Chronis disease management - Research Paper Example

?Running head: Literature review: Chronic disease management Literature review: Chronic disease management (school) Literature Review: Chronic Disease Management Introduction Chronic disease management is one of the most difficult aspects of health care delivery. It includes various procedures and processes of treatment which help prevent the exacerbation of symptoms and ensure the availability of comfort measures for the chronically ill patients. In most cases, the patients are terminally ill who are in the last few months, or even days of their life. They may also be afflicted with diseases which have no cure, only management interventions. These diseases include cancer, AIDS, diabetes, chronic obstructive pulmonary disease, coronary heart disease, and similar chronic illnesses. Knowledge of appropriate management measures helps ensure adequate management of symptoms, leading to improved patient outcomes. This paper shall critique and evaluate an article on chronic pain management among cancer patients. Literature Review In the paper by Miaskowski, et.al. (2004), the authors sought to test the effectiveness of the PRO-SELF Pain Control Program when compared with standard care in reducing pain intensity scores, increasing appropriate analgesic prescriptions, and increasing analgesic intake in cancer outpatients with pain from bone metastasis. This study covered seven outpatient settings in Northern California, including a university-based cancer center, two community-based oncology practices, one health maintenance organization, one outpatient radiation therapy center, one veteran’s affairs facility, and one military hospital. In this study, the patients were assigned randomly in either the PRO-SELF intervention or standard care intervention. Those under standard care were visited by a research nurse three times, and then called three times by phone between home visits. Those under the PRO-SELF setting patients were visited by specially trained intervention nurses and then received a psychoeducational intervention. They were instructed on how to use a pillbox, and were given instructions on how to communicate with their doctor about pain symptoms and changes needed in analgesic prescriptions. Patients were also instructed during follow-up home visits and three phone calls on how to improve cancer pain management. To ensure the ethical treatment of this study, the authors gained the respondent’s written consent, after explaining to them the purpose of the research and the fact that their identity would remain confidential throughout the research. The ethical committee was consulted first and their review and consent secured before the rest of the research process was carried out. A sample of atleast 150 patients was needed in order to complete this study. Descriptive statistics and frequency distributions were established for the patients’ demographic and disease-related qualities. Independent student’s t-tests and x2 analysis were carried out to determine differences in demographics, disease, and pain qualities between patients in the two treatment groups. Analyses of variance were carried out to establish if there were changes in pain intensity scores over time. The McNemar test was then used to establish differences over time based on kinds of analgesic prescriptions. The P-value of less than .05 was considered statistically significant. This study revealed that pain intensity scores were reduced significantly from baseline figures in the PRO-SELF group, as compared to the standard treatment group. The percentage of patients in the PRO-SELF group with the most appropriate kind of analgesia increased significantly from 28.3% to 37.0% as compared to the standard group which changed from 29.6% to 32.5%. The study therefore established that using a psychoeducational intervention, which includes nurse coaching within the standard of self-care, can improve pain management for cancer patients. Critical Analysis The authors are credible authors for this research. They possess the appropriate credentials needed to carry out the research process accurately and appropriately (Glenn and Gray, 2007). They have degrees in Nursing, as well as post-graduate studies in Nursing. Miaskowski has a postgraduate degree in Nursing, Biology, and Physiology. She has been very much involved in research and on clinical techniques in pain management for cancer patients. She is considered a distinguished nurse researcher and academician (UCSF School of Nursing, 2008). Marylin Dodd has a postgraduate degree in Nursing and a doctorate degree in Philosophy. She is a nurse scientist for the National Children's Oncology Group. She is involved in cancer pain management and has been an active in the program testing for the PRO-SELF program (UCSF School of Nursing, 2008). Claudia West also has a postgraduate degree in nursing. She has also been active in studies and research on cancer pain management. Karen Schumacher has a postgraduate in nursing as well (University of Nebraska, n.d). She has been active in family caregiving for cancer patients and has published various researches in this area. The credibility of authors can adequately established by reviewing their qualifications and background in the relevant field of study (Wolfe, 2001). The sources of the authors are peer-reviewed articles, discussing topics which are very much relevant to the current topic. These sources are sufficiently cited in the reference list. These sources are also primary sources which impart first hand information from events and interventions as they are applied in the actual clinical setting (Velliaris, 2009). They are written by experts in the relevant field of practice and they use academic and scholarly language and terms. They also provide specific and relevant medical terms which are relatable to other scholars in the clinical setting (Edwards, 2006). These sources also acknowledge their materials and they cite all relevant