Introduction
A higher percentage of people die in healthcare organizations, alone, while going through a lot of pain. For instance, according to Hagarty et al. (2020), “nearly one in ten emergency department visits from oncology patients in the last months of life cited pain as a reason for visit” (p. 1). The study also suggests that about 20% of patients dying in hospitals have reported some degree of pain related to their ailment. Some of the chronic health conditions that have been linked to these pain-related mortalities include cancer, chronic obstructive pulmonary disease (COPD), mental health illnesses like anxiety, end-stage renal disease, congestive heart failure (CHF), and others (Hagarty et al., 2020).
These high numbers suggest that nations must have systems and facilities that would help manage these individuals’ pains and facilitate their peaceful deaths. Cook, Zonies, and Brasel (2020) note that palliative care is an essential part of the healthcare process, which involves attending to terminally ill patients with dignity and managing their pain. It ensures that it anticipates, prevents, diagnoses, and treats life-threatening conditions, while also supporting patients and their families in making informed decisions.
Primarily, palliative care aims to improve the quality of life for individuals affected by a diagnosis, regardless of the specific condition (Ekberg et al., 2021). Even though this type of care does not depend on prognosis, unlike hospice care, its role intensifies and focuses more on managing aggressive symptoms and offering psychological support as the end-of-life approaches. In this sector, effective communication plays a crucial role in meeting the needs and preferences of patients and their families. It ensures that this multifaceted realm of care involves professionals, including physicians and nurses, who exchange empathy, information, and an understanding of what patients and their loved ones are going through.
Therefore, as Cook, Zonies, and Brasel (2020) note, enhanced communication is the cornerstone of this important sector in care delivery, pivoting the intricate web of challenges and emotions it encompasses. Given the profound impact of communication in end-of-life care, this research proposal aims to comprehensively explore ways to improve it among physicians, patients, and their families.
Research Design
One of the crucial components of this project is the research design. It is simply a comprehensive planning process for collecting and analyzing data from participants to increase the understanding of a specific topic (Busetto, Wick, and Gumbinger, 2020). As discussed, communication plays a crucial role in palliative care, particularly given the unique needs of patients (Ekberg et al., 2021). Therefore, to comprehensively explore this issue, a robust and appropriate research design will be chosen. This research proposal will utilize a mixed-methods research design that combines qualitative and quantitative methodologies.
Research Question
The primary question addressed in this proposal is: “In what ways can communication between physicians, patients, and families in palliative care be improved to ensure their needs and preferences are met?”
There are several reasons why this question has been selected to guide the research proposal. First, according to Dodgson (2020), it must be relevant in a way that it attempts to fill a gap that has been identified. From the study in the previous question, it is obvious that palliative care is important since many people often die while experiencing pain. Therefore, to improve the services offered in the sector, it is important to enhance communication between key individuals in end-of-life care (Ekberg et al., 2021). This research directly addresses pressing issues in healthcare delivery, making it an appropriate topic to explore. It also explores tangible solutions and improvements, considers the perspectives of many key stakeholders, including doctors, patients, and family members, and is measurable.
Rationale of Research Design
Quantitative Research
The first element of this combined approach is the quantitative research. In this proposal, the researchers will utilize surveys from a portion of the eligible participants. Surveys will have structured questions for a group of individuals from the larger population (Borgstede and Scholz, 2021). They will use it to quantify the extent and nature of issues affecting communication in palliative care. Through this, they will identify variations and similarities, including challenges that healthcare workers, patients, and loved ones face.
In the surveys in this research proposal, the research team will also include a Likert scale. It is a unidimensional rating scale utilized by researchers to gather responses from participants (Jebb, Ng, and Tay, 2021). It has a question with about five or seven statements for people to choose based on how they feel. Since it offers a range of possible answers, it is great for capturing the agreement level or feelings of respondents (Jebb, Ng, and Tay, 2021). It will allow the quantification of physicians’, patients’, and families’ perceptions. It will include open-ended questions to facilitate in-depth insight into the issues affecting effective communication and how to improve things.
Qualitative Research
The second component of the mixed-research design in this proposed study is qualitative research. Busetto, Wick, and Gumbinger (2020) define it as “the study of the nature of phenomena” (p. 2). It excludes the range and frequency of data but includes “their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived” (Busetto, Wick, and Gumbinger, 2020, p. 3).
This process aims to gain a better understanding of social phenomena within their natural context. It is more focused on answering the “why” instead of the “what” of a given challenge (Busetto, Wick, and Gumbinger, 2020). In this research proposal, the component that will be included is interviews. They are chosen because they provide flexibility while questioning participants, enabling them to effectively describe their emotions, experiences, and perspectives.
The semi-structured interviews will be conducted with all participants, including all key stakeholders in this care sector. By applying this process to each individual in these stakeholder groups, the research team will have the opportunity to obtain a clear picture of various factors related to communication during end-of-life care (Adeoye-Olatunde and Olenik, 2021). It will help uncover numerous underlying reasons for the findings from the quantitative study and gather suggestions from respondents on how to enhance communication in palliative care. It will provide a better understanding of the challenges and opportunities that physicians, patients, and family members experience in this sector.
