Qualitative Evidence Synthesis: Where Are We at?

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.

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

BMJ Global Health ◽

10.1136/bmjgh-2018-000882 ◽

2019 ◽

Vol 4 (Suppl 1) ◽

pp. e000882 ◽

Cited By ~ 51

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.

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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 ◽

10.1136/bmjopen-2019-034039 ◽

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

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

International Urogynecology Journal ◽

10.1007/s00192-020-04494-z ◽

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.

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Patient and carer involvement in palliative care research: An integrative qualitative evidence synthesis review

Palliative Medicine ◽

10.1177/0269216319858247 ◽

2019 ◽

Vol 33 (8) ◽

pp. 969-984 ◽

Cited By ~ 6

Author(s):

Eleni Chambers ◽

Clare Gardiner ◽

Jill Thompson ◽

Jane Seymour

Keyword(s):

Palliative Care ◽

Evidence Synthesis ◽

Evidence Base ◽

Qualitative Evidence Synthesis ◽

Training Support ◽

Care Research ◽

Qualitative Evidence ◽

Health And Social Care ◽

Facilitators And Barriers ◽

The Impact

Background: Patient/carer involvement in palliative care research has been reported as complex, difficult and less advanced compared to other areas of health and social care research. There is seemingly limited evidence on impact and effectiveness. Aim: To examine the evidence regarding patient/carer involvement in palliative care research and identify the facilitators, barriers, impacts and gaps in the evidence base. Design: Qualitative evidence synthesis using an integrative review approach and thematic analysis. Data sources: Electronic databases were searched up to March 2018. Additional methods included searching websites and ongoing/unpublished studies, author searching and contacting experts. Eligibility criteria were based on the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) framework. Two quality assessments on methodology and involvement were undertaken. Results: A total of 93 records were included. Eight main themes were identified, mainly concerning facilitators and barriers to effective patient and carer involvement in palliative care research: definitions/roles, values/principles, organisations/culture, training/support, networking/groups, perspectives/diversity, relationships/communication and emotions/impact. Evidence on the impact of involvement was limited, but when carried out effectively, involvement brought positive benefits for all concerned, improving the relevance and quality of research. Evidence gaps were found in non-cancer populations and collaborative/user-led involvement. Conclusion: Evidence identified suggests that involvement in palliative care research is challenging, but not dissimilar to that elsewhere. The facilitators and barriers identified relate mainly to the conduct of researchers at an individual level; in particular, there exists a reluctance among professionals to undertake involvement, and myths still perpetuate that patients/carers do not want to be involved. A developed infrastructure, more involvement-friendly organisational cultures and a strengthening of the evidence base would also be beneficial.

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Qualitative Evidence Syntheses Within Cochrane Effective Practice and Organisation of Care: Developing a Template and Guidance

International Journal of Qualitative Methods ◽

10.1177/16094069211041959 ◽

2021 ◽

Vol 20 ◽

pp. 160940692110419

Author(s):

Claire Glenton ◽

Simon Lewin ◽

Soo Downe ◽

Elizabeth Paulsen ◽

Susan Munabi-Babigumira ◽

...

Keyword(s):

Systematic Reviews ◽

Evidence Synthesis ◽

Health Conditions ◽

Qualitative Evidence Synthesis ◽

Effective Practice ◽

Organisation Of Care ◽

Qualitative Evidence ◽

Cochrane Effective Practice

A growing number of researchers are preparing systematic reviews of qualitative evidence, often referred to as ‘qualitative evidence syntheses’. Cochrane published its first qualitative evidence synthesis in 2013 and published 27 such syntheses and protocols by August 2020. Most of these syntheses have explored how people experience or value different health conditions, treatments and outcomes. Several have been used by guideline producers and others to identify the topics that matter to people, consider the acceptability and feasibility of different healthcare options and identify implementation considerations, thereby complementing systematic reviews of intervention effectiveness.Guidance on how to conduct and report qualitative evidence syntheses exists. However, methods are evolving, and we still have more to learn about how to translate and integrate existing methodological guidance into practice. Cochrane’s Effective Practice and Organisation of Care (EPOC) ( www.epoc.org ) has been involved in many of Cochrane’s qualitative evidence syntheses through the provision of editorial guidance and support and through co-authorship. In this article, we describe the development of a template and guidance for EPOC’s qualitative evidence syntheses and reflect on this process.

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Synthesis for health services and policy: case studies in the scoping of reviews

Health Services and Delivery Research ◽

10.3310/hsdr09150 ◽

2021 ◽

Vol 9 (15) ◽

pp. 1-84

Author(s):

Rob Anderson ◽

Andrew Booth ◽

Alison Eastwood ◽

Mark Rodgers ◽

Liz Shaw ◽

...

