scholarly journals Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis

2019 ◽  
Vol 33 (6) ◽  
pp. 607-617 ◽  
Author(s):  
Victoria Turner ◽  
Kate Flemming
Keyword(s):  
Qualitative Research ◽  
Socioeconomic Factors ◽  
Evidence Synthesis ◽  
Population Level ◽  
Place Of Death ◽  
Cochrane Library ◽  
Qualitative Evidence Synthesis ◽  
Factors Affecting ◽  
Quantitative Evidence ◽  
Qualitative Evidence

Background: Existing quantitative evidence suggests that at a population level, socioeconomic factors affect access to preferred place of death. However, the influence of individual and contextual socioeconomic factors on preferred place of death are less well understood. Aim: To systematically synthesise the existing qualitative evidence for socioeconomic factors affecting access to preferred place of death in the United Kingdom. Design: A thematic synthesis of qualitative research. Data sources: Cochrane Library, MEDLINE, Embase, CINAHL, ASSIA, Scopus and PsycINFO databases were searched from inception to May 2018. Results: A total of 13 articles, reporting on 12 studies, were included in the synthesis. Two overarching themes were identified: ‘Human factors’ representing support networks, interactions between people and decision-making and ‘Environmental factors’, which included issues around locations and resources. Few studies directly referenced socioeconomic deprivation. The main factor affecting access to preferred place of death was social support; people with fewer informal carers were less likely to die in their preferred location. Other key findings included fluidity around the concept of home and variability in preferred place of death itself, particularly in response to crises. Conclusion: There is limited UK-based qualitative research on socioeconomic factors affecting preferred place of death. Further qualitative research is needed to explore the barriers and facilitators of access to preferred place of death in socioeconomically deprived UK communities. In practice, there needs to be more widespread discussion and documentation of preferred place of death while also recognising these preferences may change as death nears or in times of crisis.

scholarly journals Qualitative Evidence Synthesis: Where Are We at?

2021 ◽  
Vol 20 ◽  
pp. 160940692199327
Author(s):  
Kate Flemming ◽  
Jane Noyes
Keyword(s):  
Qualitative Research ◽  
Systematic Reviews ◽  
Evidence Synthesis ◽  
Synthesis Methods ◽  
Qualitative Evidence Synthesis ◽  
Policy Makers ◽  
Qualitative Evidence ◽  
Health And Social Care ◽  
Method Paper ◽  
Increasing Demand

Qualitative evidence syntheses (QES) have increased in prominence and profile over the last decade as a discrete set of methodologies to undertake systematic reviews of primary qualitative research in health and social care and in education. The findings from a qualitative evidence synthesis can enable a richer interpretation of a particular phenomenon, set of circumstances, or experiences than single primary qualitative research studies can achieve. Qualitative evidence synthesis methods were developed in response to an increasing demand from health and social professionals, policy makers, guideline developers and educationalists for review evidence that goes beyond “what works” afforded by systematic reviews of effectiveness. The increasing interest in the synthesis of qualitative research has led to methodological developments documented across a plethora of texts and journal articles. This “State of the Method” paper aims to bring together these methodological developments in one place, contextualizing advances in methods with exemplars to support readers in making choices in approach to a synthesis and aid understanding. The paper clarifies what a “qualitative evidence synthesis” is and explores its role, purpose and development. It details the kind of questions a QES can explore, the processes associated with a QES, including the methods for synthesis. The rational and methods for integrating a QES with systematic reviews of effectiveness are also detailed. Finally approaches reporting and recognition of what a “good” or rigorous QES look like are provided.

scholarly journals Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: protocol for a qualitative evidence synthesis using the Theoretical Domains Framework

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e034039
Author(s):  
Amanda J Cross ◽  
Rachelle Buchbinder ◽  
Allison Bourne ◽  
Christopher Maher ◽  
Stephanie Mathieson ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Cancer Pain ◽  
Assessment Tool ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Theoretical Domains Framework ◽  
Opioid Analgesics ◽  
Qualitative Evidence Synthesis ◽  
Barriers And Enablers ◽  
Qualitative Evidence

