scholarly journals Ethical and Methodological Challenges in Research with Hard-to-Reach Groups: Examples from Research on Family Caregivers for Migrant Older Adults Living with Dementia

2021 ◽  
Author(s):  
Hürrem Tezcan-Güntekin ◽  
Ilknur Özer-Erdogdu ◽  
Yüce Yilmaz-Aslan ◽  
Tugba Aksakal ◽  
Rona Bird

Abstract Family caregivers of migrants with dementia constitute a population group that is hard to reach for research participation due to factors such as shame about the disease and past experiences of discrimination. In this paper, research-ethical challenges associated with participant recruitment and qualitative data collection among relatives of migrants with dementia are discussed. Over a period of 8 years, three studies were conducted to investigate the experiences of family caregivers for persons with dementia of Turkish descent in Germany. Across these studies, a total of 32 family caregivers were interviewed. In this paper, based on the “Principles of Biomedical Ethics” according to Beauchamp and Childress (2009), research-ethical conflicts associated with sampling methods and the presence of third parties during qualitative interviews are discussed. The potential risks emanating from sampling strategies and the presence of third parties during interviews regarding the voluntary nature of study participation are examined. Additionally, this paper formulates recommendations for ensuring truly voluntary participation and protecting both the participants (family caregivers) and third parties (especially relatives with dementia) from harm. These practical recommendations aim to help future researchers to avoid ethical pitfalls and represent a roadmap for making necessary methodological decisions.

2021 ◽  
Vol 9 ◽  
pp. 205031212110009
Author(s):  
Melahat Akdeniz ◽  
Bülent Yardımcı ◽  
Ethem Kavukcu

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.


2020 ◽  
Author(s):  
Kate C. McLean ◽  
Brianna C Delker ◽  
William Lewis Dunlop ◽  
Rowan Salton ◽  
Moin Syed

The present studies examined the common, but untested, theoretical assumption that those in the United States prefer negative past experiences, such as trauma, to be redeemed, to be resolved in some positive or growth-promoting fashion. Narratives of six types of traumatic events that were rated by U.S adults (n = 1872) across six samples and two studies. Confirming pre-registered hypotheses, there was a reliable preference for stories that were redeemed compared to stories that ended negatively, as well as for the narrators of redemptive stories, who were judged as likable and to have desirable personality traits. There was no support for the hypothesis that redemptive stories would be viewed as more common than non-redemptive stories, or that the relation between story type and preference would be mediated by Belief in a Just World. Implications include the compulsory nature of storying trauma and potential risks of these cultural expectations.


Author(s):  
Stephanie Moser ◽  
Susanne Elisabeth Bruppacher ◽  
Frederic de Simoni

ICT advances will bring a new generation of ubiquitous applications, opening up new possibilities for the health sector. However, the social impacts of this trend have largely remained unexplored. This study investigates the public representation of future ICT applications in the outpatient health sector in terms of their social acceptance. Mental models of ICT applications were elicited from inhabitants of Berlin, Germany, by means of qualitative interviews. The findings revealed that the interviewees felt ambivalent about anticipated changes; only if ICT use were to be voluntary and restricted to single applications and trustworthy institutions did they expect individual benefits. Concerns about data transmission to unauthorized third parties and widespread technological dissemination forcing compulsory participation led people to feel averse to such technology. Implications for potential implementation of future ICT applications in the outpatient health sector are discussed.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S791-S792
Author(s):  
Dawon Baik ◽  
David Russell ◽  
Lizeyka Jordan ◽  
Frances Dooley ◽  
Ruth Masterson Creber

Abstract Older adults with heart failure (HF) face many end-of-life care issues. Shared decision making (SDM) in hospice is an important process that allows HF patients and their family caregivers to discuss their preferences on goals of care (GOC) with their healthcare team. Yet, little research has explored how the values and preferences of HF patients and their family are integrated into their care plans through SDM process. This presentation examines facilitators and barriers to setting GOC among hospice HF patients. Qualitative interviews were conducted with HF patients/family caregivers (n=7) and providers (n=32) at a large not-for-profit hospice agency. Several facilitators emerged: building trust, active listening, helping patients and family caregivers understand hospice and prognosis. Barriers included acceptance, family conflict, language discordance between patients and providers and lack of communication about care transition. Findings confirmed the need for individually-tailored goal-setting approaches to navigating the end-of-life trajectory among HF patients.


2020 ◽  
pp. 073346482090456
Author(s):  
Elizabeth A. Disbrow ◽  
Connie L. Arnold ◽  
Nathaniel Glassy ◽  
Collette M. Tilly ◽  
Kate M. Langdon ◽  
...  

