Research Proposal: Predictive Factors for Hodgkin's Lymphoma Patients

This research proposal explores predictive factors associated with Hodgkin's lymphoma relapse. It begins with an introduction to cancer, life expectancy, and lymphoma, specifically focusing on Hodgkin's lymphoma, its stages, and the impact of aging. The proposal includes a literature review, detailing the search strategy and a review of relevant articles. It outlines the research question, aims, and objectives, providing an overview of the study's methodology, including study design, sample selection, data collection, and analysis. Ethical considerations, a study timetable, a Gantt chart, and resource allocation are also presented, along with plans for dissemination and a conclusion. The proposal aims to identify factors that predict patient outcomes after relapse, contributing to improved treatment strategies and patient care. The document is a comprehensive overview of the research process, from background information to detailed methodological approaches.

Running head: RESEARCH PROPOSAL
Predictive factors which associate patients with Hodgkin’s lymphoma after relapse
Name of the Student
Name of the University
Author Note

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RESEARCH PROPOSAL
Table of Contents
Introduction...................................................................................................................2
Cancer and life expectancy.......................................................................................2
Lymphoma................................................................................................................3
Hodgkin’s Lymphoma............................................................................................4
Advanced stage........................................................................................................5
Hodgkin’s Lymphoma and aging...........................................................................5
Background to the study...........................................................................................7
Literature Review..........................................................................................................7
Literature Search Strategy........................................................................................7
Review of the Articles...............................................................................................8
Research question......................................................................................................11
Research aim..............................................................................................................12
Research objectives...................................................................................................12
Overview of the study.............................................................................................12
Methodology...............................................................................................................13
Study Design...........................................................................................................13
Sample........................................................................................................................15
Data collection............................................................................................................16
Data Analysis..............................................................................................................17
Ethical Issues..............................................................................................................17
Study Time Table........................................................................................................18
Grant Chart.............................................................................................................18
Resources...................................................................................................................19
Dissemination.............................................................................................................19
Conclusion..................................................................................................................20
References.................................................................................................................21

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Introduction
Cancer and life expectancy
In the UK and worldwide the incidence of cancer is constantly rising. Despite
the increase in cancer rates, average life expectancy of the population has also
increased over time. Worldwide, the number of people with cancer has increased
from approximately 45.6 million in 1990 to 100.4 million in 2017 (Max Roser&
Hannah Ritchie, 2019). This worldwide increase in cancer incidence is aligned with
the increase in the global population (Figure 1).
Figure 1: Cancer incidence and population growth.
Sources: a) https://data.worldbank.org/indicator/sp.pop.totl
b) https://ourworldindata.org/cancer

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More specifically for the UK, the age-standardised cancer incidence rate has
increased for both men and women. The percentage include516.2 per 100,000
females in 2006 to 541.1 in 2016 and from 671.0 per 100,000 males in 2006 to 704.4
per 100,000 in 2013 (Office of National Statistics, 2019). Incidence rates forall
cancer types are strongly associated with the age of the cancer patients, with the
highest rate of incidence is observed among older people. Between 2013-2015 in the
UK, on average each year around 36% of reporting of new cases were in people
aged 75 and over (Cancer Research UK, 2019). Furthermore, cancer casesare
expected to rise even more in the next years. According to City of Hope (2019),
between 2010 and 2030, cancer incidence is expected to rise by around 67% in
those aged 65 or older. Also, the cancer incidence is expected to rise by 11% for
those under the age of 65.
Globally, deaths from cancer increased from 5.7million in 1990 to 9.5 million
in 2017(Max Roser& Hannah Ritchie, 2019). The number of deaths by cancer is not
only influenced by the actual change in the prevalence of cancer, but also from the
population size and age. One metric that corrects for the population size and age is
the age-standardised mortality rate. An age-standardised rate should not be affected
by any changes in the distribution of the population by age and size (WHO, 2019).
Although cancer incident numbers are increasing, the age-standardised death rate
from cancer is globally decreasing. According to Max Roser and Hannah Ritchie
(2019), the age-standardised mortality rate has decreased by between 15% to 20%
globally between 1990 and 2017.
Lymphoma
A big proportion of the blood cancers that occur are lymphomas or cancers of
the lymphatic system. Lymphomas are a group of lymphatic cancers that occur in the
lymphocytes. There are two types of Lymphomas, Hodgkin’s lymphoma and non-
Hodgkin’s lymphomas. Like many other type of cancers, the overall incidence of
lymphomas mainly increases by age, with a third of most newly diagnosed cases
diagnosed in those aged 75 years or older (Cancer Research UK, 2018).
Risk factors for lymphoma include:

