Patient’s Experiences Of Ongoing Palliative Chemotherapy For Metastatic Colorectal Cancer: A Qualitative Study

Clear statement of problem and its significance to nursing

Clear statement of problem and its significance to nursing, Broadness of the research question for a qualitative study and Appropriateness of the data analysis procedures for collected data and qualitative method?

The concerned article on “Patient’s experiences of ongoing palliative chemotherapy for metastatic colorectal cancer: a qualitative study by Jenny Cameron and Susan Waterworth published in the International Journal of Palliative Nursing in 2014, Volume 20, No 5”, clearly states the focus of the article on highlighting the experiences evident in patients of colorectal cancer at metastatic stage and undergoing palliative chemotherapy. As asserted by Chawla et al. (2013), it is important to identify the issues and areas of positivity for the patients to provide them with relevant nursing care and improve the nursing efficiency as well. This research also clarifies the issue of finding out relevant coping strategies for such patients to be able to receive the extended chemotherapy for long time. Therefore it is quiet significant to nursing.

The purpose of this research is very clear to highlight the experiences or reflects of the specific category of patients with a strong focus on identifying the coping strategies for colorectal cancer (CRC) patients with the need to survive for long periods with extended chemotherapy.

The stated research question in this article deals with the wide range of experiences encountered by CRC patients under extended palliative chemotherapy treatments. It forms a sufficiently broad research question to conduct a qualitative study, which as per view of Holloway & Wheeler (2010) requires a question that will leave space for all the possible inputs of the subjects that are able to incorporate in a research.   

The descriptive design adopted in this research aligns perfectly with the qualitative approach. In descriptive design there is a scope of assembling the minute details and hidden facts related to the study topic thus enabling consideration of wide range of details, which is in consistence with the qualitative approach (Toloie-Eshlaghy et al. 2011).  

The subjects for this research are selected with purposive sampling based on specific inclusion criteria. The qualitative methodology is in alignment with the purposive sampling and induces the selection of categorized individuals for the study to attain quality and relevant data regarding the topic (Leavy & Hesse-Biber, 2010). The 10 subjects chosen for this research meeting all the inclusion criteria set for sampling is consistent with the qualitative method. Thus, the subjects selected through alignment with inclusion criteria aptly suit the purpose of the qualitative approach for the research in this article

Clarity of purpose

The regional cancer centre in North Island, New Zealand is an appropriate setting to conduct this study on the patient’s experiences of receiving extended palliative chemotherapy for metastatic CRC. Since, a qualitative research requires a small number of sample deriving valid and relevant data, this place with 416200 population base suits the need for qualitative research requiring smaller number of subjects. The number of cases for patients receiving palliative chemotherapy on extended basis is expected to be lesser in this place. As opined by Denzin & Lincoln (2011), a qualitative study is best conducted with a small sample.

The use of the 10 semi-structured interview questions with scope of follow up cues for the participants is highly consistent with qualitative approach as it provided ample scope of putting own psychological information regarding the research topic by the participants. The demographic data and audio recording of the 30-60 minutes interviews are highly aligning to the need of the qualitative approach, which emphasizes on deriving subjective data from the respondents (Appleton et al. 2013). The questions identified in the research that are presented to the patients are highly relevant to the research topic. It provides ample opportunities to the respondents to provide detail insights of their perceptions identifying the issues and positive aspects of palliative chemotherapy in treating patients with CRC.

The current research stated in this article was conducted with the ethics approval from New Zealand Health and Disability Ethics Committee. It is an indication that the research complies with the human rights of the subjects without which they would not have been able to gain the permission. The ethics approval constitute of the criteria of assuring privacy and confidentiality of the patients identity and their data collected, the use of the data for only academic purposes and the assurance of preventing any force of any kind on patients to collect the data (O’Brien et al. 2010). The research highlighting instances when patients were discussed for several times in the data collection and analysis processes are indicative of the fact that a high priority is given to the consent and convenience of the patients. Therefore, it is clearly evident in this research that the rights of the human subject are strictly protected at a high level.

