HS860 Unit 10 Doctoral Project Proposal Draft Example

Three Chapters and Every Approval Pending: A Unit 10 Project Proposal Draft on Where Women Leave Lymphedema Surveillance

[Student Name]

Purdue University Global

HS860: Doctoral Project I: Project Proposal

Unit 10 Project Proposal Draft

[Instructor Name]

[Date]

The cancer center, local figures and approvals are composite and shown as placeholders; no data have been collected, and the studies cited are real.

Status Statement

Nothing in this document reports findings. The records have not been pulled, no woman or staff member has been approached and every approval listed at the end is still pending. Local numbers come from the breast program's yearly quality summary, used with the director's permission, and appear in brackets because they will be replaced by audited counts.

Chapter 1: Introduction

Background. Arm swelling after breast cancer treatment is frequent enough to plan for: pooled prospective data put it near one case in five, and the risk climbs steeply when the axillary nodes are removed rather than sampled (DiSipio et al., 2013). It is also catchable. Women whose arms were measured before their operation and rechecked afterward had small volume gains spotted months before anyone could see them, and short-term compression undid those gains (Stout Gergich et al., 2008). That evidence led a multidisciplinary group to recommend building rehabilitation surveillance, measurement before treatment and on a set schedule after it, into breast cancer care (Stout et al., 2012).

Problem. Adoption on paper has not meant use in practice. Community programs have little evidence to tell them at which point high-risk women drop out of the surveillance sequence, or what those women and the staff around them would say caused it, and without that knowledge improvement efforts are guesses. At the study site, the quality summary shows a baseline arm measurement for roughly one woman in five with node dissection, [22] percent, and a first follow-up measurement visit for under a third, [31] percent, within the expected window.

Purpose. The project will map how far women treated with axillary dissection at one community cancer center travel along its surveillance sequence before dropping out, and will gather the accounts that women and the responsible staff give for each break.

Research questions. First: For the two-year cohort of women treated with axillary dissection, how many reached each stage, a measurement before surgery, a surveillance order on leaving the hospital and an attended follow-up appointment inside four months, and which stage lost the most? The pre-surgery stage will be estimated from a random sample of operative clinic notes. Second: What reasons do women who dropped out at the stage with the heaviest loss, and staff who own each stage, give for stages being completed or missed?

Significance. Knowing which stage breaks would let the center spend its improvement effort where it will count, and a careful description of one community program would add to a literature drawn mostly from academic hospitals.

Definitions. Surveillance sequence means the three stages adopted by the center. Dropping out means not completing a stage within its window. High risk means axillary lymph node dissection, the group the center's pathway covers.

Chapter 2: Review of the Literature

Organizing the review by how firmly each claim is held, rather than by topic, produces three groups. Firmly held are the frequency of arm swelling, its risk factors and the payoff from catching it early. Still argued are the best measuring tool and the right threshold for acting; in one randomized comparison, women monitored by bioimpedance were flagged for early treatment less often than those monitored by tape and progressed less often to intensive therapy (Ridner et al., 2019). Also argued is why women struggle to keep up with self-care, where reviews point to time, money and thin support (Ostby & Armer, 2015). Largely unstudied is how surveillance sequences actually run after a community center adopts one; the closest account is a single academic hospital's description of the staffing and scheduling problems it met while building its program (Brunelle et al., 2015). That last group is where this project sits.

The review's last paragraph states the gap, and the method's first paragraph answers it; a reader should feel no seam between them.

Chapter 3: Method

Design. Explanatory sequential mixed methods: a records review to answer question one, followed by interviews to answer question two, with interview sampling guided by the records results and the two strands integrated in a joint display (Ivankova et al., 2006).

Setting. A community cancer center performing about [95] axillary dissections a year.

Population and sample, strand one. All women aged 18 and older who had axillary dissection at the center over two years, about [170] after exclusions. Baseline measurement will be estimated from a random sample of [60] surgical notes read by the candidate, with a second reader checking [20].

