Influence of Pain on Quality of Life for Cancer Patients

Influence of Pain on Quality of Life for Cancer Patients Abstract Purpose: Pain is a common complaint of cancer patients which is found to significantly affect the quality of life of Head and Neck cancer patients. For patients suffering from cancer, control of symptoms and pain play a significant role in improving the overall quality of life of head and neck cancer patients. A literature search revealed that studies on the intensity of pain and quality of life before receiving anticancer therapy are lacking. Thus, this study was an attempt to assess the influence of intensity of pain on quality of life of cancer patients before receiving anticancer treatments Methods: A total of 100 histopathologically confirmed cases of head and neck cancer were interviewed. Intensity of pain was evaluated using the Brief Pain Inventory and the quality of life of patients was evaluated using EORTC QLQ-C30 module.. Results: The results showed that majority of patients suffering from oral cancer belonged to 5th and 6th decade of life. Kruskal Wallis test showed statistically significant in the quality of life and tumour stages. Chi square test also gave significant association between the quality of life and pain. Conclusions:. Assessment of Quality of life in cancer patients will direct the attention of clinician to the most important symptom; pain. Thus appropriate interventions can be instituted at right time along with palliative care to improve the Quality of Life of cancer patients. Keywords: Pain, Quality of Life, Cancer, Palliative care Introduction: Head and neck cancer encompasses a group of tumours involving the lip, oral cavity, nasal cavity, larynx, pharynx and paranasal sinuses. By incidence, it is the sixth leading cancer worldwide and eighth by fatality. Every year 0.5 million new cases are reported. It usually develops in 6th-7th decade of life and five year survival rate in a patient suffering from HNSCC is 40-50%. Approximately 40% of these tumours occur in the oral cavity, 15% occur in the pharynx, and 25% occur in the larynx; in 90% of the cases, the most common histologic type is squamous cell carcinoma. (1) Pain is the most burdensome symptom and is one of the most common complaints in a patients suffering from Head and Neck cancer. A systematic review evaluating the prevalence of pain in cancer patients over past 40 years reported high figures in the range of 52-77%. (2) The review also stated that as the stage of cancer advanced the prevalence of pain also increased. They reported a prevalence of 62%–86% in patients with advanced cancer. (2) These figures are in contrast to rapidly increasing research work in the field of pain relief. Pain is one of the most significant symptoms of cancer patients that affects multiple domains of life ranging from its impact on physical functioning to emotional functioning. It is a usual symptom of cancer patients, accounting for 30% to 40% of their chief complaints, and is of multifactorial aetiology. Approximately 58% of cancer patients suffer from unbearable pain, and this prevalence increases to 85% in patients with cancer in advanced stages. (3. A metanalysis which was carried out in the year of 52 studies for evaluating the prevalence of pain in cancer patients, reported that head and neck cancer patients had the highest prevalence of pain exceeding gastrointestinal gynaecological, breast and lung tumours. (2) In Head and Neck cancer patients, pain distresses the oral functions and is chief complaint in approximately 58% of the patients awaiting treatment and in 30% of the treated patients (4,5). The term â€Å"Quality of Life† has been used in literature in various ways both as a concept and an instrument of measurement. Very rarely has it been defined clearly. It may be considered as a subjective term which conveys the perception of a patient about his life which may either be positive or negative. It includes an assessment of general health, satisfaction, fulfilment, ability to cope, happiness, being in control and degree of independence. (6) Not only does pain affect the life of quality of patients before seeking antineoplastic treatment, also it has devastating effect in patients undergoing treatment. Thus there has been a growing interest in the inclusion of measures for improving life quality of patients before, during and after undergoing quality of life treatments. Literature search revealed that studies on the intensity of pain and quality of life before receiving anticancer therapy are lacking. Thus, this study was undertaken to assess the severity of pain and its impact on the quality of life (QoL) in untreated patients with head and neck carcinoma using questionnaire. Also the association of pain severity with clinical stage of the tumour and lymph node involvement was assessed. Materials and Methods: The study was carried out in the patients reporting to the outpatient department of K.L.E.V.K.I.D.S and Belgaum Cancer Institute. Ethical clearance was obtained from the institution. A total of 100 confirmed head and neck cancer patients were interviewed. Untreated histopathologically confirmed head and neck cancer patients were included in the study while patients who were receiving, or had completed their course of treatment for cancer, with recurring malignant disease and with compromised physical and mental state which prevented them from answering questions were excluded from the study. Patients were divided into four groups depending on their stage of tumour as follows:- Group I = Stage I=23 patients Group II = Stage II=25 patients Group III = Stage III=25 patients Group IV = stage IV=27 patients Pain was evaluated using â€Å"Brief Pain Inventory (BPI)† (7) which was validated in the North Indian Population.