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● Relatively uncommon risk factors. The most common example of relatively
uncommon risk factors is immune-deficiency states. As it is mentioned by
Hatton, Collins andSweetenham (2014) the emergence of HIV/AIDS during
the 1980s and 1990s was reflected by the rising incidence of lymphoma
during this period. Furthermore, there has been a significant decrease of
AIDS-associated lymphoma since the introductionof highly active anti-
retroviral therapy (HAART).
● Common risk factors. Many studies have implicated incidence and
development of lymphoma with various environmental factors. Many of these
studies have the disadvantage of recall or selection bias.However, a non-
harmful environmental exposure which is not highly related with the incidence
of lymphoma can still contribute substantially to the rising incidence of
lymphoma if this exposure happens to a large number of people.
Different treatments forHodgkin’s and non-Hodgkin’s lymphomas include
systematic treatment like chemotherapy and immunotherapy, or localised treatments
such as radiotherapy.There are two treatment options which are
● Curative (i.e., eradicate the cancer completely)
● Palliative (i.e., alleviate symptoms of cancer)
The treatment option is selected based on the lymphoma type, previous
treatments, other health problems and patient wishes (National Institute for Clinical
Excellence, 2004).
Hodgkin’s Lymphoma
Hodgkin’s lymphoma is a type of lymphoma which emerges from a malignant
B-cell. Therefore, Hodgkin’s lymphoma is regarded as a B-cell lymphoma. It usually
affects young people and it can be cured in most cases.The most common signs of
adult Hodgkin’s lymphoma are swollen lymph nodes, high fever, night time sweats,
and extreme weight loss (National Cancer Institute,2019).
Hodgkin’s lymphoma is divided into the following two types:

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 Classic Hodgkin’s lymphoma (cHL): Approximately 1800 new cases of CHL
are diagnosed every year in the UK. The majority of the patients are between
15 and 35 years old (Hatton, Collins &Sweetenham, 2014).
 Nodular lymphocyte-predominant Hodgkin’s lymphoma (nLPHL): nLPHL is
more rare and clinically different than cHL and the malignant cell is called
lymphocytic and histiocytic (L&H) call.
Management
Early stage cHL used to be treated by radiotherapy alone. The disadvantage
of this treatment was the association with high relapse rate and toxicities caused by
the radiotherapy. Recent treatments involve two to four cycles of chemotherapy
(e.g., ABVD) which sometimes is followed by radiotherapy. There are two groups of
treatments for early stage nLPHL patients(Lymphoma Action, 2019). Patients without
B symptoms usually have a surgery to remove all lymph nodes that contain
lymphoma, or radiotherapy alone, or a combination of a surgery followed by
radiotherapy. nLPHL patients with B symptoms need stronger treatments which
involve chemotherapy.
Advanced stage
Hodgkin’s Lymphoma and aging
Hodgkin lymphoma affects both children and adults and it is most commonly divided
in the following groups:
 The first group contains people aged from 15 to 40years old and usually
young adults in their 20s.
 The second group contains older people over 55 years old.
The average age of diagnosis is 39. However, the disease is rare in children who
are younger than 5 years. It is the most commonly diagnosed cancer in teens ages
15 to 19years(Cancer.Net, 2019).A 5-year survival rate is used to estimatethe
approximate percent of people live at least 5 years after the diagnosis of cancer. The
5-year survival rate for all people with Hodgkin lymphoma is 87%. Depending on the
stage the 5-year survival rates are the following:
 Stage I – 92%
 Stage II – 93%

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 Stage III – 83%
 Stage IV – 73%
The rates may be affected by the cancer subtypes and the stages of Hodgkin
lymphoma and the age and gender of the patient (Cancer.Net, 2019).

