1. Critically Appraising Qualitative Evidence for Clinical Decision Making

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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.

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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. Thanks