{"content":[{"content":{"params":{"panels":[{"content":{"params":{"text":"

\u201cDespite major advances in cancer therapeutics over the past decades, patients with cancer continue to experience significant morbidity and mortality\u201d (Hui et al., 2018, p. 356). According to the Canadian Cancer Society (2020), there would be an estimated 225,800 new cancer cases and 83,300 cancer deaths in Canada for the year of 2020. In 2016, 29.3% of deaths in Ontario were caused by cancer, making it the provinces leading cause of death <\/span><\/span><\/span>(Cancer Care Ontario, 2018). Cancer Care Ontario (2018) also surmised that 1 in 4 Ontarians would die from cancer with men having a greater chance at 27.8% and women at 23.5%. These statistics illustrate a fact that all healthcare practitioners in oncology are aware of: a cure is not always available for people with cancer (Zimmermann et al., 2014). The oncologic journey is taxing on those with advanced, uncurable cancers. The difficulty lies coming to terms with their diagnosis and managing the devastating physical and psychosocial symptoms (Bruera & Hui, 2010). The complex needs of people with advanced cancer and their caregivers come to light months before the persons death (Zimmerman et al., 2014). At this time, they are required to navigate through a healthcare system that places much of the emphasis in cancer care toward <\/span>curative or life-prolonging treatments<\/span> (Zimmermann et al., 2014)<\/span>. <\/span>The<\/span>se <\/span>approaches to cancer care can be quite overwhelming for patients and their families. Berger et al. (2013) surmised that if patients were given the choice, most would not choose to focus their energy on frequent interactions with healthcare systems.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"d58601b0-1036-4db6-a358-e486b73dd4e2","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Background"},{"content":{"params":{"text":"

Palliative care is defined as \u201can approach that improves the quality of life of patients and their families by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual\u201d (Zimmermann et al., 2014, p. 1721).<\/span> E<\/span>arly initiation of palliative care for p<\/span>atients<\/span> newly diagnosed<\/span> with<\/span>advanced cancers is recommended to enhance quality of life, improve symptoms, mood and survival (Bagcivan et al., 2018).<\/span> Christianer and Blinderman (2016) sought to understand patterns of referral to outpatient palliative care services and acknowledged that the <\/span>early implementation of palliative care services<\/span> was<\/span> recognized as an<\/span> essential<\/span> aspect of oncologic care. However, <\/span>the <\/span>rates of referral to palliative care services among oncology patients <\/span>were<\/span> still low, and the decision to refer <\/span>was<\/span> frequently at the discretion of the treating oncologist<\/span> (Christianer & Blinderman, 2016), making the physicians the gatekeepers of this referral process.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n

\u201cPhysician knowledge and attitudes about palliative care have been shown to influence referral patterns for patients with chronic disease in general\u201d (Prizer et al., 2017, p. 862).<\/span> Furthermore, <\/span>\u201c<\/span>s<\/span>everal studies have found that physicians commonly associate palliative care strictly with end of life care, limiting the number of referrals to the service\u201d (Prizer et al., 2017, p. 862).<\/span> As a result, p<\/span>alliative care referrals for most cancer patients take place in the last 2 months of their life or not at all (Zimmermann et al., 2014, p. 1721).<\/span> In cancer care, \u201concology nurses occupy a central role in caring for patients receiving active cancer treatments, including those with serious disease who may benefit from palliative care services. However, there is scant research on the unique impact of oncology nurses in introducing palliative care\u201d (Mohammed et al., 2020, p. 210).<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"32defdb9-398e-46d0-a91e-fcf102c581e2","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"What is Palliative Care?"},{"content":{"params":{"text":"