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Background to the study
A review of previously published literature is important in order to gain proper
understanding about the topic of the research, the scope of the research, research
gap and research question (Kinght, 2002). “Claim making” then helps to connect
these understanding with the ideas that are pre-existing in the literature in order to
support the significance of the conduction of research. It also helps to set the
direction of the research of the path in which the research is required to be
undertaken (Kinght, 2002). The positioning of the research proposal in relation to the
review of literature is regarded as one of the primary pillar of the conceptual
framework generation of the research (Holliday, 2016).
Literature Review
Literature Search Strategy
The main databases that were used for the research of the literary article
include Medline, CINHAL, BNI and PsycINFO. The databases were accessed with
the help of NICE Healthcare Database Advanced Search (HDAS). These databases
were selected for the search of the previously published literary articles because
there databases are hub of literary papers that are aligned to nursing research, or
the scope of professional practice of allied healthcare professionals, mental health
therapists and health or social care workers. Since the main aim of the research was
to align with the nursing or medical practice, the selection of these databases was
justified.
The keywords were used that found to coincide with the research topic and
this include predictive factors, Hodgkin’s lymphoma and relapse. Other associated
keywords that are used include relapse factors, lymphomas, chemotherapy. Broader
keywords were used in order to increase the overall hits in the database search.
Boolean operators like AND, OR and NOT were used in order to narrow down and
expand the search result accordingly. Whenever required truncation of words were
used in order to vary or manipulate the ends or spellings. The searches of the literary
articles were restricted within last 10 years (2009 to 2019). English language and the
subty that were conducted over the human subjects were two other inclusion criteria
used for the study. The type of publication were restricted to book, clinical trial,

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journal articles, systematic review and meta-analysis of randomised control trial,
meta-synthesis and other randomised control trial studies. The total number of
articles found after the initial search was 207. Of them 34 were found to coincide with
the scope of the study. Of them only 4 studies were qualitative studies and were
reviewed below based on the parameters highlighted by the qualitative framework of
Critical Appraisal Skills Programme (CASPs) (CASP, 2018).
Review of the Articles
The systematic review conducted by Townsend and Linch (2012) was
selected in order to get a brief overview of the prognosis and pathophysiology of
Hodgkin’s lymphoma. Getting a detailed insight of the pathophysiology of Hodgkin’s
lymphoma will help to ascertain the plausible caused behind the relapse of Hodgkin’s
lymphoma. Townsend and Linch (2012) stated that majority of the patients with
Hodgkin’s lymphoma are cured after the first line of therapy. However, the main
challenge in the disease treatment is management of the toxic disease outcome and
improvement in the overall survival rate of the patients who have relapsed with the
disease and have poor refractory advances. The review conducted by Townsend
and Linch (2012) highlighted that the main international prognostic index
(Hasencleverscore) for the advance stage of the Hodgkin’s lymphoma is age greater
than 45v years of age, sex is male, high concentration of the serum albumin (greater
than 40 gram per litre), poor level of haemoglobin concentration (less than 105 gram
per litre), the people who are in their stage IV of their disease. Other factors that
modulates the international prognostic index is high level of leucocytosis, (either
greater than or equals to 15 x 10^9 white cells per litre, low level of lymphopenia
(less than 0.6 x 10^9 lymphocytes per litre). Both the study conducted by Townsend
and Linch (2012) and Hosing et al. (2009) showed that low platelet count is one of
the predictive factor behind the possible chances of disease relapse in both Hodgkin
and non-Hodgkin’s lymphoma patients. However, Townsend and Linch (2012)also
highlighted in their study that the International prognostic index (Hasenclever score)
is a direct representative of negative progression of the disease and cannot be
regarded as predictive factors behind the relapse of Hodgkin’s lymphoma.
The study conducted by Majhailet al. (2009) was aimed towards identifying
the long-term outcomes for the autologous haematopoietic-cell transplantation for
the treatment of the advanced Hodgkin (HL) and non-Hodgkin lymphoma (NHL). The