Keyword(s):

Health Services ◽

Case Studies ◽

Systematic Reviews ◽

Information Exchange ◽

Social Care ◽

Evidence Synthesis ◽

Synthesis Methods ◽

Health And Social Care ◽

Review Team ◽

The University

Background For systematic reviews to be rigorous, deliverable and useful, they need a well-defined review question. Scoping for a review also requires the specification of clear inclusion criteria and planned synthesis methods. Guidance is lacking on how to develop these, especially in the context of undertaking rapid and responsive systematic reviews to inform health services and health policy. Objective This report describes and discusses the experiences of review scoping of three commissioned research centres that conducted evidence syntheses to inform health and social care organisation, delivery and policy in the UK, between 2017 and 2020. Data sources Sources included researcher recollection, project meeting minutes, e-mail correspondence with stakeholders and scoping searches, from allocation of a review topic through to review protocol agreement. Methods We produced eight descriptive case studies of selected reviews from the three teams. From case studies, we identified key issues that shape the processes of scoping and question formulation for evidence synthesis. The issues were then discussed and lessons drawn. Findings Across the eight diverse case studies, we identified 14 recurrent issues that were important in shaping the scoping processes and formulating a review’s questions. There were ‘consultative issues’ that related to securing input from review commissioners, policy customers, experts, patients and other stakeholders. These included managing and deciding priorities, reconciling different priorities/perspectives, achieving buy-in and engagement, educating the end-user about synthesis processes and products, and managing stakeholder expectations. There were ‘interface issues’ that related to the interaction between the review team and potential review users. These included identifying the niche/gap and optimising value, assuring and balancing rigour/reliability/relevance, and assuring the transferability/applicability of study evidence to specific policy/service user contexts. There were also ‘technical issues’ that were associated with the methods and conduct of the review. These were choosing the method(s) of synthesis, balancing fixed and fluid review questions/components/definitions, taking stock of what research already exists, mapping versus scoping versus reviewing, scoping/relevance as a continuous process and not just an initial stage, and calibrating general compared with specific and broad compared with deep coverage of topics. Limitations As a retrospective joint reflection by review teams on their experiences of scoping processes, this report is not based on prospectively collected research data. In addition, our evaluations were not externally validated by, for example, policy and service evidence users or patients and the public. Conclusions We have summarised our reflections on scoping from this programme of reviews as 14 common issues and 28 practical ‘lessons learned’. Effective scoping of rapid, responsive reviews extends beyond information exchange and technical procedures for specifying a ‘gap’ in the evidence. These considerations work alongside social processes, in particular the building of relationships and shared understanding between reviewers, research commissioners and potential review users that may be reflective of consultancy, negotiation and co-production models of research and information use. Funding This report has been based on work commissioned by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme as three university-based evidence synthesis centres to inform the organisation, delivery and commissioning of health and social care; at the University of Exeter (NIHR 16/47/22), the University of Sheffield (NIHR 16/47/17) and the University of York (NIHR 16/47/11). This report was commissioned by the NIHR HSDR programme as a review project (NIHR132708) within the NIHR HSDR programme. This project was funded by the NIHR HSDR programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.

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

Physical Therapy ◽

10.1093/ptj/pzaa229 ◽

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.

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

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000720 ◽

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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A Qualitative Evidence Synthesis Review of Longitudinal Qualitative Research in Gerontology

The Gerontologist ◽

10.1093/geront/gny134 ◽

2018 ◽

Vol 59 (6) ◽

pp. e791-e801 ◽

Cited By ~ 3

Author(s):

Andrea L Nevedal ◽

Liat Ayalon ◽

Sherylyn H Briller

Keyword(s):

Qualitative Research ◽

Best Practices ◽

Evidence Synthesis ◽

Qualitative Evidence Synthesis ◽

Group Level ◽

Exclusion Criteria ◽

Qualitative Evidence ◽

Design And Methods ◽

Longitudinal Qualitative Research ◽

Level Analysis

Abstract Background and Objectives Gerontologists have long been interested in longitudinal qualitative research (LQR), yet ambiguity remains about best practices. The purpose of this review was to conduct a qualitative evidence synthesis to identify strengths and limitations in existing gerontological LQR. Research Design and Methods We searched for studies published in English before September 2017, using longitudinal qualitative methods and focusing on gerontology. We searched the following databases: PubMed and ProQuest. This was followed up by a snowball search to identify additional LQR articles that were not gerontologically focused but provided conceptual or methodological information to enhance gerontological LQR. Article titles and abstracts were reviewed, and selected articles were independently evaluated by all authors and summarized in a descriptive matrix based on design, analysis, and strengths and limitations. Results Our literature search resulted in 225 articles, which was then narrowed to 71 articles from 47 different journals based on our inclusion/exclusion criteria. LQR in gerontology varies considerably by study design and analysis approach. LQR design considerations involve number of time points and duration; rapport and retention; and consistent or different sampling, data collection, and measures. LQR analysis considerations involve synchronic and diachronic approaches, consistent or evolving coding, and individual- or group-level analysis. Gerontological LQR articles vary in the extent to which they address special aging considerations. Discussion and Implications This review indicates that there are areas where gerontological LQR can be strengthened going forward. We provide researchers with strategies to improve LQR rigor in our field and beyond.

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