Treatment of Breast Cancer – Medical Ethics Example

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"Treatment of Breast Cancer" is a perfect example of a paper on medical ethics. The article is titled “ Telephone follow-up after treatment for breast cancer: views and experiences of patients and specialist breast cancer care nurses [BCN]” and it is authored by Beaver, Williamson, and Chalmers (2010, p. 2916). It is an eight-page article published in the 19th volume of the Journal of Clinical Nursing. Telephone follow-up is viewed as a prospective alternative follow-up other than routine hospital visits. A fraction of patients and all the BCN involved in a previous follow-up formed the study participants.

From the results, the authors concluded that both patients and nurses were positive about the telephone follow-up. Major patient themes identified from the follow-up include putting a face to the voice as some patients missed seeing the interviewer, an appropriate structure and format of the interview, normalizing as the interview was akin to an ordinary telephone conversation, the continuity of patient care after treatment, and convenience on the part of the patient. The BCN identified the intervention as a welcomed patient choice, meeting more patient needs, developing nurses’ listening and communication skills, and beneficial to the patient.

The telephone follow-up intervention can be a viable alternative patient follow-up option if the intervention is carried out by well-trained and experienced staff. However, continuous feedback on the process before it is wholly accepted into practice is essential as the intervention relies more on audio than visual cues ad the former is a unique element of assessment without much evidence to support its efficiency. Overview of Research DesignThe research sought to identify the opinion of BCN and patients, who had previously been on telephone follow-up post breast cancer treatment, on the effectiveness and significance of telephone follow-up as an intervention.

The research design used was qualitative. This design was appropriate for the study since the study’ s goal was to understand an aspect of the experience of human beings after a given intervention had been implemented (Polit & Beck, 2010). The study participants were interviewed extensively to identify a possible hypothesis based on the participant’ s perspective, meanings, and how they interpret the intervention in question (Holloway & Wheeler, 2010). The researchers gave the participants the reign to air their unadulterated opinion through semi-structured interviews, a typical component of qualitative research, and as it was captured in the article’ s title (Holloway & Wheeler, 2010).

In addition, the validity of the study outcome largely depended on the skill and competency of the interviewers (BCN) as is common in most qualitative research. SamplingThe study participants were patients who had previously received breast cancer treatment and had been followed up via telephone by BCNs. 20% (39) of these patients were randomly picked out of which 28 participated in the study conclusively.

In addition, the fraction of study participants comprised four BCN nurses all of whom had also previously been following up patients via telephone. However, the study method does not identify any distinct exclusion and inclusion criteria only mentioning those study participants who were initially on telephone follow-up. It is paramount to define the study participants succinctly to enhance the credibility of the study findings, something this study overlooked (Caldwell, Henshaw & Taylor, 2011). The sampling technique used was simple random sampling (SRS) using a computer-based system that selected patient identification numbers.

It was appropriate for this research design since the sample population to be sampled was small and readily available (Holloway & Wheeler, 2010). However, it is not mentioned or explained why the sample size or the number of participants to participate in the study was chosen to be 39, 20% of the available number of patients. An explanation of how or the method used to arrive at such a sample size would be prudent to avoid making unrealistic assumptions on the size.

Using Sloven’ s formulae of sample size calculation, an appropriate sample size would be 120 participants for this study (Tejada & Punzalan, 2012). Therefore, the sample size used was smaller casting doubts on the validity of the findings (Flikkema & Pereyra, 2012). Data CollectionTwo semi-structured interview guides were formulated targeting the two groups of study participants, the patients, and the BCN. The guide for the patients comprised questions regarding the significance of post-treatment follow-up, the participants' perception on the conductance of appointments by a nurse over a general practitioner, their opinion on telephone follow-up including what they admired and detested in the telephone follow-up, the kind of questions asked during the interview, and how they felt after having not to physically attend the hospital sessions (Beaver, Williamson & Chalmers, 2010).

A similar guide was provided for interviewing the BCN assessing their perspective on employing telephone follow-up compared to face-to-face appointments with the patients including the demerits and merits from the patients and their perspectives too. The collection of data lasted for about 30-60 minutes for patient interviews while interviewing the BCN took at most one hour.

The data collection utilized semi-structured interviews, and accepted data collection methods for such a qualitative study. Since the researchers wanted to understand the views of the patients and the nurses, a semi-structured interview was the appropriate data collection method to employ in this study. It has the advantage of been flexible thereby allowing the elaboration of misunderstood questions and discovery of new significant information about the participants that may not have been given much attention by the researchers (Erickson, 2012). The guidance provided by such kind of interview also allows collection of more relevant information saving on time unlike in non-structured interviews (Erickson, 2012).

