Managing Futility in Oncology Settings Partnerships in Peril Research Proposal

Pages: 10 (2900 words)  ·  Style: Harvard  ·  Bibliography Sources: 10  ·  Level: College Senior  ·  Topic: Health - Nursing

MANAGING FUTILITY IN ONCOLOGY SETTINGS; PARTNERSHIPS IN PERIL

ABSTRACT

Ideally, doctors and nurses work as a team to try to achieve a similar, overall goal: Contribute treatment to foster improvement in patients' health. In consideration of contemporary concerns in this area, this proposed study primarily aims to examine an aspect of the medical professional that requires a partnership approach, the relationship between the nurse and the doctor. During the forthcoming study, the researcher will also consider whether the nursedoctor relationship may be in peril, i.e. due to over-treatment or futile care in the oncology setting. When nurses and doctors experience conflict over the treatment decision, the treatment itself serves as the primary stimulant for the disagreement. Recognizing that other issues may trigger conflict may help doctors and nurses address conflict more constructively, and in turn contribute to nurturing the partnership between them. When nurses and doctors experience conflict due to over-treatment or futile care in the oncology setting and do not utilize tools that help them constructively address the concern, their relationship may be jeopardized.

CHAPTER I

INTRODUCTION

"[A nurse] must begin her work with the idea firmly implanted in her mind

that she is only the instrument by whom the doctor gets his instructions carried out;

she occupies no independent position in the treatment of the sick person"

- McGregor-Robertson, 1902 (Fagin & Garelick, 2004, p. 277).

1.1: Study Background

Simple Teamwork Challenges

The quote introducing the proposed study's Literature Review Chapter (II), which Leonard Fagin and Antony Garelick (2004) present in the journal article, "The doctor–nurse relationship," recounts a time in history when the professional lines in the medical field were perhaps more defined. Today, more than a hundred years after the time of McGregor-Robertson, the relation between the doctor and the nurse may ideally be defined as a partnership relationship.

Ideally, doctors and nurses work as a team to try to achieve a similar, overall goal: Contribute treatment to foster improvement in patients' health, according to the medical publication, "Doctors and nurses: a new dance?"(2000). "In most health services - and certainly in Britain's NHS[,] – [however,] there is more to do than people to do it…"(Doctors and…, 2000, p. 1). Consequently, the inadequate number of professional personnel, along with a myriad of other reasons, contributes to a contemporary concern regarding the "real problem" of conflict between the doctor and the nurse.

When the doctor and the nurses do not work as partners, according to the PRNewswire report in "Physician Executives and Nurses Team Up to Fight Disruptive Behavior" Physician Executives and Nurses Team Up to Fight Disruptive Behavior," (2009), "no one wins. In addition to creating an unpleasant working environment, patient safety can be severely compromised" (¶ 2). In a survey implemented by the American Organization of Nurse Executives (ACPE), more than 95% of the respondents reported regularly witnessing disturbing, disruptive and potentially dangerous behaviors among physicians. More than 56% related that the conflicts they witnessed the doctor engaged in, generally involved a nurse or a physician's assistant.

In consideration of contemporary concerns in this area, this proposed study primarily aims to examine an aspect of the medical professional that requires a partnership approach, the relationship between the nurse and the doctor. During the forthcoming study, the researcher will also consider whether the nursedoctor relationship may be in peril, i.e. due to over-treatment or futile care in the oncology setting. Futile CareOvertreatment

In the article, "'Futile Care': What to do when your patient insists on chemotherapy that likely won't help," James Khatcheressian, Sara Beth Harrington, Laurel J. Lyckholm, Thomas J. Smith (2008), each a medical doctor, as well an active professor, concur that no traditional medical definition of futile care currently exists. According to Khatcheressian, et al., however, "If one considers that the goal of medical care is to achieve a benefit above a certain minimal threshold, then futile care could be defined as care that fails to achieve that benefit" (¶ 1). Confusion may occur, albeit, with conflicting definitions of the word benefit. In addition, use of the word "futility" in discussions of medical care, Khatcheressian, et al. point out, may be ethically hazardous, particularly when the physician's values conflict with those of hisher patient. Vivian E. von Gruenigen, Department of Reproductive Biology, Division of Gynecologic Oncology, Cleveland, Ohio and Barbara J. Daly (2004), Clinical Ethics and School of Nursing, Cleveland, Ohio, however, assert a clinical meaning of futility does, in fact, exist. They relate the following in "Futility: Clinical decisions at the end-of-life in women with ovarian cancer":