(8) The BPI is a 11 point scale which is presented horizontally from numbers ranging from 0-10. The Questions were translated in the local language of the patient. Patients were asked to rate their pain in the last 24 hours at its Worst, Least and on Average. Patients were also asked to encircle the number indicating the amount of pain they were having at present. The pain was then categorized into four groups: No pain (0), Mild pain (1-4), Moderate pain (5-6) and Severe pain (7-8) The Quality of Life of patients was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) version 3.0 (9) which was validated in Indian Population (10).EORCTC QLQ-C30 is a 30 item questionnaire which consists of five functional scale, three symptom scale, six single items and Global Quality of life question.(8) The functional scale comprises a set of questions to evaluate the functioning of a cancer patient which includes Physical, Role, Cognitive, Social and Emotional Functioning. Symptom Scale includes three items to evaluate the fatigue, pain and nausea in patients. A number of single items such as Dyspnoea, Insomnia, Insomnia, Constipation, appetite loss, Diarrhoea and Financial difficulties were also included. The Symptom scale evaluated Fatigue, Pain and Nausea. Patients were asked to answer each question on a 4 point scale ranging from 1-4; corresponding to pain as Not at all (1), A little bit (2), Quite a Bit (3, Very Much (4). Patients were asked to rate the last two items (Global Quality of Life ) on a horizontal scale ranging from 1-7. All the scores thus obtained were linearly transformed to be expressed on a scale from 0-100. All the data was tabulated and non-parametric tests were applied. The data was subjected to Descriptive statistics, Mann-Whitney and Kruskal – Wallis test. Results: 100 histopathologically confirmed cases were enrolled in the study. The results showed that head and neck cancer was common in patients in 5th and 6th decade of life (35% and 32% respectively) with a mean age of 54.8 years (age range-24-86 years). Strong predominance of male population (79%) was seen. Out of a total 100 patients, 67% patients had the site of primary tumour in Oral cavity followed by Oropharynx (22 %), Larynx (6%)and Hypopharynx (5%). Lymph node involvement was present in 66% patients. The Mean scores for all the items on the scale was obtained using the EORTC QLQ-C30 Scoring Manual. Patients in the early stages of tumour scored significantly higher on function scale indicating higher functionality and ease in their daily activities. On contrary patients with advanced cancer scored higher on symptom scale indicating hampered quality of life and greater difficulty in doing their day to day work. Kruskal wallis test showed significant difference in the quality of life and the tumour stages, which was statistically significant .(p value On applying Mann Whitney test significant differences in the quality of life of patients with lymph node involvement and without lymph node involvement. (p value Chi square test also gave significant association between the quality of life and pain. (p value Discussion: This study was carried out to assess the influence of pain severity on quality of life of head and neck cancer patients before receiving any antineoplastic treatment. With approximately one million of new cancer cases being added every year in India and 80% of them presenting in advanced stages ( stage III and stage IV)(11)the need for pain relief and palliative therapy is imperative. Cancer pain still being one of the most dreaded and burdensome aspects of cancer patients draws attention to the management of pain in head and neck cancer patients. Inspite of introduction of WHO’s step ladder pattern for the management of pain control in cancer patients (12) it has been reported that less than 3% patients in India have an adequate access to pain relief. (13) . The present study also showed signification association between the cancer pain and stage of tumour. Patients with advanced stage of tumour experienced more difficulty in talking, swallowing etc. and poorer quality of life thus indicating a greater need for the institution of pain relief measures. The findings were consistent with the study done by Oliveira KG et al (14) who concluded that patients in advanced stages showed higher impairment in their functional status. Similar findings were noted by Connely et al (4) who reported that patients with squamous cell carcinoma experienced significantly incr eased function-related intensity of pain rather than spontaneous. The reasons for under treatment and inadequate pain relief could be attributed to poor resources, inaccessibility to morphine, misconception about the drugs for pain relief e.g. addiction, opiophobia of patients and communication problems. (15) Also the nature of Cancer pain is not fixed. It has multiple complex aetiologies and is recurring in nature. One of the very important reasons for the inadequate pain relief in cancer patients is that currently no such medication exists for chronic cancer pain that will provide more than 30% relief to the cancer patients.