In recent years, the concept of increasing life expectancy in the management of chronic illnesses such as cancer has prompted changes in the scenario of causes of morbidity and mortality across the globe. Research indicates almost fifty percent of all cancer patients suffer from the advanced stage of the disease which is characterized by a lack of responsiveness to curative treatment (Zimmermann et al., 2014). As such, at the advanced stage, many healthcare professionals provide palliative care with the intention of not only managing the symptoms but also prolonging life. Patients with advanced cancer showcase various symptoms such as pain, malnutrition, anxiety, sleeplessness, vomiting, nausea, depression among others. Palliative care has been recognized as the best management option since it focuses primarily on relieving pain. The World Health Organization defines palliative treatment as ongoing care that is provided to an individual whose condition is not responsive to curative interventions (Mehta, Cohen, & Chan, 2009). Essentially, palliative treatment supports the overall quality of life of patients with debilitating conditions since it focuses on the management of both symptoms and side effects. Since more than eight percent of cancer patients experience pain during the end-of-life care control of pain is of utmost importance.
Previously, the success of cancer treatment was grounded in end-point aspects such as the survival rate of the patients, disease-free survival, and evaluation of the tumor size among others. However, as more patients move to the advanced stages which are unresponsive to treatment, it is evident that patients are not gaining benefits regarding endpoints as such there is a necessity of application of other techniques in assessing the success of medical interventions applied. Undeniably, quality of life is now valued as an outcome especially in the management of pain and prolonging life. Indeed, many medical providers currently recognize the quality of life as an essential outcome next to survival. Since the management of pain is vital among patients with advanced cancer, there is an increasing association between pain intensity and the quality of life in these patients. The need for analyzing and emphasizing techniques associated with enhancement of quality of life and palliation is grounded on the concept that cancer patients deserve to lead a fulfilling painless life despite their lack of responsiveness to curative medication. The study focuses on how healthcare providers and family members of the cancer patients can emphasize both palliation and quality of life as important endpoints in patients with advanced cancer.
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Literature Search
The review was conducted with the intention of identifying articles in palliative care focusing on advanced cancer patients. The studies considered must have applied particular c onceptual or theoretical frameworks to guide their research. Several standard bibliographic databases such as Google Scholar, PubMed, Cuiden, PMC and Research Gate were used. The study applied a combination of various search terms with the intention of increasing the range and the material captured in the search. The terms palliative care, terminal care, and end of life were used to cover palliative intervention. Moreover, the research sought articles that recognize both palliative care and quality of care as essential outcomes in pain management.
The research excluded publications that were grounded on commentaries and editorials. The articles taken into consideration were those that focused on quality of life and palliative care in cancer patients in addition to illustrating a particular theoretical and conceptual framework. The study concentrated on articles published recently, particularly those from the year 2005 to the present day with the intention of capturing as many documents as possible while acknowledging the many changes in the field of healthcare. After careful consideration of more than 25 papers, four relevant articles were selected. The articles postulated different theoretical and conceptual framework in the emphasis of quality of life as an essential outcome in pain management among cancer patients.
Annotated Bibliography
McCaffrey, N., Bradley, S., Ratcliffe, J., & Currow, D. (2016). What aspects of quality of life are important from palliative care patients' perspectives? A systematic review of qualitative research. Journal of Pain and Symptom Management, 52 (2), 318-333.
The purpose of this particular study was to identify the attributes of quality of life that are vital from palliative care patients' perspectives with the intention of supporting the coverage and content validity of the assessment tools associated with quality of life care measurement. The contextual framework adopted in the research showcases that although many tools profess to measure and to assess the quality of life in the palliative care setting no single measurement technique captures all the patient-valued domains. The researchers adopted a systematic review methodology where a synthesis of previous qualitative research was conducted based on the Preferred Reporting Items and Meta-analysis guidelines. The researchers sought articles from various tools including ASSIA, CINAHL, Cochrane Library, Embase, Medline, PsycINFO, and PubMed. The selection criteria included published peer-reviewed, English-language articles that were grounded in primary data. Framework synthesis was eventually applied the identification of significant themes across the different studies. The results of the survey showcased more than 3500 articles were screened, and 24 reviews were selected. The study identified eight important aspects of quality of life including physical, personal autonomy, emotional, social, spiritual, cognitive, healthcare and preparatory. The study concluded there is a broad range of domains that are vital in quality of life assessment in palliative care in patient with life-threatening illnesses. The implication to clinical practice includes the refinement of measures used to ensure the services provided address the various variables of quality of life to support patients and ultimately inform financial decisions in palliative care.
The conceptual framework adopted in this particular research guided the researchers to recognize all the domains associated with quality of life palliative interventions. The conceptual framework provided insight on how the current measures of quality of life are inadequate in addressing different aspects of patients’ perspectives on quality of life as such important in highlighting the purpose of the current research to emphasize the quality of life and palliation in patients with advanced cancer. Therefore, the current research supports the conceptual framework adopted in identification of the different variables associated with quality of life.
Mehta, A., Cohen, R. S., & Chan, L. S. (2009). Palliative care: A need for a family systems approach. Palliative and Supportive Care, 7 (2), 235-243.
The objective of this particular research is to highlight the necessity of care from family members in the event one member of the family has a life-threatening illness such as cancer. The research article is grounded on the Family Systems Theory and its associated tenets applicable to the palliative cancer population. The report applied the systematic review approach where the researchers searched for articles from different databases including Medline and CINAHL for items that were related to palliative care and were grounded in the Family Systems Theory. Several articles confirmed the necessity of holism, balance, boundaries and hierarchal systems in handling the benefits associated with the care of the family for individuals with a life-threatening illness. The results of the study also acknowledged that previous research fails to capture the perception of the entire family and in many cases relies on the opinions of a single member. The clinical implication of the study is that the analysis of the family systems theory is helpful to healthcare providers particularly nurses to ensure they deliver optimal care to the patients particularly care that acknowledges the needs of the family members and the patient alike.
