Effectiveness Of Screening In Treatment Of Ovarian Cancer Patients Who Have Attained Menopause

Addressed problem or issue

What Are The Effectiveness Of Screening In The Treatment Of Ovarian Cancer Patients Who Have Attained Menopause?

What Are The Plight Of Women Due To Their Biological Condition Of Menopause, Cancer And The Economic Burden Of These Test?

Whether There Has Been A Lacunae In Medical And Healthcare Literature In Delving Into The Lives Of These Women And The Family Support Received By Them During The Process Of Screening And After That?

According to the American Cancer Society in United States of America, ovarian cancer is the fifth highest cause of death and has been reported the as the primary cause of death among women. It has been reported as the highest cause of gynecological death in USA. It has been found that 95 per cent of the ovarian cancer deaths occur among who are 45 years and older (Siu, 2015). The Preventive Services Task Force (UPSTF) have reviewed several evidence on the potential harm and benefits of screening of patients with ovarian cancer. In this case, high risk includes for these female cancer patients specific hereditary cancer syndromes that would heighten their risk of ovarian cancer. Some of the outcomes of ovarian cancer include quality of life, cancer mortality, false positive rate, rates of surgical complication and surgery, and the mental health condition post the screening (Neuman, 2013). According to USPTF, it was found that the belief that the screening of ovarian cancer reduce ovarian cancer is false. On the contrary, screening of ovarian cancer can cause potential harm to the cancer survivors. There are situations when the cancer survivors have to undergo surgical procedures that have been found as unnecessary by a section of doctors and scholars specializing in science & technology studies. Transvaginal ultrasonography is considered an important part of ovarian cancer screening trials. There is the scenario where there is lack of mortality benefit of screening to test the results relevant to surgery. It has concluded that there is moderate certainty about the potential harms of screening of screening that is higher compared to the benefits. The positive value of ovarian cancer has been low and the number of women who have incurred positive predictive value are not the ones detected with cancer. It has further been found that depending on the kinds of test used, the danger on the lives of women varies. TVS (Transvaginal ultrasonography) has been understood as effective for detecting the pathological condition in ovarian volume of the female patients and their morphology. However, Transvaginal ultrasonography has been considered by experts to be less reliable in distinguishing between benign from the malignant tumour.

Research Objective

The critical review of the existing literature along with the engagement with the government sources on the impact of screening on the ovarian cancer survivors have found that there are ambivalent views. Cancer has been understood as one the main causes of death and ovarian cancer is being looked as the fifth highest cause of death in United States. The broader research question of this study is to identify whether screening is effective for the postmenopausal patients who have survived ovarian cancer. Menopause has been  defined as the juncture in the life of a woman when her menstrual cycle creases owing to the depletion of the ovarian oocytes as a result of ageing. Some of the symptoms of menopause are low estrogen production in women that leads to vasometer instability like night sweats and hot flashes, psychological changes, genital tract atrophy, changes in the skin, insomnia amongst others. Another symptom of menopause is abnormal bleeding in the vagina and the low production of androgen hormones. Cancer being one of the highest causes of death all over the world especially in United States, it is important to conduct a study that is committed in understanding the revolution of technology (in this case screening) and its scope in ameliorating the condition of ovarian cancer patients in their menopausal stage.

• To identify the effectiveness of screening in the treatment of ovarian cancer patients who have attained menopause.
• To understand the plight of women due to their biological condition of menopause, cancer and the economic burden of these test.
• To compensate for the lacunae in medical and healthcare literature in delving into the lives of these women and the family support received by them during the process of screening and after that.

According to Farr and Cressey (2015), staff perspectives in the domain of healthcare services, developing, and analyzing the different performance is important to understand the status of healthcare. Having an understanding of the perspectives of the staff is important as it enable in understanding the quality of healthcare and seeking mechanisms about the different mechanisms in assessing and managing quality of healthcare. The staff who will be in charge of conducting the research will be students in their masters degree pursuing medical sociology, anthropology of health and students in community health. The rationale behind the deployment of students for the collection of data as it will give them an opportunity to understand the nuances of fieldwork, familiarity with participant observation and it will give them a firsthand experience of fieldwork. The staff of the research will be students who have completed their masters degree and would be available during the summer period for conducting the research. The staff will be comprised of Anne, Rheson and Harry. Anne has completed her masters in science health sociology; Rheson has completed her masters in medical anthropology and Harry who has earned his master’s degree in science in community health.

