Research Proposal on "Medical Futility in Oncology Settings a Conceptual Analysis"

Research Proposal 8 pages (2228 words) Sources: 10 Style: Harvard

[EXCERPT] . . . .

Medical Futility in Oncology Settings: A conceptual analysis

This study will present a conceptual analysis of medical futility in renal care and cancer. It will do so by first analyzing how the funding for medical treatments affects choices to go for certain medical treatments that contribute to the success or failure of medical successes. Then this paper will present numerous other studies that have aimed to lucidly explain the concepts of renal care and cancer support.

"Decision making in terminal care is a demanding and stressful duty for all involved. Frequently, moreover, the situation is ethically complex, and the decisions have been shown to depend not only on patients' preferences or clinical circumstances but also on the personal characteristics of the physician" (Hinkka, 2002). Medical futility in any and every department is dependent upon the kind of decisions that are made on a regular basis, whether it is purely a medical decision, an ethical one or even a personal one.

In a recent study conducted by Soares and colleagues, the impact that the decision making processes have on patients' lifestyles was discussed. They highlighted that most physicians tended to overlook and discourage the use of certain life-sustaining treatments (LST) because of a prior personal experience that they had with it. Others went for only specific treatments because of their familiarity with them. They also assert that the factors of prior knowledge, management, and postgraduate learning were weighed in decision making for more conventional or formal care and treatment choices. Hence, the ethics of one's choices is very important when dealing with medical successes or futility (Hinkka, 2002).

There are certain diagnoses that are found in high percentages amongst nations across the world and hence need high caliber decision making processes that can help the patients and provide them with effective and fruitful treatments and decrease overall medical futility rates. In the table below, we see the distribution of different diagnoses across a random sample of 230 people:

In this study we will primarily focus on renal failure and cancer. There are numerous ways that the patient can choose to seek renal care treatment dependent upon their access to finance. It has to be mentioned here that the medical futility in renal care is directly, and at times, indirectly related to the format and access of finances of the physicians and patients which is why we are studying it here. The following table shows the different ways that finance can be gathered for renal medical treatments and the respective percentages of their use.

If we were to look at UK, and the state of Birmingham specifically, in the years through 1997-1999, we can see that the financial distribution for medical expenditures and funding is not as unevenly distributed, but if finances truly impact that decisions being made on the kind of medical treatment being taken, then medical futility can and is most likely to be simultaneously influenced by it as well. In this study conducted by Bailey (2000, as cited in RWJF 2000), the overall percentage of financial breakdown for the funding processes used within Birmingham has been illustrated in the pie charts below. The figures show that the funding for medical treatments have varied on a year to year basis primarily for patients whose treatments is funded by either Medicare or Medicaid. Also the patients who don't have medical insurance also make up a high percentage of the patients seeking renal care and treatment. It is not hard to find a connection between how funding from Medicare or Medicaid would influence a different format of medicinal treatment and hence a different futility ratio then those patients who don't have necessary funding or insurance.

Numerous studies in the past have focused on how the doctor's personal traits like preferences, opinions, age, ethnicity, expertise, gender and experiences impact their decision to provide either palliative or active treatment to their patients in terminal care. Other factors that have influenced decisions to move forward with a palliative treatment include the patient's perception of the life-sustaining treatment (LST) as well as the physician's ability to understand and correctly diagnose their pain and disease (Hinkka, 2002). However, there have been very few studies done in the past that have focused on how the ethnic differences between the physician and the patient impact the overall vulnerability to deciding to go for a palliative medical treatment especially in the oncology departments.

One of the directions that have been taken in recent years regarding medical futility in renal care is the percentage of elderly patients who suffer from rigorous renal impairment. One such study that was recently conducted was by Stengel and colleagues (2003) where they conducted a through investigation of the occurrence of End Stage Renal Disease (ESRD) across Europe. They found that while age was a significant aspect to understand the phenomenon, it had to be investigated with the phenomena of diabetes, hypertension and renal vascular disease to clearly understand the impact that it had in the patients' lifestyle and decisions to go for medicinal treatments that could prove to be fruitful such as Renal Replacement Therapy (RRT) (Stengel et al., 2003). The following diagram shows the possible reactions of patients when dealing with ESRD or RRT under circumstances that could posed pressures on them, financial, mental, health-wise or lifestyle-dependent, etc.

In a related study, Munshi and colleagues (2003) examine a more holistic reasoning behind the aspects that could influence the overall decision making from the patients to seek palliative treatment for RRT. They highlight that one of the ways that RRT ratios can be improved for the elderly patients is through the change of attitude to a more receptive and recognition ones from the physicians and the nurses.

One of the ways that the physicians and nurses can make the patients seeking RRT feel more comfortable is through enhancing the ways in which they can be facilitated the dialysis treatments and facilities. They can also attain the same results by improving the various strategies available for the dialysis therapies that are offered to the patients seeking RRT (Munshi et al., 2003). One of the main ways that physicians can improve medical futility for Renal Care is by ensuring the new patients of the timely and encompassing approach to solving their medicinal needs. The diagram below shows the options that can be made available

This particular study will take guidelines from other studies that have focused on the medical futility when dealing with renal care and cancer or kidney disorder. For this purpose, we will be discussing the relative and appropriate studies and how they are related to our study. One possible dimension that we can take this paper to is the impact that the financial breakdown of medical funding available to patients can have on the percentage of medical futility that they face.

In a supporting research conducted by Nobel and colleagues (2007), an analysis of the concept of medical futility and renal care was presented. They assert that nearly 1.5 million people all over the world live with an effective procedure of renal dialysis. According to Nobel and colleagues, dialysis is fast emerging in the medical field because now more and more medical care procedures are inclined to focus on preventing patients from going into withdrawals; hence the use of renal care or renal supportive care has been added in the medical lingo. Renal care can and is often used simultaneously with the terminologies of palliative treatment, end-of-life care, terminal care and (Nobel et al., 2007). Hence, in their study, they aim to distinguish what renal care is from all the other treatments.

They used the methodology suggested by Rodgers, termed Rodgers' evolutionary method, to gather the data that they felt would be useful in their study. They also collected abstracts, analyses and evaluations from CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA, published between the 1806 and 2006 with specific keywords like 'renal' and 'supportive care' and searched scholarly articles on eth internet as well (Nobel et al., 2007).

In their study, the asserted that five of renal care procedures were relevant and appropriate. These five renal care procedures included:

"Available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease;

Interdisciplinary approach to care;

Restorative care;

Family and career support; and,

Effective, lucid communication to ensure informed choice and clear lines of decision-making" (Nobel et al., 2007).

These results helped them assert the fact that renal care procedures and treatments were even though most commonly found in the near-the-end-cycle for patients, that wasn't always a necessity or criterion for renal failure to develop. This conclusion helped them assert that there was a need for a multidimensional strategy that involved the patients as well as the family, friends and medical to come together and find common and intricate similarities and aims. This particular practice, according to Nobel and colleagues, will be a great addition in the overall theoretical strength that exists in the… READ MORE

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