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Theißen T, Ullrich A, Oechsle K, Wikert J, Bokemeyer C, Schieferdecker A. "Being an informal caregiver - strengthening resources": mixed methods evaluation of a psychoeducational intervention supporting informal caregivers in palliative care. BMC Palliat Care 2024; 23:95. [PMID: 38600500 PMCID: PMC11007958 DOI: 10.1186/s12904-024-01428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Informal caregivers are key support for patients with progressive incurable diseases. However, their own needs often remain unmet. Therefore, we developed, manualised and implemented the intervention "Being an informal caregiver - strengthening resources" aiming to support and empower informal caregivers by addressing relevant information-related, physical, psychological and social needs. METHODS In this pilot study, we evaluated the acceptance and experiences with this psychoeducational intervention. The study was conducted over two years (2019-2021). Informal caregivers were recruited from the University Medical Centre Hamburg-Eppendorf and the metropolitan region of Hamburg, Germany. The intervention was aimed at adult persons who identified themselves as an informal caregiver to an adult patient with a progressive incurable cancer and non-cancer disease. For the evaluation we used a mixed methods approach, combining a longitudinal questionnaire survey (pre-intervention, after each module, 3-months follow-up) and semi-structured interviews post-intervention. Quantitative data were analysed using descriptive statistics and a paired t-Test, interviews were analysed based on the qualitative content analysis according to Mayring. Results were triangulated using a convergent triangulation design. RESULTS Of 31 informal caregivers who received the intervention, 25 returned the follow-up questionnaire and 20 informal caregivers were interviewed. Triangulated results showed a high satisfaction with the implementation of the intervention. Of a broad range of subjective benefits, gaining knowledge, self-awareness and self-efficacy were most apparent. Informal caregivers reported improved preparedness, awareness of own needs as well as confidence regarding handling own emotions and interacting with the ill person. However, implementing the learned skills into daily life can be challenging due to internal and external factors. Motivations and challenges for participating as well as potential for improvement were identified. CONCLUSIONS This pilot study showed an overall positive evaluation and several subjective benefits of the psychoeducational intervention "Being an informal caregiver - strengthening resources". Further research is needed to measure the efficacy of this intervention on informal caregivers' outcomes. Therefore, a multicentre randomized prospective study is planned.
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Affiliation(s)
- Tabea Theißen
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Julia Wikert
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Aneta Schieferdecker
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Verma S, Hingwala J, Low JTS, Patel AA, Verma M, Bremner S, Haddadin Y, Shinall MC, Komenda P, Ufere NN. Palliative clinical trials in advanced chronic liver disease: Challenges and opportunities. J Hepatol 2023; 79:1236-1253. [PMID: 37419393 DOI: 10.1016/j.jhep.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
Patients with advanced chronic liver disease have a complex symptom burden and many are not candidates for curative therapy. Despite this, provision of palliative interventions remains woefully inadequate, with an insufficient evidence base being a contributory factor. Designing and conducting palliative interventional trials in advanced chronic liver disease remains challenging for a multitude of reasons. In this manuscript we review past and ongoing palliative interventional trials. We identify barriers and facilitators and offer guidance on addressing these challenges. We hope that this will reduce the inequity in palliative care provision in advanced chronic liver disease.
