Priority areas for clinical research in palliative care nursing

Prioritisation of future research topics in paediatric palliative care in Ireland: a Delphi study

This paper reports the findings from a Delphi Study undertaken to identify the research priorities in children's palliative care in Ireland. Palliative care for children is a small and highly specialised field of healthcare that focuses on improving the quality of life of children living with, or dying from, a life-limiting condition. Ideally, support for children requiring palliative care begins at the time of diagnosis, which for many children with life-limiting conditions can be from birth. There is a notable overlap between the needs of children requiring palliative care and those with disabilities and other complex care needs, resulting in care being provided by a range of voluntary and statutory agencies. As a new specialty, there is a need to develop an evidence-based approach to providing children's palliative care. In order to do this in a systematic way, identification of the research priorities in children's palliative care within Ireland is required.

Defining research priorities in complementary medicine in oncology

OBJECTIVES

The high usage of complementary and alternative medicines (CAM) by cancer patients is increasing, despite limited research available to support their use. Therefore identifying research priorities that can inform the evidence base for CAM treatment is relevant for many stakeholders, including funders, researchers and consumers.

DESIGN AND SETTING

Integrative medicine experts, oncologists with interest in CAM research, consumer representatives and CAM practitioners and researchers took part in a modified Delphi process conducted online over three rounds. In round 1 each participant recommended up to five CAM research priorities, which were collated and ranked in round 2 by their potential usefulness in cancer care, using a Likert scale. In round 3, participants ranked the remaining propositions by their ability to impact cancer care in Australia. The lowest ranking priorities were eliminated at the completion of each round.

RESULTS

From the 122 propositions originally submitted by the 27 participants, the highest scoring ones included: studying interactions between biologically based CAM and conventional cancer treatments, examining CAM effects on quality of life, identifying effective communication strategies around CAM, studying the role of physical activity in symptom relief and cancer prevention and exploring the role of acupuncture in cancer care.

CONCLUSION

This method of research prioritisation achieved consensus of opinion among a very diverse group of stakeholders, invited to collaborate around a highly polarising topic. Through a structured interaction, the group agreed on a priority research list acceptable to all stakeholders, which can serve as a blueprint for CAM research in oncology in Australia.

The Delphi process: a solution for reviewing novel grant applications

INTRODUCTION

Traditional scientific review processes are not well suited for evaluating the merits of research in situations where the available scientific evidence is limited and if review panels have widely divergent opinions. This study tested whether a Delphi process is useful in grant selection.

MATERIALS AND METHOD

A Delphi process prioritized novel research proposals in pancreatic cancer. Five reviewers holding similar grants overseas ranked research applications by scientific merit, innovativeness, and level of risk.

RESULT

Three rounds of voting evaluated the best 10 applications received. In the first round of the Delphi process, scores ranged from 5.0 to 8.3. After the second round, the cumulative scores of the eight remaining applications ranged from 10 to 12.6. At the end of the third round, the final cumulative scores of the remaining six applications ranged from 13.6 to 18.2. The four highest ranking applications were recommended for funding, with agreement from reviewers.

CONCLUSION

A modified Delphi process proved to be an efficient, transparent, and equitable method of reviewing novel grant applications in a specialized field of research, where no local expertise was available. This process may also be useful for other peer review processes, particularly where there is limited access to local experts.

Defining research priorities for pancreatic cancer in Australia: results of a consensus development process

Introduction

Pancreatic cancer (PC) is the sixth leading cause of cancer death in Australia and the fourth in the United States, yet research in PC is lagging behind that in other cancers associated with a high disease burden. In the absence of agreed processes to reliably identify research areas which can deliver significant advances in PC research, the Cancer Council NSW established a strategic partnership with the NSW Pancreatic Cancer Network to define critical research issues and opportunities that could accelerate progress in this field in Australia.

Materials and methods

The process consisted of five distinct stages: a literature review on recent progress in PC research, semi-structured expert interviews, a Delphi process, consumer focus groups, and a nominal group process. Information collected at each step informed the development of subsequent stages.

