Quality Care for Dying Patients in Hospices and Hospitals

Mayland et al. (2014) do not provide the degrees of freedom (df) in their study. Use the degrees of freedom formulas provided at the beginning of this exercise to calculate the group df and the error df.

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The number of degrees of freedom is equal to the sample size, N, minus the number of groups, k. N = 255, k = 3. Therefore:

df = 255 – 3 = 252.

The error df is calculated using the formula k – 1. Therefore,

Error df = 3 – 1 = 2.

What is the F value and p value for spiritual need—patient? What do these results mean?

For this case, F = 38.1, p <.0001. It means that there is a highly significant difference between some of the groups that were analyzed. In other words, it is very unlikely that the difference occurred due to chance alone. However, p-value alone says nothing about the magnitude of the difference. Also, post-hoc analyses will be needed to identify which groups differ significantly.

What is the post hoc result for facilities for the hospital with LCP vs. the hospital without LCP (see Table 2)? Is this result statistically significant? In your opinion, is this an expected finding?

According to post-hoc analysis, the p-value of the difference between facilities for the hospitals with LCP and for those without LCP is p =.85, which is greater than the chosen α. Therefore, there is no statistically significant difference; the difference has probably occurred due to chance. It might be an expected finding because the standards of care ought to be similar in different hospitals and facilities.

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What are the assumptions for use of ANOVA?

The assumptions for ANOVA are as follows:

  • The dependent variable is measured at interval/ratio level, and is normally distributed for each category of the independent variable;
  • Independence of observations;
  • The groups do not overlap;
  • Homoscedasticity between the groups.

What variable on Table 3 has the result F = 10.6, p < 0.0001? What does the result mean?

The variable reflecting symptom management has the result F = 10.6, p <.0001. It means that there is a statistically significant difference between at least two of the groups. In other words, symptom management is significantly better or worse in one of the groups than in at least one of the other groups which were compared.

ANOVA was used for analysis by Mayland et al. (2014). Would t-tests have also been appropriate?

In the named analysis, it was required to compare more than 2 groups. Therefore, it could have been possible to use multiple t-tests to compare the groups pairwise, but this would have raised the chance of Type I error due to running several analyses. Therefore, running several t-tests would have been less appropriate.

What type of post hoc analysis was performed? Is the post hoc analysis performed more or less conservative than the Scheffé test?

The Tukey’s honest significant difference test was run. The Scheffe test is considerably more conservative than Tukey’s HSD, resulting in smaller probability of Type I error; however, it increases the probability of Type II error.

State the null hypothesis for care for the three study groups (see Table 2). Should the null hypothesis be accepted or rejected?

The null hypothesis is that care would be quantified as equal across the three study groups. The null hypothesis should be rejected because the F = 35.9 and the p = < 0.0001.

The null hypothesis is that there are no significant differences in care across the three groups. It should be rejected due to the fact that p <.0001.

What are the post hoc results for care? Which results are statistically significant? What do the results mean?

The results of post-hoc tests indicate that care was significantly higher at the hospice than at the hospital with LCP and at the hospital without LCP; and that care was significantly higher at the hospital with LCP than at the hospital without LCP.

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In your opinion, do the study findings presented in Tables 2 and 3 have implications for end of life care?

These findings indicate that there were no significant differences between the hospice and the hospitals with LCP when it came to symptom control and management, but there were significant differences between the hospice and the hospitals with LCP. Also, the hospice scored significantly higher than the other hospitals when it came to facilities, care, ward environment, and communication provided during EOL care. Therefore, the hospice is apparently better for provide EOL care.

Reference List

Mayland, C. R., Williams, E. M. I., Addington-Hall, J., Cox, T. F., & Ellershaw, J. E. (2014). Assessing the Quality of Care for Dying Patients From the Bereaved Relatives’ Perspective: Further Validation of “Evaluating Care and Health Outcomes–for the Dying.” Journal of Pain and Symptom Management, 47(4), 687–696. Web.

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