Quasi-Experimental Design, Article Critique Example

An article by Borglin et.al (2011) addresses the significance of nursing education and its impact on the understanding of pain management for cancer patients. The article title addresses the selected population focus of nurses and the desired variables for consideration, as well as the type of study that will be conducted. The title is wordy but is necessary to summarize the study objectives. The authors’ background is not addressed other than to provide the employer of Gunilla Borglin, lead author, who works in Sweden (Borglin et.al, 2011). There is also no indication that external funding was secured to perform the study; however, the study is registered with ClinicalTrials.gov.

The study abstract is the appropriate length and provides several headers, such as background, methods/design, and discussion to summarize the most relevant points of the article and its contents (Borglin et.al, 2011). In addition, the abstract is interesting enough to warrant further reading and investigation. The introduction/background section of the article considers the important aspects of cancer and the pain that is often experienced as a result of this disease in its many forms (Borglin et.al, 2011). This section also emphasizes the lack of control and support for pain management in cancer patients, including a summary of the EPIC study and a meta-analysis of 52 prior studies regarding pain in this population group (Borglin et.al, 2011). The nursing problem of ineffective knowledge regarding cancer pain management strategies and techniques is also identified in this section (Borglin et.al, 2011).

The study purpose is clearly explored at the end of the background section and addresses the importance of further knowledge and educational guidance regarding cancer-related pain management (Borglin et.al, 2011). In addition, the study design is introduced to explore pain assessment and management guidelines to improve RN knowledge and understanding of cancer pain and its impact on patients (Borglin et.al, 2011). This section provides further evidence of the study population of RNs and their necessity to obtain additional knowledge and guidance to improve pain management in their cancer patients (Borglin et.al, 2011). The study design is described as quasi-experimental with the use of non-equivalent control groups to determine efficacy and appropriateness for this population (Borglin et.al, 2011). This type of design is described as “less intrusive” and supports a differentiation between the intervention and the variables that may detract from the study findings (Borglin et.al, 2011).

Study participants are clearly identified as RNs from two separate surgical cancer units at a hospital located in Southeast Sweden, and describes the units in detail (Borglin et.al, 2011). Both wards have made the decision to participate in the study, with up to 70 RNs working in these units as eligible for participation (Borglin et.al, 2011). Participants were selected using the Knowledge and Attitudes Survey (KAS) Regarding Pain, along with the inclusion of patients with cancer who have experienced pain under predetermined conditions (Borglin et.al, 2011). RNs who are classified as temporary workers are not eligible for the study (Borglin et.al, 2011).

The study intervention included educational workshops and pain assessment guidelines in order to accomplish study objectives (Borglin et.al, 2011). The control intervention group was designated to receive standard care, while RNs will be measured according to their knowledge and perceptions of pain management using the KAS (Borglin et.al, 2011). Primary and secondary outcome measures are addressed in the study and provide additional support for the study objectives. The study was to be conducted in accordance with a comparison of outcomes measures, such as age, RN experience and education, and cancer diagnosis across the control and intervention groups (Borglin et.al, 2011). The statistical analysis would utilize multivariate and univariate methods to ensure accuracy and appropriateness for further investigation (Borglin et.al, 2011).

The study also emphasized the importance of ethical frameworks in order to protect participants from unnecessary risks by using the Declaration of Helsinki (Borglin et.al, 2011). This included the formal provision of informed consent in both written and verbal terms to ensure that all patients were provided with the study objectives, the risks, and their ability to withdraw from study participation at any time if necessary (Borglin et.al, 2011). It is expected that the risks of participation in the study will be minimal, as the primary objective is to enhance and improve education regarding cancer-related pain management for RNs to be able to treat their patients more successfully in this manner (Borglin et.al, 2011).

Finally, the article concludes with a discussion of the different demands of modern nursing practice and care and the level of knowledge that is required to accomplish these objectives in a manner that is consistent with established guidelines (Borglin et.al, 2011). This section also supports the need for a study of this nature because there are significant challenges associated with the creation of nursing work environments that support continuous knowledge growth and development in the area of cancer-related pain management (Borglin et.al, 2011). The article summarizes the importance of knowledge and accuracy in pain management in order to improve the quality of life for cancer patients (Borglin et.al, 2011). The study does not address significant limitations or conclusions because the article was written during the planning stages; however, it does consider the potential impact of this type of study, its quasi-experimental design, and the development of new improvements in evidence-based practice to expand nursing knowledge and effectiveness in the treatment of patients with cancer-related pain in Sweden and beyond (Borglin et.al, 2011).

