Using a PICO(T) Framework and Evidence to Develop Care Practices

Evidence-base practices in healthcare have gained increased importance over recent years. The aim of the model in question is to incorporate previous findings into medical procedures to meet the patients’ needs. Evidence-based approach corresponds with the principles of patient-centered care, as its primary purpose is to ensure patients’ comfort and avoid unnecessary complications. In fact, there are several issues that nurses face nowadays, and evidence-based practices can be effectively used to resolve them. The purpose of this paper is to examine the practical issue of providing terminally ill patients with effective care within the framework of the patient-centered model.

Use of the PICO(T) Approach in the Case of Terminally Ill Patients

Caring for terminally ill patients, namely those with cancer, is a topical issue in the modern healthcare environment. The problem consists of the necessity of a balance between the views of the medical staff and patients’ own wishes. Modern approaches emphasize the importance of patient-centered care, meaning that the opinion of the recipient of medical services must be able to affect treatment procedures, thus promoting patients’ autonomy (Kogan et al., 2016). However, it may difficult to follow this principle when it comes to terminally ill persons, as their wishes sometimes contradict medical practitioners’ ideas of effective treatment. It is possible to implement the PICO(T) approach in this case, meaning that the issue is to be examined within the paradigm of Population (P), Intervention (I), Control (C), and Outcome (O). In the context of the present study, the Population refers to terminally ill patients, especially those receiving cancer treatment. Intervention implies the use of a patient-centered model, allowing people to influence the course of their own treatment. Therefore, the question is: Does the patient-centered model remain effective in comparison to traditional biomedical models in terminally ill patients?

Research Findings

The patient-centered paradigm dominates today’s medical environment and correlates with modern principles of delivering quality care in light of patients’ opinions. According to Tzelepis et al. (2018), this model has been recommended by the Institute of Medicine suggesting major improvements in the areas of “safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness” (para. 2). Decision-making is a matter of paramount importance in any treatment, but it becomes particularly crucial when it comes to terminal conditions. As a rule, medical practitioners remain in control of all treatment-related actions due to their unquestionable expertise. However, as suggested by the patient-centered model, each person deserves to have their autonomy respected. Nevertheless, it is possible to assume that doctors and nurses may prefer biomedical aspects over the patients’ subjective opinion, as terminal conditions usually become a matter of life and death.

While it is natural to attempt to meet the needs of terminally ill patients, practitioners may hesitate to do so if they believe that the person’s decision could lead to severe biomedical repercussions. However, research suggests that cancer patients positively respond to patient-centered efforts on behalf of medical teams (Tzelepis et al, 2018). Tzelepis et al. (2018) state that terminally ill persons value such aspects of care as emotional support and respect. Evidently, having such diseases puts an immense amount of stress on an individual, which is why it is vital to provide emotional guidance combined with physical treatment. According to Miranda et al. (2017), it is widely suggested that quality communication is the key to mutual trust and lower levels of distress. Alleviating stress is, indeed, important in the discussed scenario, and allowing patients to partake in decision-making is one the most efficient ways of creating a better atmosphere.

Traditional models were widely used prior to the development of patient-centered care. While they are presently not as popular in the majority of settings, nursing experience suggests that such paradigms remain in lethal condition treatment. It was often observed that, when facing a dilemma, doctors and nurses focused on biomedical aspects rather than patients’ controversial decisions. In other words, a decision could be made to start or resume treatment, even though it might contradict the person’s views. As a result, patients often reported having poor treatment experience, which contributed to their overall stress levels. Evidently, such a situation is highly unfortunate in the cases of people who face imminent demise, and the patient-centered model aims at eradicating this problem. Berman et al. (2016) highlight the importance of the care paradigm in question, adding that shared decision-making “improves patients’ knowledge, satisfaction, physical and emotional well-being, and trust in providers” (p. 1571). Therefore, the advantages of patient-centered care have valid evidence, gaining additional importance within the framework of evidence-based nursing practice.

Relevance of the Findings

The discussed findings are relevant in the context of the present research, as they provide a professional perspective. Cancer treatment, as well as other lethal illnesses, entails particularly delicate circumstances, as nurses face an ethical dilemma. Evidence-based practice aims at resolving such issues in the most beneficial way. Accordingly, research by Berman et al. (2016), Tzelepis et al. (2018), and Miranda et al. (2017) provides a substantial evidence base. The findings support the patient-centered model and demonstrate effective approaches in palliative nursing.

Conclusion

In conclusion, despite the increasing importance of the patient-centered healthcare model, practical observations suggest that there is room for improvement in the case of terminally ill patients. The PICO(T) method was used to distinguish the primary aspects of the discussed situation. Evidence collected through research suggests that patient-centered care and shared decision-making demonstrate excellent results in medical practice. Therefore, it is important to implement this model effectively in nursing practice, as it ensures trust between patients and practitioners while alleviating stress for the former.

References

Berman, A. T., Rosenthal, S. A., Moghanaki, D., Woodhouse, K. D., Movsas, B., & Vapiwala, N. (2016). Focusing on the “person” in personalized medicine: The future of patient-centered care in radiation oncology. Journal of the American College of Radiology, 13(12), pp. 1571-1578. Web.

Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Person‐centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1). Web.

Miranda, L. S., Datta, S., Melzer, A. C., Wiener, R. S., Davis, J. M., Tong, B. C., Golden, S. E., & Slatore, C. G. (2017). Rationale and design of the lung cancer screening implementation. Evaluation of patient-centered care study. Annals of the American Thoracic Society, 14(10). Web.

Tzelepis, F., Clinton-McHarg, T., Paul, C. L., Sanson-Fisher, R. W., Joshua, D., & Carey, M. L. (2018). Quality of patient-centered care provided to patients attending hematological cancer treatment centers. International Journal of Environmental Research and Public Health, 15(3). Web.