No particular evidence of data saturation is provided in this research article. However, the identification of the 20 patients from 32 selected ones based on the eligibility criteria and on expertise of the oncologist indicates the assumption of data saturation at an early stage of the research conduction. Out of 12 selected through follow up and contact by the oncologist the 10 finally selected respondents indicate a slight degree of data saturation. But any strong evidence is missing.

Broadness of the research question for a qualitative study

Transcribing interviews from digital recordings are highly efficient in data immersion. Consideration of the various interpretations of the collected data through discussions and analysis enable enhancement of trust quotient and rigor of the data. Ellis & Levy (2009) identified the high trust quality and rigor as essential for the data of a qualitative research. It assisted in the providence of experience reflection at the setting and an idea of the effect it has on the data. In the concerned research, the development of significant dominant theme is evident as per frequency through the adoption of an inductive approach. The transcripts used here are very useful in development of the theme by extensively going through the data to develop the new inductive theme. Enhancement of rigor and trustworthiness is evident in the research which is enabled by the efficient data analysis procedures. Therefore, the data analysis process used here are quiet appropriate for analyzing the data collected over here for the qualitative approach.

The evidence of scientific rigor in a research study is based on the presence of aspects as credibility, dependability, trustworthiness, conformability and transferability (Nasponline.org, 2015). In this research the presence of credibility is high depicted by the selection of the subjects by the eminent experienced oncologist. The data analysis processes as transcripts, codes and theme construction from data gathered by digital recording provide evidence for the credibility and the dependability of the research data collection method ensuring high accuracy of the data interpretation. The inclusion criteria used in this research are quiet efficient in ensuring the selection of the most appropriate candidates for the research data collection.

This research depicts high transferability as the subjects are themselves suffering from CRC and undergoing the chemotherapy procedure for over 12 months. However, this research lacks conformability as there is no mention of audit or record keeping of the details of the research. Therefore this research provides sufficient evidence of scientific rigor.

The conclusion of this research identifying the changed trajectory of palliative chemotherapy treatment for the CRC as providing control over the disease for several periods asserting the need of the nurses to develop deeper understanding of the patient experiences and highlighting the effective coping strategies is very appropriate for this research. As stated by Rajandram et al. (2011), this research also concludes by highlighting the importance of communication development between patients, families and health-care teams to ensure transparency, support and trust for a better and effective assessment, understanding and caring for the patient. The conclusion also emphasizes on its efficiency to assess and improve healthcare professionals’ skills and scope of intervention availability. It also focuses on the improvement of ongoing treatment options experienced by the patients of CRC to enhance the quality and quantity of life. Thus, the conclusion of this research seems very appropriate for the study topic.

Consistency of the study design with the qualitative approach

This research seems to provide an implication identifying the potential of the nurses to influence the CRC patients’ experiences regarding the palliative chemotherapy in the setting. Although the implication provide an in-depth idea of the usefulness of the positivity approach at healthcare setting to cope up with the issues of chemotherapy, yet it lacks the specific mention of the experiences encountered by the patients through the procedure. As per the view of McCreaddie Payne, & Froggatt (2010), the efficiency of positivity among patients is seen to enable the development of strong and productive relationship minimizing side effects experienced by the patients. It is a major facilitator for coping with the constant treatment process of chemotherapy. Therefore, the implications are clearly stated.

This study does not include any suggestion for future research.

References

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Chawla N, Butler EN, Lund J, Warren JL, Harlan LC, & Yabroff KR (2013) Patterns of colorectal cancer care in Europe, Australia, and New Zealand. J Natl Cancer Inst Monogr 2013(46): 36–61. doi: 10.1093/jncimonographs/lgt009

Denzin, N. K. & Lincoln, Y. S. (2011) The SAGE Handbook of Qualitative Research.  Page 271, 4th ed. London: Sage Publications

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Leavy, P. & Hesse-Biber, S. N. (2010) The Practice of Qualitative Research. Page 253, 2nd ed. London: Sage Publications

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