As a health care student, I am curious about how health care professionals deal with issues related to their fields. I selected this article, titled “Support Needs of Patients With Oral Cancer and Burden to Their Family Caregivers” because I want to know what are the perceptions of the caregivers regarding their burdens that they bear while caring for their wards. This study (Chen, Tsai, Liu, Yu, Liao, and Chien Chang, 2009 ) was taken from the Cancer Nursing Journal. I am interested in this article since it explained how a.) caregivers take care of patients having operated from oral cancer, and b.) how those patients deal with their conditions and air their needs to the caregivers. At the same time, I wrote this critique to know and elaborate the accuracy, depth and scope of the study especially it concerns about oral cancer. As pointed out by the authors, oral cancer is one of the more common forms of cancer in Taiwan (Chen et.al, 2009), I would like to know how the specific exigencies of this cancer affect caregiver treatment of their wards and how the latter react.
The study, as summarized in its abstract, specifically researched on how patients see their supportive care of needs levels, what are the burdens which the caregivers experience in taking care of them , and what are their factors. For the purposes of this research, 122 pairs of caregivers and oral care patients were used, selected from a facility in Taiwan. (Chen, et.al, 2009),
The patient-respondents-who had just been operated upon- were selected based on a set of criteria pertaining to their health condition and willingness to participate in their study. T The caregiver-respondents are selected based on their age, experience, Chinese-languages communication abilities, and willingness to participate in the study. Several measures were used in the study to determine the burden perception among caregivers and the factors influencing them. The study also used the cross-sectional correlational design as the framework for the research. The authors found out that caregivers primarily consider self esteem as a main “domain” to consider in their perception of burdens even as they have moderate levels of perceptions of burden. The patients highly perceive “unmet supportive care needs” as their main concerns after operations. (Chen, et.al, 2009).
Introduction, Problem Statement And Purpose
In the introduction section, the authors give readers a background on cancer in general, occurrences of oral cancer in the United States, European Union and Taiwan (primarily among males and the result of some individual practices such as drinking, smoking and betel chewing) and the findings of previous studies with regard to perceived needs among patients and caregivers alike. The study specifically notes how postoperative oral cancer patients in Taiwan require attention from caregivers since they have many needs to be addressed. This in turn puts pressure on caregivers to provide the best responses as possible to their wards. The authors also reveal that they utilize the Lazarus and Folkman stress coping and caregiving models as framework.
I believe the study's authors provided an adequate context of the research topic within a.) the issue of cancers and caregiving as a whole. The authors have b.) mentioned the increasing incidences of oral cancer in Taiwan, c.) cited specific culture-centric factors affecting the occurrence of oral cancer in that East Asian country methods most commonly used to treat oral cancer and d.) detailed the known issues about caregiving needs viz-a-viz patients' care requirements. (Chen, et,al, 2009 ) This gives readers-both laymen and health care professionals- an idea on the extent of the issue at hand. I also got interested in the fact that Taiwan was used as the locale for the study. However, it is not clear in the research the rationale why Taiwan was chosen by the authors as the site for the study. They could have elaborated on how the specific traditional practices mentioned could have affected the frequency of oral cancer incidences in Taiwan.
One more positive aspect of the study is that it sought to connect and augment previous studies on oral cancer patients' needs and caregivers' issues on burdens. (Chen, et.al, 2009 ). The authors claim there are no researchers linking the two topics. I believe this will help experts and professional understand further the correlation of the issues and how these can be responded/met. The study is also commendable since it contextualized the perceived “heavy burden” by caregivers within the need to make the hospital stay of the patients as short as possible.
Research Question And Hypothesis
I noticed that the paper did not give out the authors' preliminary research questions and hypotheses. Instead, they have already integrated the questions into the aims which are discussed in the body and mentioned in the introduction. But we can surmise that the researchers wanted to primarily answer the questions of b.) what are the perceived needs of oral cancer patients and b.) how these influences the caregivers perceptions of burden in their work. (Chen, et.al, 2009 ) I also assume that the authors hypothesized that there is a high correlation between patients' needs and caregivers' perceptions of burdens. They may also think that the caregivers' burdens are affected by their relationship with the patients; (eight out of ten respondents are spouses of the patients) (Chen, et.al, 2009 )
This nine-page research doesn't have a separate literature review as is commonly found in journals. Similar to the research questions and hypothesis, the review has been integrated within the paper's body. Some brief highlights of literature reviews are to be seen in the second page-in the introductory part-where it cited studies by Sharpe, et.al (2005), Goldstein, et.al (2004), Houldin (2007) and Blood et.al ( 1994) on the relationship between senses of burden and levels of family support, restricted patient activities, disruption of family life and duration of care, respectively. Semlyn et.al (1998) are also cited when it comes to discussing the relationship between providing forms of assistance to patients and caregivers' levels of perceived burdens.