The family systems theory as a framework provides a standard approach on the role of the family members in palliative care and quality of life of an individual suffering from cancer at the advanced stage as such an important emphasizes in the quality of life paradigm. The article supports and recognizes the role of the family members in the care of patients with advanced cancer as postulated in the family systems theory. However, the theory has little weight in the entirety of care of cancer patients considering that patients with life-threatening illnesses require a diverse set of support.
Pereira, A., Ferreira, A., Martins, J., & Barbiera-Figueiredo, C. M. (2018). Nursing theories in palliative care investigation; a review. Hospice and palliative Medicine International Journal, 2 (4), 231-234.
The objective of the study was to clarify the unique and vital contribution of nursing to the delivery of palliative care through the identification and analysis of the different nursing theories applied in palliative care. The study asserts that while palliative care is an interdisciplinary approach, nurses play a significant responsibility in the team context. The research is grounded in different nursing theories and their application in quality of life in the palliative care of patients with a life-threatening illness such as cancer. The study applied literature review methodology where articles published between the year 1994to 2014 were selected from different databases such as Pubmed, CINAHL, B-on, Cuiden, Scopus, Cochrane Library and Embase. Eventually, the researchers chose fifteen articles from six different countries that applied ten different nursing theories in the delivery and assessment of the quality of life in palliative interventions. The results of the study showcased different approaches of nursing are applied in palliative intervention. The model includes the grand method which was the most used model, the Humanistic Nursing theory, Self-care theory, theory of awareness, culture care theory, man living health theory, the theory of transpersonal care, theory of chronic sorrow, theory of unpleasant symptoms, theory of nursing as caring and the method of transition. The survey concluded there is no consensus on the nursing theories applied in palliative care among patients with advanced cancer. The clinical implication of this particular research is that the application of different approaches in different contexts is necessary for the provision of insight on the various domains associated with quality care in palliative interventions.
The nursing theories directed the research process since the researchers concentrated on articles that applied the different nursing theories in the analysis of the delivery of palliative care. Indeed, the survey indicates nurses play a vital rule in the delivery of quality care for patients with life-threatening diseases such as cancer. The present article supports the opinions of the above research on the diverse and vital role of nurses in care of patients in advanced cancer. The different nursing theories in palliative care reflect on the various roles of nurses in patients in advanced stage of cancer.
Zimmermann, C., Swami, N., Krzyzanowski, M., Hannon, B., Leighl, N., Oza, A., . . . Lo, C. (2014). Early palliative care for patients with advanced cancer. Lancet, 383 (17), 21-30.
The primary objective of this particular research paper was to assess the rationale for early palliative care for patients with advanced cancer as grounded on various aspects of quality of life evaluation. The researchers conceptualized that since patients with advanced cancer have a reduced quality of life due to the extensive symptoms including pain associated with the illness, there is a necessity to evaluate the impact of early palliative care. The research applied a case study methodology where the entire research was conducted in Princess Margaret Center located in Toronto, Canada. The survey was conducted between 2006 and 2011. The review encompassed 24 medical oncology clinics that were a cluster randomized through a computer-generated sequence and eventually categorized based on tumor size and clinical site. The study postulated after consultation; follow-up activities involved palliative care or other standard cancer care. Patients gave consent to participate in their group without the knowledge of the existence of another group. The study applied different quality of life measurements including the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp), Quality of Life at the End of Life (QUAL-E), Edmonton Symptom Assessment System (ESAS) among others. The results of the study showcased out of 461 patients involved in the research where 228 were under intervention and 233 under the control group, 393 completed a minimum of one follow-up evaluation. At three months there was no significant difference in the FACIT-Sp score between the two groups, there was a substantial difference in QUAL-E score and no difference in ESAS. The results recorded at the fourth month recorded a significant difference between the control and intervention groups as such implying it is beneficial to pursue early palliative care for patients with advanced cancer. The clinical implication of the research is that there is a necessity of early palliative care for cancer patients in the bid to achieve the various variables of quality of life associated with the end of life care.
The conceptual framework adopted in the study pinpoint on the necessity of early palliative care for cancer patients in efforts of improving quality of life that tends to worsen during the end of life days. The framework guides the entire research and informs on the benefits of early care as showcased by the various quality of life measurement scales. The current article concur with the perceptive of the above research on the importance of early palliative care in efforts of improving quality of life particularly in management of pain in advanced cancer patients.
Conclusion
The four articles utilized in the literature review are mostly systematic reviews of the different conceptual and theoretical frameworks applied to emphasize quality of life in palliative care particularly in the management of pain in cancer patients. Different studies postulated different theories including those grounded on nurses and other medical providers and those rooted in the family members of the patients. One study analyzed the different nursing theories applied in palliative care and provided insight on the role of nurses in care. Another survey relied on the family system theory to evaluate the influence of the family members. However, the approach is inadequate since it focuses on family members as an insight into the care provided to a patient rather than relying on evidence-based practice. Another research built on the perspectives of the patients to develop variables to include in quality of life measurement tool an important aspect in designing and delivering palliative care. Essentially, the articles indicate it is important to develop a comprehensive quality of life measure, insists on the importance of early palliative care for cancer patients in addition to applying different nursing theories depending on the context.