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study included the recipients of the autologous HCT for NHL (960) and HL (407)
during the tenure of 1990 to 1998. These patients were under the complete
remission for at least 2 long years after the HCT. The selection of the large sample
size for both the HL and NHL group can be regarded as one of the strength of the
study. Marshall, Cardon, Poddar and Fontenot (2013) stated that large sample size
helps to interpret the results in a generalised format. The study pattern included
median follow-up for 104 months for HL and 107 months for NHL. The use of the
long follow-up sessions for the cancer patients study can be regarded as one of the
significant limitation as the number of total population might get reduced during the
follow-up sessions and thus limiting the sample size. The sourcing of the data was
done from the Centre for International Blood and Marrow Transplant Research
(CIBMTR). It is a voluntary group with more than 500 transplant centres worldwide.
Souring data from internationally operating group is strength of the study and it
helped to get an overview of the international aspect of the cancer scenario.The
study highlighted that the overall survival rate of at least 10 years is 77% for HL and
78% of NHL. The study also showed through the multi-variative analysis highlighted
that patients who are suffering from mantle-cell NHL have highest risk of late stage
mortality arising out of disease relapse. The relapse is regarded as one of the most
common cause of death between both NHL ad HL patients. Though the exact cause
of relapse was not highlighted in the study as it was not the direct scope of the study
however, Majhail et al. (2009) stated that people who are greater than 55 years of
age, gender is male, and lead an unhealthy lifestyle are more prone towards
becoming the victim of disease relapse in HL and NHL. The overall result of the
study showed that recipients of autologous HCT for both the NHL and HL who
remain in remission for at least 2 years have favourable condition for subsequent
long-term survival but the level of risk of relapse is high during late stage of life. The
study also showed that the rate of mortality is high among the lymphoma population
with patients after 10 years of post-transplantation. Overall the study highlighted
some common factors behind the relapse of the disease like the age and gender and
this is similar in with the factors highlighted in the study of Townsend and Linch
(2012). Townsend and Linch (2012) however, highlighted some common factors
behind the relapse of the disease and this is unhealthy lifestyle habits. Linsky,
Nyambose and Battaglia (2011) state that unhealthy lifestyle habits (smoking and
drinking) not only leads to poor propagation of the non-communicable disease but

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also increase the tendency of relapse of cancer. The unique approach highlighted in
the study, irrespective of the nature of the disease like the Hodgkin's and non-
Hodgkin's lymphoma, eve under the treatment of the bone-marrow transplant, the
disease mainly relapse within 10 years. Review of this study also helped us to
understand that irrespective of the best treatment given to the NHL, the relapse of
the disease is inevitable.
The study conducted by Casuloet al. (2015) was based on the follicular
lymphoma (FL). The study was selected as it coincided with the boarder keywords
that were used in the database search. The aim of the study was to identify the
prognostic FL factors that are interlinked with the prognosis of the disease (POD).
The study also helped in highlighting whether early POD are at high risk for disease
relapsing and recurrence. Casulo et al. (2015) screened 588 patients who are in their
stage two of the FL factors who are receiving their first-line R-CHOP therapy
(rituximan plus cyclophosphamaide, doxorubicin, vincristine and prednisone). The
mainly use an independent validation set of 147 patients with FL who have received
their first line of RCHOP and the results was analysed based for reproducibility. The
results showed that 588 patients that are 19% had early POD and 71% were under
the reference group and 8% were lost in the follow-up and 2% died during the course
of the study. The decrease in the sample size during the follow-up session can be
regarded as one of the limitation of the study as it restricted generaisability of the
data. The analysis of the results highlighted that the FL patients who received first-
line of R-CHOP, POD within their 2 years of disease diagnosis was associated with
poor outcomes. Thus further validation is required to be undertaken at standard point
of time by the use of the chemo-immunotherapy trials of the untreated FL. The
overall study showed that high-risk FL population must be studied further in order to
highlight the predictive factors for the disease recurrence. The study mainly showed
that starting disease treatment with the use of chemotherapy within 2 years of the
disease diagnosis help to increase the relapse of the disease.
The study conducted by Martinez et al. (2013) is based on the Hodgkin’s
lymphoma patients how are fighting through disease relapse after autologous
transplantation of stem cells. The aim of the study is to elucidate new information
about the predictors of the outcomes for the patients whose Hodgkin’s disease has
reoccur after the autologous stem cell transplant (ASCT). The study included 511

