Psychological Issues in Hospice Care: A PICOT Question Analysis

This paper presents a PICOT question designed to investigate the psychological issues and emotional challenges experienced by caregivers and family members of patients undergoing hospice care for life-limiting illnesses. The introduction highlights the emotional impact of terminal diagnoses on families, often leading to sadness, anger, anxiety, and guilt. The paper utilizes the PICOT framework to formulate a research question, detailing the population (patients with life-limiting illnesses), intervention (hospice care), comparison (control group without hospice care), outcome (psychological instability), and time frame (2 months). It identifies relevant databases like CINAHL, MEDLINE, and PubMed for literature searches, outlining a search strategy that includes specific subject headings, inclusion/exclusion criteria, and Boolean operators. The methodology involves screening articles based on relevance, eligibility, and duplication, followed by a full-text review and evaluation of research outcomes to address the research question and provide insights for home health care nurses. The paper aims to understand the emotional and psychological needs of family members and analyze their attitudes and behaviors related to hospice care withdrawal.

Running head: PICOT QUESTION BASED ON HOSPICE CARE
PICOT QUESTION BASED ON HOSPICE CARE
Name of Student:
Name of University:
Author’s Note:

1PICOT QUESTION BASED ON HOSPICE CARE
Introduction
This paper is based on the usage of evidence-based practice for understanding the
emotional issues and psychological challenges that the caregiver and family members a patient,
suffering from life limiting disease undergo, when the patient undergoes care at a hospice.
Having patients who have been diagnosed with terminal disease creates a strong emotional
impact on the family members, who often report signs and symptoms of sadness, anger,
depressed mood, anxiety and guilt, as normal reactions to stress. This paper will be based on the
PICOT framework that will help in the formulation of a research question, comprising of five
components, and relevant to the phenomenon that is currently under investigation.
PICOT question formulation
Development of PICOT question has been identified imperative for conducting a
literature review and helps in extracting the most pertinent and contemporary scholarly pieces of
evidences in a precise manner. The table given below highlights the PICOT components:
The Research question:
What are the psychological issues and emotional challenge the caregiver and family of the
patient with life limiting illness undergo when the patient is being cared in hospice?
The PICOT FRAMEWORK
POPULATION (P) Patient with life limiting illness diagnosed
with lethal disease. The patient must be
under hospice care by the nurse. The
patients who are not in hospice care are
excluded from the research. Additionally,

2PICOT QUESTION BASED ON HOSPICE CARE
the care giver and family member of the
chosen population will be included.
INTERVENTION (I) The subject randomized would receive
hospice care and end limiting care. To
understand the emotional challenge by the
caregiver, control group are not given any
kind of emotional support.
COMPARISON (C) A control group with no hospice care and
patient with end limiting illness and
comparison of the psychology of the each of
the care giver of both group.
OUTCOME (O) Perspective of family member will show
high level of psychological instability.
TIME (T) The outcome would be measure for 2
months
Identification of databases for search strategy
There are several electronic databases such as, CINAHL, Google Scholar, MEDLINE
and PubMed that act as a repertoire of scientific information and can be used for literature search
of evidence. CINAHL (Cumulative Index to Nursing and Allied Health Literature) refers to an
index of English language published journal articles that focus on biomedicine, allied health,
nursing and healthcare. In contrast, MEDLINE (Medical Literature Analysis and Retrieval
System Online, or MEDLARS Online) refers to a bibliographic database that comprises of
information on biomedical and life sciences. It also includes bibliographic evidence for

3PICOT QUESTION BASED ON HOSPICE CARE
publications from academic newsletters that are based on nursing, pharmacy, medicine,
veterinary medicine, dentistry, and health care. Nonetheless, access to these two databases can
only be obtained through paid subscription and there occurs significant content overlap between
CINAHL and MEDLINE. However, PubMed database was chosen for the search of evidence.
Selection of PubMed can be accredited to the fact that it is a free search engine that
predominantly accesses the MEDLINE database of abstracts and references on biomedical and
life sciences topics. Furthermore, PubMed also translates the early search formulation and
robotically adds pertinent MeSH (Medical Subject Headings) terms, field names, Boolean
operators, synonyms, and amalgamates the subsequent terms suitably, thus augmenting the
search formulation meaningfully, by characteristically uniting (using the OR operator) the MeSH
terms and text-words.
Search strategy
A definite plan was followed for the extraction of articles that were considered
prospective for this research. The table given below illustrates the measures that were followed:
Inclusion Exclusion
Primary research Case studies and clinical guidelines
Year of publication: 2015 to 2019 Earlier than 2015
Language: English Other than English
Peer reviewed journal article Abstracts and unpublished
manuscripts

4PICOT QUESTION BASED ON HOSPICE CARE
Research method: Quantitative Qualitative
Subject of studies Psychological challenge, emotional
challenge, caregiver, terminal illness,
patients
Gender Male and female
Limited to Full-text eligibility
The search of the evidences was done by the use of specific subject heading relevant to
research question. For example
 Life limiting illness
 Hospice care
 Home nurse
 Care giver family
 Palliative care
 Terminal illness.
The next step after searching the article using subject heading was to select the appropriate paper
and follow these steps:
 Reviewing the concept related to hospice care.
 The relevant subheading of the paper will be selected

5PICOT QUESTION BASED ON HOSPICE CARE
 The article will be selected for assessment after accessing the PubMed database
Snow ball technique was also used that involved conducting a manual search of the
bibliography of the selected articles. The key terms that were considered relevant to the research
question were namely, life limiting illness, hospice care, palliative care, home nurse, care giver,
family care giver, emotional challenge, psychological issue, mental instability, perspective
family caregiver, emotional outcome, terminal care, and experience. The table given below
highlights the combination of the search terms using boolean operators:
Hospice care OR Palliative Care
Hospice care OR life limiting illness
Hospice care AND nurse
Hospice care AND Patient
Hospice care AND family care giver
Emotional instability AND family care giver
Family member AND patient will illness OR life limiting illness AND perspective AND
emotional behavior
Hospice care experience AND family member AND life limiting illness
Care giver perspective AND end life care OR hospice care
Challenges hospice care AND life limiting care AND home health care nurse
Emotional issue OR emotional challenges OR emotion distress OR Emotional outcome AND
care giver OR family caregiver
Psychological issue AND family care giver AND hospice care
Outcome hospice care OR emotional issue
Outcome of hospice care AND life limiting illness

6PICOT QUESTION BASED ON HOSPICE CARE
Home health care nurse AND outcome of hospice care
Outcome of family member AND hospice care
Screening articles
For screening of the research article following steps will be followed namely, (i)
recognition of relevant article based on research question, (ii) investigating the paper by the title
and abstract by the use of key terms, (iii) excluding and including the paper by the eligibility
criteria, (iv) making report of total number of proceedings, (v) screening the article for excluding
the duplicate copy. The paper selected will then be reviewed for full text. The paper will be
consulted with senior staffs for any kind of discrepancy. The total number of paper obtained will
then be retrieved for appraisal of paper. The good quality paper will then be finally selected.
Evaluating research outcome
In order to examine the rationale for the withdrawal of care giver and family member in
hospice care, the information obtained regarding the experience and emotional challenge, will
help in interpretation of the requirement of family member and analyses the withdrawal attitude
and behavior. Hence, the method used will help to find the answer to the research question.
Additionally, will give knowledge to the home health care nurse to better handle such situation.