resources included during the research process. The research was very much appropriate in the clinical setting because it was an appropriate venue for the research. There were also available individuals who helped in the conduct of the research process (Moore, n.d). The researchers were able to establish that the research was to be carried out in their own service and that the colleagues would cooperate in the data collection. Moreover, a sufficient number of patients were available to make the study doable in the time set by the researcher. Administrative support was also available for the researchers. In effect, this study became very much appropriate in the clinical setting. The authors justified their interest in their choice of subject by highlighting the fact that the cancer is a major health issue which is not given enough attention. However, the number of randomized controlled trials testing the efficacy of patient interventions on pain management has been extremely limited. The authors then saw the need to test the standard interventions, pitting it against the PRO-SELF intervention, to assess whether or not one is more effective than the other. The design methodology is appropriate to answer the research question because the research theory for this paper helps explain the question. Based on the standards laid out by Coughlan, et.al. (2011) on critiquing research methodology, the research design is clearly identified by the authors. This study is a randomized clinical trial. The data gathering instrument was also described by the authors. Data gathering was done through phone interviews which were carried out in order to monitor patient’s adherence in completing the diary. An academic detailing session with the patient and family caregiver was also carried out; such detailing session was customized to meet the specific of the patient and family caregiver based on responses to the survey. Phone interviews were used to review pain intensity scores and pain medication intake. This instrument is appropriate because it helped establish a clear and accurate picture for the interventions and how they applied to each patient/respondent. The instrument was developed based on the variables and on the research questions which the authors were seeking to answer. Reliability and validity testing were undertaken with the study seeking approval first by the Human Subjects Committee at the University of California in San Francisco. All the subjects and their caregivers were also given a written consent form to fill-up and sign as a means of entering their assent to the procedure. The authors did not mention is a pilot study was undertaken for this research. This study is relevant to the clinical practice because in the current practice, there are no adequate pain management procedures and interventions for cancer pain. Pain is often one of the primary considerations in chronic disease management and in cancer management. Knowing how to manage pain among cancer patients can assist in the improvement of physical and physiological functioning, thereby improving the quality of a patient’s life (Portenoy and Lesage, 1999). Establishing the appropriateness of one pain treatment over another can assist in the application of evidence-based practice. No bias was unintentionally introduced in the study by the authors. No assumptions were made by the author in relation to the rationale of the article. No judgments in relation to the author’s personal preferences were inculcated by the author into the research analysis. The general structure and flow of the research is smooth, with appropriate transitions between sentences and paragraphs. The research process was orderly and organized. There were no grammatical or spelling mistakes seen and the literature was appropriate and very much in relation to the research question. Conclusion Based on the above critique, the study chosen for this critique is a strong and appropriate research for the research question raised. The research is orderly, organized and adequate in relation to validity and reliability standards. It provides an appropriate reference and evidence for actual clinical practice in terms of chronic pain management relief. In effect, the results in this research can be used by practitioners and health managers in the planning and application of interventions for cancer patients suffering from chronic pain. Reference Coughlan, M. Cronin, P. & Ryan, F. (2011). Step-by-step guide to critiquing research. Part 1: quantitative research. British Journal of Nursing, volume 16(2), pp. 658-663. Edwards, S. (2006). 50 Plus One Ways to Improve Your Study Habits. New York: Encouragement Press. Glenn, C. & Gray, L. (2007). The Writer's Harbrace Handbook, Brief. California: Cengage Learning. Miaskowski, C., Dodd, M., West, C., Schumacher, K., & Paul, S. (2004). Randomized Clinical Trial of the Effectiveness of a Self-Care Intervention to Improve Cancer Pain Management. Journal of Clinical Oncology, volume 22(9); pp. 1713-1720. Moore, A. (n.d). Research in the clinical setting. Radcliffe Publishing. Retrieved 12 August 2011 from http://www.radcliffe-oxford.com/books/samplechapter/7068/11_jones%5B6%5D-2c42ce40rdz.pdf Portenoy, R. & Lesage, P. (1999). Management of cancer pain. The Lancet, volume 353(9165), pp. 1695-1700. UCSF School of Nursing. (2008). Christine Miakowski. Retrieved 12 August 2011 from http://nurseweb.ucsf.edu/www/ffmiask.htm UCSF School of Nursing. (2004). Claudia West. Retrieved 12 August 2011 from http://nurseweb.ucsf.edu/www/ffwestc.htm University of Nebraska. (n.d). Karen Schumacher. Retrieved 12 August 2011 from http://app1.unmc.edu/nursing/conweb/view_profile.cfm?lev1=facstf&lev2=fac&lev3=fackschumacher&PubStat=%28none%29&web=pub Velliaris, D. (2009). Source Credibility. University of Adelaide. Retrieved 12 August 2011 from www.adelaide.edu.au/clpd/all/.../learningGuide_sourceCredibility.pdf Wolfe, C. (2001). Learning and teaching on the World Wide Web. New York: Academic Press Read More