Managing Futility in Oncology Settings  Research Proposal

Excerpt from Research Proposal :

The hypothesis for the proposed study asserts: When over-treatment is implemented for the patient in the oncology setting, then the partnership between the nurse and the doctor may be in peril.
1.3: Study Structure

Chapters following Chapter I, the Introduction, for the proposed study will include:
1. Chapter II: Literature Review
2. Chapter III: Methodology
3. Chapter IV: ResultsAnalysis
4. Chapter V: Discussion, Conclusions & Recommendations

During the forthcoming empirical investigation, the researcher plans to develop the literature review, the second chapter of this study, from a minimum of 25 credible sources.
The third chapter for the proposed study, the methodology will relate the method the researcher utilized to complete the research effort.
Utilizing the methods of
Specific techniques utilized to analyze access to informationdata include Chapter four of the proposed study will present findingsresults the researcher retrieves from the analyses of informationdata secured during the literature review, as well as, data determined from the survey conducted for the proposed study. Chapter five of the forthcoming study will recount the study details, along with revealing the verdict of the proposed study's hypothesis. The researcher will also present conclusions regarding the study components, along with making recommendations for future research efforts. 1.4: Aim and Objectives The researcher's primary aim for the proposed study will be to conduct a thorough literature review, along with conducting a survey to answer the proposed primary and sub-questions and in turn determine the verdict of the hypothesis.
Objective 1
Objective 1 for the proposed study will be to conduct a thorough literature review and compile pertinent information in the proposed study's second chapter.
Objective 2
Objective 2 will be to develop andor obtain a survey relating to this study's focus and subsequently implement this study to participant stakeholders.
Objective 3
Objective 3 will be to interview (in depth) one representative from each group represented in the proposed study, including, but not limited to a nurse; a doctor; an oncology patient; a family member of an oncology patient.
During the next chapter of the proposed study, the Literature Review, the researcher further investigates considerations regarding the doctor and nurse partnership, relating to over-treatment implemented for the patient in the oncology setting, considering whether the partnership between the nurse and the doctor may be in peril. Today, more than a hundred years after the time when McGregor-Robertson noted that the nurse may keep the "fact foremost in her mind that she was only the doctor's instrument, this stated position does not align with the ideal partnership presently prescribed for doctors and nurses now. Individuals are not tools, the researcher asserts, but patients, nurses and doctors who are real live human beings, who need to learn how to best communicate with each other, so that in treatment, they may know how to best partner with each other to ensure the best of care.


Phillips (2008) relates the following real-life scenario, which reflects on concern regarding consideration of the aspect of the medical professional that requires a partnership approach, the relationship between the nurse and the doctor
When faced with mistaken instructions from a physician, many nurses correctly identified refusing the doctor's order as the appropriate action-in theory and according to professional associations and textbooks. Rather than refuse the order, however, many nurses said they would deceive the physician, find another way to work around the conflict, or obey the instructions and hope no harm( Phillips 2008, 6).
Debra Parker-Oliver, PhD, MSW, assistant professor, School of Social Work, University of Missouri, Columbia, Laura R. Bronstein, PhD, ACSW, is associate professor, Division of Social Work, School of Education and Human Development, Binghamton University and Lori Kurzejeski (2005) MSW, is a graduate research assistant, School of Social Work, University of Missouri, assert in the journal article, "Examining Variables Related to Successful Collaboration on the Hospice Team," Hospice was built on the interdisciplinary team model. Cicely Saunders, founder of the modern hospice movement, serves as a role model for interdisciplinary work because she was trained as a social worker, nurse, and physician (Saunders, 1978). In hospice, teamwork is critical to the service and management of the entire person and his or her environment and is essential in providing a "good death" for the hospice patient. Saunders' commitment to dying individuals resulted in a social model of care that advocates a holistic perspective, reflecting social work values and standards at its heart (Torrens, 1985). Management of pain for the dying person requires attention to the physical, spiritual, financial, and psychosocial needs of the patient and his or her family, none of which can be accomplished by only one "kind" of professional (Skobel, Cullom, & Showalter, 1997). Social work is a vital component of hospice care, formalized in the Medicare Conditions of Participation as a core service requirement (Health Care Financing Administration [HCFA], 1983). (Parker-Oliver, Bronstein & Kurzejeski, 2005, p.1). Leonard Fagin and Antony Garelick (2004) relate considerations for doctors to implement to help improve their relationship with nurses in the journal article, "The doctornurse relationship". The following section includes common sense strategies to complement the doctor and nurse relationship, yet involves the doctor be aware, mirror professional respect, be tactful and sensitive.
? Make sure that your clinical decisions are well understood by others and that you have covered all contingency plans and set review dates
? When giving instructions make sure that you address them to the senior nurse, who will delegate to other nurses if necessary
? Do not volunteer nurses to carry out a task without asking them first
? If you pick up early signs of disgruntlement, particularly with any decisions that you have made, don't let things fester, thinking that the problem will go away: be prepared to be criticised and to make changes to your clinical judgements when appropriate
? When delegating, do not presume that nurses are there to carry out menial tasks or that they are less busy than you are: it might take the same time to explain what you want done, as to do it yourself; some tasks, such as finding out information or sending invitations to care programme approach meetings, can be carried out by administrative or clerical staff. (Fagin & Garelick 2004, p. 284).
Nurses, nevertheless, also need to be sensitive to the working relationships they experience with colleagues. The nurse also needs to stay attuned to hisher responsibility to patients and to handle anyall questions with the utmost care (Becker 2009). The article, "Scientific Evidence that Supports Our Work," (2008) reported the that in one recent study, concerned patients expressed problems communicating with their doctors. The article, "When You and Your Family Differ on Treatment Choices," (2007) offers the following suggestions for patients regarding communication about treatment. An initial question the patient should ask the oncologist : "When [does] the treatment decision needs to be made. Often, a decision is not needed immediately, and this can reduce the level of anxiety of everyone involved in reviewing the various options" (When you 2007, p. 3). It is also proves helpful when the nurses and doctors talk openly about the patient's priorities for treatment. The Kenneth B. Schwartz Center, offers a number of suggestions for those involved in care in the oncology setting in the article, "Disagreement about Dying Wishes," (2008) for patients and family members when dealing with cancer. Two of these include:
1. Ongoing education and discussions about advance directive choices should
begin in the outpatient setting, before acute issues arise. All families should beasked to document health care proxy choices.
2. A patient's wishes always outweigh a family member's. Even a designated health care proxy cannot make decisions if a patient is still able to
communicate hisher own desires. (Disagreement about 2008, p. 4)
Questionnaire Sample
Fagin and Garelick (2004) recommend the following questionnaire to help nurture a positive doctornurse relationship.
Multiple choice questions
1. The doctornurse relationship is affected by:
a. status
b. experience
c. working environment
d. patient diagnosis
e. gender.
2. In the doctornurse game, nurses will:
a. challenge the doctor's decisions
b. take control of in-patient care plans
c. suggest changes to care plans
d. start to play it only after being given their

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