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adult patients with relapsed HL after getting ASCT. Theinformation was extracted
from the EBMT-GITMO databases. The results showed that the main treatments
administered after the AST failure are conventional chemotherapy and/or
radiotherapy and the requirement of the second line of these therapy was evident
from at least 90% of the population is highlighted from the data of the 49 months of
follow up. The mains factors that promoted increase severity of the disease relapse
is people who are in their stage IV of the disease, have the age group of more than
50 years and with poor performance status of the disease are more likely to become
victim of the disease relapse (Martinez et al., 2013). This again coincided with the
study of Townsend and Linch (2012) that also showed that predictive factors of
disease relapse in case of Hodgkin's lymphoma is age, stage of the disease and
lifestyle habits. One of the limitations of the diseaseis they study only the population
that has availed the ASCT and not other therapy of the
The scared availability of papers in the electronic database highlighted in that
there is a limited availability of papers in the domain of Hodgkin's lymphoma and the
predictive factors associated with disease relapse. The analysis of the paper
however, helped in the identification that Hodgkin's lymphoma disease has a high
rate of relapse irrespective of the nature of the treatment like AST, chemotherapy
and radiotherapy. Review of the papers also indentified few common predictive
factors behind the disease relapse and this includes age of the patients, gender of
the patients, poor platelets and haemoglobin counts and lifestyle of the patients.
Hosinget al. (2009) are of the opinion that proper identification of the predictive
factors for the disease relapse in case of Hodgkin's lymphoma will help to devise
proper therapy plan for the disease treatment and disease relapse prevention.
Hosing et al. (2009) state that having proper knowledge about the lymphoma will
help to design person-centred care and thereby helping to promote successful
outcome of the disease prognosis.
Research question
Since there was no research conducted so far to highlight the perspective of
the healthcare professional over the predictive factors behind the relapse of the
Hodgkin’s lymphoma, thus the main research question will be:

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What are the predictive factors which associate patients with Hodgkin's lymphoma
after relapse?
Highlighting the perspective of the healthcare professionals with the help of
their loved experiences will help to unearth this important corner of the oncology
research.
Research aim
To study the main predictive factors which associate patients with Hodgkin's
lymphoma after relapse from the perspective of the health-professionals operating in
the oncology unit.
Research objectives
 To explore the predictive factors associated with the relapse of the Hodgkin’s
lymphoma
 To explore the diagnostic factors that can be used for the early diagnosis of
Hodgkin’s lymphoma
 To explore the goals of treatment for patients with relapsed Hodgkin’s
lymphoma disease
Overview of the study
Frewet al. (2010) stated that the use of the quantitative survey is helping in
undertaking a comparative study between different independent variable and their
relationship with the dependent variable. In this study, the dependent variables are
the relapse of the Hodgkin disease and the independent variable are the predictive
factors that increase the severity of the disease relapse. As the study is focused on
the highlighting the predictive factors over increasing the severity of Hodgkin’s
lymphoma, quantitative study will be appropriate for the research. The main target of
the survey with close ended questionnaire or the survey population are the
healthcare professionals (nurses and the doctors) operating the haematology-
oncology unit and handling patients and handling patients of Hodgkin’s lymphoma.
For the recruitment of the prospective sample groups in the study, the researcher will
employ purposive sampling. The data collection will be done based on the close-
ended questionnaire in a survey format. The surveys will be conducted online with