The researchers used the Lazarus and Folkman stress coping and caregiving models in formulating the conceptual framework. These models pertain to how physical and emotional strains on caregivers' family ties may result once the caregiver thinks his/her ward is already a burden. (Lazarus, RS. and Folkman, 1984 and Pearin, Mullan, Semple and Skaff, 1990 cited in (Chen, et.al, 2009 ). I believe the researchers have adequately conducted the study because they used those models as their conceptual frameworks. These models have adequately explained the adverse reactions by stressed caregivers in caring for their wards. Chen and associates may have augmented Lazarus, Folkman and Pearin,et.al by concluding that a.) there is a two-way process between caregiver perceptions of burden and patients' needs and the necessity for caregivers to have support networks and being prepared to provide long-term care for the patients.
Chen, et.al used the cross-sectional correlation design for this paper; this design is part of the cross-sectional method of study designs. As defined by Peat (2001), cross-sectional studies generally use a randomly selected number of subjects, classified as ‘representative of a defined general population” and then their specific characteristics are measures. This form of study design is useful in providing a “snapshot view” of a trend in a specific sample for a certain period. This study is correlative since it tries to link trends and traits of two different samples (caregivers and patients). This is means that Chen et.al has a “snap-shot” view of trends for two particular samples.
I learned how rigorous were the steps done by the authors in conducting the study. They first sought permission of the respondents and a review board, examined the viability of the respondents and then formulated four questionnaire forms (two each for patients and nurses). The authors then conducted the two-pronged study with the aims of getting the respondents' demographic profile, and the perceived needs (among patients) and levels of burdens (among caregivers). The authors also applied descriptive statistics in interpreting the gathered responses. Specifically, they a.) correlated the relationship between the perceived needs of patients and perceived burdens of caregivers, then they also correlated the identified significant independent variables with five regression models viz-a-viz the five perceived burdens of caregivers.
After reading through the detailed explanation of the findings, I learned that, among other things- majority of the patients were middle aged males, while the most of the caregivers were their spouses. Most of the patients had underwent surgery while two out of three caregivers had no previous experience with caregiving. Of all the respondent caregivers, eight out of ten lived with their wards and spend around 11 hours with them. At some point, almost seven out of ten respondent caregivers had rotated their shifts to other members of the households. (Chen, et.al, 2009),
I also earned that on average, the patients most prioritize the health system and information needs, psychological and patient care and support needs. They least prioritize physical, interpersonal communication and head neck cancer specific needs.
Ranked most among the burden dimensions of caregivers are self esteem, disrupted schedule burden, financial problems, health problems and lack of family support. (Chen, et.al, 2009). The authors say caregivers feel burdened because of lack of social support, and are pressured to provide the patients with daily needs, health system/information details and psychological support. The authors elaborated that the findings supported earlier studies pointing on caregivers' negative outlook. This was because the caregivers were generally caring for their wards- for the first time, hence may not know much about their needs. Many caregiver-respondents-majority belongiogn to lower-income families- say they are worried over the financial costs of taking care of their wards. (Chen, et.al, 2009). These findings show that the authors comprehensively tackled the issue by segregating the variables between the caregivers and their patients.
Summary Conclusion/Limitation And Recommendations
I noticed there is no separate summary for the paper, but this is offset by the brief yet succinct conclusion. The authors have pointed out it's important that caregivers have a comprehensive plan and provide adequate resources to meet their patients' needs. This means that first time caregivers must undergo some review-to be guided by doctors or nurses- before starting to take care of their wards. They should also have adequate money and equipment for them to take care of their wards for a long time. I also agree with the authors' observations that the study was limited only to post-operative stage, hence may not have covered all aspects of patient care.
Chen, S.C., Tsai M.C., Liu C.L., Yu W.P., Liao,C.T, and Chien Chang, J 2009 ) Support Needs of Patients With Oral Cancer and Burden to Their Family Caregivers Cancer Nursing, 32 (6), 473-481. Retrieved from References:http://docs.google.com/gview?a=v&pid=gmail&attid=0.1&thid=12604a73af283a66&mt=application%2Fpdf&url=http%3A%2F%2Fmail.google.com%2Fmail%2F%3Fui%3D2%26ik%3Daeef3b211f%26view%3Datt%26th%3D12604a73af283a66%26attid%3D0.1%26disp%3Dattd%26realattid%3Df_g44dkiml0%26zw&sig=AHIEtbS-NsRJOATgl0QhEoVfHzb-ILDwVw
Peat, J.K. (2001). Health Science Research: A Handbook of Quantitative Methods. New South Wales: Crows Nest.