Population and sample, strand two. Roughly [10] to [15] women whose records show them dropping out at the heaviest-loss stage, recruited by letter from their surgeon and calls from the research coordinator, with options for written responses; and [6] to [8] staff from surgical nursing, navigation and rehabilitation, excluding staff who report to the candidate.

Data collection. Structured extraction by the analytics office of referral orders and clinic visits; coding of sampled notes; semi-structured interviews conducted by the research coordinator.

Analysis. Strand one: proportions completing each step with confidence intervals, a step-by-step attrition count and comparisons by age group, insurance and distance. Strand two: thematic analysis of deidentified transcripts. Integration: a joint display placing each step's results beside the explanations given.

Ethics and positionality. Approval will be requested from the university's review board, which will also be asked, acting as privacy board, to waive individual HIPAA authorization for the chart portion. The candidate manages the lymphedema clinic; to limit her influence, she will not recruit, interview or read identified transcripts, and a second analyst will verify step counts. A reflexive journal will be kept.

Approvals Table

Letter of site support from the breast program director: pending. University review board approval: pending. Waiver of HIPAA authorization: pending. Data extraction request: pending. Staff access approvals from service managers: pending.

Appendices

The full proposal includes seven appendices: the extraction specification, the note coding sheet, the surgeon letter, recruitment scripts, consent forms, the interview guides and the timeline.

Limitations Anticipated

One center limits transfer to other settings, particularly to centers where surveillance is run by a dedicated nurse rather than folded into surgical and rehabilitation clinics. Records describe what was documented, not what was said at the bedside, which is why interviews ask what women remember being told. Baseline measurement is estimated from a sample. Women who left the pathway may decline interviews for the same reasons they left, and the recruitment fallback is designed for that risk.

References

Brunelle, C., Skolny, M., Ferguson, C., Swaroop, M., O'Toole, J., & Taghian, A. G. (2015). Establishing and sustaining a prospective screening program for breast cancer-related lymphedema at the Massachusetts General Hospital: Lessons learned. Journal of Personalized Medicine, 5(2), 153-164. https://doi.org/10.3390/jpm5020153

DiSipio, T., Rye, S., Newman, B., & Hayes, S. (2013). Incidence of unilateral arm lymphoedema after breast cancer: A systematic review and meta-analysis. The Lancet Oncology, 14(6), 500-515. https://doi.org/10.1016/S1470-2045(13)70076-7

Ivankova, N. V., Creswell, J. W., & Stick, S. L. (2006). Using mixed-methods sequential explanatory design: From theory to practice. Field Methods, 18(1), 3-20. https://doi.org/10.1177/1525822X05282260

Ostby, P. L., & Armer, J. M. (2015). Complexities of adherence and post-cancer lymphedema management. Journal of Personalized Medicine, 5(4), 370-388. https://doi.org/10.3390/jpm5040370

Ridner, S. H., Dietrich, M. S., Cowher, M. S., Taback, B., McLaughlin, S., Ajkay, N., Boyages, J., Koelmeyer, L., DeSnyder, S. M., Wagner, J., Abramson, V., Moore, A., & Shah, C. (2019). A randomized trial evaluating bioimpedance spectroscopy versus tape measurement for the prevention of lymphedema following treatment for breast cancer: Interim analysis. Annals of Surgical Oncology, 26(10), 3250-3259. https://doi.org/10.1245/s10434-019-07344-5

Stout Gergich, N. L., Pfalzer, L. A., McGarvey, C., Springer, B., Gerber, L. H., & Soballe, P. (2008). Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer, 112(12), 2809-2819. https://doi.org/10.1002/cncr.23494

Stout, N. L., Binkley, J. M., Schmitz, K. H., Andrews, K., Hayes, S. C., Campbell, K. L., McNeely, M. L., Soballe, P. W., Berger, A. M., Cheville, A. L., Fabian, C., Gerber, L. H., Harris, S. R., Johansson, K., Pusic, A. L., Prosnitz, R. G., & Smith, R. A. (2012). A prospective surveillance model for rehabilitation for women with breast cancer. Cancer, 118(S8), 2191-2200. https://doi.org/10.1002/cncr.27476