Protection of human subjects,Phenomenon ,Methodology,Study design,Theoretical model,Significance of the study,Research problem, WHAT IS THE IMPACT OF COMFORT CARE VERSES ALTERNATIVE CARE FOR THE CHRONIC DYING PATIENT FAMILY AND THE HEALTH CARE TEAM

1. Research Proposal
Topic: WHAT IS THE IMPACT OF COMFORT CARE VERSES ALTERNATIVE CARE FOR THE
CHRONIC DYING PATIENT FAMILY AND THE HEALTH CARE TEAM

2. INTRODUCTION
Background to the study
Comfort care is a type of patient care that focuses on symptom and pain managements
Palliative care is a type of comfort and it aims to prevent suffering throughout the course of an illness.
(Blinderman & Billings, 2015).
Hospice care is a type of comfort care whereby a patient is given at least six months to live
Alternative care is a practice that promotes healing that is not based on evidence from the scientific
approach, example include herbalism, yoga, homeopathy, acupuncture, among others.
Observed in a situation whereby physicians find that they can no longer concentrate on offering curative
treatment.(Zimmermann et al. 2016) .
There is a dilemma when it comes to choosing the appropriate type comfort care.

3. Research problem
Comfort care gives patients more comforting and peaceful end (Moir et
al.2015)
Alternative care are more comforting and peaceful for patients (Wiener et
al.2015)
The proposed study will therefore look into the problem of palliative care
selection dilemma.

4. Purpose of the study
The purpose of the study is to:
look into the main determinants that make comfort care and alternative
care effective and desirable for particular patients.
 answer the questions that make patients prefer either comfort care or
alternative care.

5. Significance of the study
When the right form of palliative care is offered, the idea behind this type of healthcare
of making end-of-life comforting and peaceful will be achieved.
Will help understand the factors that make either comfort care or alternative care
more desirable and effective for patients
The study will be seeking to address a particular problem, which is dilemma on the
part of physicians.
The study will be a guide for physicians on how to address this dilemma by offering

6. Theoretical model
The Katharine Kolcaba’s Comfort Theory.
A middle range theory, useful for health practice, education and research.
Places comfort as the forefront of healthcare (Kolcaba & Kolcaba, 1991).
Comfort can exist in three major forms, which include relief, ease and
transcendence.
 There are four main contexts that patients can receive comfort, which
include physical, psycho-spiritual, environmental, and sociocultural.
 By inference, regardless of how close a patient is to death, as long as they
are not dead yet, they need to be comforted.

7. Research questions
What specific benefits associated with comfort care and alternative do
patients mostly desire?
What are the main factors that make either comfort care or alternative
care more desirable by a patient?
How does the use of either comfort care or alternative affect health care
delivery for physicians?

8. Literature Review
The various studies conducted on the impact of palliative care on patients provides
two main forms of care offered; comfort and alternative care(Muecke et al. 2016)
(Jonge et al., 2017)
 Comfort care focuses on keeping patients as comfortable in their last years as
possible (Drolet et al., 2016)
Not all comfort care constitute alternative care (Coelhoet al. 2018),
comfort care is a form of symptom management but alternative care may be used
to treat actual sickness (Schram et al., 2017).

9. Literature Review Cont.’
patients benefit from comfort care by answering favorable to a comfort
rating questionnaire prepared for them (Blinderman and Billings (2015),
The most common forms of alternative care that the study investigated
were massage, acupuncture, and animal assisted therapy (de Jonge et
al., 2017)
the dilemma arise largely because of the fact that different palliative
patients have been found to react differently to comfort care and
alternative care (van Soest-Poortvliet et al. (2015)
the ultimate means by which patients can get the kind of comfort and
peace they need towards the last moments of their lives (Schram et al.,
2017; Spice et al., 2016).

10. Literature Review Cont.’
For palliative care, although the dying patient is the ultimate recipient of
treatment, they are not the only ones who benefit from the outcome of
comfort and peace.
 The immediate relations and friends of patients also benefit when they
can be assured that their loved ones are having a comforting and
peaceful end.
The benefits of the study will therefore expand to include the relatives
and friends who are always close by during palliative care.(Noome et al. 2016), (Drolet et al. 2016)

11. MethodologyStudy design
The study design will be phenomenology- a qualitative research method
Will seek to explore the lived experience of patients, family members as well as the
health care team on the main social factors that influence the reaction of patients to
comfort care options
It enables in-depth and thorough data collection exercise to be performed(Given
,2008)

12. Methodology
Study setting and sample
Medical Oncology unit, four of such facilities will be targeted.
Convenience sampling will be used to select five patients
from each facility and four physicians.
Convenience sampling will help to get access to people
whose current medical conditions make it possible for them to
take part in the study (Hunter & Leahey, 2015).

