Curative and Palliative Choices

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Topic: Health & Medicine
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Introduction

The end-of-life phenomenon has always been a complicated issue for health care practitioners, families, and patients. This is because each of these parties has different interpretations in relation to the appropriateness of the available treatment alternatives. According to practitioners, changing the families’ and patients’ decisions from curative to palliative strategies depends on the ability of the medical staff to convince the two parties to change their stance. The article by Norton and Bowers reviews the approaches practitioners use when they realize that a patient’s death is unavoidable. This paper is a critique of the article by Norton and Bowers in relation to curative and palliative choices.

The Research Question and Relevance of the Research Design

Norton and Bowers look at how practitioners manage to change the patient’s and relatives’ end of life decisions from curative to palliative. They state the purpose of their research as “to develop a grounded theory of how decisions were negotiated among providers and family members near the end of a patient’s life” (Norton & Bowers, 2001, p. 259). They also define how they were able to identify the “several approaches practitioners used to help patients and families to change from curative to palliative treatment choices and goals” (Norton & Bowers, 2001, p. 260) during the development of the grounded theory. As stated in the article, the research report mainly focuses on the tactics used by medical practitioners in convincing patients to agree to palliative choices. Norton and Bowers (2001) discuss the background literature on the patient’s advance directives, self-determination, and beliefs about treatment and prognosis, the change of the victim’s treatment decisions, and how the patients, relatives, and practitioners reach an agreement on such verdicts. The use of the grounded theory was appropriate for this survey given that Norton and Bowers were concerned about how the three parties would agree comprehensively without the occurrence of a conflict.

Appropriateness of the Method of Sampling to the Research Question and Design

The authors interviewed 15 health care practitioners. Given that theoretical sampling is an important approach in grounded theory based research, Norton and Bowers have explained how they designed their interviews to get all the information they required. The most important information was whether the practitioners considered patients’ and relatives’ understanding and decisions, strategies used to change the patient’s and relatives’ perceptions, and actions taken to achieve the objective. The article also highlights the various sampling approaches employed by the medical practitioners in the study, as well as their work surroundings and level of expertise with regard to the end of life issue (Norton & Bowers, 2001).

Norton and Bowers clearly show the hypotheses that made them choose the particular type of participants in the study. The recruitment of the participants was done through invitation letters. Approximately 60% of the invitees, who were 25 in number, agreed to take part in the study. The report did not address the characteristics of the participants that refrained from participation. Although it is unimportant, understanding the people that failed to respond to the invitation is important in formulating future studies.

Appropriateness of the Data Analysis

All the participants in the research were interviewed once; conversely, among the various practitioners involved, three of them were interviewed two times. Initially, all the questions in the interview were open ended and lasted for 60-90 minutes. In the later stages of the interview, the questions were more focused and took 30-60 minutes to answer. In addition, the article has tabulated all the modifications, which were made to the interview queries. Although the authors noted that their research was part of “member checking’, they failed to provide a full description of the aspect of participant observation in the study. When the ground theory was established by Glaser and Strauss, the most important data collection methods were participant observation and interviews (Jones & Hunter, 1995). However, most of the ground theory research today uses only interviews to collect data.

Another error the two authors have done is failure to examine the records they obtained for the study (Jones & Hunter, 1995). For instance, a chart review might have been appropriate in illuminating what the practitioners recorded in relation to the patients’ and relatives’ treatment decisions. Although the lack of such records does not weaken the study, their presence would have provided additional information to address the research question in an adequate manner. The survey was conducted in a mid-size Western city in the United States. The medical employees involved in the research were those who specialized in cancer, home based and critical therapies.

The interview queries were recorded, written down, and tested if they were accurate, after which they were fed into a computerized information management system. The authors used QSR NUD*IST 4 for qualitative data management. Norton indicated that she was involved in the collection and analysis of data for 22 months. She also met a multidisciplinary grounded theory dimensional analysis group once a week. The group members provided a critique and commentary on the analysis process, thus expanding Norton’s perceptions in relation to the issue (Russell & Gregory, 2003).

The extensiveness or breadth of the qualitative inquiry is impressive, with the attention of the researcher shifting to various perceptive and vantage points in relation to the area of inquiry (Jones & Hunter, 1995). The breadth as well as depth aspects of the study are illustrated by the diversity of the chosen medical staff in relation to their level of expertise and areas of placement. The researchers’ purposive nature in selecting and interviewing three of the medical staff twice, as a result of their vast experience in the research topic, is also an indication of the presence of the two aspects in the article.

In qualitative studies, the depth aspect depends on the quantity and kind of data assortment spots employed. For this research, the authors interviewed 12 practitioners once and 3 practitioners twice. Interview sessions took a longer time toward the end of the study as they got more specific with time. The two authors employed the depth aspect in their study by using grounded theory oriented methods for constant data analysis (Russell & Gregory, 2003).

Meaning and Relevance of the Research for Health Care Practice

This research met the Thorne’s 5 criteria for assessing relevance and usefulness of a research study because the authors have clearly indicated the need for the study. The topic is also relevant to a health care setting because the practitioners often interact with the patients and their relatives in making end-of-life decisions. The study positions itself in the context of technological advancement, patients’ rights to self-determination, advance directives, and complex end-of-life choices (Russell & Gregory, 2003). The authors established that only the perceptive of the practitioners was the most important in the end-of-life decision because they are experienced in such incidents.

Evaluation

The authors have given a detailed description of the context and setting of the research. The findings they obtained can help practitioners to understand the perspectives of the patients and their families for solid decision making. The outcomes of the study also imply that medical practitioners need to explore more strategies to convince patients and their families to shift from curative to palliative treatment methods when making end-of-life decisions. Although this may be challenging task for the practitioners considering the high number of individuals who are unwilling to compromise, it is important to inform patients and their families the importance of changing the treatment method where necessary. Doing that shows the practitioners’ respect for the patient and their families at the crucial end-of-life period.

Conclusion

The research was generally conducted well, but there are some modifications to it that would have made it better. One of the alternations includes incorporating participant observation into the data collection methods because it is one of the most important strategies, as stipulated by the founders of the ground theory. Another modification, which would have been important, is the examination of records in the data analysis stage to have a better understanding of the research question. However, it is evident that the article’s shortcomings in relation to the two issues did not significantly affect the results of the research. The only thing these modifications would have done is to improve the understanding of the research question, which is important for future similar studies. In spite of the minor shortcomings, the research was an accomplishment as the authors were able to obtain all the information they were looking for successfully.

References

Jones, J., & Hunter, D. (1995). Qualitative research: Consensus methods for medical and health services research. BMJ, 311(7001), 376-380.

Norton, S. A., & Bowers, B. J. (2001). Working toward consensus: Providers’ strategies to shift patients from curative to palliative treatment choices. Research in Nursing & Health, 24(4), 258-269.

Russell, C. K., & Gregory, D. M. (2003). Evaluation of qualitative research studies. Evidence Based Nursing, 6(2), 36-40.