Evidence-based nursing research and practice

Johnasson, C.; Axelsson, B. & Danielson, E. "Living with incurable cancer at the end of lie -- patient's perceptions on quality of life." Cancer nursing, 29(5), pp. 391-399.

Facing the end of one's life is never an easy task. It is often assumed that in the instance of terminal illnesses such as certain cancer cases, this process would be made even more difficult by the prolonged reduction in quality of life resulting from both the symptoms and/or the care needed to mange symptoms. This view, however, is challenged by evidence that improvements in symptom management of terminally ill patients has led to a shift in perception of end of life care. Perhaps more importantly, a more comprehensive understanding of the factors that contribute to quality of life has led to a reassessment in the methods of measuring this essential aspect of patient care. The study examined addresses both this overall reassessment of the quality of life in terminal situations, and specific methods of providing proper and quality-improving end-of-life care to terminally ill cancer patients.

Specifically, five terminal cancer patients in the final stages of their diseases participated in repeated focus groups, and through their discussions certain themes nd other patterns were developed. Assessing what factors to measure in making a quality of life determination and obtaining accurate measurements of these factors has always been a somewhat difficult and subjective process, and this study, rather than attempting to quantify this subjectivity, instead exploits and expands upon it in order to come to a more accurate and individualistic approach at improving the quality of life during end-of-life care for cancer patients.

Descriptive Vividness

Description of the participants was incredibly detailed, referencing all medically relevant information, including general demographic data and medical information specific to each patient's case, such as that "most had lived with metastasis since several months and lived only for a short time after the last interview...cancer is defined as incurable from the day metastasis is confirmed" (Johnasson et al. 2006). Factors such as age, type of cancer, education, and many other factors that generally are used to establish psychological condition and adjustment were also collected and presented. The description of the actual process used and the initial results of the open-ended focus groups was equally detailed, including procedures used to put the participants at ease. The analysis was somewhat more general, but given the aim of collecting "as profuse information as possible" this is to be expected (Johansson et al. 2006).

Methodological Congruence

As mentioned briefly above, the methodological congruence was also quite high given the rigor of the procedure and documentation of the participants and their responses during the focus groups. With patients given full choice of what to talk about -- and not talk about -- appropriate ethical considerations were also in place. Auditability is the only area of congruence that is somewhat in question, given the extreme subjectivity of qualitative responses delivered by five individual patients with their own life stories and medical histories.

Analytical and Interpretative Preciseness

The small number of participants and open-endedness of the focus groups also led to a degree of imprecision in the analysis and interpretation of the study's results, but this was expected and even sought to a degree by the researchers (Johansson et al. 2006). One of the primary findings of the study was "that the patients used individual strategies to relive pain by emotional and physical distractions," and this is only a base indicator of the individualism expressed by the five participants (Johansson et al. 2006). On the other hand, there was enough agreement among the participants for the researchers to determine five distinct themes around which the discussion in the focus groups revolved, providing perhaps more prescision in the results than hoped for.

Philosophical and Theoretical Connectedness

Throughout this research article, the theoretical and philosophical connections of the study to the larger practice of medicine is made abundantly clear. The question is essentially a philosophical one, attempting to determine the outlook and perspective of near-end-of-life patients. Certain beliefs regarding pain management were reassessed, as was the previously documented search for ordinariness in life in chronically ill women: "our study shows the opposite; that is, the patient did not have to struggle to live as usual" (Johansson et al. 2006). The attitudes of the participants and the various sources they cited for helping to improve their quality of life in this period suggest a reevaluation of patient's general attitudes towards death and dying.

Heuristic Relevance