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Affiliation(s)
- Sumita Verma
- Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
| | - Jay Hingwala
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Arpan A Patel
- Division of Digestive Diseases, University of California, Los Angeles, USA; Department of Gastroenterology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Manisha Verma
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Stephen Bremner
- Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Yazan Haddadin
- Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Paul Komenda
- University of Manitoba, Winnipeg, Manitoba, Canada
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Drury A, Goss J, Afolabi J, McHugh G, O’Leary N, Brady AM. A Mixed Methods Evaluation of a Pilot Multidisciplinary Breathlessness Support Service. EVALUATION REVIEW 2023; 47:820-870. [PMID: 37014066 PMCID: PMC10492442 DOI: 10.1177/0193841x231162402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Breathlessness support services have demonstrated benefits for breathlessness mastery, quality of life and psychosocial outcomes for people living with breathlessness. However, these services have predominantly been implemented in hospital and home care contexts. This study aims to evaluate the adaptation and implementation of a hospice-based outpatient Multidisciplinary Breathlessness Support Service (MBSS) in Ireland. A sequential explanatory mixed methods design guided this study. People with chronic breathlessness participated in longitudinal questionnaires (n = 10), medical record audit (n = 14) and a post-discharge interview (n = 8). Caregivers (n = 1) and healthcare professionals involved in referral to (n = 2) and delivery of (n = 3) the MBSS participated in a cross-sectional interview. Quantitative and qualitative data were integrated deductively via the pillar integration process, guided by the RE-AIM framework. Integration of mixed methods data enhanced understanding of factors influencing the reach, adoption, implementation and maintenance of the MBSS, and the potential outcomes that were most meaningful for service users. Potential threats to the sustainability of the MBSS related to potential preconceptions of hospice care, the lack of standardized discharge pathways from the service and access to primary care services to sustain pharmacological interventions. This study suggests that an adapted multidisciplinary breathlessness support intervention is feasible and acceptable in a hospice context. However, to ensure optimal reach and maintenance of the intervention, activities are required to ensure that misconceptions about the setting do not influence willingness to accept referral to MBSS services and integration of services is needed to enable consistency in referral and discharge processes.
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Affiliation(s)
- Amanda Drury
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Julie Goss
- Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Jide Afolabi
- Our Lady’s Hospice and Care Services, Dublin, Ireland
| | | | - Norma O’Leary
- Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Anne-Marie Brady
- Trinity Centre Practice & Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Emary PC, Stuber KJ, Mbuagbaw L, Oremus M, Nolet PS, Nash JV, Bauman CA, Ciraco C, Couban RJ, Busse JW. Quality of Reporting Using Good Reporting of A Mixed Methods Study Criteria in Chiropractic Mixed Methods Research: A Methodological Review. J Manipulative Physiol Ther 2023; 46:152-161. [PMID: 38142381 DOI: 10.1016/j.jmpt.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/25/2023] [Accepted: 11/07/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The purpose of this review was to examine the reporting in chiropractic mixed methods research using Good Reporting of A Mixed Methods Study (GRAMMS) criteria. METHODS In this methodological review, we searched MEDLINE, Embase, CINAHL, and the Index to Chiropractic Literature from the inception of each database to December 31, 2020, for chiropractic studies reporting the use of both qualitative and quantitative methods or mixed qualitative methods. Pairs of reviewers independently screened titles, abstracts, and full-text studies, extracted data, and appraised reporting using the GRAMMS criteria and risk of bias with the Mixed Methods Appraisal Tool (MMAT). Generalized estimating equations were used to explore factors associated with reporting using GRAMMS criteria. RESULTS Of 1040 citations, 55 studies were eligible for review. Thirty-seven of these 55 articles employed either a multistage or convergent mixed methods design, and, on average, 3 of 6 GRAMMS items were reported among included studies. We found a strong positive correlation in scores between the GRAMMS and MMAT instruments (r = 0.78; 95% CI, 0.66-0.87). In our adjusted analysis, publications in journals indexed in Web of Science (adjusted odds ratio = 2.71; 95% CI, 1.48-4.95) were associated with higher reporting using GRAMMS criteria. Three of the 55 studies fully adhered to all 6 GRAMMS criteria, 4 studies adhered to 5 criteria, 10 studies adhered to 4 criteria, and the remaining 38 adhered to 3 criteria or fewer. CONCLUSION Our findings suggest that reporting in chiropractic mixed methods research using GRAMMS criteria was poor, particularly among studies with a higher risk of bias.
