Impact of Hospital Palliative Care Consultation - Statistics Project Example

Epidemiologic Critic Paper EPIDEMIOLOGIC CRITIQUE PAPER Context and Rationale Terminally ill patients, as well as their families, are in need of specialized care for various reasons. These are help in decision-making, alleviation of physical distress, reduction of the burden to family caregivers, and improving relationships of the patients and family members (Gelfman et al, 2008). An enormous demand for palliative care has emerged because of an increase in terminal illnesses coupled to the burden it brings on family caregivers. However, scientific knowledge concerning palliative care has been limited, especially with regards to how palliative care programs impact on the patient’s family members. Previous studies have reported that families of terminally ill patients have a significantly high burden. Therefore, Gelfman, Meier, and Morrison (2008) set out to examine quantitatively the impact that consultative services at palliative care centers have on the patient’s family members. This particular research study does not utilize any conceptual or theoretical framework. Purpose and Problem Statement Critique This quantitative research study’s purpose was to examine whether consultative services at palliative care centers improved care quality for the bereaved family. The research question was: what is the impact of hospital palliative care consultation service on the quality of care received by family members of patients who dies at a large NYC tertiary hospital? (Gelfman et al, 2008). The research study qualifies the importance of this question by stating that there is the need for additional information of the relationship between hospital palliative care services and its effects on members of the family. This research question, in turn, qualifies the use of descriptive statistics as part of a descriptive research design. The research article set out to examine a subject that has not been researched widely with regards to hospital palliative care and its impacts on bereaved family members. Assessment of Research Hypothesis The hypothesis for this study was that palliative care hospital services would improve care quality for members of the patient’s family (Gelfman et al, 2008). The research is expected to show that family members of patients who die at palliative care centers, especially those involved in the process of care, have a more favorable experience of their kin’s death, reduced costs and length of stay, and improved satisfaction. The exposure of interest was palliative care support services for the family members of terminally ill patients, while the outcome of interest was the emotional and spiritual effects of the palliative care on the family members. The study used prior research regarding palliative care issues to come up with its hypotheses, citing findings that, members of the patient’s family who had palliative care services reported greater satisfaction overall compared to those who were in institutional settings (Gelfman et al, 2008). In addition, it was also expected that they would have fewer concerns related to unmet issues of care and personal needs. In addition, involvement of family members in the process of decision-making, as well as the process of preparation for bereavement, was also expected to improve the quality of their bereavement period. Sample Size and Study Design Critique This research study used an appropriately assembled sample that is easily identifiable from the report with description of the size and demographic characteristics of the selected sample. The study also incorporates sampling biases, methods used to ensure that the rights of the participants in the sample were protected, and whether participants dropped out of the study prior to its completion. The researchers conducted the study using a criterion that selected participants from the database at the hospital containing names of patient family members (Gelfman et al, 2008). Their eligibility depended on their ill family member having been admitted to hospital for a period longer than ten days, as well as having received consultative palliative care for three days prior to the family member’s death. The family members were contacted using telephone interviews after the terminally ill patient passed away. The interviews were carried out after patients died between April of 2005 and December of 2005. Out of all the eligible 190 participants, 149 interviews were successfully completed with family members. Eligibility for participation also included being a family member, listing as next of kin by the deceased, age of eighteen and above, ability of being contacted up to 200 days after death of their family member, be involved in caring for the patient, and speak English (Gelfman et al, 2008). However, the article did not address ethical issues that could have arisen from the interviews. The research study design was centered on examining improvement of outcomes centered on the family for those who were part of palliative care services (Gelfman et al, 2008). Because the study sought to investigate various aspects of the families that were affected by palliative care services, the research design was appropriately done. One area that was to be described by the study was confidence of family members in their skills of self-efficacy regarding their participation in caring for their terminally ill patients. For this research study, the self-efficacy used was defined as competence that family members perceived when taking part in caring for their dying family members. Some of the descriptive statistics from the study included that, for those taking part in usual care, the reported confidence with regards to knowledge concerning the process of dying was at 68%, while those who received palliative care stated confidence levels of 82%. Another factor