Mixed Methods and Triangulation
Bringing qualitative and quantitative approaches in this proposal will offer a comprehensive view of responding to the research question. Borgstede and Scholz (2021) suggest that a mixed-methods design allows researchers to triangulate their findings. This involves comparing and contrasting the results of one method with another. For instance, since both qualitative and quantitative research have their benefits and limitations, combining them can complement each other, ensuring that results are credible and valid.
Wasti et al. (2022) note that mixed designs are particularly important in health research because they can enhance the description and comprehension of phenomena. Additionally, it “helps to understand the holistic picture from meanings obtained from interviews or observation to the prevalence of traits in a population obtained from surveys, which add depth and breadth to the study” (Wasti et al., 2022). Therefore, it will help go beyond numbers and reveal the real-life experiences of doctors, patients, and their loved ones in palliative care.
Data Collection
The next crucial phase of this research proposal involves collecting data through both qualitative and quantitative methods. This process will be planned and executed more effectively to ensure that the research team meets the objectives. In this study, outcomes will be gathered systematically to help obtain views from both the surveys and semi-structured interviews. The last step will involve comparing the two sets of results on challenges and opportunities in communication in palliative care.
Quantitative
The most suitable tool for this research proposal is a survey, which will help collect quantitative data from all key participants in palliative care, including physicians, patients, and their families. During this study, the researchers will design an instrument to adequately address the research question and achieve the primary objective. Additionally, they will use a list of structured questions, consisting of closed-ended questions on a Likert scale. This will help to gauge participants’ perceptions and experiences of communication between key participants in end-of-life care.
To obtain eligible participants for the survey, the researchers will employ a stratified sampling approach. Howell et al. (2020) note that this method involves dividing subjects into subgroups known as strata based on their varying features. After that, each category is sampled using another probability sampling technique (Howell et al., 2020). In this research proposal, participants will be divided into three groups: physicians, patients, and their loved ones. Within each stratum, they will incorporate random sampling to pick representatives from the wider population.
The research team will utilize numerous channels and tools to distribute the surveys and analyze the gathered data. They will use email, online platforms such as Facebook and X, and in-person methods. As Howell et al. (2020) suggest, utilizing various communication methods will help reach every participant and avoid delays. Therefore, they will be asked about their preferences and accessibility before the whole process begins. Additionally, they will receive clear instructions on the study’s aim and their rights throughout the study. The researchers will utilize the Statistical Package for the Social Sciences (SPSS) to analyze the data (Howell et al., 2020). They will calculate descriptive statistics, such as frequencies, means, and percentages, to summarize the collected responses and identify trends.
Qualitative
After collecting quantitative data, the next process will involve qualitative data. The researchers will employ semi-structured interviews to explore the perceptions, experiences, and suggestions of the key stakeholders in this sector. To help paint a vivid picture of the results obtained from the quantitative approach, the interview will include open-ended questions that seek to understand the in-depth narratives of all individuals’ feelings about communication between key stakeholders in end-of-life care. They will recruit skilled interviewers in the next step to help retrieve more credible responses.
Before commencing, they will use a purposive sampling technique to have the most appropriate participants. Campbell et al. (2020) note that this approach is a form of non-probability sampling that relies on the experimenters’ judgment when choosing those suitable for participating. Through this process, only those with experience in palliative care will be questioned, and their answers will be taken into consideration.
To collect data from the chosen participants, the researchers in this proposal will conduct interviews using various methods, depending on the participants’ preferences and accessibility: video conference, phone, or in-person. Those who are far from the research location will need to select methods that are convenient for them, such as phone calls or video conferencing via Zoom. Moreover, before these activities commence, the research team will obtain informed consent, and all conversations will be recorded for future reference (Pietrzykowski and Smilowska, 2021). The primary reason for conducting semi-structured interviews is to allow for flexibility in responses and to gather more information on the topic.
The responsible individuals will employ numerous steps to analyze qualitative data. The first step will be transcribing the audio recordings of the interviews into verbatim transcripts. During this process, they will ensure that no personal identifiers are included in the responses, such as names, ages, locations, and other sensitive information (Pietrzykowski and Smilowska, 2021). The second process will involve coding the transcripts and then thematically analyzing them to identify patterns, trends, and differences among physicians, patients, and loved ones. This will yield an in-depth understanding of the challenges in palliative care communication and offer recommendations on how to improve things.
Data Management
While the researchers aim to collect data using a mixed-methods approach, it is essential to ensure that the data are securely managed and that the confidentiality of participants is maintained. Kanza and Knight (2022) note that data management is the process of creating, organizing, documenting, accessing, and reusing research findings. It generally enhances the workflow of research, making the entire project efficient, resilient, and productive (Kanza and Knight, 2022). This research proposal will employ a detailed data management procedure to achieve all its objectives.