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Affiliation(s)
- Peter C Emary
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada; Chiropractic Department, D'Youville University, Buffalo, New York; Private practice, Langs Community Health Centre, Cambridge, Ontario, Canada.
| | - Kent J Stuber
- Parker University Research Center, Parker University, Dallas, Texas; Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Lawrence Mbuagbaw
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada; Centre for the Development of Best Practices in Health, Yaundé, Cameroon; Division of Global Health, Stellenbosch University, Stellenbosch, South Africa; Division of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul S Nolet
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jennifer V Nash
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Craig A Bauman
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
| | | | - Rachel J Couban
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
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Guetterman TC, James TG. A software feature for mixed methods analysis: The MAXQDA Interactive Quote Matrix. METHODS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.metip.2023.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Nicolau B, Eslamiamirabadi N, Dudubo O, Hong QN, Bedos C, Macdonald ME. How to use mixed methods in oral health research. Community Dent Oral Epidemiol 2023; 51:71-74. [PMID: 36749665 DOI: 10.1111/cdoe.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 09/05/2022] [Accepted: 10/10/2022] [Indexed: 02/08/2023]
Abstract
Wicked problems exist in the realm of oral health research. Due to their inherent complexity, using qualitative or quantitative methods alone may not be adequate for resolving them. Mixed methods approaches combine qualitative and quantitative methods, and thus, can provide a powerful tool for understanding and solving complex problems in dental public health. However, using mixed methods does not come without its challenges. This commentary outlines four main tips for researchers to consider when applying mixed methods to their research projects.
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Affiliation(s)
- Belinda Nicolau
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Negin Eslamiamirabadi
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Olawale Dudubo
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Quan Nha Hong
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada
| | - Christophe Bedos
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Mary Ellen Macdonald
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
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Fàbregues S, Sáinz M, Romano MJ, Escalante-Barrios EL, Younas A, López-Pérez BS. Use of mixed methods research in intervention studies to increase young people's interest in STEM: A systematic methodological review. Front Psychol 2023; 13:956300. [PMID: 36687955 PMCID: PMC9849589 DOI: 10.3389/fpsyg.2022.956300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Mixed methods research intervention studies integrate quantitative evaluation approaches, such as randomized controlled trials and quasi-experimental designs, with qualitative research to evaluate the effectiveness, efficacy, or other results of an intervention or program. These types of studies, which have attracted growing attention in recent years, enhance the scope and rigor of the evaluation. While various frameworks that summarize the justifications for carrying out these types of studies and provide implementation guidance have been published in the last few years in the health sciences, we do not know whether such frameworks have been properly implemented in the social and educational sciences. This review examined the methodological features and reporting practices of mixed methods intervention studies aimed at increasing young people's interest in STEM. Methods A systematic search was carried out in APA PsycNET, ERIC, ProQuest, Scopus, and Web of Science, and a hand search in 20 journals. We included peer-reviewed English-language articles that reported intervention studies with a quantitative component measuring outcomes specific to increasing secondary school students' interest in STEM fields, a qualitative component conducted before, during, or after the quantitative component, and evidence of integration of both components. Qualitative content analysis and ideal-type analysis were used to synthesize the findings. Results We found 34 studies; the majority published in the last ten years. Several patterns of mixed methods application were described in these studies, illustrating the unique insights that can be gained by employing this methodology. The reporting quality of the included studies was generally adequate, especially regarding the justification for using a mixed methods intervention design and the integration of the quantitative and qualitative components. Nonetheless, a few reporting issues were observed, such as a lack of detail in the presentation of the mixed methods design, an inadequate description of the qualitative sampling and analysis techniques, and the absence of joint displays for representing integration. Discussion Authors must pay attention to these issues to ensure that the insights obtained by the use of mixed methods research are effectively communicated.
