Post-treatment symptom experiences in breast cancer survivors

RRL#1

The following questions pertain to:

McMillan, S.C., & Small, B.J. (2007). Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients. Oncology Nursing Forum, 34(2), 313-21.

What is the purpose of this research?

The purpose of this research was to describe the unexpected and distressing symptom experiences that women may have after undergoing breast cancer treatment, with the goal of enhancing follow-up care through practitioner education and an increase of the knowledge base.

What is the research question (or questions)? This may be implicit or explicit.

What symptoms may be experienced after breast cancer treatment that contribute to symptom distress and psychological stress that are may be temporal, situational, or attributive -- and that may be ameliorated during follow-up care?

What theories, frameworks, models or concepts may have influenced the researchers' choice of a research design?

The qualitative approach stems from a phenomenological philosophical background that considers the personal accounts of the study participants to be valued narrative secondary data. In this study, the qualitative narrative data was analyzed by using constant comparative methods, in which emerging themes are teased out by an iterative process of discovery that is fostered by the categorization of data.

11) What is the purpose of this research?

The purpose of the research was to test an intervention to be used by family caregivers in hospice settings with regard to better management of the symptoms that their family member patients with cancer experienced.

12) What is the research question (or questions)? This may be implicit or explicit.

What impact will improved knowledge base and the use of a problem-solving intervention by family caregivers in hospice settings have on the quality of life experienced by hospice patients?

13) What theories, frameworks, models or concepts may have influenced the researchers' choice of a research design?

The researchers wondered if providing hospice caregivers different and more extensive education, and instruction in how to use a problem-solving intervention while caring for hospice patients, would result in better management of symptoms and, thereby improve the general condition of the patients and result in higher quality of life.

14) How do the authors describe the design of this study?

The authors describe the study as a three-group comparative design with repeated measures.

15) Determine the classification of this secondary study; is it

Quantitative, qualitative or mixed method?

Experimental or nonexperimental?

Prospective or retrospective?

The study design is described as a repeated measures clinical trial, which is an quantitative experimental prospective design.

16) What is the evidence that this journal is peer-reviewed? Does the journal have an editorial board? (Look for the journal's website to discover this information).

The Editor of Oncology Nursing Forum provides this in her introduction to the "Submissions" section of the journal website:

"The Oncology Nursing Forum (ONF) publishes manuscripts that focus on nursing achievements in the field of oncology including, but not limited to, clinical advances, research findings, educational developments, and role and theory development…Manuscripts are accepted for consideration with the understanding that they are contributed solely to this journal, that the material is original, and the articles have not been published previously…All submitted papers are subject to blind peer review. Papers will be judged on the quality of the work and suitability for the audience."

17) Is there evidence of any conflict of interest that might introduce bias into the way the study is designed, or the way the results are viewed? Do the authors have any potential financial gain from the results of this study?

There is no evidence of conflict of interest or basis for the introduction of bias in the study design or the way the results were viewed. Moreover, the authors do not stand to achieve any financial gain as a result of conducting this study. The study was funded by the National Cancer Institute and the National Institute for Nursing Research.

18) Describe the population for this study.

The population in this study is family caregivers in hospice environments, who were actively providing care to patients nearing end of life while receiving home care.

19) How was the sample selected? What are the strengths and weaknesses of this sampling strategy?

The sample was selected from a large nonprofit hospice in which a majority of the patients receive home care. By using power calculations, the researchers determined that a sample size of 160 dyad pairs in each group would be effective for total sample of N = 480. Inclusion criteria included at least a 6th grade education and able to understand English, a diagnosis of cancer for the patient, informed consent to participate, two or more symptoms present (of the following: pain, dyspnea, and constipation) and minimum scores as follows on pertinent measures: the Short Portable Mental Status Questionnaire (SPMSQ) = minimum score of 7; and, Palliative Performance Scale (PPS) = minimum score of 40.

20) Were the subjects in this study vulnerable? Were there any risks for them as the result of participation in the research study?

The subjects in this study were vulnerable, with the potential to benefit from the COPE intervention or, if the subjects were not in a group receiving the COPE intervention, they were vulnerable to having a different experience in the hospital, absent a change to a higher quality of life as anticipated by those who did receive the intervention. Naturally, the participants all gave their informed consent to participate and their privacy and rights were protected by the human subjects process requirements of the college.