(16) This makes the institution of palliative and support care even more essential. The World Health Organization has defined Palliative care as â€Å"An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.† (17) WHO emphasizes on meeting the psychological, social and mental needs of the patients so as to improve their quality of life. However, it has been reported that approximately 85% of patients who are admitted to palliative care centres have inadequate relief of pain. (18). Despite the fact that HNC has the highest pain prevalence of all the cancers and is one of the initial symptoms that motivate the patients to seek medical opinion, health care professionals concentrate solely on the surgical aspects, radiotherapy and chemotherapy. The management of chief complain of the patient i.e. pain is neglected which leads to poor quality of life. Therefore an evaluation of cancer patients before initiating any antineoplastic treatment is critical to because most of the studies concentrate on the assessment of pain during or after treatment. Conclusion: The average time from the admission of patients to palliative care unit and their death is usually less than a month thus indicating that palliative care is usually initiated only in the terminally ill patients, An assessment of quality of life of cancer patients before treatment will draw the attention of the clinician to the most symptomatic and feared aspect of cancer i.e. pain. Thus appropriate measures for pain relief along with supportive and palliative care can be instituted right from the beginning of the treatment which will greatly enhance the quality of life of cancer patients. References: Parkin DM, Bray F, Ferlay J, Pisani P:Global cancer statistics, 2002. CA Cancer J Clin2005,55:74-108. Van den Beuken-van Everdingen MH1, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007 Sep;18(9):1437-49. Cuffari L, de Tesseroli SJT, Nemr K, Rapaport A:Pain complaint as the first symptom of oral cancer: a descriptive study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2006,102:56-61. Connelly ST, Schmidt BL: Evaluation of pain in patients with oral squamous cell carcinoma. J Pain 2004, 5:505-510 Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D: Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck 1999, 21:1-11. Bjordal K1, Kaasa S. Psychometric validation of the EORTC Core Quality of Life Questionnaire, 30-item version and a diagnosis-specific module for head and neck cancer patients. Acta Oncol. 1992;31(3):311-21. Cleeland CS, Ryan K: Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994, 23:129-138. Saxena A , Mendoza T,. Cleeland C. The assessment of cancer pain in north India: the validation of the Hindi Brief Pain InventoryBPI-H. J Pain Symptom Manage. 1999 Jan;17(1):27-41 Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee MC, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw KCA, Sullivan M, Takeda F.The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 1993; 85: 365-376. Chaukar DA, Das AK, Deshpande MS, Pai PS, Pathak KA, Chaturvedi P, Kakade AC, Hawaldar RW, DCruz AK. Quality of life of head and neck cancer patient: validation of the European organization for research and treatment of cancer QLQ-C30 and European organization for research and treatment of cancer QLQ-HN 35 in Indian patients. Indian J Cancer. 2005 Oct-Dec; 42(4):178-84. Seamark D, Ajithakumari K, Burn G, Saraswalthi Devi P, Koshy R, Seamark C. Palliative care in India. J R Soc Med. 2000;93:292–5. Vardy J, Agar M. Nonopioid drugs in the treatment of cancer pain. J Clin Oncol. 2014 Jun 1;32(16):1677-90. Khosla D, Patel F, and Sharma S. Palliative Care in India: Current Progress and Future Needs. Indian J Palliat Care. 2012 Sep-Dec; 18(3): 149–154. Oliveira KG, von Zeidler SV, Podestà ¡ JR, Sena A, Souza ED, Lenzi J, Bissoli NS, Gouvea SA. Influence of pain severity on the quality of life in patients with head and neck cancer before antineoplastic therapy. BMC Cancer. 2014 Jan 24;14:39. Thapa D, Rastogi V, Ahuja V. Cancer pain management-current status. J Anaesthesiol Clin Pharmacol. 2011 Apr-Jun; 27(2): 162–168. Bloodworth D. Opioids in the treatment of chronic pain: Legal framework and therapeutic indications and limitations. Phys Med Rehabil Clin N Am. 2006;17:355–79. Geneva: World Health Organization; [Last accessed on 2012 Mar 02]. â€Å"WHO Definition Of Palliative Care â€Å"Available from: http://www.who.int/cancer/palliative/definition/en . Lin YL, Lin IC, Liou JC: Symptom patterns of patients with head and neck cancer in a palliative care unit. J Palliat Med 2011, 14:556-559.