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Affiliation(s)
- Sergi Fàbregues
- Department of Psychology and Education, Universitat Oberta de Catalunya, Barcelona, Spain,*Correspondence: Sergi Fàbregues,
| | - Milagros Sáinz
- Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain,Milagros Sáinz,
| | - María José Romano
- Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Ahtisham Younas
- Faculty of Nursing, Memorial University of Newfoundland, St. John’s, IL, Canada
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Emary PC, Brown AL, Oremus M, Mbuagbaw L, Cameron DF, DiDonato J, Busse JW. The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study. BMC Health Serv Res 2022; 22:1313. [PMID: 36329472 PMCID: PMC9635131 DOI: 10.1186/s12913-022-08632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Emerging evidence suggests that access to chiropractic care may reduce the likelihood of initiating an opioid prescription for spinal pain; however, the impact of chiropractic care for patients already prescribed opioids is uncertain. We undertook a sequential explanatory mixed methods study to evaluate the association between initiating chiropractic care and continued opioid use among adult patients attending an Ontario community health centre (CHC) and receiving opioid therapy for chronic non-cancer spinal pain. METHODS We conducted a retrospective cohort study of 210 patient records between January 1, 2014 and December 31, 2020. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year, to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use (e.g., unique opioid fills, number of refills, and dosages) up to one year following the index chiropractic visit. We also completed follow-up interviews with 14 patients and nine general practitioners from the CHC and integrated these data with our quantitative findings. RESULTS Over 12-month follow-up, there were lower rates of opioid fills (incidence rate ratio [IRR] = 0.66; 95% confidence interval [CI], 0.52-0.83) and refills (IRR = 0.27; 95% CI, 0.17-0.42) among chiropractic recipients (n = 49) versus non-recipients (n = 161). Although patients who did and did not receive chiropractic care began the study with the same dose of opioids, recipients were less likely to be prescribed higher-dose opioids (i.e., ≥ 50 mg morphine equivalents daily) compared to non-recipients at three months (odds ratio [OR] = 0.14; 95% CI, 0.04-0.47), six months (OR = 0.14; 95% CI, 0.05-0.40), nine months (OR = 0.19; 95% CI, 0.07-0.57), and 12 months (OR = 0.22; 95% CI, 0.08-0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding use of opioids, and access to chiropractic treatment were important influencing factors. CONCLUSION We found that continued prescription opioid use among patients with chronic non-cancer spinal pain who received chiropractic care was lower than in patients who did not receive chiropractic care. Four themes emerged in our qualitative interviews to help provide a richer understanding of this association. Randomized controlled trials are needed to establish the effect of chiropractic care on opioid use for chronic spinal pain.
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Affiliation(s)
- Peter C. Emary
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada ,Chiropractic Department, D’Youville University, Buffalo, NY USA ,Private Practice, 1145 Concession Road, N3H 4L5 Cambridge, ON Canada
| | - Amy L. Brown
- Private Practice, 1145 Concession Road, N3H 4L5 Cambridge, ON Canada
| | - Mark Oremus
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, Waterloo, ON Canada
| | - Lawrence Mbuagbaw
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355Biostatistics Unit, Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare- Hamilton, Hamilton, ON Canada ,Centre for the Development of Best Practices in Health, Yaundé, Cameroon ,grid.11956.3a0000 0001 2214 904XDivision of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jenna DiDonato
- Chiropractic Department, D’Youville University, Buffalo, NY USA
| | - Jason W. Busse
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227Department of Anesthesia, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON Canada ,Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON Canada
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Shahar-Lahav R, Sher-Censor E, Hebel O. Emotional availability in mothers and their children with spinal muscular atrophy type 1 who require augmentative and alternative communication: a mixed-methods pilot study. Augment Altern Commun 2022; 38:161-172. [PMID: 36285736 DOI: 10.1080/07434618.2022.2124928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Emotional availability in parent-child interactions fosters children's socioemotional development. Little is known about the emotional availability of parents and children with profound motor disabilities and complex communication needs or the contributions of augmentative and alternative communication (AAC) to emotional availability. To begin addressing these gaps, this pilot study focused on three mothers and their children with spinal muscular atrophy Type 1 who could not speak and required AAC. The study used a mixed-methods design. Mother-child interactions were rated using the Emotional Availability Scales. Semi-structured in-depth interviews with the mothers were qualitatively analyzed. Emotional availability in mother-child dyads was adequate. In the interviews, mothers addressed significant challenges but described mainly typical parent-child relationships and adaptive child and mother coping attributable to the use of AAC. Results suggest that emotional availability is possible and can be facilitated by AAC, even with children with profound motor disabilities and limited ability to communicate needs and desires. The findings highlight the importance of targeting children's socioemotional needs and parent-child emotional availability in AAC interventions with families of children with profound motor disabilities.
