Critically Appraising Qualitative Evidence for Clinical Decision Making

Qualitative Research and Decision-Making Qualitative research is usually placed near the bottom of hierarchies of evidence However, it is important in regard to clinical questions that address human responses and meaning Recall that patient preferences and values are key components of EBP Qualitative methods have evolved and expanded in recent years

Question Qualitative evidence is most likely to inform which of the following aspects of the care of patients with cancer? Cancer patients’ perceptions of hope during chemotherapy treatment Treatment options for chemotherapy-induced nausea Clinicians’ choices of chemotherapeutic agents The relationship between anxiety and nausea in patients undergoing chemotherapy

Answer a. Cancer patients’ perceptions of hope during chemotherapy treatment Rationale: The concept of hope is an aspect of the human responses and meaning that surround a health experience. Treatment options and the relationships between different concepts are likely better addressed by quantitative evidence.

Qualitative Research Traditions Clinicians must appreciate the diversity within the methodology Ethnography - the study of a social group’s culture through combining participant observation, in-depth interviews, and the collection of artifacts Useful for elucidating People’s experiences of health/illness Issues of concern to caregivers Individuals’ experiences in certain types of settings

Qualitative Research Traditions (cont’d) Grounded theory Purpose is to generate theory about how people deal with life situations that is “grounded” in empirical data Movement through time is often expressed in terms of stages or phases Phenomenology - the study of essences (meaning structures) intuited or grasped through descriptions of lived experience Hermeneutics - viewing human “lived experience” as a text that is to be understood through the interpreter’s dialogical engagement

Question Tell whether the following statement is true or false. Grounded theory is the most appropriate tradition for a study that explores women’s coping as they move through different stages of fertility treatment.

Answer True Rationale: Grounded theory often focuses on changes in the human experience as they move through time.

Internal Diversity in Qualitative Research Representation and conceptualization Historical evolution Description, interpretation, and theory generation Qualitative descriptive studies Generic qualitative studies Qualitative evaluation and action research studies

Qualitative Research Techniques Observation and field notes Interviews and focus groups Narrative and content analysis Sampling strategies Data management and analysis

Appraising Qualitative Studies No single set of criteria can serve all qualitative approaches equally well Lincoln and Guba’s (1985) trustworthiness criteria have broad application Credibility Demonstrated by accuracy and validity that is assured through documentation Roughly parallel to internal validity in quantitative appraisal

Appraising Qualitative Studies (cont’d) Lincoln and Guba Transferability Demonstrated by information that is sufficient for a research consumer to determine whether findings are meaningful to other people in similar situations Parallels external validity Dependability Demonstrated by a research process that is carefully documented to provide evidence of how conclusions were reached and whether, under similar conditions, a researcher might expect to obtain similar findings Parallels reliability

Appraising Qualitative Studies (cont’d) Lincoln and Guba Confirmability Demonstrated by providing substantiation that findings and interpretations are grounded in the data Parallels objectivity Authenticity criteria (Guba & Lincoln, 1989) Less commonly used than Lincoln & Guba’s trustworthiness criteria

Question A nurse has examined whether the participants in a qualitative study on the meaning of dependence among IV drug users are similar to the clients that the nurse works with. This nurse has evaluated this study’s: Dependability Confirmability Transferability Credibility

Answer c. Transferability Rationale: Transferability addresses the question of whether the findings of a qualitative study are applicable to other people who are in similar situations.

Thanks