Human Nature As Competitive :: essays research papers

Thomas Hobbes believes that humans are born equal. He means the bodies and minds of newborn people are of equal ability. One person sometimes becomes stronger in body or quicker in mind than another. When one becomes stronger in body, the person can claim he is better than another is. This causes other people around him to become threatened and jealous by the stronger person. People are more equal when it come to wisdom of the mind, because almost all people think they have more wisdom than the common people do. â€Å"They will hardly believe there be many so wise as themselves (201).† Because people basically have equality of ability, they all have hope of attaining what they want and dream of. The conflict comes when two men want the same thing, which they both cannot have. They become enemies and they seek to destroy or subdue the other. Some examples of this are two families that want to purchase the same house. They try to subdue each other by raising the amount they are willing to pay for the house, even if it is more than they were planning on spending. Every person thinks their companion should value them and when the person undervalues them, they will do whatever it takes to be as valued as they would like to be. There are three principle causes of quarrel in the nature of man. They are competition, diffidence (or distrust), and glory. In human nature, competition is for gain, diffidence is for safety, and glory is for reputation. It is the competitive human nature that renders people apt to invade and destroy one another. The reading gives and example of a man who arms himself when taking a journey, locks his doors when he goes to sleep, and locks his chest even when he’s home. He is trying to protect himself from others competing against him for what he has. The reading give another example of how governments and leaders have their weapons pointed at the enemy at all times and how leaders continually spy on their neighbors. This is true because for years the US and Russia have had weapons pointed at each other and the U.

Different Conceptions of Deity and Sacred Power

Throughout history and all across the different races of men and their equally varying cultural codes, ethnic and social beliefs, there have also been a varying conceptions of Deity and Sacred or Divine Powers. All kinds of gods and goddesses: their origins and attributes; their powers and characteristics; their stories in myths, legends and fables; have all shown a diversity and paradoxically, a unity as well. The diversity stems from the varying beliefs about life and nature, which includes culture, climate, weather, other natural phenomena, and the environment around the people who originated such beliefs.James Livingston, in his book Anatomy of the Sacred: An Introduction to Religion, have enumerated these conceptions of the Divine and the Sacred Power from polytheism, pantheism, dualism, and monotheism, among others. Such characters have included gods of thunder and lightning, mother goddesses, entire pantheons of gods and goddesses, and more. And surprisingly, there is an under lying unity in these conceptions. For they all point to the inherent goodness of the Divine, as well as Its Ultimate omnipotence and immortality. What are these conceptions, and what are their characteristics?Let us tackle each and provide examples. Firstly, there is polytheism. This is the belief in the multiplicity of gods and goddesses. It shows that Divine Powers are not limited to one being, but divided in many. The gods and goddesses of polytheistic religions each have specific powers and characteristics, and each can be invoked for specific blessings or help. Examples include the deities of Hinduism. There are also the gods and goddesses of Olympus in Greek mythology. The Chinese also have different gods and goddesses which have specific powers.The deities of Ancient Egypt also show the polytheism of its people. Monotheism, in contrast, is the belief in a single god or deity. It supposes that this single being created the whole universe, and controls all and has the Ultimate Power. Examples include Islam, most forms of Christianity, and the monotheistic religion of an exceptional Egyptian pharaoh, Amenhotep IV or Akhnaton. Akhnaton is said to be the first monotheist in human history, who worshipped the sun-god Ra and no one else, to the enmity of the polytheistic temple priesthood of his time.Pantheism is the belief that everything in creation is the Deity or part of the Deity. Adherents of this concept usually are amenable to worshipping or treating as sacred all the things of nature, such as the sun, the trees, and animals. The pagans can be considered as such. Mystics are sometimes classified as pantheists, for they adhere to the conception that the Deity is in everything and is everywhere. However, mystics are not exactly pantheists in some classifications.Dualism adheres to the concept of two great Deities in opposite extremes or poles, which eternally battle for dominion of creation or the universe. One is traditionally the Creator god who is all- good, while the other is his adversary, who is totally evil. Such religions include forms of Christianity (where God and Satan eternally battle), and Zoroastrianism where the gods Ahura Mazda and Ahriman are good and evil, respectively. This concept adheres to the cosmic struggle between the forces of Light and Darkness.