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Affiliation(s)
| | - Efrat Sher-Censor
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Orly Hebel
- Department of Special Education, Levinsky College of Education, Tel-Aviv, Israel
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Emary PC, Brown AL, Oremus M, Mbuagbaw L, Cameron DF, DiDonato J, Busse JW. Association of Chiropractic Care With Receiving an Opioid Prescription for Noncancer Spinal Pain Within a Canadian Community Health Center: A Mixed Methods Analysis. J Manipulative Physiol Ther 2022; 45:235-247. [PMID: 36008170 DOI: 10.1016/j.jmpt.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between receipt of chiropractic services and initiating a prescription for opioids among adult patients with noncancer spinal pain in a Canadian community health center. METHODS In this sequential explanatory mixed methods analysis, we conducted a retrospective study of 945 patient records (January 2014 to December 2020) and completed interviews with 14 patients and 9 general practitioners. We used Cox proportional hazards regression analyses, adjusted for patient demographics, comorbidities, visit frequency, and calendar year to evaluate the association between receipt of chiropractic care and time to first opioid prescription up to 1 year after presentation. Qualitative data were analyzed thematically and integrated with our quantitative findings. RESULTS There were 24% of patients (227 of 945) with noncancer spinal pain who received a prescription for opioids. The risk of initiating a prescription for opioids at 1 year after presentation was 52% lower in chiropractic recipients vs nonrecipients (hazard ratio [HR], 0.48; 99% confidence interval [CI], 0.29-0.77) and 71% lower in patients who received chiropractic services within 30 days of their index visit (HR, 0.29; 99% CI, 0.13-0.68). Patients whose index visit date was in a more recent calendar year were also less likely to receive opioids (HR, 0.86; 99% CI, 0.76-0.97). Interviews suggested that self-efficacy, access to chiropractic services, opioid stigma, and treatment impact were influencing factors. CONCLUSION Patients with noncancer spinal pain who received chiropractic care were less likely to obtain a prescription for opioids than patients who did not receive chiropractic care.
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Affiliation(s)
- Peter C Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; Chiropractic Department, D'Youville University, Buffalo, New York; Private practice, Cambridge, Ontario, Canada.
| | - Amy L Brown
- Private practice, Cambridge, Ontario, Canada
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada; Centre for the Development of Best Practices in Health, Division of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jenna DiDonato
- Chiropractic Department, D'Youville University, Buffalo, New York
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; Department of Anesthesia, McMaster University, Waterloo, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada; Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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DU W, WANG L, JIA M, LIANG X, LI B, ZHANG Y, LIAO X. Mixed methods research in complementary and alternative medicine: a scoping review. J TRADIT CHIN MED 2022; 42:652-666. [PMID: 35848983 PMCID: PMC9924665 DOI: 10.19852/j.cnki.jtcm.20220602.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To update the current characteristics about the scope and quality of mixed methods research (MMR) in complementary and alternative medicine (CAM) after nearly 10 years. METHODS A 5-stage approach for conducting a scoping review was adopted. Articles published on the top 10 journals in CAM with the highest impact factor in 2020 were screened for MMR. Information of included articles were extracted, and then synthesized to illustrate the current state. Methodological quality was evaluated according to the Mixed Method Appraisal Tool (MMAT) 2018 version. RESULTS A total of 55 (55/2991, 2%) articles using mixed methods were retrieved, including 17 medical studies and 38 ethnobotanical studies. We performed an in-depth analysis on the 17 medical studies, which studied cancer, stress, pain, fatigue, exercises, mindfulness