Secondly, by the sample size being large (n=251) serves as the basis of preventing bias in the results (Barry et al., 2012). The time frame used in conducting the study also upholds the validity of the study since there may have been variations along the way. The process of data analysis was also vital in determining the validity of the results. Applying the FACT-G quality of life scale and the PACIC scales provided results which showed the relationship between the two interventions (Wagner et al., 2013).
The results of the test are valid basing on the fact that the participants in the study were selected using a randomized technique whereby the primary care physicians formed the basis of randomization. As such, the results could not be easily manipulated (Wagner et al., 2013). Additionally, the possibilities of bias arising are also minimal.
There was no concealment of random assignment on the individuals who were tasked with recruiting the participants into the study since the primary care physician who were supposed to participate in the process were required to provide beneficial information to the individuals who were carrying out the study.
Both the participants and the providers in this test were not blind in the study due since, first; there was the need to have consent from these two groups to achieve the objectives of the study and secondly, to make it easy for the providers to communicate with persons carrying out the study (Wagner et al., 2013). It was also important to make the objectives of the study known to them to reduce any possibilities of recruiting ineligible participants in the study.
Some participants in the study were not able to complete the study due to the depressive symptoms that some of them showed. This fact was the likely reason why these participants could not survive past 12 months which was the period of the study. Some of them could not complete the study because of their high social economic status. Attrition is a probable cause of bias in the study since by the number of participants reducing, the sample will end up not being diverse therefore affecting the reliability of the results (O’Brien et al., 2012). An Attrition analysis is an important factor in determining the number of persons who have left the study and their reasons for that. It is important to reduce the reasons for departure to prevent cases of compromised reliability in the test results.
The study was carried out with the first four months acting as the baseline of the study. The remaining part was done upto the 12th week for a comprehensive report about the progress of the study. The follow up assessment after the baseline period was done to analyze how effective the nurse navigator interventions were in improving the quality of life and patient experience of the participants (Wagner et al., 2013). These follow up studies were done using differences in scores between the secondary analysis results.
The analysis of data was done between the two groups by focusing on the effect that the analysis programs could have on the results. The application of linear regression to determine the mean overall FACT-G and PACIC scores acted as a basis of determining the differences between the outcomes on normal care and nurse navigator interventions.
The control group was appropriate since it served the purpose of showing the differences between patients in the intervention group and those ones who were not under any interventions. From the analysis, the control group was more likely to show complications for not receiving nurse navigator interventions compared to the intervention groups (Wagner et al., 2013). For instance, the control patients were likely to have surgeries way earlier than their intervention counterparts.
Since the number of patients that each provider had was small, there was the need to make use of intent-to-treat analysis which resulted in outcomes that showed the p-value being two sided and less than 0.05. This p-value shows that the results from the statistical analysis were statistically significant which eventually translates to the outcomes of the study being reliable and valid.
Part 2
At a 5% significance level and 95% confidence level, the interventions from the study indicate that the participants in the intervention group show negligible effects in terms of the diagnostic days, first physicians visit and the start of the treatment. This results compared to the control group indicate a difference of 6 days compared to the control group.
The precision in the interventions comes in the sense that the costs incurred in the treatment of the cancers reduce in comparison with the control group (Wagner et al., 2013). For instance, the costs incurred in treating patients with lung cancer dropped by 6,852 dollars compared to those ones in the control group.
Part 3
These results are important in the treatment of patients since it is evident that applying nursing navigator interventions is an important factor in ensuring that patients come out with better outcomes and improved qualities of life compared to other patients who are not treated in this manner. The application of the FACT-G and PACIC assisted in the measurement of all clinical outcomes of improved patient life quality (Wagner et al., 2013). The benefit of this treatment regime is that it is crucial in addressing any possible barriers that patients with financial challenges have in addressing the problem of accessing cancer care. There are no risks involved with this treatment regimen. This treatment regime is feasible in my care setting since there are primary care physicians and nurses who can be trained to provide the care (Wagner et al., 2013). This care regimen respects the ethical stands and the values that my patients hold since one is required to give their consent first before this treatment regimen is provided to them. As such, my patients are likely to be appreciative of this type of care and the outcomes associated with it.
References
Barry, A. E., Chaney, B., Piazza-Gardner, A. K., & Chavarria, E. A. (2014). Validity and Reliability Reporting Practices in the Field of Health Education and Behavior A Review of Seven Journals. Health Education & Behavior,41(1), 12-18.
O’Brien, R. A., Moritz, P., Luckey, D. W., McClatchey, M. W., Ingoldsby, E. M., & Olds, D. L. (2012). Mixed methods analysis of participant attrition in the nurse-family partnership. Prevention Science, 13(3), 219-228.