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the help of online app and after recording the survey, the survey will be stored in the
cloud memory from which it will be retrieved that during the process of data analysis.
The analysis of the survey will be done by the use of the SPSS in order to highlight
the common perceived predictive risk factors behind the relapse of Hodgkin’s
lymphoma(Frew et al., 2010). The analysis of the data will be done as per the
research objective. The results will be then disseminated. In the first instance the
results will be given to the lymphoma multidisciplinary team where the research will
be conducted and then the results will be disseminated to the professional audience
and this include British Geriatric Society, International Society of Geriatric Oncology
and other patients’ organisation like Lymphoma Action National Charity.
Methodology
Study Design
Starks and Trinidad (2007) stated that selection of methodology that closely
aligned with the research inquiry is critical for ensuring that the overall aim of the
objective of the research is achieved. As the aim of the research is explore the
predictive factors behind the relapse of the Hodgkin’s lymphoma from the
perspective of the healthcare professionals working in the haematological oncology
ward. The main research approach will be quantitative research by the use of
survey.
According to Bell, Bryman and Harley (2018), research methodology is an
important for conduction of the research. Research methodology deals with the
collection of data, data analysis and interpretation of data. Saunders, Lewis and
Thronbill (2007) stated that methodology is design of the research and research
design is like an onion. Every layer of onion is defined as different steps of the
research design.

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Figure 2: Research Onion
(Source: Saunders, Lewis &Thornhill, 2007)
Research philosophy is the first layer of the research opinion. There are three
types of research philosophy that is interpretivism, pragmatism, realism and
positivism. Pragmatism research philosophy will be suitable for research. It will help
in exploring the relationship between risk factors and relapse of Hodgkin’s
lymphoma. Pragmatism research philosophy is based on the lived experience and it
will help to extract the lived experience of the healthcare professionals during their
clinical practice and utilization of the lived experience in highlighting the risk factors
for the relapse of Hodgkin’s lymphoma (Simpson, 2009). The second layer of the
research opinion is research approach. There are two types of research approach
one is deductive and the second one is inductive (Saunders, 2011). In this
quantitative research deductive research approach will be used. It will helping in
moving the reasoning from general to specific predictions. It will also help in
formulation of the few hypothesis based on the observable data (Saunders, 2011).
The third layer of the research opinion is the research strategy and time horizon is
the fourth layer of the research opinion. There are two time horizons, one is
longitudinal and another one is cross-sectional. In this research, the researcher will

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make use of the cross-sectional study as it will conduct the research at a single time
point and not in two different time points (longitudinal study) (Saunders, Lewis and
Thornhill, 2007). The research strategy that will be used in this research as already
discussed in quantitative study. This will help the research to highlight the statistical
significant relationship with the different risk factors and disease relapse and the
importance of different approaches for early detection of the disease vulnerability
(Cresswell, 2002).
Sample
Representative purposive sampling will be employed in this research based
on the characteristics of the phenomenon of the study. All the sampling however is
associated with certain degree of convenience because of the nature of the
recruitment measures including this study as the prospective participants will be
identified based on their level of experience in the haematology ontological wards of
clinics registered under the NHS trust.
The sample size will be 10 doctors from the haematological – oncology unit
and 10 nurses from the same unit. According to Singleton and Straits (2005), large
sample size helps in the generalization of the research. Moreover generalised data
will help to highlight a diverse overview of the principal predictive factors associated
with the relapse of Hodgkin’s lymphoma. But due to time and financial constraints,
the small sample size was taken. Singleton and Straits further highlighted that
purposive sampling is a type of non-probability sampling that is used for the selection
of the small sample size based on the set of certain previously determined set of
characteristic. The small sample size will be included in this study, selection of the
purposive sampling is however associated with certain limitation like it leads to the
selectional bias unlike the probability sampling which help in the reduction of
selection bias.
Inclusion criteria of the doctors and the nurses
Experience More than 5 years in the oncology unit or the
haematological department
Language of communication English
Computer proficiency Excellent
Main focus of patient Both Hodgkin’s and Non-Hodgkin’s

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lymphoma
Kind of care given ASCT, chemotherapy and radiology
Data collection
The quantitative method is made of two sections. First section is section “A”
that will include nine different items like the demographic data like age, sex, level of
education, level of operation. The section “B” will consist of Likert-scale-type
questions that will aim towards collection of the information about the predictive risk
factors for Hodgkin’s lymphoma relapse, the diagnosis and early interventions. For
the purpose of the development of the questionnaire, Lacobucci and Churchill (2010)
proposed a special approach that comprises of nine different steps in order frame
the research question.
Figure 3: Development of questionnaire for the survey
(Source: Lacobucci& Churchill, 2010)