College Degree Nearly Doubles Annual Earnings

Just in case you still had some doubts as to the power of a college degree, the U.S. Census Bureau has released data proving the substantial value of a college education in the United States. Workers 18 and over sporting bachelors degrees earn an average of $51,206 a year, while those with a high school diploma earn $27,915. But wait, theres more. Workers with an advanced degree make an average of $74,602, and those without a high school diploma average $18,734. According to a new census report titled Educational Attainment in the United States: 2004, 85 percent of those age 25 or older reported they had completed at least high school and 28 percent had attained at least a bachelorÂ’s degree Ââ€" both record highs. Other highlights for the population 25 years and over in 2004: Minnesota, Montana, Wyoming and Nebraska had the highest proportions of people with at least a high school diploma, all around 91 percent.The District of ColumbiaÂ’s population had the highest proportion with a bachelorÂ’s degree or higher at 45.7 percent, followed by Massachusetts (36.7 percent), Colorado (35.5 percent), New Hampshire (35.4 percent) and Maryland (35.2 percent).At the regional level, the Midwest had the highest proportion of high school graduates (88.3 percent), followed by the Northeast (86.5 percent), the West (84.3 percent) and the South (83.0 percent).The Northeast had the highest proportion of college graduates (30.9 percent), followed by the West (30.2 percent), the Midwest (26.0 percent) and the South (25.5 percent).High school graduation rates for women continued to exceed those of men, 85.4 percent and 84.8 percent, respectively. On the other hand, men continued to have a higher proportion of their population with a bachelorÂ’s degree or higher (29. 4 percent compared with 26.1 percent).Non-Hispanic whites had the highest proportion with a high school diploma or higher (90.0 percent), followed by Asians (86.8 percent), African-Americans (80.6 percent) and Hispanics (58.4 percent).Asians had the highest proportion with a bachelorÂ’s degree or higher (49.4 percent), followed by Non-Hispanic whites (30.6 percent), African-Americans (17.6 percent) and Hispanics (12.1 percent).The proportion of the foreign-born population with a high school diploma (67.2 percent) was lower than that of the native population (88.3 percent). However, the percentages with a bachelorÂ’s degree or more were not statistically different (27.3 percent and 27.8 percent, respectively).The data on educational trends and attainment levels are shown by characteristics such as age, sex, race, Hispanic origin, marital status, occupation, industry, nativity and, if foreign-born, when they entered the country. The tables also describe the relationship between earnings and educational attainment. Although the statistics are primarily at the national level, some data are shown for regions and states.Source: U.S. Census Bureau Education Also Effects Unemployment Just as income increases, unemployment decreases with higher educational attainment. According to the U.S. Bureau of Labor Statistics, the nationwide unemployment rate based on educational attainment in 2017 dropped from 6.3 percent among those who did not complete high school, to 4.6 percent among high school graduates, to 2.5 percent among persons with a bachelor’s degree, to only 1.5 percent among persons with doctoral or professional degrees. In addition, higher levels of education tends to reduce the time required for persons who find themselves between jobs to find new employment at equal or better wages.

Context And Principles For Early Year s Progression

Context and principles for early year’s progression 1.1 Explain the legal status and principles of the relevant early year’s framework/s, and how national and local guidance materials are used in settings The legal status of learning that we must follow is the EYFS (Early year’s foundation stage) and the ECM (every child matters). The local guidance is that we must do our own two year checks and also our own referrals where children may need extra support. To support the implementation of the national framework each country has also developed guidance, information about the statutory elements, and training materials. Common features of the early years framework depends on the nation as they may have a different approach to the care and education of young children but they do all have some common features. Such as †¢ Partnership and involvement with parents †¢ Learning through active play †¢ Need for children to have opportunities for child- initiated and adult- directed activities †¢ Education programme is to be delivered holistically although divided into areas of learning †¢ Importance of assessing children’s individual needs. 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The Aztecs And The Aztec Mythology Essay - 1620 Words

â€Å"Proud of itself / is the city of Mexico-Tenochtitlan. / Here no one fears to die in war. This is our glory†¦Ã¢â‚¬  (Joseph and Henderson, 61). The Aztec mythology claims their god Huitzilopochtli ordered them to leave the seven caves to find new land they would call home. They traveled many years until they found the eagle with a serpent on his mouth standing on top of a cactus. There the Aztecs were to build a temple for the god of war and of the sun, Huitzilopochtli. The Aztecs were tried by many but they learned to become skillful warriors, which allowed them to survive for many years. They were not afraid to die and their warriors were skillful, tactical, and one of the best in its time. They were landscapers, amazing architects, mathematicians, poets, but most importantly skillful warriors. The Aztecs were religious people, which also made them very superstitious. 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Business Process Outsourcing Supply Chain -Myassignmenthelp.Com

