The following questions pertain to: McMillan, S. C. , & Small, B. J. (2007). Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients. Oncology Nursing Forum, 34(2), 313-21. 1) Describe the data collection methodology. What instruments were used? Within 24-48 hours after hospice admission, the RA HHA interviewed the patients independently to obtain demographic information and administered the HQLI, pain intensity scale, dyspnea intensity scale, and CAS.
The RA nurse simultaneously interviewed the caregivers. The three symptom assessments determined which problems the patient was experiencing so the intervention for group III could be tailored to each patient’s situation. In addition, patients completed the MSAS to assess for distress caused by symptoms other than pain, dyspnea, or constipation. Two weeks after entry into the study, and again two weeks later, patients were again asked to report symptom intensity and complete the MSAS and HQLI. The data collection methodology used was interviews.
2) What did the authors say about the reliability and validity of their instruments? To assess pain in patients an NRS was used. Previous research indicates that an NRS is valid and reliable and correlates well other measures of pain intensity. A dyspnea intensity scale was used to assess dyspnea intensity because of its ease of administration and accuracy. Reliability and validity of the one-item rating scales have been supported by a number of studies. Validity of the CAS was evaluated using the known-groups method.
A significant difference between the CAS scores of 32 working adults and 32 patients receiving treatment with morphine or vinca alkaloids supported the validity of the CAS. To ensure that questionnaires were answered completely, data collectors were instructed to review each form as the patient completed it and gently point out any omissions. The RA HHA and RA data collector nurses exchanged forms before leaving the home and checked one another’s forms to ensure that no data were omitted.
3) What limitations did the authors face in data collection? How could these have been lessened or minimized? A limitation of the study is that the protocol as funded did not involve auditing the behaviors of caregivers to determine whether their symptom management changed and whether any changes that were made were appropriate and effective. Patients who were admitted to the hospice often were too ill to participate in the study, and despite careful screening, those who did participate were likely to die before all data were collected.
Starting the study with patients just prior to their hospice admission could minimize the loss of patients during the data collection. Questioning the caregivers about their symptom management strategies at the initial interview and during follow ups can lessen the chance that caregivers changed their symptom management strategies unknowingly to the researchers. 4) What demographic information was reported? On average, the hospice patients were aged approximately 70 and mostly male and had a high school education, PPS scores of 50, and SPMSQ scores of less than 9 points.
5) What were the variables that were studied? Intensity of pain, dyspnea, and constipation, overall symptom distress, and quality of life are the main research variables. 6) Were there any inferential tests used in the analysis of data in this study? If so, what were they? The researchers employed random effects regression models to the data to examine longitudinal changes in the outcomes across the three measurement times. 7) Discuss the use of any figures, graphs and tables. Was the information conveyed in an understandable and meaningful way?
Figure 1, Progression of Patients through the study provided an easy to understand model of the dyads and their activity at each time point. Table 1, Baseline Demographic Characteristics by Intervention Group, and Table 2, Summary of Random Effects Models Over the Follow Up Period, as a Function of Intervention Group Status is not as easy to understand by the general public. One would have to be educated in statistics in order to understand the statistical symbols and what they represent.
Figure 2, Memorial Symptom Assessment Scale Scores Across the Follow Up Period by Intervention Group, is an easy to read and dramatic way to display the results of the research. The following questions pertain to: Rosedale, M. , & Fu, M. R. (2010). Confronting the unexpected: Temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Oncology Nursing Forum, 37(1), 28-33. 1) Describe the data collection procedure. Re-analysis of phenomenologic data from the first author’s original study on survivor loneliness revealed sufficient information to conduct a secondary data analysis.
The first author (a) read the transcripts several times to gain a broad understanding of the text; (b) met with a group of qualitative researchers who reviewed transcripts, identified key quotations, and discussed key codes related to the research question; (c) combined the coded quotations into one file and confirmed the accuracy of the code and quotation; (d) carefully read quotation files and, with the group, identified major major themes by putting key coded quotations together for each research question;
(e) met with the group, reviewed major themes, and engaged in active dialogue to resolve any discrepancies; and (f) reviewed the transcripts and validated the structure of themes alongside interview data. 2) How did the authors address the reliability and validity of their methods? As Thorne (1998) noted, the constant comparative method, interspersing immersion and distance, can be applied to text and support the value of qualitative secondary analysis. 3) What limitations could the authors face when using secondary data for analysis?
The accuracy and completeness of the data are dependent on the individuals capturing and recording the data accurately, completely, and reliably. 4) What demographic information was reported by the authors? The participants were recruited from a volunteer list at Reach for Recovery. There were 13 English speaking women, aged 33-74, who had completed active therapy for breast cancer 1-18 years prior to the study, living in an urban US setting. 5) What were the variables that were studied? Main research variables include breast cancer symptom distress, ongoing symptoms, and unexpected experiences. Symptoms included pain, loss of energy, impaired limb movement, cognitive disturbance, changed sexual experiences, and lymphedema.
The four central themes derived from the women’s experiences of ongoing and unexpected symptoms included living with lingering symptoms, confronting unexpected situations, losing precancer being, and feeling like a has-been. 6) Were there any inferential tests used in the analysis of data in this study? If so, what were they? None that were evident. 7) Discuss the use of any figures, graphs and tables. Was the information conveyed in an understandable and meaningful way? The only figure in the research is figure 1, Temporal, Situational, and Attributive Dimensions of Symptom Distress. The figure displays the three dimensions of symptom distress experienced by post breast cancer treatment females in an easy to read figure.