The application of research methodology to cancer research

Carmel Sheppard

Unfortunately the impressive list of advancements in the science of medicine appears to have led to a decline in the art of medicine. Patients complain increasingly that high tech' medicine dehumanises them. In the eternal quest for a new and better treatment for every known ailment we have started to forget the other important needs of sick people

Fallowfield (1990, p. 16)

The preceding chapters of this book have focused principally on the 'scientific' advances in cancer treatment that have been primarily led by scientists and consequently mostly lie within the biomedical domain. This never-ending search for a greater understanding of what causes cancer, the biological effect of cancer on the body, and the search for new drug regimens to improve survival or even cure cancer are essential and give hope to us all. Indeed the recent improvements in cancer survival rates demonstrate the advances made through such clinical research. Many patients' lives have been extended and enhanced through the introduction of new treatment regimens. Nevertheless, it is important not to forget the individual in all of this, who has to cope with the consequences of treatment, live with the knowledge of a life-threatening illness and the devastating psychological effects that this brings to the patient and family. In the past decade it has been encouraging to see this aspect of care incorporated into many national clinical trials and the growing recognition of its importance. This is illustrated by the emergence of quality of life as a required endpoint of many trials. However, although some progress has been made overall, there remains a paucity of nursing research to support certain nursing interventions, e.g. the advantages of specialist nursing intervention, as well as evidence relating to survivorship and rehabilitation, and the relationship between nursing and patient outcomes (Corner, 2002; Richardson et al., 2002). Following a literature review between 1980 and 2000, only

446 articles pertaining to cancer nursing research were identified, with less than 50% of these reporting primary nursing research (Richardson et al., 2002).

Why do we need to continue to develop a research-based knowledge in cancer nursing? Research is the means through which we can gain a deeper understanding of the effects of cancer, formulate questions about patient care, test the effectiveness of pre-existing treatment and care, and in turn generate new ideas and evidence for practice. Understanding the effects of cancer and its physical and psychological impact will inevitably enable nursing to prepare patients more readily and support patients experiencing similar circumstances. Ultimately, through research we aim to improve the overall quality of care for patients. In addition, through nursing research we can strengthen the ability and opportunities for nurses to influence health-care policy by identifying the priorities and requirements of the future health service (DoH, 2000c). Sadly, the ability to do this has been hampered by the lack of research-based knowledge from which to draw, in comparison to our medical colleagues. It is not therefore surprising that health-care policy has been traditionally dominated by medicine. To ensure that patients benefit from a truly multidisciplinary approach to care, it is essential that we strive to develop this knowledge base. To do so is dependent not only on time and funding, but also on the ability to produce well-designed research that generates meaningful results. Richardson et al. (2002, p. 7) suggest that 'nursing research has too often been hampered by a limited focus, small sample sizes or inadequate rigour'. Although nurse education now includes training in research methodology, this has not always been the case, and the general prevailing culture in nursing outside academic institutions does not appear to sustain a major commitment to research. Richardson et al. (2002) identified that less than half (44%) of lead cancer nurses identified current nursing research initiatives in their clinical areas.

The Department of Health document The Nursing Contribution to Cancer Care (DoH, 2000d) suggests that one of the main barriers to research is the lack of training in this area. One of the functions of this chapter is to provide the reader with a basic understanding of research design, setting out steps towards developing a research proposal, as well as being a useful guide to critiquing published research.

Research is sometimes viewed as a series of complex methodological investigations reserved for academics, yet as nurses we are frequently engaged in research without realizing it. Research questions should be formulated within clinical practice, e.g. where there is limited evidence to support a particular aspect of clinical care, or through the observation of certain trends while working with a group of patients, or concerns relating to treatments. Some clinical areas have developed journal clubs that serve as a vehicle through which debate can be encouraged and ideas generated for investigation.

A well-structured proposal is a prerequisite for any research investigation. This should follow a systematic set of rules, which importantly demonstrate that rigour has been applied to the study. A research proposal should include a literature review that justifies the need for research in a given area. The overall aims and objectives of the project should be stated and, if the project aims to test theory (deduction), the hypothesis should be stated. The design of the study, the sample unit, methods of data collection and analysis should be presented and justified. In developing a study several considerations should be made:

• What is the topic to be investigated? This should be clear, focused on a specific aspect, free of ambiguity and achievable.

• What sort of information is needed before the start of the research, i.e. literature search, anecdotal evidence?

• What sort of evidence is needed to answer the question?

• What type of investigation would provide the evidence needed?

• What are the resources required for the study, e.g. time, finances, supervision etc?

• What is a realistic time frame for the study?

• How will the results be disseminated?

The design of the study should be that which answers the question best. In reality the design is often determined not only by the question but also by the philosophical underlying assumptions/ perspectives of the researcher, which fall into either positivist or naturalistic perspectives, sometimes referred to as quantitative or qualitative research, respectively. Costs, time and expertise will also to some extent influence the design the study.

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