IntroductionThe over-prescription and overuse of opioid analgesics for chronic non-cancer pain (CNCP) is a growing issue. Synthesis of evidence about the barriers and enablers to reducing long-term opioid prescribing and use will enable the development of tailored interventions to address both problems.ObjectiveTo synthesise the barriers and enablers to monitoring the ongoing appropriateness of opioid treatment and deprescribing opioids for CNCP from the clinician, patient and general public point of view, and to map the findings to the Theoretical Domains Framework (TDF).Methods and analysisWe will perform a qualitative evidence synthesis using the TDF. We will include qualitative research that has explored clinician, patient and the general public’s perceptions regarding barriers and enablers to monitoring and deprescribing opioids for CNCP. Studies will be identified via searches in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Databases will be searched from inception to July 2019, and the studies must be published in English. Article selection and data extraction will be completed independently by two review authors. Methodological quality of included studies will be independently assessed by two review authors using the Critical Appraisal Skills Programme quality assessment tool. We will conduct thematic synthesis and then map identified themes and sub-themes to TDF domains. Confidence in synthesis findings will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research tool.Ethics and disseminationEthical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal.PROSPERO registration numberCRD42019140784

scholarly journals A qualitative evidence synthesis using meta-ethnography to understand the experience of living with pelvic organ prolapse

2020 ◽  
Vol 31 (12) ◽  
pp. 2631-2644
Author(s):  
Francine Toye ◽  
Jeannine Pearl ◽  
Katy Vincent ◽  
Karen Barker
Keyword(s):  
Decision Making ◽  
Qualitative Research ◽  
Pelvic Organ Prolapse ◽  
Evidence Synthesis ◽  
Pelvic Organ ◽  
Qualitative Evidence Synthesis ◽  
Conceptual Approach ◽  
Qualitative Evidence ◽  
Healthcare Improvement ◽  
Healthcare Decision Making

Abstract Introduction and hypothesis Pelvic organ prolapse (POP) affects the lives of many people. We aimed to systematically search for, identify and synthesize qualitative research that explores what it is like to live with POP and make this knowledge available for healthcare improvement. Methods We systematically searched Medline, PsychInfo, Embase and CINAHL, from inception to March 2020, for qualitative research exploring the experience of living with POP. We used meta-ethnography to synthesize findings. This is a conceptual approach to qualitative evidence synthesis. We used the recent guidelines for reporting meta-ethnography. Results We screened 3103 titles and 255 abstracts and included 37 primary studies. These incorporated the experience of 777 women, (aged 18 to 95 years) from a range of countries. We organized 162 ideas into 27 conceptual categories and 10 themes. We developed a conceptual model that helps us to understand the experience of pelvic organ prolapse. This model indicates that (1) the physical losses of POP are intricately linked to loss of identity; (2) women conceptualized POP as part of womanhood, yet also its thief; (3) there is a vicious cycle of taboo, silence and misunderstanding about POP and its treatment; (4) this silence is exacerbated by a feeling that POP is not taken seriously in healthcare. Conclusions This meta-ethnography helps us to understand the experience of living with a POP. Our model illustrates the complex process of healthcare decision making. Further studies to explore the complexity of decision making from the perspective of patient and health professional are timely.

scholarly journals Qualitative evidence synthesis for complex interventions and guideline development: clarification of the purpose, designs and relevant methods

2019 ◽  
Vol 4 (Suppl 1) ◽  
pp. e000882 ◽  
Author(s):  
Kate Flemming ◽  
Andrew Booth ◽  
Ruth Garside ◽  
Özge Tunçalp ◽  
Jane Noyes
Keyword(s):  
Qualitative Research ◽  
Systematic Reviews ◽  
Guideline Development ◽  
Evidence Synthesis ◽  
Complex Interventions ◽  
Real Life ◽  
Synthesis Methods ◽  
Qualitative Evidence Synthesis ◽  
Qualitative Evidence ◽  
Broad Term

This paper is one of a series exploring the implications of complexity for systematic reviews and guideline development, commissioned by the WHO. The paper specifically explores the role of qualitative evidence synthesis. Qualitative evidence synthesis is the broad term for the group of methods used to undertake systematic reviews of qualitative research evidence. As an approach, qualitative evidence synthesis is increasingly recognised as having a key role to play in addressing questions relating to intervention or system complexity, and guideline development processes. This is due to the unique role qualitative research can play in establishing the relative importance of outcomes, the acceptability, fidelity and reach of interventions, their feasibility in different settings and potential consequences on equity across populations. This paper outlines the purpose of qualitative evidence synthesis, provides detail of how qualitative evidence syntheses can help establish understanding and explanation of the complexity that can occur in relation to both interventions and systems, and how qualitative evidence syntheses can contribute to evidence to decision frameworks. It provides guidance for the choice of qualitative evidence synthesis methods in the context of guideline development for complex interventions, giving ‘real life’ examples of where this has occurred. Information to support decision-making around choice qualitative evidence synthesis methods in the context of guideline development is provided. Approaches for reporting qualitative evidence syntheses are discussed alongside mechanisms for assessing confidence in the findings of a review.