Results

The results from these steps were refined by the nominal group into a set of seven specific pancreatic cancer research goals. The goals were disseminated and led to a new funding scheme for key PC research priorities.

Discussion

This prioritisation exercise provided a much needed “road map” for research prioritisation in PC and served as a checklist to researchers applying for PC research grants to confirm how their research can contribute towards accelerating progress in PC research in Australia.

Prioritization of future research topics for children's hospice care by its key stakeholders: a Delphi study

The Delphi process, widely used in health research to seek consensus on key issues amongst large stakeholder groups, was adopted to allow families, hospice staff/volunteers and linked professionals to identify and prioritize future research priorities for children's hospice care. In the qualitative Round 1, interviews with families (n = 5), linked professionals (n = 18) and focus groups with hospice staff and volunteers (n = 44) led to the generation of 56 research topics categorised within 14 broad themes. To give a larger number of stakeholders (n = 621) (including families n = 293; hospice staff/volunteers n = 216 and professionals n = 112) the opportunity to rate the importance of each research topic and seek group consensus on the future research priorities for children's hospice care, subsequent Rounds 2 and 3 involved the use of postal questionnaires. Response rates to questionnaires were 44% in Round 2 (274/621) and 83% in Round 3 (204/247). Participants prioritized research topics relating to 1) hospice and respite care needs of young people (aged 16 +), 2) pain and symptom management and 3) bereavement and end-of-life care. There was wide acknowledgement by those took part in the process of the difficulty in rating the topics, and emphasis on the fact that all of the topics raised during the project are of high importance and merit further research. The current salient issues perceived by key stakeholders as being the research priorities for children's hospice care were identified. Addressing these priority topics for research would further contribute to the development of a much needed evidence base in children's hospice and palliative care research and optimise the delivery of children's hospice services that are underpinned by valid and robust research.

Exploring the experiences and perspectives of families using a children's hospice and professionals providing hospice care to identify future research priorities for children's hospice care

The main objective of this study is to generate a list of priority topics for children's hospice care research in Scotland from the perspective of its key stakeholders. The method consists of qualitative semi-structured interviews with families using hospice services (n = 5), four focus groups with hospice staff and volunteers (n = 44) and telephone interviews with professionals associated with the hospice (n = 18). Fourteen broad themes emerged following thematic content and interpretive analysis of the interview data. Some of the research themes were specific to certain stakeholder groups, whereas other themes were identified unanimously across all the stakeholder groups as being priority areas for future research. Increasing awareness of and improving access to children's hospice care, hospice and respite care needs of young people, community/home care and issues related to supporting the wider family arose, independently, in all three stakeholder groups as being priority topics for future research. In conclusion, a greater evidence base is required in the field of children's palliative care and the topics researched should be identified and led by those most closely involved in the hospices. Engaging families and care providers in the process of identifying research priorities resulted in the development of an extensive research agenda, which will contribute to quality hospice care for children and families.

Delphi survey of nursing research priorities

PURPOSE/OBJECTIVES

To identify oncology nurses priorities for topics and issues to be addressed by developing a clinical nursing research program at a large comprehensive cancer center.

DESIGN

Delphi survey, completed in two rounds.

SETTING

A large comprehensive cancer center in the southern United States.

SAMPLE

All 1,500 RNs employed at the cancer center. Round I asked nurses to identify topics they believed needed to be studied, and 642 nurses responded. In round II, 567 nurses ranked these priorities.

METHODS

Surveys were distributed to all nurses who work in a variety of settings at the cancer center. Open-ended responses from round I were content analyzed, round II rankings of importance were described, and factor analysis was performed.

MAIN RESEARCH VARIABLES

120 topics were identified from a content analysis of research areas described by nurses in the cancer center.

FINDINGS

120 research priorities were identified. Factor analysis revealed three factors: clinical care, nurses and skills, and administrative aspects.

