¶ … professional fields that confirm, through studies and other means, the effective use of evidence-based practices. The field of education, business, technology, and especially the medical field all, to varying degrees, use the concept of evidence-based practices to improve the manner in which solutions to problems are sought and implemented. It is important that studies are conducted that allow for quantitative and qualitative methodologies to confirm that the practices being touted are acceptable to the audience to which they are presented.
One such study was recently published in a peer-reviewed publication; the objective of the study was to make evidence-based recommendations to medical professionals. The study specifically targeted those physicians, medical professionals, nurses, and administrators that in one form or the other deal with patients diagnosed with cancer, or cancer related diseases. The study wished to affirm and confirm the importance of effective communications between the medical personnel and the patient or the patient's family, friends and colleagues.
The study was published in 2009 in Current Oncology, Vol. 16, Number 6 and was conducted by G. Rodin, C. Zimmermann, C. Mayer, D. Howell, M. Katz, J. Sussmann, J.A. Mackay, and M. Brouwers. The study was titled; Clinician-patient communication: Evidence-based recommendations to guide practice in cancer. An analysis of the study is conducted herein.
Recent literature states that medical professionals "should be more forthcoming to initiate discussions with palliative care patients about prognosis and end-of-life issues" (Slort, Schweitzer, Blankenstein, Abarshi, Riphagen, Echteld, Aaronson, der Horst, Deliens, 2011, p. 613).
The Rodin et al. study presents recommendations that were based on an updated systematic review of the research evidence and a consensus by the Clinician-Patient Communications Working Panel of the Program in Evidence-Based Care of Cancer Care Ontario (p. 42). The study used statistical procedures to confirm the recommendations made by the study.
The statistical procedures used by the study included a "systematic review of the literature" (p. 42) and "a formal external review was conducted to validate the relevance of these recommendations" (p. 42). The systematic review was comprised of searching current literature for evidence-based practices guidelines with "explicit literature selection criteria, systematic reviews, meta-analysis, and randomized trials" (p.43). According to the study, the quality of the guidelines, randomized trials, and systematic reviews was assessed "using standardized criteria for each type of publication" (p. 43). One of the highlights of the study is that it states exactly what 'standardized criteria" was employed by the study in order to determine what recommendations should be made to the professional audience that would be reading the study.
In fact, the study shows that each recommendation was based on NBCC-NCCI grading levels I and II and all relevant randomized controlled trials (RCTS). An analysis was developed on each of the evidence-based rationales, for each recommended approach.
There were further statistics used in the study when the external review was conducted. These statistics included 110 surveys sent to nurses, physicians, surgeons, medical oncologists, patient educators, and medical physicists.
The statistical procedure used in the external review included percentages of surveys returned categorized by respondent's profession. From those categories further statistics were derived based on the number (and percentage) of the responses who agreed (84%) with the summary of evidence, who indicated (94%) that the study was relevant to their practice(s), who agreed (87%) with the recommendations, and who approved (90%) the recommendations.
Considering these statistics, complemented by the study's internal review of the current literature, conclusions were reached by the study that found that 'almost all respondents agreed with the recommendations' (p. 44), while at the same time 20 respondents (61%) provided written comments and suggestions on how to improve the recommendations. The study also found that participants would like to modify some of the recommendations in order to ensure relevance and clarity, both for themselves and for the patients they served.
The study's conclusions...
An agreement level of at least 84% is a strong indicator of consensus among participants. In that regard, at least, the percentages bear out the recommendations made by the study. However, statistically speaking, there could have been a much higher percentage of overall respondents to the external survey. The study states that there were 110 surveys sent to the medical professionals. Of those 110 surveys, only 33 responses were returned to the study's authors. That is a 30% response rate. A 30% response rate is not a strong indicator of interest.
Those respondents that did take the time to return the survey seemed to be highly motivated in making their opinions known as evidenced by the fact that 61% of the respondents included their own written comments in response. The 61% figure is a very strong indicator of purpose.
The study mailed out 110 surveys, yet only received 33 responses. According to the statistics provided by the study, responses were delivered via mail, telephone, fax, and email (p. 43). A recent study, however determined that "offering fax options increases response rates, but providing other electronic options does not" (Nicholls, Chapman, Shaw, Perkins, Sullivan, Crutchfield, Reed, 2011, p. 1676). Statistically speaking the study seems to have offered as many options as possible to the survey participants and yet only received 33 responses. This is either an indication of a 'normal' response rate to this type of survey, or it could be high or low depending on what is considered normal. One of the study's drawbacks is that it does not specifically state whether this response rate is good, bad or average.
The study's conclusions do not necessarily hinge on how many survey responses were received, but it is a contributing factor as to whether the study's conclusions are appropriate or are not. Based on the study's overall veracity, as well as other factors considered (not just the response rate), it would seem that the conclusions were appropriate. The conclusions can be considered appropriate due to the strong and positive responses by the 33 individuals who did respond as well as the internal review that was conducted by the researchers. The internal review of literature provided a strong foundation for the conclusions.
The internal review, taken solely upon its merits, may be strong enough without considering the external review, to justify the study's conclusions. Therefore, the conclusions can be considered appropriate, especially in light that the 33 survey respondents overwhelmingly supported the study's conclusions as well.
The study's findings are statistically significant based on the fact that there are a constantly rising number of individuals who are in need of palliative care and long-term medical treatments due to cancer and other life-threatening and debilitating diseases. Providing recommendations regarding effective communications by, and with, the appropriate medical personnel can help alleviate concerns faced by these individuals. The study's findings provide significant upside potential to helping to treat and heal those patients who might not otherwise be helped. According to the study, patients who experience effective communications while facing stressful medical scenarios are more apt to positively respond to treatments than those patients who are not provided information or effective (and ongoing) consultations.
Although the study did not provide specific statistics on the number of patients that could be assisted by implementing the recommendations it does state that "the process of communication between providers and cancer patients can significantly affect clinical outcomes" ((p. 42) Simpson, Buckman, Stewart, 1991).
The process used to determine whether the findings were significant were both intuitive and thoroughly ensconced in research. Intuitively, the author determined the significance based on the knowledge of how large the number of patients are affected by cancer on a yearly basis. Additionally, research shows that a large number of individuals are diagnosed with various cancers each and every year.
As an example, one study found that type 1 endometrial cancers have been increasing (and) type 2 endometrial cancers and all invasive uterine cancers have been relatively stable…