scholarly journals The barriers and facilitators to screening in emergency departments: a qualitative evidence synthesis (QES) protocol

2020 ◽  
Vol 3 ◽  
pp. 50
Author(s):  
Louise Barry ◽  
Rose Galvin ◽  
Sylvia Murphy Tighe ◽  
Margaret O'Connor ◽  
Damian Ryan ◽  
...  
Keyword(s):  
Conceptual Model ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Adverse Outcomes ◽  
Barriers And Facilitators ◽  
Screening Tools ◽  
Cochrane Library ◽  
Qualitative Evidence Synthesis ◽  
Clinical Workflow ◽  
Qualitative Evidence

Background: Early detection of adults at risk of adverse outcomes through systematic screening in the emergency department (ED) can serve to identify high risk groups in need of targeted assessment and early intervention in the hospital or community setting. However, issues such as time pressures, inadequate resources, poor integration of tools into clinical workflow and lack of staff training are cited among the barriers to successfully implementing screening tools in the ED. The aim of this qualitative evidence synthesis (QES) is to synthesize evidence pertaining to the barriers and facilitators to implementing screening tools in the ED. Methods: A comprehensive literature search will be completed in the following databases Scopus, CINAHL, Medline, Embase, Pubmed and Cochrane library. Grey literature sources will also be searched. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of stakeholders on the implementation of screening tools in the ED will be included. “Best fit” framework synthesis will be utilised to produce a context specific conceptual model to describe and explain how these barriers and facilitators may impact on implementation. An a priori framework of themes, formed from the existing evidence base, will inform the ultimate thematic analysis and assist in the organisation and interpretation of search results, ensuring the QES is built upon current findings. CASP will be utilised to quality appraise articles and GRADE CERQual will assess confidence in the QES findings. Conclusions: This synthesis will offer a new conceptual model for describing the perspectives, perceptions and experiences of barriers and facilitators experienced by patients and key stakeholders involved in the implementation of screening tools in the ED. The results of this review will inform practice and aid the development and implementation of change strategies to support the implementation of screening tools in the ED. Registration: PROSPERO CRD42020188712 05/07/20

scholarly journals Understanding Shoulder Pain: A Qualitative Evidence Synthesis Exploring the Patient Experience

2020 ◽  
Author(s):  
Christina Maxwell ◽  
Katie Robinson ◽  
Karen McCreesh
Keyword(s):  
Qualitative Research ◽  
Shoulder Pain ◽  
Methodological Quality ◽  
Evidence Synthesis ◽  
Treatment Options ◽  
Included Study ◽  
Qualitative Evidence Synthesis ◽  
Qualitative Evidence ◽  
The Impact ◽  
Research Studies

Abstract Objective The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments. Methods A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) appraisal tool. Results Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact (“It has been a big upheaval”), (2) developing an understanding (“Why is it hurting so much?”), and (3) exercise (“Am I going to go through a lot of pain in moving it…?”). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a “permanent” solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations. Conclusion These findings deepen understanding of the impact of shoulder pain on peoples’ lives and provide novel insight into the experience of treatment. Enhanced awareness of people’s experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation. Impact To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms. Lay Summary Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People’s understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.

A qualitative evidence synthesis of users’ experience of mobile health applications in the self-management of type 2 diabetes

2021 ◽  
pp. 174239532098387
Author(s):  
Margaret O’Neill ◽  
Catherine Houghton ◽  
Geraldine Crilly ◽  
Maura Dowling
Keyword(s):  
Type 2 Diabetes ◽  
Health Information ◽  
Mobile Health ◽  
Evidence Synthesis ◽  
Self Management ◽  
Cochrane Library ◽  
Qualitative Evidence Synthesis ◽  
Qualitative Evidence ◽  
Mhealth Apps