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The survey used in this research will be originally written in English. In order
to examine the validity and reliability of the questionnaire, a test will be conducted
over a sample of healthcare professionals and nurses with the required knowledge
related to the field of research. Ten participants (5 doctors and 5 nurses) will be
selected randomly from NHS clinics. These selected groups of professionals will be
asked to given their opinion about the content and nature of the study and thus
helping to improve the validity of the questionnaire. The reliability of the
questionnaire will be framed based on how accurately the research question will be
related to the scope of the research. The survey will be conducted with the help on
online software (Google forms).
The survey will consist to 10 questions and there will be no time limit to finish
the survey. The survey question will be drafted in close ended format and the type of
questions that will be used in the survey will be drafted based on the review of
literature.
Data Analysis
The analysis of the data will be done through Statistical Package for Social
Sciences (SPSS.20). Numerous researchers have suggested that statistical
techniques are regarded as an important tool for data analysis in the medical and
social science research. Since the research include different researcher questions
and various research objectives different statistical tools were used(Crowder, 2017).
Analysis of means, Pearson’s correlations and standard deviations willbe used to
explore and describe the relationships between variables used in the study. Use of
descriptive statistics thus will help to give a proper description of the standard
deviation. Multiple regression analysis will be employed to investigate the
relationships between dependent and independent variables. It will be appropriate
for the single-metric dependent variable(Crowder, 2017).
Ethical Issues
Globally, any research that involves any human subjects is required to comply
by the international ethical, scientific and other practical standards that help to form
proper clinical practice guidelines. Clinical practice guidelines aim to protect the
rights and safety of the participants of the research (National Institute for Health

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Research, 2018). As no patients are involved in this study, clinical practice
guidelines will mainly involve protection of the privacy, confidentiality and autonomy
of the subject.
Before undertaking the research, ethical approval is required from the local
NHS committees of research ethics. University Research Ethics Panel will be
sought. As tis research will be undertaken under an NHs organisation, all the ethical
permission along with approval for the conduction of the research will be handled
through the Integrated Research Application system (IRAS) that will be accessed
with the help if NHS Health Research authority website (HRA).
Before including any healthcare professional in the survey proceedings, an
informed consent will be obtained from each of the prospective participants. Here it
will be made clearly that none of them are compelled to take part in the survey
session and they can leave the survey at any point of time without any prior notice
(Neale, 2009). Their personal information will be kept confidential and will not be
used in the research program. All the electronic data will be stored securely with
proper encryption and password protection. Sudden withdrawal from the survey
session will not cast any negative impact on their career (Long & Johnson, 2007).
Study Time Table
Grant Chart
Activity Month
1 2 3 4 5 6 7 8 9 10 11 12 1
3
14 15 16 17 18
Ethics
approval
Recruitment
of the
participants
Data
collection

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Data analysis
Final Report
writing
Dissemination
of the results
Resources
It is assumed that the cost of materials including the printing of the survey
results will be £200 approximately. Travel to NHS clinics for the conduction of the
survey will be £50 only.
Dissemination
According to Corbin and Strauss (2015) the process of research Is not
complete until proper knowledge is obtained and us made available to the interested
candidates. Crombie and Davies (199) also stated that a healthcare research aims in
improving overall quality of health and this can be achieved by communicating the
findings to the healthcare professionals.
The detailed research report will be framed and will mainly follow the format of
this proposal. This will also include the research findings and discussion. Holloway
and Wheeler (2002) recommends to remain careful for different types of research
audiences while preparing to disseminate the findings of the research. The
completed research will be presented in the form of oral presentation to the Trust of
Lymphoma research groups and then to the oncology group of professionals.
If the individual participants prefer to receive separate copy of the results,
their wish will be respected and written summary of the results will be forwarded to
them. An abstract in the form of poster will be submitted to international and national
specialist meetings. At last a manuscript will be submitted for taking into
consideration of the printed publication to a national peered reviewed journal.

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RESEARCH PROPOSAL
Conclusion
Thus from the above discussion, it can be concluded that the said research
proposal will help to provide effective treatment planning and early research
diagnosis of relapse of Hodgkin’s lymphoma. This in turn will help to cast a positive
impact on the lymphoma patients overall health and well-being.

21
RESEARCH PROPOSAL
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