intervention, herbal medicine use, art and acupuncture. Thirteen pilot studies applied MMR to evaluate the feasibility of interventions or programs (13/17, 76%); phenomenology was inferred as the most common philosophical assumptions (13/17, 76%); the most applied type of MMR was convergent design (16/17, 94%); integration often took place at integration (12/17, 71%). Among the 16 eligible studies for quality appraisal, majority were rated as good (14/16, 88%), whereas two studies were rated as poorly described. Primarily, a poor rating was due to incomplete reporting of data analysis and citations in qualitative components; lack of confounder controlling and the sampling strategy in quantitative components; poor description of integration and justification for mixed methods. Comparing with the previous review, fewer MMR were published in 2020 in CAM, but the proportion of studies that clearly reported MMR has increased by 4 times (4%→15%). CONCLUSION CAM researchers need to realize the benefits that MMR can have on conducting further health care research. Our findings highlight that applying MMR will be helpful to understand the complex dynamics and interdisciplinary nature of complex intervention. In addition, addressing a standardized reporting criteria for MMR is recommended.
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Affiliation(s)
- Wanqing DU
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- 2 Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
- 3 Xiyuan School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Liuding WANG
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Min JIA
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Xiao LIANG
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Bo LI
- 4 Department of Clinical Epidemiology, Beijing Traditional Chinese Medicine Hospital, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China
| | - Yunling ZHANG
- 1 Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- Prof. ZHANG Yunling, Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing100091, China. , Telephone: +86-15201084286; +86-17888805760
| | - Xing LIAO
- 2 Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
- Prof. LIAO Xing, Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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12
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Fàbregues S, Mumbardó-Adam C, Escalante-Barrios EL, Hong QN, Edelstein D, Vanderboll K, Fetters MD. Mixed methods intervention studies in children and adolescents with emotional and behavioral disorders: A methodological review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 126:104239. [PMID: 35526490 DOI: 10.1016/j.ridd.2022.104239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mixed methods intervention studies can improve the accuracy of interventional evaluations in the field of emotional and behavioral disorders by helping researchers gain a more nuanced understanding of how a particular intervention works. However, no studies to date have systematically examined the ways in which this type of studies have been carried out and reported. AIM To examine the methodological features and reporting practices found in mixed methods intervention studies in children and adolescents with emotional and behavioral disorders. METHOD Methodological review based on a systematic search from inception to July 2021 in Embase, Medline, PsycINFO, and SCOPUS, and a hand search in seven journals. RESULTS We found 30 studies, most of them published since 2019. These studies reported several patterns of mixed methods use which illustrated the unique insights that researchers can gain by using this approach. We identified several ways that authors could more clearly report the justification for using a mixed methods approach, the description of the design used, and the evidence of integration of the quantitative and qualitative components. CONCLUSION We make recommendations for improving the reporting quality of mixed methods intervention studies in the field of emotional and behavioral disorders.
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Affiliation(s)
- Sergi Fàbregues
- Department of Psychology and Education, Universitat Oberta de Catalunya, Spain.