First, the process will focus on the forms and instruments incorporated for collecting data. This research will collect both qualitative and quantitative data, employing various tools and methods that may confuse participants and potentially interfere with the outcomes. Therefore, as Donner (2023) suggests, all equipment, including interview and survey protocols, will be organized and labeled. Moreover, all of them will be stored in a secure location to prevent them from falling into unauthorized hands or getting lost. Secondly, the research team will ensure that they enter accurate, consistent, and thoroughly collected data. Donner (2023) notes that data entry is a crucial step that must be undertaken carefully. This can include inputting data into a more safeguarded electronic database.
The third consideration for the researchers is storing data in protected and controlled environments. According to Donner (2023), better storage can be achieved with systems such as cloud-based platforms, secure servers, or encrypted hard drives. This will ensure that all participants are assured that those not involved in the study will not have access to their information and that they can retrieve it at any time. Sensitive information will be protected using robust data security measures, including firewalls and password protection systems (Donner, 2023). Additionally, physical copies, such as the survey documents, signed consent forms, and other valuable documents, will be filed appropriately and kept in locked cabinets.
To prevent losing information through data breaches and other electronic risks, the research team will conduct regular backups to ensure data security and integrity. Reserve data will be secured in hard copies and placed in a separate location to prevent redundancy or any other incident (Kanza and Knight, 2022). Other guidelines include removing personal identifiers, establishing procedures for handling data access, developing clear data retention and disposal policies, and ensuring compliance with privacy regulations.
Ethical Considerations
The last key section in this research proposal is an ethical framework. Wexler and Largent (2023) note that researchers must always adhere to different codes of conduct while undertaking their projects. They are a set of principles that guide their study designs and practices, improving the validity of their outcomes and maintaining scientific integrity (Wexler and Largent, 2023). Vital considerations include privacy and confidentiality, informed consent, the well-being of participants, the principles of beneficence and non-maleficence, voluntary participation, and others.
Consent from Participants
Informed consent will be a crucial component of this research proposal. Before commencing the study, all participants, including healthcare workers, patients, and their relatives or loved ones, will be informed about the study’s purpose, design, methods, potential risks, and benefits. Moreover, as Pietrzykowski and Smilowska (2021) suggest, every individual involved in the research must provide a willful agreement to participate. When they are unable to provide consent due to illness, their family members or legally authorized individuals will be consulted.
Voluntary Participation
Each individual included in this proposed study will have the right to withdraw at any point when they no longer feel comfortable. According to Pietrzykowski and Smilowska (2021), participants must be aware that their decision to discontinue will not negatively impact their future involvement in any other related activities. They can still work with other research organizations that seem reasonable to them. It is their right to leave a program at any time without an explanation and not be pressured to continue.
Data Anonymity
Information gathered from all participants in this research proposal will be kept private and confidential. According to Pietrzykowski and Smilowska (2021), confidentiality is essential because it helps protect every person’s information by ensuring that their data is not disclosed to authorized personnel. This project will utilize a secure server to store data, remove any form of identification, retain data for the minimum required time, and avoid discussing the outcomes in public forums.
Participants Well-Being
Participants are vital in helping researchers gain a deeper understanding of a topic under consideration. This implies that they should always be protected and guaranteed the same (Borgstede and Scholz, 2021). Some participants, such as patients and family members in end-of-life care, may share sensitive experiences and emotions that require support. This will be attained by training researchers on how to respond and referring others to appropriate psychological professionals.
Beneficence and Non-Maleficence
While conducting this proposed study, researchers must conduct their activities in a manner that is moral, humane, and thoughtful, and also ensure that participants are not harmed. The research team must approach these individuals with love, generosity, and genuine concern when conducting the interviews (Varkey, 2021). For instance, strategies will be put in place to ensure that the collection and analysis of data does not affect their feeling in any way. All their responses to the survey questions and interviews will be taken into consideration. This will show that they are valued, and the improvements will be tailored to their preferences and needs.
Access Only Relevant Components
This research proposal will only assess those elements in people that are relevant to the topic and aim. Borgstede and Scholz (2021) suggest that some studies often violate their participants’ ethical rights by asking them questions that are irrelevant to the exploration being done. This is more likely to have adverse impacts on key stakeholders, including the wastage of time, failure to meet milestones, and stoppage (Varkey, 2021). Therefore, it is essential that the experiment remains simpler and shifts the approach to attaining the primary objective.
Conclusion
This research proposal aims to explore various strategies for enhancing communication among clinicians, patients, and family members during palliative care. Palliative care plays an important role in helping to manage the pain and suffering of patients with chronic conditions, such as cancer, COPD, end-stage renal disease, and congestive heart failure, and ensures they die peacefully. This sector of care relies on seamless communication as the key factor in providing information, emotional support, and assisting patients in making informed decisions about their health.
Through the use of a mixed-methods research design, this study combines surveys, semi-structured interviews, and interview responses to offer a comprehensive view of the topic. Moreover, it will use multiple data management techniques to protect privacy and confidentiality, including de-identification, secure data storage, and encryption. Furthermore, the researchers will ensure the project is ethical by considering various ethical principles, including ensuring the welfare of every participant, obtaining informed consent, allowing voluntary participation, and other relevant considerations. By complying with all these, this project will have a better chance of achieving its overall goal.
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