CLINICAL PROBLEM STATEMENT
The problem that identified in this paper concerns end of lifepatients suffering from Diabetes Mellitus, and specifically addressesthe methodological and ethical issues encountered in research toguide care. These issues affect facets of research such as researchermental and emotional well-being interview strategy recruitingvulnerable people into research projects privacy beneficenceautonomy and justice and, informed consent.
Based on an article by Dunning, Duggan, Savage, and Martin [CITATION Dun13
l 1033 ],multiple notable methodological and ethical issues arise whenattempting to gather evidence to guide the care of end-of-lifediabetes patients. As observed by the authors in search of researcharticles that concerned combinations of diabetes andend-of-life/palliative care, none of the research articles foundincluded the viewpoints of the patients who needed palliative care.
With the current push within the healthcare industry towardsvalue-driven and patient-centered care, it is vital for the inclusionof such patients in the decisions regarding their care. Bischoff etal. [CITATION Bis13
l 1033 ] found a positive link betweenAdvance care planning and improved palliative care quality. Advancecare planning relates to the process through which individualsexpress their priorities and values with the aim of preparing forend-of-life care following their personal preference. These findingscorroborate the primary goal of the research by Dunning [CITATION Dun13
l 1033 ]and colleagues which sought to include end-of-life diabetes mellituspatients in their care process. Not only do end-of-life patientrequire inclusion, but they also need the health professionals torespect their decisions and way of being, and to recognize that timeis precious at the end of their life [CITATION Dun131 l 1033 ].
The theme of inclusion is one that is repeated by Munshi et al. [CITATION Mun16
l 1033 ].They note that palliative care of diabetics is a highlyindividualized process, and consultation with the patient, or atleast with their families, is imperative. End-of-life patientssuffering from diabetes are a heterogeneous population, meaning thateffective treatment strategies can only be attained by carefulexamination of overall health and comorbidities.
The Student Learning Outcome (SLO) related to the earlier mentionedproblem is the second one, which advocates for the ethical conduct ofresearch and translational scholarship. Furthermore, the SLOspecifically cites that the patient’s role as a researchparticipant should be the governing perspective when contemplatingthe research ethics. This outcome is directly related to the abovediscussion since as mentioned by Dunning [CITATION Dun13
l 1033 ]and colleagues, end-of-life care patients warrant particular ethicalconsiderations from the researcher. This is especially true due tothe special ethical considerations that may have to be taken withrespect to such patients. An example is their deteriorating physicaland mental state, which demands periodic checking by the researcherso as to gain informed consent and an affirmation of willingness tocontinue from the patient.
Despite the numerous, and unique ethical and methodological issuesfound when including end-of-life care patients in research concerningtheir welfare, each of the concerns is resolved easily. Suchsuccessful navigation of the ethical paradigm affecting end-of-lifepatients requires the researcher be honest, respectful, interactive,available, and visible to colleagues, participants, and themselves.Furthermore, it is imperative that the researchers have debriefingsessions. Due to the nature of the patients that they will be dealingwith, the researcher involved may encounter emotional and mentaltoll. Debriefing sessions are important to ensure that theresearchers are mentally and emotionally healthy. This action furtherhas a positive effect on the interaction of the researchers with thepatients.
Bischoff, K. E., Sudore, R., Miao, Y., Boscardin, W. J., & Smith, A. K. (2013). Advance Care Planning and the Quality of End-of-lLife Care in Older Adults. Journal of the American Geriatrics Society, 61(2), 209. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760679/
Dunning, T. (2013). Care of People with Diabetes: A Manual of Nursing (Fourth ed.). WILEY Blackwell.
Dunning, T., Duggan, N., Savage, S., & Martin, P. (2013). Diabetes and end of life: Ethical and methodological issues in gathering evidence to guide care. Scandinavian Journal of Caring Sciences, 27, 203.
Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Pandya, N., Swift, C. S., . . . Haas, L. B. (2016). Managment of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association. Diabetes Care, 39, 308. Retrieved from http://care.diabetesjournals.org/content/diacare/39/2/308.full.pdf