Introduction
Most chronic illnesses occur in older adults and as the average age of the population goes up, the prevalence of chronic illnesses also goes up; indeed, current statistics shows that many older people aged 60 are becoming vulnerable and most affected by these chronic illness (Chronic Illness, n.d). Cancer is seen as one of the chronic illnesses which can be said to be an abnormal condition that currently is accounting for almost 13 per cent of all deaths in the world (The Cancer Cure Foundation, 2002). Lung cancer constitutes the most prevalent form and leading cause of cancer in both women and men especially in USA and other parts of the world (Medicinehealth, n.d). Of all people on whom diagnosis has been carried out, only 2 per cent of those with lung cancer manage to live five years after the diagnosis.
The aim of this essay is to discuss three pertinent questions that are of benefit to healthcare providers and in a way have the capability to increase the awareness of the professionals about the life experience of lung cancer patients, the strategies employed to cope up with the chronic disease and lastly, the means healthcare system could be improved to effectively manage the situation of lung cancer patients using three qualitative research paradigms. Further qualitative interpretive and critical methodologies will be applied to the research question.
Literature review
Lung cancer is a prevalent and a major cause of death for both women and men; and smokers of all type are the ones at highest risk of getting the disease (MERCK, n.d). The issue of cancer in older people is becoming a great concern especially when one considers the aging population (Edelman and Marlene, 2007). The authors suggest that elderly patients with lung cancer need not to be under -treated or over -treated and that those giving care to patients with lung cancer need not to forget that lung cancer is largely an extraordinarily symptomatic disease (ScienceDaily, 2008).
Haas (2010) observes that management of fatigue among elderly lung cancer patients can be facilitated efficiently when all symptoms are assessed and managed effectively. Further, numerous suggested interventions for the management of fatigue are usually drawn from the NCCN Practice guidelines for cancer-related fatigue. There exists barriers to cancer management and despite the existence of numerous guidelines on how effective cancer can be managed, under- treatment of pain remains a significant problem (Sun, Borneman, Ferrell, Piper and Koczywas, 2007). According to the authors they outline barriers to cancer management to be: poor physician training; inadequate knowledge of pharmacologic and other management strategies; and, negative and patient attitudes toward medicine use for pain (Ferrell et al., 2007).
Self-management and self-care interventions aimed at improving physical function and quality of life in cancer patients for a long time have focused on the control of individual symptoms and in general, they have been individually administered by nurses (Adler, Page and Institute of Medicine, 2008, p.96). Most of interventions have targeted control of nausea, pain and lymphedema (McKenzie and Kald, 2003; cited in Adler, Page and Institute of Medicine-U.S., 2008). The interventions have been involved, psychoeducational, self-care, self-management support and cognitive-behavioral interventions (Adler, Page and Institute of Medicine-U.S., 2008). Study by NEW England Journal of Medicine has established that early integratation of lung cancer patients into palliative care systems has the potential to improve patients’ mood and also quality of life while at the same time extend their lives. PRO-SELF program is the most widely used form of intervention for lung cancer patients. The program targets various symptoms of cancer and its treatment and it involves nurses coaching patients and their families (Adler, Page and Institute of Medicine-U.S., 2008).
Research questions
As outlined in the introduction section, this paper will mainly address three key questions: 1) what is the general life experience for lung cancer patients, in this case the elderly? 2) How do the lung cancer patients manage to cope up with their condition? 3) How can healthcare provided to lung cancer patients be improved on?
Qualitative research approach
Tradition of science has heavy roots in quantitative research and its approaches have been justified by the great successes in measuring, analyzing, replicating and applying the gained knowledge from this paradigm (Speziale and Carpenter, 2007). With time, this approach appeared ineffective in some instances this resulted into development of interest in adopting other approaches to study particular human phenomena. The interest finally led to the acceptance of qualitative research approaches as a different way to discover knowledge. According to Pope and Mays (2006), qualitative research does not seek to quantify or enumerate information and as a result, it does not measure. Moreover, qualitative research is not entirely devoid of measurement and it can be used to explain social phenomena. Qualitative research is regarded as the best method which describes human experience and psychological phenomena by use of words instead of numbers. The authors continue to note that qualitative research is concerned with the numerous meanings people attach to their experiences of the social world and as a result, it tries to interpret social phenomena in ways people bring meanings to them (Pope and Mays, 2006). Furthermore, the strength of qualitative research rests on the fact that it is able to study people in their natural setting rather than in artificial or experimental ones.
On the use of qualitative research, Pope and Mays are convinced that qualitative research classifies phenomena or, in this case, answer the question, what is lung cancer which in turn can precede the process of enumerating cases of lung cancer in a defined population (Pope and Mays, 2006). In defining qualitative research, Qualitative Research Consultants Association, provide one of the definitions of qualitative research by stating that qualitative research is, “a systematic, subjective approach that is usually used to describe life experiences and give them meaning” (Qualitative Research Consultants Association, n.d).