Study description

The term research philosophy or epistemology refers to the belief or principle of data collection about a particular phenomenon (Lewis, 2015). This indicates about the source of knowledge and the ways in which knowledge should be pursued and provides the direction about the way in which knowledge will be interpreted and presented. The term research design refers to the systematic plan of action that guides the researcher about the actions and thoughts that would be used for conducting the research. The approach that would be adopted by the study is inductive approach. The thrust of inductive approach is to develop theory or look into the pattern of meaning during the phase of data collection. In this case, the approach of data collection and subsequent analysis will be methodical but at the same time would allow greater opportunity for flexibility compared to quantitative research (Ritchie, Lewis, Nicholls & Ormston, 2013).

There can be different kinds of epistemologies- positivist, post-structuralist, interpretivist, and constructivist, Marxist, critical social science research and post-modernist. Given the nature, quintessence and thrust of the study I would like to employ the qualitative research design. The feature of qualitative research is that strive to produce an understanding from the data to the analysis of the data. The research design of the qualitative study is quite different from the other kinds of research design especially quantitative research design. Unlike quantitative research where there is a hypothesis to guide the researcher, the qualitative research begins with a broader research question. It has been found that qualitative research is not usually preemptive. The indications, forms and scope of the research is obtained from the question (Sanjari, Bahramnezhad, Fomani, Shoghi & Cheraghi, 2014). Designing a qualitative research is both challenging and at the same time insightful for the researcher. As the research problem has been identified, the first step is to design the pacing of process and determine the strategies that are to be used in the research. There is also the need to look after the project as a whole. The aspect of pacing of the project includes planning and sequencing of the components and the movement between the phase of collection of data and the analysis. The term research design is concerned with being moulded and cast by the method and is conducive to the context of research.

An efficient research design draws from the scope of the research and the nature of data to be collected. The scope of research refers to the domain of inquiry, reach and coverage of the project. The scope of research is concerned with the strength, possibilities as well as the limitations of the research along with the areas that are to be researched. It has been found that definitions of the topic and the pertinent concepts and theories as envisaged by the researcher. It is important for the researcher to process the data and then analyze the data. In qualitative research the scope of the sample and the selection of the setting are guided by two key principles. The setting in the research is purposively selected. This entails selecting the most optimal illustration of the phenomenon and the setting in which the research is to be conducted. Once the setting is decided and selected by the researcher, the next step is to engage in thorough observations of the setting. Given the nature of the research, the setting or the universe of study of the research will be public hospitals and private hospitals in Chicago , United States.

Research design

This research will integrate both primary collection of data as well engaging with the secondary sources of data. The primary data will be collected by the staff and the sampling of the research will be done through probability sampling (Siu, 2016). The term research population refers to the population on whom the research will be conducted and the sampling population refers to the population that is representative of the characteristics of the research population. The independent variable of the study is screening of the ovarian cancer survivors who are menopausal and the dependant variable of the study is effectiveness of screening to reduce ovarian cancer in USA. Since this qualitative research there is no hypothesis. Instead, a broader researcher question has been discussed in the study description section of the research.

To accomplish the goals and objectives of the research, the setting or the universe of study for the research will be private and public hospitals. The rationale behind choosing the public and the private hospitals is to find the relevant stakeholders of the healthcare organization like the doctors, nurses and patients suffering from ovarian cancer. However, the major focus will be to select hospitals where there is a thrust of cancer research and cancer treatment.

The term research population refers to the group that is compatible for the purpose of the research. However, a research cannot accommodate all the people in the given population therefore a sample population is selected for the purpose of the research to study the given phenomenon. The sample population possess the characteristics that is representative of the research population (Suri, 2011). Considering the qualitative research design, the sampling framework for this study will be non-probability sampling. This refers to the researcher being aware about the location of the research participants. Convenience or judgmental sampling technique will be adopted for the purpose of the research for reaching out to the oncologists in five public hospital and five private hospital (Taylor, Bogdan, & DeVault, 2015). The rationale behind selecting oncologists for the purpose of the study is to derive information about cancer, ovarian cancer, profiling of the patients and the impact of screening on postmenopausal ovarian cancer survivors.

Focused group discussions will be conducted with the patients in the community hall of Chicago where the patients will be shown a documentary about ovarian cancer and the impact of screening that would be followed by discussion.  Focused group discussions will be taking place for three times. Each time the group will comprise of 10-12 participants and the role of the researcher would be moderate the discussion. Clinical records will be used for the purpose of secondary data analysis this provide an insight into the recent spate of research on the outcomes of screening on the ovarian cancer patients who are in their postmenopausal stage. Face-to-face personal interviews with the research participants will enable in establishing rapport with the research participants and understanding their viewpoints regarding the effectives of screening for ovarian cancer treatment (Siegel, Miller & Jemal, 2018).