Aim The aim of this qualitative evidence synthesis was to identify and synthesise qualitative research relating to experiences of using mobile health (mHealth) applications to aid self-management of Type 2 Diabetes. Methods Using a systematic search strategy, 11 databases were searched (Medline, CINAHL, PsychInfo, PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest A&1, ProQuest UK & Ireland, Mednar). “Best fit” framework synthesis was used guided by the Health Information Technology Acceptance Model (HITAM). Assessment of methodological limitations was conducted using Critical Appraisal Skills Programme (CASP) and confidence in the review findings were guided by GRADE-CERQual. Results Fourteen eligible studies were included in the synthesis (7 qualitative and 5 mixed methods). Key themes identified under the health, information and technology zones of the HITAM revealed the benefits of mHealth apps, barriers to their use, their perceived usefulness and ease of use. Discussion Most people used the apps for feedback on their self-management and found them helpful in their communication with health care providers. Some embraced the technology and found it easy to use while others found mHealth apps to be counterintuitive.

scholarly journals How human factors affect escalation of care: a protocol for a qualitative evidence synthesis of studies

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025969
Author(s):  
Jody Ede ◽  
Verity Westgate ◽  
Tatjana Petrinic ◽  
Julie Darbyshire ◽  
Peter J Watkinson
Keyword(s):  
Human Factors ◽  
Situational Awareness ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Clinical Excellence ◽  
Qualitative Evidence Synthesis ◽  
Failure To Rescue ◽  
Factors Affecting ◽  
Safe Patient Care ◽  
Qualitative Evidence

IntroductionFailure to rescue is defined as mortality after complications during hospital care. Incidence ranges 10.9%–13.3% and several national reports such as National Confidential Enquiry into Patient Outcomes and Death and National Institute of Clinical Excellence CG 50 highlight failure to rescue as a significant problem for safe patient care.To avoid failure to rescue events, there must be successful escalation of care. Studies indicate that human factors such as situational awareness, team working, communication and a culture promoting safety contribute to avoidance of failure to rescue events. Understanding human factors is essential to developing work systems that mitigate barriers and facilitate prompt escalation of care. This qualitative evidence synthesis will identify and synthesise what is known about the human factors that affect escalation of care.Methods and analysisWe will search MEDLINE (Ovid), EMBASE (Ovid) and CINAHL, between database inception and 2018, for studies describing human factors affecting failure to rescue and/or care escalation. A search strategy was developed by two researchers and a medical librarian. Only studies exploring in-hospital (ward) populations using qualitative data collection methods will be included. Screening will be conducted by two researchers. We are likely to undertake a thematic synthesis, using the Thomas and Harden framework. Selected studies will be assessed for quality, rigour and limitations. Two researchers will extract and thematically synthesise codes using a piloted data extraction tool to develop analytical themes.Ethics and disseminationThe qualitative evidence synthesis will use available published literature and no ethical approval is required. This synthesis will be limited by the quality of studies, rigour and reproducibility of study findings. Results will be published in a peer-reviewed journal, publicised at conferences and on social media.PROSPERO registration numberCRD42018104745.

scholarly journals Rapid qualitative evidence syntheses (rQES) in health technology assessment: experiences, challenges, and lessons

2020 ◽  
pp. 1-9
Author(s):  
Umair Majid ◽  
Laura Weeks
Keyword(s):  
Qualitative Research ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Evidence Synthesis ◽  
Health Technology ◽  
Lessons Learned ◽  
Qualitative Evidence Synthesis ◽  
Health Technologies ◽  
Related Data ◽  
Qualitative Evidence

Abstract Healthcare decision makers are increasingly demanding that health technology assessment (HTA) is patient focused, and considers data about patients' perspectives on and experiences with health technologies in their everyday lives. Related data are typically generated through qualitative research, and in HTA the typical approach is to synthesize primary qualitative research through the conduct of qualitative evidence synthesis (QES). Abbreviated HTA timelines often do not allow for the full 6–12 months it may take to complete a QES, which has prompted the Canadian Agency for Drugs and Technologies in Health (CADTH) to explore the concept of “rapid qualitative evidence synthesis” (rQES). In this paper, we describe our experiences conducting three rQES at CADTH, and reflect on challenges faced, successes, and lessons learned. Given limited methodological guidance to guide this work, our aim is to provide insight for researchers who may contemplate rQES. We suggest several lessons, including strategies to iteratively develop research questions and search for eligible studies, use search of filters and limits, and use of a single reviewer experienced in qualitative research throughout the review process. We acknowledge that there is room for debate, though believe rQES is a laudable goal and that it is possible to produce a quality, relevant, and useful product, even under restricted timelines. That said, it is vital to recognize what is lost in the name of rapidity. We intend our paper to advance the necessary debate about when rQES may be appropriate, and not, and enable productive discussions around methodological development.

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