In general, qualitative research focuses on the perceptions people have in trying to understand the phenomena related to it. Basically, a good qualitative research has three main characteristics: a clearly formulated question; the use of more than one research method (triangulation); and analysis need to be carried out using explicit systematic and reproducible methods (Ereaut, 2007). Doyle et al. (2005) state that in both palliative care and qualitative research, there is always an emphasis on understanding individual experiences that in most cases may not fit into established categories of knowledge. Generally, there is recognition that each person’s perspective is unique, complex and multifaceted and it is the personal experience that is much valued as a means of establishing what is relevant to care and research.
Qualitative research has the ability, for instance, to explain the factors that influence lung cancer among different groups of people, establish the understanding of many individual people and communities on their held beliefs about lung cancer, explain why majority of people continue to smoke despite the act being the major contributor of lung cancer, and give detailed meaning attached to smoking by different groups in society (Voce, n.d). Moreover, Silverstein, utilization of qualitative research tools in studying particular phenomena is considered as the best method which has the capacity to provide an in-depth description of human life experience and psychological phenomena by using words instead of figures; moreover, it is through qualitative research methods that researchers have the opportunity to collect data in order to provide a valuable exploration of human experience (The International Development Research Center, n.d)Lung cancer among older people can be studied using qualitative research techniques for a number of reasons: lung cancer patients lived experiences are as a result of their perception of the disease; stigma experienced by lung cancer patients can best be described by qualitative research techniques; and lastly, daily experiences of elderly lung cancer patients can be described and analyzed with less quantification hence qualitative techniques becomes the best methods.
Interpretive Phenomenological approach
This research paper is based on three research questions where the first question seeks to explore the general life experience of lung cancer patients and in this case, the older people. As a result, interpretive phenomenological approach will be utilized to provide analysis of the life experience of lung cancer patients. This will be done through adequate descriptions and intense comprehension of lung cancer in elderly people: however, healthcare providers have the role to understand the life experiences of elderly lung cancer patients in order for necessary support to be accorded to them and in the process cope with their chronic illnesses.
Interpretive phenomenological research usually employs tools of research with aim of studying situations in the everyday world from the viewpoint of the experiencing person. Generally, interpretive phenomenology emphasizes the individual’s construction of the life-world (Fade, 2004). For instance, Husserlian phenomenology articulates that social enterprise is a descriptive enterprise that constitute an account of how perception is caused by the interaction of eye and the brain and Husserl note that, researchers need to provide a careful description of what perception it is in order to get a clear picture about the phenomenon that an individual is trying to explain (Dreyfus and Wrathall, 2009). Further, Husserlian phenomenology aims at clarification and not just explanation and in this regard phenomenological descriptions have no aim of employing nor providing casual laws but they mark distinctions among the involved phenomena. The life-world includes assumptions about everyday life such as why people smoke tobacco, the way society regards smoking individuals, and how lung cancer patients can be managed.
Therefore, the aim of interpretive phenomenological approach is to determine the meaning of an experience for the people who have had the life experience and are able to provide a comprehensive description to it (Fade, 2004). Therefore, the life experience of lung cancer patients can be comprehensively analyzed, described and identified using the phenomenological approach since lung cancer patient’s life experience is subjective and reflects perceptions of their living with the disease. Elderly lung cancer patients’ life experiences reflect their perceptions of their living with the disease and also that of their families. The aim of health workers is to obtain in-depth understanding into the daily experiences of lung cancer patients and to gain understanding how they live their daily lives in view of them being affected by lung cancer illness. Interpretive phenomenological approach is seen to provide insightful analysis of lived experiences of lung cancer patients where it is carried out in live narrations and observation by lung cancer patients and therefore health practitioners can understand lived experiences of patients from such interpretive phenomenological approach.
Grounded Theory Approach
The second research question aims to find out how lung cancers patients cope up with their condition. To provide an adequate answer to this question, the grounded theory was utilized. According to Strauss and Corbin (1990), grounded theory investigates six elements in any social experience: causes, contexts, contingencies, consequences, covariance and condition; and they aim to clarify the individual behavior and also the correlation of the factors in any social process (cited in Borgattin, n.d). Furthermore, grounded theory is seen to be more explorative, descriptive and negotiates the assumptions through the interaction of the social process. As a result, grounded theory forms a theory of particular phenomenon rather than description of life experience.