The doctors and registration notebooks possessed by the hospital authority will contact the patients through the medical records possessed. Another technique of contacting the ovarian cancer patients will be through the snowballing process. The number of oncologists who will be interviewed for the study is 20 and the number of patients who will be interviewed for the study is 30. However, the numbers may change depending on the progress of fieldwork. Ethical measures will be followed by seek by informing a priori about the purpose of the research. However before the actual research, a pilot study will be conducted to test whether the given interview schedule in effective in understanding the proposed research objectives. After the collection of data, the data will be coded and transcribed and analyzed through the appropriate theories.

	1st week	2nd week	3rd week	4th week	5th week	6th week	7th week	8th week	9th and 10th week
Drafting of the research proposal	Yes (resources at this stage will be online literature collected from scopus, proquest, google scholar and journal of medical ethics)
Literature review and secondary data research	Yes	Yes
Pilot study		Yes (resources that will be used at this stage be questionnaire)	Yes	Yes
Fieldwork  or collection of data(interview, focused group discussion and case study)				Yes (resources that will be collected at this stage will projector for screening a documentary, questionnaire, semi-structured interview schedule	Yes	Yes
Coding and Transcription of data							Yes (the resource require in this stage will be print and online literature to link the findings of the research with existing theories)
Analysis of data							Yes
Writing the dissertation							Yes	Yes	Yes
Sharing the information with the participants, academic community and publication									Yes

Image: Gantt Chart created by the author

Apart from the tabulated timeframe more time might be required considering the unforeseen circumstances during the phase of fieldwork.h

United Sates in the last five years has strived to improve the organization and provide financial assistance to the organization. There has been an increasing amount of research in the domain of health science in the US that boosted the growth of healthcare services in US. The highlight of health services is affects all the parties who are involved in the either or the individual level or the collective level (Bowling, 2014). Ethical consideration or protocol are to be followed by the professional researcher with the aim of ensuring fair treatment, sensitivity and appropriate behavior with the participants. Given the qualitative research design, there can emerge a web of challenges for the researcher. In qualitative research, the researcher and the research participant has the maximum interaction and therefore, the ethical issues take a different form. Researchers who carry out healthcare research have the responsibility of being sensitive and benevolent towards the participants (Silverman, 2016). In the absence of statistical analysis it is the responsibility of the researcher to evaluate appropriately what s/he is observing. Because of the production of texts rather than the numerical output, the researcher is the research instrument. Since the researcher and the research participant have the potential to develop intimacy, there emerges the issue of transgressing the boundaries of privacy during the phase of interviews, case study of families and focused group discussions with the female ovarian patients. Another ethical concern pertaining to the study is stigma (Gentles, Charles, Ploeg & McKibbon, 2015). Informed consent will be sought from the participants and the patients will be allowed to give their interview according to their preferred setting. Due to the stigmatization of menopausal women in the patriarchal society along with the stigmatization of ovarian cancer, the cancer survivors might not feel comfortable in participating in the research. This posits to the corollary that it would be difficult to access the participants as well. The doctors who will be participating in this research might provide opinions that is compatible with their interest of protecting their profession, therefore as a researcher it is important to ascertain and decipher the power dimensions whilst the fieldwork, transcription and analysis of data.

References 

Bowling, A. (2014). Research methods in health: investigating health and health services. McGraw-Hill Education (UK).

Gentles, S. J., Charles, C., Ploeg, J., & McKibbon, K. A. (2015). Sampling in qualitative research: Insights from an overview of the methods literature. The Qualitative Report, 20(11), 1772.

Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475.

Neuman, W. L. (2013). Social research methods: Qualitative and quantitative approaches. Pearson education.

Ritchie, J., Lewis, J., Nicholls, C. M., & Ormston, R. (Eds.). (2013). Qualitative research practice: A guide for social science students and researchers. Sage.

Sanjari, M., Bahramnezhad, F., Fomani, F. K., Shoghi, M., & Cheraghi, M. A. (2014). Ethical challenges of researchers in qualitative studies: the necessity to develop a specific guideline. Journal of medical ethics and history of medicine, 7.
Siegel, R., Miller, K. & Jemal, A. (2018). Cancer statistics, 2018. CA: A Cancer Journal for Clinicians, 68(1), pp.7-30.

Silverman, D. (Ed.). (2016). Qualitative research. Sage.

Siu, A. (2016). Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals Of Internal Medicine, 164(4), 279. doi: 10.7326/m15-288

Suri, H. (2011). Purposeful sampling in qualitative research synthesis. Qualitative Research Journal, 11(2), 63-75.

Taylor, S. J., Bogdan, R., & DeVault, M. (2015). Introduction to qualitative research methods: A guidebook and resource. John Wiley & Sons.