Randomized Controlled Trial

An article by van der Peet et.al (2009) addresses the importance of nursing education regarding pain management for cancer patients in an outpatient setting using a randomized clinical trial method. The article title is succinct and describes the study population effectively. The study authors are listed along with their current affiliations at hospitals in the Netherlands; they appear to be qualified to perform the study effectively (van der Peet et.al, 2009). The study abstract is of the appropriate length and describes the relevant aspects of the study using an introduction, materials and methods section, a results section, and conclusions (van der Peet et.al 2009). Each section of the abstract provides basic details regarding the purpose of the study, the number of participants, and the study results in order to keep the reader interested in the topic and the forthcoming discussion.

The introduction section provides additional details regarding the relevance of cancer pain in this population group, with almost 60 percent or more of patients experiencing pain at different stages of the disease (van der Peet et.al, 2009). In addition, this section describes the impact of poor pain management techniques and how this influences patient care (van der Peet et.al, 2009). The current study is also introduced in order to establish the key objectives and purpose of the study, which is to determine how patients impact pain management knowledge and recognition by evaluating the results of 17 prior randomized controlled trials (van der Peet et.al, 2009). The purpose of this exercise was to avoid prior mistakes in study preparation and conduction and to improve outcomes for the study in question (van der Peet et.al, 2009).

The study population was identified using patients in the Netherlands who scored high on the pain intensity scale, which identified 54 patients, along with patients recruited by nurses from outpatient clinics, which identified 65 patients, with a final total of 120 patients (van der Peet et.al, 2009). Eligibility was determined on the basis of a cancer diagnosis, over the age of 18, they could complete the required questionnaire, and their current pain score was four or higher (van der Peet et.al, 2009). They were excluded if they were finished with their cancer treatment prior to 2000, and informed consent was provided to all patients under an approved study protocol (van der Peet et.al, 2009). The control group was provided with the standard care of treatment, while the intervention group was provided with specialized care in the home environment in addition to their usual and customary treatment in the outpatient setting (van der Peet et.al, 2009). The intervention method was broken down into several home visits and sought several outcome measurements at several intervals and included pain intensity, knowledge, quality of life, and anxiety/depression, amongst others (van der Peet et.al, 2009).

The statistical analysis portion of the study included the use of SPSS, including descriptive statistics to convey a number of study variables accordingly (van der Peet et.al, 2009). Mixed regression was also used to establish the use of the protocol method and its impact on patients over a longer period of time, with the random intercept model also explored to identify outcome measures (van der Peet et.al, 2009). Although 120 patients began the study, 83 completed the study and the required follow up procedure (van der Peet et.al, 2009). The study results are described in great detail and emphasize the importance of different perspectives on knowledge and understanding of cancer pain for this population group (van der Peet et.al, 2009). A number of tables are also provided to support the study results and the measurements that were taken throughout the study.

The discussion section describes the relevance of pain intervention on the improvement of pain in cancer patients on a short-term basis, which was beneficial to patients in important ways (van der Peet et.al, 2009). In this context, it was also important to convey the approval of patients receiving the intervention and their support of future interventions to assist with their pain management needs (van der Peet et.al, 2009). However, the efficacy of this type of study over the long term has yet to be determined and requires further investigation (van der Peet et.al, 2009). This may include familial involvement, feedback, and other sources of support to ensure that long-term effectiveness could be achieved (van der Peet et.al, 2009).

The study results demonstrated that there are a number of limitations to consider, which were brief yet concise. For example, the limitations section addresses the significance of discussions regarding the intervention process, which may have impacted associations between patients and their caregivers in different ways (van der Peet et.al, 2009). In addition, the written communication portion of the intervention study was not effective in achieving its desired goals and objectives (van der Peet et.al, 2009). The study recommendations section addresses the importance of educational growth and knowledge acquisition through patient and family involvement in the pain management process, communication using the telephone to improve information exchange and conduct pain assessments, improve nurse-physician contact and communication to address pain management needs, and improve instructional dialogue regarding the needs of patients to improve outcomes (van der Peet et.al, 2009).

This study is relevant because it conveys the importance of improved pain management techniques in an effort to improve outcomes for cancer patients who experience pain throughout the treatment process (van der Peet et.al, 2009). In addition, this process also demonstrates that nurse knowledge must be infused with proper assessment techniques to measure such areas as quality of life, symptom management, recognition and level of pain, and the ability to continue medication as needed in the desired manner (van der Peet et.al, 2009). Therefore, the study is effective to some degree in achieving its objectives, but additional questions must be addressed in future studies in this area.

References

Borlin, G., Gustaffson, M., and Krona, H. (2011). A theory-based educational intervention targeting nurses’ attitudes and knowledge concerning cancer-related pain management: a study protocol of a quasi-experimental design. BMC Health Services Research, 11, 1-7, retrieved from http://www.biomedcentral.com/content/pdf/1472-6963-11-233.pdf

Van der Peet, E.H., van den Beuken-van Everdingen, MHJ, Patijn, J., Schouten, H.C., van Kleef, M., and Courtens, A.M. (2009). Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain. Support Care Cancer, 17, 1089-1099.