To understand the nature of the problem, it is essential to understand the current role of the nurse in oncologic palliative care. Nurses occupy a significant space in the provision of oncologic palliative care by way of ensuring that the patient and their family, understand, administer, and report the efficacy of their palliative care treatment plan (Brown, 2013). Furthermore, nurses are involved in many aspects of oncologic palliative care such as \u201cpain assessment\/reassessment, development of a patient-centered treatment plan, implementation of that plan, observing and reporting the impact of that plan, as well as providing and reinforcing patient education\u201d (Brown, 2013, p. 300). These are all the principle features of the nursing process that support best practices in oncologic palliative care (Brown, 2013). Moreover, nurses act an ally to the patient by coordinating many aspects of oncologic palliative care in various settings (Brown, 2013). <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n

What is clear is that nurses are capable of executing oncologic palliative care orders, what is unfortunate is that nurses are not granted sufficient recognition and legitimacy to be involved in the referral process (Sekse et al., 2017), thereby leaving room to further research the <\/span>role of the nurse within the palliative care referral process for oncology patients in the outpatient setting<\/span>. The implication of this research would be to shed light on nursing\u2019s potential contribution to the palliative care referral process by highlighting the areas of the oncology nurses\u2019 scope of practice in the provision of palliative care and creating a space for nurses within the referral process. This will address the issues of sufficient recognition and legitimacy and add to larger number of healthcare practitioners that are able to refer oncology patients with advanced cancers to the timely palliative care services they need.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"b09aaf50-5420-4586-853d-840458852293","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"The Nursing Problem"},{"content":{"params":{"text":"

Given my understanding of the background of this nursing problem, I believe that the philosophical paradigm of pragmatism can be used as lens view this issue. Pragmatism as a philosophical paradigm emerged in the 19thcentury in the United States of America (Kaushik & Walsh, 2019). Pragmatism can be traced back to a discussion group that was formed in the early 1870s in Cambridge, Massachusetts (Kaushik & Walsh, 2019). The founding fathers of pragmatism included \u201cphilosopher, educationist and social reformer John Dewey\u201d (Kaushik & Walsh, 2019, p. 2), who\u2019s work I will cite below. This discussion group included numerous other philosophers, academics and non-academics that further developed the tenet of pragmatism over the past century (Kaushik & Walsh, 2019). Pragmatism as a philosophical movement was established as a result of the founding fathers reaching a fundamental consensus about the underlying assumptions of the paradigm (Kaushik & Walsh, 2019).<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"fe721ff2-1422-435a-906e-91c88a130d11","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"The Beginnings of Pragmatism"},{"content":{"params":{"text":"

Pragmatism was founded on the basis of rejecting the conventional assumptions about the essence of reality, knowledge and inquiry (Kaushik & Walsh, 2019). The pragmatic scholars believed that the scientific method was not sufficient enough to truly approach social science inquiry and the nature of reality (Maxey, 2003). Consequently, pragmatism holds the belief that reality is not static and changes at every turn of events (Kaushik & Walsh, 2019). In this way, pragmatism is similar to the world in which we live, a world that is consistently in a state of change (Kaushik & Walsh, 2019). Pragmatists believe the world is changed through actions and actions are the way we change the nature of our existence; therefore, actions are paramount in pragmatism. (Goldkuhl, 2012; Maxcy, 2003; Morgan, 2014). For pragmatists, knowledge is created through a systematic approach to inquiry that is based on experience, meaning that each person\u2019s knowledge is unique and based on their individual reality (Morgan, 2014). 21st century scholars of pragmatism place emphasis on the work of Dewey (1941), specifically his philosophy of knowledge, which in turn relies on his systematic approach to inquiry (Dewey, 1941 as cited in Morgan, 2014). For Dewey (1941), actions are outcomes of inquiry and serve as a basis for beliefs (Dewey, 1941 as cited in Morgan, 2014). Furthermore, pragmatism insists on \u201crefocusing on inquiry as a central form of human experience\u201d (Morgan, 2014, p. 1048), which requires \u201creconsidering the philosophy of knowledge by replacing the older emphasis on ontology and epistemology with a concentration on inquiries about the nature of human experience\u201d (Morgan, 2014, p. 1048). This act of refocusing allows for pragmatist to create their own meanings of pragmatic epistemology and ontology.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"25de2c22-3127-49b3-b28f-a7c1b1a3a6b6","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"The Underlying Assumptions of Pragmatism"},{"content":{"params":{"text":"