CONCLUSIONS

The top five research priorities identified at the cancer center were, in rank order, acute and chronic pain, infection rates and control, job satisfaction, nurse-patient ratios and staffing, and nurse retention. This study's survey included items similar to those on the recently conducted Oncology Nursing Society research priority survey. Pain and issues with infection were among the top five priorities in both surveys.

IMPLICATIONS FOR NURSING

Conducting a survey to identify nurses perceptions of research was useful in involving nurses in the conduct of research, and the results were useful guides to beginning a coordinated program of nursing research.

The research potential of practice nurses

Little is known about the research aspirations and experiences of practice nurses. The study discussed in the present paper had three main aims: (1) to assess the level of research interest among practice nurses working in Essex and East London, UK; (2) to identify practice nurses' research priorities; and (3) to explore factors which facilitate and impede the development of practice nursing research. All practice nurses (n = 1,054) in the above areas were sent a questionnaire, and a total of 40% (n = 426) responded after two follow-up letters. Fifty-five respondents who volunteered for further participation were interviewed, either individually or in focus groups. About half (n = 207) of the survey respondents expressed an interest in undertaking research. One-third (n = 145) reported previous participation in research, and 20% (n = 85) had initiated their own research. Logistic regression showed that practice nurses educated to graduate level, and those working in practices with nurse training or participation in external research, were most likely to want to undertake research. Working in a medical training practice was found to be a negative predictor of research interest. Respondents prioritised research into long-term health problems with a high prevalence in the local population; for example, diabetes. Their reasons for wishing to engage in research included improving the service, career development, making work more interesting and reducing isolation. The main barriers identified were lack of time, lack of support from some general practitioners and poor access to higher education resources outside formal courses. The development of practice nurse research would provide a distinctive perspective on health need and service provision. It would contribute to the achievement of the national strategic objective of improving the quality of primary care, enhance the status of the profession, utilise the enthusiasm of individuals, increase job satisfaction and staff retention, and answer real questions.

A Delphi study on the research priorities of European oncology nurses

The importance of establishing priorities for cancer nursing research has been repeatedly acknowledged (Corner 1993, Hunt 2001). A Delphi survey designed to capture research priorities of European cancer nurses was undertaken to document issues perceived as important to European Oncology Nursing Society (EONS) members and to set priorities to underpin an evolving research strategy. The survey comprised three phases, beginning at the second EONS Spring Convention (2000) when European cancer nurses were approached to complete a phase 1 questionnaire. In phase 2, research priority categories generated from responses to the phase 1 questionnaire were reviewed by a group of European cancer nurses. The categories and the placement of all the research questions within these categories were comprehensively reviewed. The final phase involved the distribution of the second questionnaire. Two hundred and twenty three nurses responded to the first questionnaire and 117 responded to the second questionnaire. Prioritisation of research categories reflected diverse views between respondents, with many categories receiving similar overall scores, of almost equal priority. Nonetheless, a number of categories demonstrated high priority throughout Europe namely needs of patients related to communication, information and education; symptom management; experiences of disease and its treatment; cancer nursing research issues (e.g. research facilitation) and cancer nursing education issues. It is recommended that future research examines clusters of research questions around the highest ranked priorities. This may provide both direction and focus to European-wide cancer nursing research, whilst ensuring clinically relevant investigation.

Identification of priorities for nursing research in Spain: a Delphi study

AIM

The aim of this work was to identify priorities for nursing research in Spain. The Co-ordination and Development of Nursing Research Centre (Investén-isciii group) carried out the study using the Delphi technique during the period April 1998 to January 1999.

METHODS

Study subjects were professionals involved in different nursing activities. From 1250 eligible professionals initially contacted, 452 (38%) responded in round 1 and 258 (57%) in round 2. But only 189 filled out correctly the questionnaires from both rounds of data collection (overall response rate was 21.6%).

RESULTS

The participants identified priorities related to continuity and co-ordination of nursing care, quality of nursing care, impact of invasive techniques and treatments on the quality of life of patients, needs of the primary care givers, quality of life among elders, satisfaction of customers and needs of terminal patients and their families.