Patricia Munhall, note that grounded theory captures social process in social context and grounded theory research approach is useful when the goal is a framework or theory that explains human behavior in context (Byrne, 2001) thus human behaviors related to health issues (lung cancer) and the accompanying situational challenges can well be suited to grounded theory research. In the perspectives of medicine, grounded theory has been useful in extracting phenomena and hence forms qualified theory that has capacity to discover a solution to various issues while at the same time generating useful information. Explaining the process that elderly lung cancer patients have to cope with in their social lives, Grounded theory is seen to be useful in explaining how lung cancer patients adapt to daily coping mechanisms together with self-management and self-care programs prescribed to them by health professionals. Coping interventions include daily programs to enhance self-care activities, control of symptoms and the eventual prevention of illness symptoms. Therefore, employing grounded theories in addressing the issue of lung cancer enable healthcare providers with adequate strategies to support their patients specifically in their social lives and improve caring strategies in order to achieve better health living goals.
Action Research Approach
The third question generally seeks to find out how healthcare provided to lung cancer patients can be improved. Action research takes place between research and intervention and the main objective of action research is to realize the established particular problems or issues in the social world or in medical sphere (O’Brien, 1998). Furthermore, action research is seen to pay attention to problem solving in social or medical field (Moody, Choong and Greenwood, n.d) by ensuring all participants in the research process are under adequate supervisory management. Moreover, action research has been seen to involve: planning, action, observation and reflection and the research process further involves problem identification, data collections and setting up clear diagnosis, applying achievable solutions. Lees (1975) observes that “action research aims to contribute both to the practical concerns of people in an immediate problematic situation and to the goals of social science by joint collaboration within a mutually acceptable ethical framework.” Hence, action research will provide health care givers with relevant information that in turn helps them to enhance their practice by providing adequate and effective support to elderly lung cancer patients through designing programs to assist them and also lung cancer patients will need to be involved in decision-making processes affecting them.
Conclusion
Lung cancer remains a killer disease especially among tobacco smokers. Of note is the fact that even passive smokers are fast becoming victims of lung cancer and this particular issue has become a great concern to public health officials. Therefore, adequate and combined efforts will be needed in order to address this problem. As a result, this research paper tried to explore in length lung cancer problem in older people whereby three qualitative research techniques were employed in providing answers to three key questions in accordance to lung cancer management. Overall, the three techniques were useful and in-depth in providing suitable answers which healthcare management teams can adopt. Health care providers will need efficient and reliable information to help them provide excellent care to lung cancer patients and such information can only be obtained by employing effective research techniques.
References
Adler, N. E., Page, A. E. K. and Institute of Medicine. (2008). Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting Cancer care for the whole patient: meeting psychosocial health needs. NW: National Academies Press.
Borgattin, S. (N.d). Introduction to Grounded Theory.Web.
Byrne, M. (2001). Health Care Industry: Grounded theory as a qualitative research methodology. Web.
Chronic Illness. (N.d). wrongdiagnosis.com. Web.
Dreyfus, H. L. and Wrathall, M. A. (2009). A Companion to Phenomenology and Existentialism. MA: Wiley-Blackwell.
Edelman, M. and Marlene, S. (2007). Lung Cancer in the Elderly: Factors to Consider. Cancer Network. Web.
Ereaut, G. (2007). What is Qualitative Research? QSR International. Web.
Fade, S. (2004). Using Interpretive Phenomenological Analysis for Public Health Nutrition and Dietetic Research: a practical guide. Proceedings of Nutritional Society. Web.
Haas, M. (2010). Contemporary Issues in Lung Cancer: A Nursing Perspective. MA: Jones & Bartlett Learning. Web.
Lees, R. (1975). Research strategies for social welfare. NY: Routledge. Web.
Medicinehealth. (N.d). Lung Cancer. Web.
MERCK. (N.d). Lung Cancer.The MERCK MANUALS, online Medical Library. Web.
Moody, G., Choong, Y. Y. and Greenwood, J. (N.d). An action research approach to the development of a clinical pathway for women requiring caesarean sections. Web.
O’Brien, R. (1998). An Overview of the Methodological Approach of Action Research. University of Toronto. Web.
Pope, C. and, Mays, N. (2006). Qualitative research in health care. MA: Wiley-Blackwell.
Qualitative Research Consultants Association. (N.d). What is Qualitative Research? Web.
ScienceDaily. (2008). Best Care for the Oldest Lung Cancer Patients, According to New Review.Web.
Speziale, H. S. and Carpenter, D. R. (2007). Qualitative research in nursing: advancing the humanistic imperative. PA: Lippincott Williams & Wilkins.
Sun, V., Borneman, T., Ferrell, B., Piper, B. and Koczywas, M. (2007). Overcoming Barriers to Cancer Pain Management: An Institutional Change Model.Journal of National Institute of Health. Web.
The Cancer Cure Foundation. (2002). Cancer Statistics from NCI/ACS in the United States. Web.
The International Development Research Center. (N.d). An Overview of Data Collection Techniques. Web.
Voce, A. (N.d). An Introduction to Qualitative Research. Web.