| | - Cristina Mumbardó-Adam
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Spain
| | | | - Quan Nha Hong
- School of Rehabilitation, Université de Montréal, Canada
| | | | | | - Michael D Fetters
- Department of Family Medicine and Mixed Methods Program, University of Michigan, USA
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13
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Tripartite Analysis: A Data Analysis Technique for Convergent Mixed Methods Designs. Nurs Res 2022; 71:313-321. [PMID: 35149628 DOI: 10.1097/nnr.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective data integration is a daunting task in mixed methods research. Several frameworks for data integration exist, but the choice of and the technique for integration depends upon the research question and design. Innovative integration techniques continuously need to be developed to tackle the integration challenge and provide alternative ways for researchers to generate plausible mixed inferences. OBJECTIVES To describe a new data analysis technique, tripartite analysis (TriPA), and illustrate its use in a convergent mixed methods study. METHODS This technique was developed based on a convergent mixed methods study underpinned by dialectical pluralism aimed to understand Pakistani nursing students' perspectives about compassion and compassionate care and how these perspectives are consistent with the conceptualizations of compassion in nursing literature. RESULTS TriPA entails analysis and integration using joint displays at three levels: case-by-case integrated analysis, separate and then merged quantitative and qualitative analysis, and comparative and integrated analysis of Levels I and II findings. DISCUSSION TriPA can enable researchers to develop a more nuanced understanding of a given phenomenon through integration at various levels by identifying linkages within cases and across the whole data set and recognizing relational connections and emerging patterns.
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14
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van der Steen JT, Bloomer MJ, Martins Pereira S. The importance of methodology to palliative care research: A new article type for Palliative Medicine. Palliat Med 2022; 36:4-6. [PMID: 34965752 PMCID: PMC8796148 DOI: 10.1177/02692163211069566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics, Universidade Católica Portuguesa, Porto, Portugal
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
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15
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Emary PC, Stuber KJ, Mbuagbaw L, Oremus M, Nolet PS, Nash JV, Bauman CA, Ciraco C, Couban RJ, Busse JW. Quality of reporting in chiropractic mixed methods research: a methodological review protocol. Chiropr Man Therap 2021; 29:35. [PMID: 34526065 PMCID: PMC8442283 DOI: 10.1186/s12998-021-00395-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023] Open
Abstract
Background Mixed methods designs are increasingly used in health care research to enrich findings. However, little is known about the frequency of use of this methodology in chiropractic research, or the quality of reporting among chiropractic studies using mixed methods.
Objective To quantify the use and quality of mixed methods in chiropractic research, and explore the association of study characteristics (e.g., authorship, expertise, journal impact factor, country and year of publication) with reporting quality.
Methods We will conduct a systematic search of MEDLINE, EMBASE, CINAHL, and the Index to Chiropractic Literature to identify all chiropractic mixed methods studies published from inception of each database to December 31, 2020. Articles reporting the use of both qualitative and quantitative methods, or mixed qualitative methods, will be included. Pairs of reviewers will perform article screening, data extraction, risk of bias with the Mixed Methods Appraisal Tool (MMAT), and appraisal of reporting quality using the Good Reporting of A Mixed Methods Study (GRAMMS) guideline. We will explore the correlation between GRAMMS and MMAT scores, and construct generalized estimating equations to explore factors associated with reporting quality. Discussion This will be the first methodological review to examine the reporting quality of published mixed methods studies involving chiropractic research. The results of our review will inform opportunities to improve reporting in chiropractic mixed methods studies. Our results will be disseminated in a peer-reviewed publication and presented publicly at conferences and as part of a doctoral thesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00395-0.
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Affiliation(s)
- Peter C Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. .,Chiropractic Department, D'Youville College, Buffalo, NY, USA. .,Private Practice, Cambridge, ON, Canada.