We examined knowledge of Alzheimer’s disease and related dementias (ADRD), resources, and research opportunities among older African American (AA) and Caucasian caregivers. A mixed methods design integrated qualitative (focus group) and quantitative (survey) data from Northwest Louisiana. Eight focus groups (59 adults, 92% female, 78% AA, 25% rural) revealed limited knowledge. Quantitative findings from 117 ADRD caregivers (83% female, 72% AA, 30% limited heath literacy, 27% low income) indicated participants obtained information from providers (54%), friends and relatives (32%), and the internet (37%). Barriers to care were cost (24%) and lack of family agreement (17%). Few families used adult daycare (8%) or support groups (28%). Concerns about research participation were violation of privacy (30%) and fear of patient distress (27%). Distrust of doctors was minimal (3%). Findings did not vary by race. There is a need for clear, literacy-appropriate information about ADRD, caregiver resources, and clinical trials.


2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Anneke Ullrich ◽  
Marianna Theochari ◽  
Corinna Bergelt ◽  
Gabriella Marx ◽  
Katharina Woellert ◽  
...  

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2573-2573
Author(s):  
Loretta A Williams ◽  
Jorge E. Cortes ◽  
Patricia S Ault ◽  
Araceli Garcia-Gonzalez ◽  
Janet L Williams ◽  
...  

Abstract Abstract 2573 Introduction: The United States Food and Drug Administration (FDA) recognizes patient-reported outcomes (PROs) as acceptable measures of treatment benefit and risk in medical product clinical trials. The FDA requires that patient input be included in the development and testing of PRO instruments. We have adopted a three-step process for the development of multi-symptom PROs that includes patient input in each step. This method is being used for the development of the M. D. Anderson Symptom Inventory (MDASI) for Philadelphia-chromosome-positive chronic myeloid leukemia (CML). The MDASI is a PRO measure of symptom burden, defined as the combined impact of all disease-related and therapy-related symptoms on one's ability to function as one did before the onset of disease or therapy, in patients with cancer. The core MDASI includes 13 symptom severity items and 6 interference items rated at their worst in the last 24 hours on a 0–10 scale, with 0 meaning no symptom or interference and 10 meaning as bad as can be imagined or complete interference. Patients and Methods: The first step in the process was qualitative interviews with 35 patients with CML about their symptom experiences. Symptoms were extracted by descriptive exploratory analysis from interview transcripts. Step 2 was grading of the relevance of the symptoms (0 to 4 scale) from Step 1 by an expert panel that included professional care providers as well as patients with CML and their family caregivers. Symptoms that received a mean relevance rating of ≥ 3 were added to the 13 symptom items and 6 interference items of the core MDASI for validation in Step 3. One hundred and sixty patients with CML are completing the experimental MDASI-CML, which will undergo psychometric validation and item reduction. The first 30 patients in Step 3 completed a cognitive debriefing interview about their experience of completing the MDASI-CML. Results: Patient characteristics are in Table 1. No personal information was collected on the expert panel members. Thirty-nine symptoms (13 core and 26 CML-specific) were extracted from the Step 1 qualitative interviews and rated by the expert panel. Four physicians, 5 nurses, 3 patients, and 3 family caregivers returned ratings. Six of the 26 CML-specific items had mean relevance ratings of ≥ 3. The experimental MDASI-CML includes the 13 core symptoms, 6 CML-specific symptoms, and 6 core interference items (Table 2). During the cognitive debriefing, over 80% of patients reported that the MDASI-CML items were not at all difficult to complete or understand, were completely comfortable to answer, and were not repetitive, and that the 0–10 scoring system for rating severity of symptoms and interference with daily activities was very easy to use. Nine patients listed 12 additional symptoms that should be included, but each symptom was only mentioned by 1 patient and had already been eliminated because of low relevance ratings by the expert panel. Conclusions: Inclusion of patient input at each step of PRO development ensures that the instrument measures what is important to patients and enhances content validity. It further ensures that the measure is easy to understand and complete. Psychometric validation of the MDASI-CML is proceeding. Disclosure: No relevant conflicts of interest to declare.