Medical futility refers to treatments that serve no physiologic, quantitative or qualitative meaningful purpose. Despite the growth in options focused on symptom management rather than disease eradication, including hospice programs and the more recent development of palliative care programs, there is evidence that many patients continue to receive aggressive interventions, including chemotherapy, until days before their death. While the legal and moral acceptability of treatment limitation is well established, clarity in establishing goals of care, timing of the transition from cure to palliation and communication of specific decisions to withhold further aggressive interventions remain problematic for both patients and clinicians. (von Gruenigen, et al. 2008, Results section)

Overtreatment

In the PowerPoint presentation, "Conflict Over Futile Care: The Wrath Of Mom," Ellen Coffey MD, Erik Fromme MD, Laura Morrison MD, and Charles Schwartz MD (2008), purport the same perception as noted the following regarding overtreatment:

? Context changes as patient condition changes

? Therapy may no longer be appropriate

? Obligation to inform patients when overtreatment occurs

? Safety issue: Can cause harm and suffering (Coffey, et al. 2008, p. 12).

Khatcheressian (2008) appears to disagree with von Gruenigen, et al. 2008) as they note one traditional definition: that a futile intervention is one that:

a. is unlikely to be of any benefit to a particular patient in a particular medical situation, and

b. will not achieve the patient's intended goals.

What invites conflicts, albeit is the concept of benefit, as, the perception of benefit is

highly subjective. "The public, policymakers, ethicists and the medical profession have been unable to agree on a clear, concise definition of futility that can be applied to all medical situations" (Coffey, et al. 2008, p. 12).

Rationale for Study

When nurses and doctors experience conflict over the treatment decision, the treatment itself serves as the primary stimulant for the disagreement. Recognizing that other issues may trigger conflict may help doctors and nurses address conflict more constructively, and in turn contribute to nurturing the partnership between them. When nurses and doctors experience conflict due to over-treatment or futile care in the oncology setting and do not utilize tools that help them constructively address the concern, their relationship may be jeopardized. Robert Becker (2009), a senior lecturer in palliative care for Staffordshire University and Severn Hospice, Shropshire, recounts a number of common challenges confronting those who work in the medical profession in the article, "Palliative care 3: Using palliative nursing skills in clinical practice". Becker stresses that implementing a philosophy of care "which emphasises quality of life, holism, futility, family involvement and which sees death as a natural end of life is an enormous challenge…" (Becker 2009, p.1). Becker recommends a number of tools for medical personnel to utilize, however, Becker stresses that tools only prove to be as good as their users' competence and attitude.

Clear, concise communication, routinely constitutes one particular tool nurses and doctors routinely misuse, according to Zack Phillips (2008) in "Expert calls for action to cut medical disputes; Doctor-nurse conflicts increase hospital risks". In regard to doctor-nurse communications, Phillips notes:

? Communication between nurses and physicians in intensive care units accounts for only 2% of their time, but 37% of the errors.

? Nurses and physicians spend less than 4 minutes communicating during a normal labor. (Phillips 2008, Doctor-nurse communications section).

Along with placing the partnership between the nurse and doctor in peril, consequences from lack of communication andor miscommunication increases the risk of liability exposure for a medical facility, and even more potentially detrimental, may place the patient at risk for harm.

1.2: Study Area The background for the proposed study generally relates to the treatment of patients with cancer (especially end stage cancer), with considerations for the proposed study not being bound by any particular geographical location. The proposed study's primary focus will attune to the nurse and doctor relationship, as the researcher also addresses the futility question.

Research Questions and Hypothesis The primary research question for the proposed study queries: What particular practices may a doctor andor nurse implement to help ensure the relationships in their professional practices remain positive? The three following sub-questions will contribute to the researcher's quest to answer the primary research question:

1. What contemporary concernscontroversies contribute to setting the stage for the professional relationships the doctor andor nurse routinely participate in?

2. How do factors, i.e. over-treatment, impact the relationship between the nurse and the doctor?

3. In treating patients, what contributes to the doctor andor nurse nurturing and maintaining… [END OF PREVIEW]

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