13. Phenomenon
The phenomenon of study is palliative care options, which will
include comfort care and alternative care.
The phenomenon of study will among other things helps in
ascertaining the factors that cause patients to react differently.

14. Methodology
Instruments
Data collection will be in the form of an interview using an interview
guide as the main instrument. The study will utilize method
triangulation in collecting data.
well structured and easy to evaluate (Kasim, Alexander & Hudson,
2010).
The interview guide will also make the interview a formal one; all
respondents will answer the same set of questions.
Data collection methods
One-on-one and face to face interview will be used in collecting
data.

15. Methodology Cont.’
Analysis strategy ( statistical analysis)
The data to be collected will be analyzed through the use of
content analysis method.
A qualitative method of data analysis, whereby the researcher
thoroughly reads through the narrative data to make
deductions and interpretations of findings in relation to themes
set for the study (Moballeghi & Moghaddam, 2016).
The narrative data will be in the form of interview transcripts,
while the themes will be developed using the research
questions

16. Protection of human subjects
Data collection will be conducted in a way that protect
respondents from emotional and physical harm. Informed
consent will be obtained before participation in the study.
 Physically, it is not expected that participation in the study
will pose any harm or risk to respondents. Emotionally, the
researcher shall put in place measures to ensure data
collection is both confidential and anonymous (Diriwächter &
Valsiner, 2016). Participation will also be highly voluntary.

17. Limitations
Because the study is going to be a qualitative research, the
researcher will not be able to include as many respondents as
possible.
This situation could possibly impact on the generalization of
research findings as the findings may be only applicable to the
research settings used.
 It was part of approaches to reducing this limitation that the
researcher proposed to select respondents from different
hospice facilities.

18. REFERENCES
Blinderman, C. D., & Billings, J. A. (2015). Comfort care for patients dying in the hospital. New England Journal of Medicine, 373(26), 2549-
2561.
Ciemins, E. L., Brant, J., Kersten, D., Mullette, E., & Dickerson, D. (2015). A qualitative analysis of patient and family perspectives of palliative
care. Journal of palliative medicine, 18(3), 282-285.
Coelho, A., Parola, V., Sandgren, A., Fernandes, O., Kolcaba, K., & Apóstolo, J. (2018). The Effects of Guided Imagery on Comfort in Palliative
Care. Journal of Hospice & Palliative Nursing, 20(4), 392-399.
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19. REFERENCES
Drolet, C., Roy, H., Laflamme, J., & Marcotte, M. E. (2016). Feasibility of a comfort care protocol using
oral transmucosal medication delivery in a palliative neonatal population. Journal of palliative medicine,
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20. REFERENCES Cont.’
Hunter, L. & Leahey, E. (2015). "Collaborative Research in Sociology: Trends and Contributing Factors". The American Sociologist 39 (4): 290.
Kasim, R., Alexander, K. & Hudson, J. (2010). A choice of research strategy for identifying community-based action skill requirements in the
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Moballeghi, M. & Moghaddam, G.G. (2008). "How Do We Measure Use of Scientific Journals? A Note on Research Methodologies".
Scientometrics (1): 125–133.
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21. REFERENCES Cont.’
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review of communication-based competencies essential for patient and family satisfaction. American Journal of Hospice and Palliative
Medicine®, 34(9), 887-895.
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experience, and attitudes. Canadian Family Physician, 62(8), e484-e494.
van Soest-Poortvliet, M. C., van der Steen, J. T., de Vet, H. C., Hertogh, C. M., Deliens, L., & Onwuteaka-Philipsen, B. D. (2015). Comfort goal of
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adolescents and young adults with cancer. Clinical oncology in adolescents and young adults, 5, 1.
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22. Zwicker, J., Martineau, I., Walsh, S., Lavoie, J., Weger, E., & Scott, J. (2017). Improving the comfort of nurses caring for stroke
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