that required description was the difference regarding attendance to emotional and spiritual needs compared to those who only received usual care services. Other sub-categories, which were to be investigated included how much support was received by members of the deceased patient’s family in dealing with their personal feelings for usual care and palliative care, as well as referral of family members to psychosocial support for usual and palliative care patients (Gelfman et al, 2008). Critique of Methodology As a quantitative study, the research study used telephone interviews as a means of collecting data with administration of the After-Death Bereaved Member of the Family Interview (Gelfman et al, 2008). The article, however, did not contain the questions administered to the bereaved participants, which means that it is impossible to know what scale they used in collecting data. Data from the participants was collected from three months to six months after the terminally ill patient died. Empirical knowledge was collected, such as those suggesting family members seem to experience decreased distress if they are interviewed after three months following death of a family member, whereas their recall of events at the hospital was valid and reliable following six months of their loved one’s death. The interview instrument was validated using introspective phone surveys of deceased patients’ family members at outpatient hospice centers, nursing home consortiums, and academic medical centers. For this research study, the researchers had to modify the After-Death Bereaved member of the Family Interview to make it more relevant to a palliative setting. The quantitative data attained was analyzed via Chi-square and T tests to compare the survey domains’ summary scores (Gelfman et al, 2008). Various multivariable techniques, such as linear and logistic regression, were utilized in comparing care quality for palliative care patients against usual care patients. The research study used controls for confounding variables like race, age, functional status, socio-economic status, and the patient’s diagnosis in making this comparison. This research study prevalently used descriptive statistics, rather than inferential statistics, because descriptive statistics allowed the researchers to investigate experiences and behavior of the participants in the study. The large data amounts collected by the researchers required that it be condensed into a useable form. The use of descriptive statistics fits the hypothesis, allowing the statistics to be converted into a form that was more useable in a quantitative study. In this case, the collected data was condensed to form percentages that were representative of the sub-group as part of the entire group (Gelfman et al, 2008). Because the study involved a large participant number, validation of statistics in this way was excellent since it enhanced comprehension of the results with regards to end-of-life care. Appropriateness of Conclusion Throughout the research process, the data was supportive of the initial research question posed by the researchers, allowing for an appropriate conclusion. The researchers conclude that the palliative care programs based in hospital settings have a dramatic impact on care satisfaction and family outcomes (Gelfman et al, 2008). Carrying on from their conclusion, the researchers recommend that palliative care services in hospital settings should be improved, while there should be enhancements to training for physicians. These recommendations are also appropriate in light of the findings from the research study. Their conclusion takes into consideration the study limitations stated, especially because they might have affected the finding’s accuracy. For example, the research study only includes families who can speak English (Gelfman et al, 2008), which limits the study’s ability to generalize across families that do not speak English. In addition, the conclusion also takes into account the fact that the study only considered patients whose medical records had next of kin stated in them. This may have rendered the family members’ recall inaccurate. However, the conclusion did not factor in the effects of these limitations, despite recognizing them. Another limitation that the conclusion failed to take into consideration was that only patients who had stayed in hospital for a long time were included in the study (Gelfman et al, 2008). Therefore, families with patients who only spent a short time at the center prior to their death, as well as those who were discharged while still alive into a home-centered setting, were not included in collection of data. Because the research study was conducted in a large New York hospital, questions may be raised about the conclusions arrived at from the findings in other settings and population. The conclusion also fails to consider the lack of randomization in selecting participants, which could have resulted in extraneous variables being included inadvertently into the process of selection. The use of telephone surveys could also have had serious limitations on the validity of their conclusions. This is because, while there was validation of the general survey, the survey used for this study was modified for this specific study (Gelfman et al, 2008), which means that the responses are not valid or reliable sans further tests. However, the recommendations by the researchers that further studies are required for the detection of differences in their reviewed outcome levels are an appreciation of the factors that limit the reliability and validity of their conclusions. Reference Gelfman, L. P., Meier, D. E., & Morrison, R. S. (January 01, 2008). Does palliative care improve quality? A survey of bereaved family members. Journal of Pain and Symptom Management, 36, 1, 22-8. 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