Questions: Does BPO Enhance The Financial Performance Of The Organization? Can BPO Help To Increase Efficiency And Total Productivity Of The Company? Can The Organizations Create New Product By Adopting BPO Activities? Will The Implementation Of BPO Aid The Companies To Gain Competitive Advantage Against Their Rivals? Answers: Introduction The research study provides an analysis on the business process outsourcing and its positive and negative aspects. Business process outsourcing refers to the process of subcontracting different operation relating to business to the third party (Bentounsi, Benbernou Atallah, 2012). Most of the multinational companies (MNCs) adopts this business process outsourcing policy for reducing their overall business expenditure in the operational activities. It also facilitates them to enhance the production rate within the business. In the present era, the MNCs are hiring laborers as the form of outsourcing component. Through outsourcing as well as administrative functions, the organization allocates the resources in better way and also focuses on their core competencies that include- goods leadership, relationship with customer and excellence in operation. Purchasing raw material as well as components from third party is said to be one of the main part of the business process outsourcing. Project Objectives The basic objective of this research study is to analyze the process of business outsourcing and also highlights on its positive as well as negative aspect. This study also aims in evaluating several relevant articles for reviewing the literature that is related to this business process outsourcing. This project also focuses on the research methodology that focuses on the different methods used for conducting this research. Furthermore, the objective of this study is also to provide recommendations for certain ways that should be adopted by the business for improving the application of the business process outsourcing. Project Scope The present research study will assess as well as analyze all kinds of business outsourcing procedure and will also reflect on its advantages and disadvantages. This scope of this project is to have an idea about whether the organization taking into account this business outsourcing procedure require assessment of the right partner and their internal operations (Chou, Techatassanasoontorn Hung, 2015). This study will also highlight on the practical example of the process of business outsourcing for gaining knowledge about its positive and negative effect. In addition, this aspect will be estimated in order to provide recommendations on the improvement of existing plan regarding business outsourcing procedure. Literature Review In the present era, outsourcing has become one of the strategies that the business organization implements in order to reduce their operation cost. The visibility of business outsourcing increased vividly over the last few decades, especially in IT (Information Technology) field. Han Mithas (2013) opines that business process outsourcing (BPO) has become the biggest means of gaining competitive advantage for the entities of varied sizes. It exceptional growth has been attributed to advancement in IT as well as communications. Lacity Willcocks, (2014) stated that the BPO sector is very heterogeneous by nature and differentiated in terms of horizontal process areas such as., operations, human resource and vertical specialization namely imaging in the banking industry. It is directly related to the quest for efficient companys designs that includes- reduction of cost, growth in productivity and creative capabilities. Thus, it is an important source for the strategic advantage. However , this section of the project highlights on both the advantages and disadvantages of the BPO. Advantages of BPO One of the basic advantages of adopting BPO is to improve the level of cost efficiency in the production process. Liu, Wang Huang (2017) stated that the same function in the business can be done with good quality and at lesser price as it is handled by the experts. The huge scale MNCs generally gets raw materials from this third party agent at lower cost. This is mainly possible as several business vendors have the ability to prove upon product line quality. In addition, these organizations also get varied range of commodity quality. It has been mentioned by Sople (2016) that most of the MNCs save near about 50% of their total production cost through BPO. Furthermore, owing to the difference in work payment between Eastern and Western Europe, similar type of work is mainly done in two different nations. According to Lacity Willcocks (2014), large MNCs reduces the cost of new technology implementation and their infrastructure maintenance with the help of BPO. Few evidences reflect that some of the organization faces huge difficulty in hiring skilled workers owing to limited search options. However, allocating this task of workers recruitment to third party agents helps these MNCs in reducing recruitment cost. Additionally, it also aid them to attain wider range of the workers. Enhancement of productivity The organizations that adopt the BPO have the ability to attain new efficiencies and hence this improves the total productivity. Even they get the chance to reallocate their resources in different projects. This in turn aids the employees to increase their efficiency and productivity. It has been mentioned by Mani, Barua Whinston (2012) that, highly skilled employees improve the business processes and hence this leads to improvement in total productivity. Focusing on core competencies BPO provides incredible help to the MNCs to focus mainly on their core business operations. According to the approach of competence, every organization can outsource many activities but not their core competencies. The vital factor behind the BPO market growth is that most of the entities focus on their