For instance, despite the telephone follow-up been perceived as convenient like any other normal telephone conversation, some participants proceeded to add that they, nevertheless, missed the face-to-face interaction typical of hospital appointments because of the latter’ s physical examination that was perceived as reassuring (Beaver, Williamson & Chalmers, 2010, p. 2920). Since such patient phenomenon would not be easily obtainable via purely quantitative techniques, this data collection method was appropriate for this research’ s design. Data Analysis and Results“ Manifest content analysis procedures” were used to code the collected data by two researchers working independently (Beaver, Williamson, Chalmers, 2010, p.

2120). The researchers read and open coded the transcripts developing a codebook in the process before the data was re-inspected to make sure it fits with the coding. Different categories and themes representing the meaning and content of the collected data were identified. To ensure that the code was reliable, the researchers allowed three different researchers to verify the coding independently. Discrepancies that arose were resolved via a review of the collected and coded data, discussing the data, and collectively agreeing on the outcome.

The identification of themes and the coding were appropriate for this kind of research as they are elements of analyzing qualitative data (Grbich, 2013). The findings of the study demonstrated that both the patients and the BCN were positive about telephone follow-up post breast cancer treatment. The major themes associated with telephone follow-up recognized among the patients included convenience as the interview could be conducted from the patient's home environment saving them the need to travel to a hospital.

The patients also identified continuity of care through telephone follow-up as the same nurses were able to conduct the follow-up creating a trusting relationship with the patients. Telephone follow-up was also identified as a normal activity similar to usual phone conversation making them more relax and free to converse. The structure of the interview was also accepted by the study participants, even though, some noted that they missed face-to-face physical examination done during hospital appointments. The other group of study participants, BCN, reported that patients benefitted from the telephone follow-up as it saved them time and cost of transport.

In addition, BCN reported that the patient's health needs were met better via this follow-up, even though, the BCN added that some patients found more reassurance from a physical examination. The study findings may be applicable in other settings but to a limited extent because of some doubt on the credibility of the findings. First, the sample size seemed small from a population of 173 patients (Flikkema & Pereyra, 2012). Second, when collecting data, the researchers mention that the patient interview guide contained questions regarding their perception of a nurse-led and doctor-led appointment.

This was not identified as among the aims of the study and the study results do not show any feedback or findings in regard to this question if at all it was a significant element of the study (Caldwell, Henshaw, Taylor, 2011). Third, four BCN nurses were interviewed but only three had experience in clinics led by nurses. The fourth inexperienced BCN study participant presents a dissimilarity among study participants that may have affected the study findings since experience has an added advantage while conducting the telephone interviews.

The BCN’ s inexperience may, therefore, have affected the reporting of feedback based on the interview guide (Kaplan, 2012; Grbich, 2013). These reasons may limit the applicability of the study findings to other setups.

References

Beaver, K., Williamson, S. & Chalmers, K. (2010). Telephone follow-up after treatment for breast cancer: views and experiences of patients and specialist breast care nurses. Journal of Clinical Nursing, 19, 2916-2924.

Caldwell, K., Henshaw, L & Taylor, G. (2011). Developing a framework for critiquing health research: An early evaluation. Nurse Education Today, 31(8), e1-17.

Erickson, F. (2012). Qualitative research methods for science education. Springer International Handbook of Education, 24, 1451-1469.

Flikkema, R.M. & Toledo-Pereyra, L.H. (2012). Sample size determination ihttp://ed.grammarly.com/editor/content?page.paperReportKey=#n medical and surgical research. Journal of Investigative Surgery, 25(1), 3-7.

Grbich, C. (2013). Qualitative data analysis: An introduction. Washington, DC: SAGE Publications Ltd.

Holloway, I. & Wheeler, S. (2010). Qualitative research in nursing and healthcare. West Sussex: Wiley-Blackwell.

Polit, D.F. & Beck, C.T. (2010). Generalization in quantitative and qualitative research: Myths and strategies. International Journal of Nursing Studies, 47(11), 1451-1458.

Tejada,J.J. & Punzlan, J.R.B. (2012). On the misuse of Slovin's formula. The Philippine Statistician, 61(1), 129-136. Retrieved from http://www.philstat.org.ph/files/images/2012_611_9_On_the_Misuse_of_Slovin_s_Formula.pdf

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