The research problem is a “situation in need of a solution, improvement or alteration or a discrepancy in the way things are or the way they ought to be” (Burns & Grove, 1993). This study, “Living With Incurable Cancer at the End of Life-Patients’ Perceptions on Quality of Life” by Christina Melin Johansson, RN, Phd-student; Bertil Axelsson, MD, PhD; Ella Danielson, RN, PhD (2006) would like to answer the question: What are the perceptions of cancer patients` perceptions of quality of (QoL) in an unprejudiced way?
It explicitly aims to explore the experiences of the patients considered helpful towards better understanding of how to maintain and even improve QoL at the end of life relevant to these patients suffering from an incurable cancer (p. 1). This problem is an important one for nursing to study because the results of this study is useful in identifying strategies for the patients to manage life as ill and how to be creative in solving problems as a way to cope and achieve quality of life. As LoBiondo-Wood et al. 2002) mention, “the meaning of quality research in nursing should contribute to knowledge relevant to health care and service. ”
Further, nursing research should provide a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet these challenges and maintain our societal relevance”. Study Purpose According to LoBiondo-Wood et al. (2002), and in-depth research providing an understanding of the nursing practice is necessary to develop nursing and health care interventions, outcome studies, and policies that are congruent and sensitive.
A qualitative and descriptive research approach based on the tradition of phenomenological life-world portrayal facilitates this goal, hence this study was done. This study, ““Living With Incurable Cancer at the End of Life-Patients’ Perceptions on Quality of Life” by Christina Melin Johansson, RN, Phd-student; Bertil Axelsson, MD, PhD; Ella Danielson, RN, PhD (2006) concentrated on describing incurably ill cancer patients` perceptions of the quality of life at the end of life. Hence, the purpose of the study was to explore patients’ perceptions of QoL in incurable cancer at the end of life.
In addition, the authors of the study wanted to explore the patients’ perceptions of QoL in an unprejudiced way and to contribute to a better understanding of how we could maintain and even improve QoL at the end of life relevant to these patients suffering from an incurable cancer. Research Question According to Burns & Grove (1993) “establishing the research question directs the focus of the study toward an expected outcome. ” Johansson et al. , (2006) addressed the following questions: “What are the perceptions of incurably ill cancer patients on how their illness influenced QoL in daily life?
To state the question broadly enough for a qualitative study, the researcher further added that, “To achieve this, a valid description of the content in QoL at the end of life in the palliative context is explored. ” Further, the question was stated broadly enough since the authors used content analysis to answer this question. Study Design A descriptive qualitative method is used in the study using content analysis to frame the design of the study. The method used was appropriate for this study as it sought to examine the meaning of experiences of incurably ill cancer patients.
In addition, the content analysis was undertaken to understand the patients’ experiences and identify themes of relevance relating to QoL that emphasized what they could perform and enjoy in daily life and not their shortcomings. Subjects and Setting The study used non-probability, purposeful type, convenience sampling of subjects since this approach included patients who were still active for more than 50% of the time they were awake which made it possible to involve those who had the motivation and capacity to verbalize their perceptions.
The researchers select the subjects who are considered to be “typical” of the population. (Benner, Tanner, & Chesla, 1996). There were only few subjects (only 5 out of 25 patients with incurable cancer). These patients were all designated to a palliative homecare team. So the study population was small, but may be adequate as the five subjects fulfilled the criteria and the study took place in a single healthcare setting. Also, the setting in which data were collected are appropriate one for this study as the focus group discussions were carried out on 3 occasions.
In this focus group, most patients had a positive attitude that could influence the other patients in the group to be more positive than they usually were. Data Collection Methods Data collection procedure used which were the semi-structured interviews and content analyses were consistent with the purpose of the study since the study was a qualitative and descriptive. The data collection procedures used were consistent with the purpose of the qualitative approach and is most appropriate to ensure that nothing would be taken for granted in the study (Bengtsson, 1998).
The qualitative tape-recorded interviews was undertaken to understand thoroughly the experiences of incurably ill cancer patients. To assess whether or not ethical standards are met in relation to the protection of the rights of human subjects, the participants were informed by letter on the purpose of the study and the focus group procedures. They received the informed consent in writing, which was included with the letter of information. A week after the information was sent; the first author and moderator (CMJ) telephoned the patients for confirmation regarding participation.
Patients who agreed to participate were informed of the place and time for the focus group meeting. Most of all, in the focus group discussions, participants were afforded the opportunity to decide to what extent they will share their opinions and experiences with the group. Hence, in this atmosphere, the participants feel secure and will experience the situation as meaningful. Data saturation was achieved as tape-recorded interviews were done. Moreover, the participants’ interview occurred on three times on different occasions: within a 6-week period.
Moreover, rules were introduced at the beginning of the 3 focus group meetings. Further, before each key question, opening and introductory questions were asked to provide the patients an opportunity to tell the others about themselves. After every key question, transition and ending questions were asked. After each focus group meeting, the moderators discussed what they considered had been most significant findings during the meeting. Data Analysis Procedures Johansson et al. (2006) qualitative data analysis procedures were appropriate for the data collected as the interviews occurred in three different occasions. The tape-recorded interviews were analyzed for content on what the authors considered had been most significant findings during the meeting. The content analysis was used in several ways in this study. The text analyzed took in several steps and the analysis was performed by the first author, the second and then the third authors.
All the authors had several meetings in which they discussed the most trustworthy way of presenting data. The purpose of all this analysis was to describe and interpret the concealed message in the texts. This data analysis procedure was consistent with the qualitative method used in the study as qualitative research investigates human experiences in naturalistic settings, pursuing meanings that inform theory, practice and further research. Though generally, qualitative research is very lengthy and often explores cultural themes, this research was not.
Strengths/Limitations The major strengths of this scientific study are: first, this study showed that QoL at the end of life has a positive meaning for patients with incurable cancer. Second, this research has identified 5 themes of relevance relating to QoL, namely, “valuing ordinariness in life,” “significant relations,” “maintaining a positive life,” “alleviated suffering,” and “managing life when ill. ” These themes describe that the patients emphasized what they could perform and enjoy in daily life and not their shortcomings.
These themes were analyzed since the focus group discussions were carried out on 3 occasions. The two major limitations of this study were; first, the study was limited only to 5 patients with incurable cancer. Second, it is difficult for a moderator to predict and be fully prepared for what will happen in focus group discussions and it is also difficult to foresee if the patients would talk about meaning in life with some difficulties. Hence, the authors’ various experiences could be a weakness if the researchers are not clear on the meaning of preunderstanding and preconceptions