internal operations for understanding their core competencies. Sople (2016) founds out that the organization with the help of BPO assigns the promotion task through digital technology as well as social media to the agents. However, this provides the managers of the company to concentrate on core activities that is required to maintain sustainability in business. For example, in case of Sony mobile company, the services after sale are manly provided by their agents for dealing with excessive sale pressure (Rai et al., 2012). Therefore, the company can provide better after sale service if they focus on their core business areas including research and development (RD) activities required for upgrading their technology. Saving Time When the companies allocate the task to the third parties, it saves lot of time to focus on varied profit making procedure. Additionally, the outsourcing entities charge fewer amounts as compared to maintenance cost of full time team. This BPO also helps them to deal with some other research activities through recruiting laborers from different countries. Thus, it helps them to work on time related operation activities in business. Disadvantages of BPO When the company outsources recruitment services, HR and payroll, it generally involves risk of exposure of confidential data and technology to the third party. This means that outsourcing leads to imitation of commodities. It has been stated by Nassimbeni, Sartor Dus, (2012) that, the agents of third party misusing the entitys information leads to bad reputation as well as brand value. Several hidden cost Outsourcing is generally cost-effective but in some circumstances it might involve hidden cost while signing the contract across the boundaries, which in turn might pose threat. It has been mentioned by Weigelt Sarkar (2012) that, the parent organization requires to form legal contract for making illegal contract between the business outsourcing agents. Therefore, it is necessary that the individuals should look over the detailed contract paperwork for avoiding this risk. Risk of compromising product quality Another disadvantage relative to that of BPO is probable risk of compromising product quality as well as safety. When the organization hires raw material from third party agents, they might face difficulty in managing product quality. There are some cases in which the organization cannot provide best service quality to their client. The main reason behind this is that inexperienced individuals provide BPO service activities. However, it becomes impossible for the firm to monitor the reasons of poor product quality. Research Design and Methodology Research design refers to the conceived plan and investigation structure for attaining accurate results to these research questions. This section reflects the method to be used by the researcher to conduct the research aligning with the pros and cons of the business outsourcing process. Research Design Research design is the procedure which the researcher implements for integrating various components of this research study. It is categorized into three kinds namely- explanatory, exploratory and descriptive. Explanatory design attempts to unite the ideas for comprehending the cause and impact of relationship (Lewis, 2015). It also helps the researcher to illustrate the things coming in collective way. Exploratory design aids the researcher to discover and investigate data for giving insight about the study. It also helps to devise the problem and clarify concepts in much precise way. This design includes several procedure such as- trail studies, interviews etc for gathering accurate information about the project. Descriptive design signifies the attempt done by the researcher for investigating the theories of the study. This design helps to describe the participants with higher accuracy and circumstances in suitable manner. For this project, the researcher will use exploratory research design as it helps the researcher to save time as well as resources of this research study. Moreover, it will also aid in laying groundwork, which will further lead to future studies. Research Approach The researcher utilizes this approach for devising the plan while doing this research study. There are two kinds of research approach- deductive and inductive. Deductive approach is apprehensive with developing hypothesis based on present theories. The hypothesis is then tested for planning the strategy while doing the research. After attaining the result from hypothesis, the researcher makes inspection for either accepting or rejecting this. If this hypothesis is rejected, the researcher amends the study accordingly. In case of inductive approach, the researcher gathers data and evaluates the pattern for creating new theories. The observations used in this approach helps the researcher to develop universal principle about the research topic. For this project, the researcher will use deductive approach for concentrating on the positive and negative aspect of BPO based on present concepts. The researcher will use this approach for investigating the theory and testing the validity in certain situation. Adoption of this approach aids the researcher to gain accurate outcome from hypothesis. Research philosophy This researcher classifies the principle using the research philosophy. It is categorized into four types namely- positivism, pragmatism, realism and interpretivism. Positivism philosophy illustrates about positive facts and scientific data collection procedure that has been received from empirical evidence. The data obtained is then interpreted by applying logic that forms knowledge source. Pragmatism philosophy is used to assess the concepts used in the project in account of practical application. Realism philosophy is based on reality facet independent of beliefs. Interpretivism philosophy is used by the researcher for interpreting elements and