According to Chinn and Kramer (2008) \u201cnursing involves processes, dynamics and interactions that can only be fully understood when science, ethics, aesthetics, and personal and emancipatory knowing come together\u201d (p. 2), furthermore, Chinn and Kramer (2008) assert that \u201cbest practices in nursing are those that arise from praxis<\/span>-<\/span><\/span>critical reflection and action to change what has been in the past and to create a future that enables health for all\u201d (p. 2). The ideas of Chinn and Kramer (2008) align with Dewey (1941) and his aforementioned philosophy of knowledge and systematic approach to inquiry. According to Morgan (2014) the systematic approach to inquiry conceptualized by Dewey (1941) can be summarized into five key points:<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n

recognizing a situation as problematic, considering the difference it makes to define the problem one way rather than another, developing a possible line of action as a response to the problem, evaluating potential actions in terms of their likely consequences and taking actions that are felt to be likely to address the problematic situation. (p. 1047)<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n

This approach to systematic inquiry is the kind of critical reflection and action required to conduct nursing research using the philosophical paradigm of pragmatism. Furthermore, pragmatism and nursing research come to know the world in similar fashions: experience and actions (Kaushik & Walsh, 2019).<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"1abb8492-96ef-49e4-a983-7e9f4d2ffeb2","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Pragmatism in Nursing Research"},{"content":{"params":{"text":"

Further inquiry into the philosophical paradigm of pragmatism has validated my belief in a nurse\u2019s lived experience being the basis of their research. In my practice as an oncology nurse, I have come across this research issue. I have seen firsthand the successes of timely oncologic palliative care. However, I have also witnessed some patients and families miss out on appropriate oncologic palliative care as a result of delayed or non-existent referrals. This is in line with Dewey\u2019s (1941) systematic approach to inquiry, which has the underlying belief that research is a form of inquiry that comes to be from a self-reflective response to a problematic situation (Dewey, 1941 as cited in Morgan, 2014). Furthermore, pragmatism has allowed me to conceptualize my research issue as a call to action as \u201c<\/span><\/span><\/span>pragmatic research is driven by anticipated consequences\u201d (Cherryholmes, 1992, p. 13), which are evidenced by the aforementioned implications for this research. Moreover, applying pragmatism to this research issue recognizes that there is a space for advocacy within this paradigm as \u201cpragmatists have always had a deep sense of justice. They are deeply aware of the suffering of people and of the need to build just institutions\u201d (Kaushik & Walsh, 2019, p. 11). This is also reflected in the implications of this research as it advocates for a role for nurses and access to oncologic palliative care for patients.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"9894b235-f078-4b94-b109-6650bf9838f8","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Pragmatism and the Nursing Problem"},{"content":{"params":{"text":"

Oncology nurses interact with patients and their families in various settings and bear witness to the insidiousness of cancer, however, they are not granted sufficient recognition and legitimacy to participate in the oncologic palliative care referral process in the outpatient setting. Using the philosophical paradigm of pragmatism to guide the inquiry into this research problem will allow for research that is based in critical reflection and action; and will also create a space advocacy for a role for nurses and access to oncologic palliative care for patients.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"116c2a16-86c7-4263-8f5c-da61b8bfb0e7","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Conclusion"}],"hTag":"h2"},"library":"H5P.Accordion 1.0","metadata":{"contentType":"Accordion","license":"U","title":"The Outpatient Oncology Palliative Care Referral Process Seen Through Pragmatism"},"subContentId":"3938c052-9c2e-4b18-87aa-0bc2742d607a"},"useSeparator":"auto"}]}

The Outpatient Oncology Palliative Care Referral Process: A Pragmatic Perspective

Shingirayi Priscilla Chataika