2020 ◽  
Author(s):  
Mari-Rose Kennedy ◽  
Richard Huxtable ◽  
Giles Birchley ◽  
Jonathan Ives ◽  
Ian Craddock

BACKGROUND <i>Ubiquitous</i>, <i>smart</i> technology has the potential to assist humans in numerous ways, including with health and social care. COVID-19 has notably hastened the move to remotely delivering many health services. A variety of stakeholders are involved in the process of developing technology. Where stakeholders are research participants, this poses practical and ethical challenges, particularly if the research is conducted in people’s homes. Researchers must observe prima facie ethical obligations linked to participants’ interests in having their autonomy and privacy respected. OBJECTIVE This study aims to explore the ethical considerations around consent, privacy, anonymization, and data sharing with participants involved in SPHERE (Sensor Platform for Healthcare in a Residential Environment), a project for developing smart technology for monitoring health behaviors at home. Participants’ unique insights from being part of this unusual experiment offer valuable perspectives on how to properly approach informed consent for similar smart home research in the future. METHODS Semistructured qualitative interviews were conducted with 7 households (16 individual participants) recruited from SPHERE. Purposive sampling was used to invite participants from a range of household types and ages. Interviews were conducted in participants’ homes or on-site at the University of Bristol. Interviews were digitally recorded, transcribed verbatim, and analyzed using an inductive thematic approach. RESULTS Four themes were identified—motivation for participating; transparency, understanding, and consent; privacy, anonymity, and data use; and trust in research. Motivations to participate in SPHERE stemmed from an altruistic desire to support research directed toward the public good. Participants were satisfied with the consent process despite reporting some difficulties—recalling and understanding the information received, the timing and amount of information provision, and sometimes finding the information to be abstract. Participants were satisfied that privacy was assured and judged that the goals of the research compensated for threats to privacy. Participants trusted SPHERE. The factors that were relevant to developing and maintaining this trust were the trustworthiness of the research team, the provision of necessary information, participants’ control over their participation, and positive prior experiences of research involvement. CONCLUSIONS This study offers valuable insights into the perspectives of participants in smart home research on important ethical considerations around consent and privacy. The findings may have practical implications for future research regarding the types of information researchers should convey, the extent to which anonymity can be assured, and the long-term duty of care owed to the participants who place trust in researchers not only on the basis of this information but also because of their institutional affiliation. This study highlights important ethical implications. Although autonomy matters, trust appears to matter the most. Therefore, researchers should be alert to the need to foster and maintain trust, particularly as failing to do so might have deleterious effects on future research.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Dermot O’Callaghan ◽  
Emma O’Riordan ◽  
Yvonne Pennisi

Purpose Current domestic and international research predominantly examines the past experiences of people seeking asylum and the negative influences such experiences have on health and well-being. However, few studies address the future needs of people seeking asylum, as they transition from Direct Provision. This study aims to address this gap in knowledge by exploring the perspectives of women seeking asylum in Ireland on the skills they think they will need, as they transition from Direct Provision to life in Ireland. Design/methodology/approach A qualitative methodology using a community-based participatory research (CBPR) approach was used, to collect data collaboratively and sensitively with a vulnerable population group. Convenience sampling was used to recruit six women seeking asylum in Ireland, to participate in focus groups and semi-structured interviews. Data were transcribed and analysed using thematic analysis. Findings Women seeking asylum identified four themes of skills for doing, skills for being, skills for becoming and skills for belonging that are necessary for life in Ireland after Direct Provision. Barriers and opportunities to develop these skills were documented as sub-themes. The skills identified under these themes and sub-themes included work, education, driving, childcare, social integration, money management, home management, health management and leisure. Originality/value Using participatory methodologies, future research should further explore the skills required for transition from Direct Provision, to continue to raise awareness of the potential for occupational injustice and the role occupational therapists could play in this transitional period.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 440-440
Author(s):  
Tonie Sadler ◽  
Kevin Yan ◽  
Daniel Brauner ◽  
Harold Pollack ◽  
R Tamara Konetzka

Abstract COVID-19 poses unique challenges to family caregivers. This study explores how family caregivers for older adults with cognitive impairments experience and make decisions about caregiving during a global pandemic. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020), until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting. Questions about responses to the Pandemic were added as events unfolded. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and supports expenditures. Family caregivers experienced significant concern about COVID-19 itself, and about the indirect consequences of caregiving caused by the pandemic. Caregivers also displayed flexibility and adaptability in ceasing selected services, contingently continuing services, and utilizing telemedicine and other remote healthcare interventions to protect their loved ones. Many family caregivers utilized remote health care tools such telemedicine, no-contact prescription and grocery delivery. Such measures improved service access and reduced caregiver workload. Given the persistent challenges posed by COVID-19, long-term service organizations have an opportunity to enhance their policies to meet the needs of caregivers and those they care for. There is a need to expand telemedicine and other remote healthcare tools, while adapting these technologies to the needs of families. Also, procedures are needed for safe pathways to utilize HCBS and nursing care during a pandemic including communication supports, sufficient PPE, increased staffing, and utilization of evidence-based protocols.


Sign in / Sign up

Export Citation Format

Share Document