integrates individuals interest into the study. For this project, the researcher will use interpretivism philosophy in order to understand both positive and negative aspect of the BPO. Research Method This indicates the methods adopted by the researcher while conducting this study. Research method is usually classified into two kinds- qualitative and quantitative method. Qualitative method refers to the procedure in which the researcher gathers information or data from secondary sources namely- websites, journals, newspapers, archival materials etc (Taylor, Bogdan DeVault, 2015). On the other hand, quantitative method uses the give emphasis on the statistical analysis of gathered information by using survey questionnaire. This method is also used for collecting accurate information from different individuals. For this project, the researcher will use qualitative approach and hence gathered data from secondary sources (Eriksson Kovalainen, 2015). This method will be applied as it will help the researcher to complete the research in less time owing to accessibility of instant data from these sources. The gathered data that is used for conducting this research must be scrutinized for reliability. The authenticity of information will be ensured from the sources that are either approve by scholars or reviewed by peers (Lewis, 2015). Furthermore, the information will be collected from reliable websites and journals. Validity of data should not surpass the limitation. The information provided in the website is valid until release of new information. As the researcher will collect data from secondary sources, assurance of its validity cannot be given. Research Limitations Certain limitation can arise while conducting the research from secondary sources. If websites of the organization are not available, then the researcher can face difficulty in collecting data. In fact, some of the journals or books might be expensive and old and this in turn might increase the cost of doing research. Moreover, data given in the website might not be appropriate and hence this can result in inaccurate results. Despite all limitations, it is predicted that the researcher will make effort to make this project valid and reliable. Time schedule Sequential Activities/ Period Week 1 Week 2 Week 3 4 Week 5 6 Idea about the project Designing the present research Gathering of information from secondary sources Interpretation of this gathered information Procedure of publi Conclusion The conclusion that can be drawn from the above study is that the biggest advantage of implementing BPO is to enhance upon effectiveness of cost and incorporate skilled laborers. In fact, it also helps the organization to operate 24 hours a day and improve their operation. It also enhances their overall productivity and improve their financial performance. On the contrary, BPO includes some risk that includes exposure of companys data, compromising product quality etc. However, this in turn leads to financial loss and bad reputation in the marketplace. Therefore, it is recommended that the organizations who have involved BPO must have better level of the monitoring system and this can aid to assure better product quality. References Bentounsi, M., Benbernou, S., Atallah, M. J. (2012, June). Privacy-preserving business process outsourcing. InWeb Services (ICWS), 2012 IEEE 19th International Conference on(pp. 662-663). IEEE. Chou, S. W., Techatassanasoontorn, A. A., Hung, I. H. (2015). Understanding commitment in business process outsourcing relationships.Information Management,52(1), 30-43. Eriksson, P., Kovalainen, A. (2015).Qualitative methods in business research: A practical guide to social research. Sage. Gerbl, M., McIvor, R., Loane, S., Humphreys, P. (2015). A multi-theory approach to understanding the business process outsourcing decision.Journal of World Business,50(3), 505-518. Han, K., Mithas, S. (2013). Information technology outsourcing and non-IT operating costs: An empirical investigation.Mis Quarterly,37(1). Handley, S. M., Benton Jr, W. C. (2012). The influence of exchange hazards and power on opportunism in outsourcing relationships.Journal of Operations Management,30(1-2), 55-68. Lacity, M., Willcocks, L. (2014). Business process outsourcing and dynamic innovation.Strategic Outsourcing: An International Journal,7(1), 66-92. Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches.Health promotion practice,16(4), 473-475. Liu, S., Wang, L., Huang, W. W. (2017). Effects of process and outcome controls on business process outsourcing performance: Moderating roles of vendor and client capability risks.European Journal of Operational Research,260(3), 1115-1128. Mani, D., Barua, A., Whinston, A. B. (2012). An empirical analysis of the contractual and information structures of business process outsourcing relationships.Information Systems Research,23(3-part-1), 618-634. Nassimbeni, G., Sartor, M., Dus, D. (2012). Security risks in service offshoring and outsourcing.Industrial Management Data Systems,112(3), 405-440. Rai, A., Keil, M., Hornyak, R., WLlenweber, K. (2012). Hybrid relational-contractual governance for business process outsourcing.Journal of Management Information Systems,29(2), 213-256. Schniederjans, M. J., Schniederjans, A. M., Schniederjans, D. G. (2015).Outsourcing and insourcing in an international context. Routledge. Sople, V. V. (2016).Business process outsourcing a supply chain of expertises. PHI Learning Pvt. Ltd.. Taylor, S. J., Bogdan, R., DeVault, M. (2015).Introduction to qualitative research methods: A guidebook and resource. John Wiley Sons. Vaidhyanathan, S., Dev, L., Shattacharyya, D. (2013).U.S. Patent No. 8,392,240. Washington, DC: U.S. Patent and Trademark Office. Weigelt, C., Sarkar, M. B. (2012). Performance implications of outsourcing for technological innovations: managing the efficiency and adaptability trade?off.Strategic Management Journal,33(2), 189-216.