| | - Kent J Stuber
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare-Hamilton, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaundé, Cameroon.,Division of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Paul S Nolet
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Jennifer V Nash
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Craig A Bauman
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,The Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Carla Ciraco
- Chiropractic Department, D'Youville College, Buffalo, NY, USA
| | - Rachel J Couban
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada.,Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada
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16
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Drury A, Payne S, Brady AM. Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer. Qual Life Res 2021; 31:1117-1134. [PMID: 34417713 PMCID: PMC8960628 DOI: 10.1007/s11136-021-02975-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 12/03/2022]
Abstract
Purpose This study aims to explore the prevalence of CRC survivorship issues and their impact on survivors’ quality of life (QoL). Methods This study utilised a mixed methods sequential explanatory design. Adult CRC survivors between 6- and 60-months post-diagnosis (n = 304) were purposively recruited from three hospitals and twenty-one cancer support centres in Ireland. QoL was evaluated using the EuroQol and FACT-C questionnaires and results compared to population norms. 22 survey participants took part in semi-structured interviews exploring the impact of survivorship issues on their daily lives. Results While CRC survivors reported QoL outcomes comparable to or better than normative populations, 54% were dissatisfied with their QoL. The most common survivorship issues reported included negative body image (74%), fatigue (68%), sexual dysfunction (66%) and sleep disturbance (59%). Thematic analysis of the qualitative data illustrated survivors’ attempts to live with the impact of cancer and its treatment (loss, fear, impact) and striving to contextualise, reframe and understand the consequences of cancer and its treatment (control, vigilance, benefit). Within these themes, the cross-domain impact of less prevalent symptoms including bowel dysfunction (28–57%) and peripheral neuropathy (47%) were widely discussed. Conclusions Although cancer survivors report positive QoL outcomes, many experience distressing physical, psychological and social effects. The findings suggest less common and difficult to manage symptoms are the greatest source of distress and unmet need. Support and information must be tailored to address survivors’ individual needs and preferences for support, informed by holistic person-centred assessment. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02975-2.
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Affiliation(s)
- Amanda Drury
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Sheila Payne
- Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, LA1 4AT, UK
| | - Anne-Marie Brady
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, 24 D'Olier Street, Dublin 2, D02 T283, Ireland
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17
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Liu L, Zhao YY, Yang C, Chan HYL. Gamification for promoting advance care planning: A mixed-method systematic review and meta-analysis. Palliat Med 2021; 35:1005-1019. [PMID: 33775174 DOI: 10.1177/02692163211005343] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gamification has been adopted in the health care field for broaching sensitive topics and increasing motivation for behavior changes. Games developed to stimulate discussion surrounding end-of-life issues, and thereby promoting advance care planning also emerged. AIM The aim is to integrate the quantitative evidence and qualitative evidence to understand the effectiveness of and experience with games for advance care planning. DESIGN A mixed-methods systematic review and meta-analysis (PROSPERO ID: CRD42020163312) was undertaken. Joanna Briggs Institute Critical Appraisal tools were used for quality appraisal. Data were synthesized and pooled for meta-analysis or meta-aggregation when appropriate. DATA SOURCES We searched MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, WanFang, China Knowledge Resource Integrated Database, and Chinese Biomedical Literature Database from the inception of the databases for qualitative, quantitative, and mixed-method studies. RESULTS Eleven articles of ten studies were included, six of which were feasibility studies. The quality of the quantitative component of most included studies (7/8) was rated as low, and the qualitative component of most included studies (7/8) was rated as moderate. The meta-analysis showed that games for advance care planning are effective to increase self-efficacy, readiness, knowledge, and process of advance care planning behaviors. The meta-aggregation showed that games for advance care planning are highly acceptable and the participants perceived the game experience as fun and enjoyable. CONCLUSIONS Advance care planning games seem to be a promising intervention for increasing the uptake of advance care planning behaviors. Well-designed randomized controlled trials evaluating the effectiveness of games for advance care planning are needed in the future.
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Affiliation(s)
- Li Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ya-Yi Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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18
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Leung DYP, Chan HYL. Palliative and End-of-Life Care: More Work is Required. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207429. [PMID: 33065964 PMCID: PMC7599788 DOI: 10.3390/ijerph17207429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
There is currently growing recognition of the complex care needs of patients with life-limiting conditions and their family members, prompting the need to revisit the goals of medicine. This Special Issue reflects a broad research agenda in the field of palliative and end-of-life care. A total of 16 papers of empirical studies and systematic review are included spanning five domains, namely, patient, caregiver, healthcare provider, policy, and methodology. The results generally suggest the merits of palliative care and reveal room for further improvement in palliative care education, manpower, infrastructure, and legal and policy frameworks.
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Affiliation(s)
- Doris Y. P. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Correspondence:
| | - Helen Y. L. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
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