This is a critique of a qualitative journal article, Fatigue in patients undergoing chemotherapy, their self-care and the role of health professionals: A qualitative study by Spichiger, Rieder, Müller-Fröhlich and Kesselring published in 2011 in European Journal of Oncology Nursing, 16(2012).
The critique of a qualitative study covers title; abstract; confidence in the findings of report; statement of the problem; purpose of the study; method; sampling; data collection; data analysis; conclusion and future recommendations.
The article’s title, Fatigue in patients undergoing chemotherapy, their self-care and the role of health professionals: A qualitative study clearly and concisely describes the study. It shows that the study is about fatigue in patients undergoing chemotherapy treatment. Further, the study title shows patient self-care and the role of healthcare workers during the treatment. The study title identifies the study as a qualitative one. Hence, readers can get clear and concise meaning of the study just from its title.
There were no variables included in the title. However, the title has identified important concepts and elements of the study such as patients’ fatigue-related interactions with healthcare workers during treatment and patients’ self-care strategies.
The title has identified the study population as ‘patients undergoing chemotherapy’. The title, however, has not provided the sample size of the study participants. Nevertheless, readers can learn from the title the study participants included in this article.
The study title ensures that potential article readers find it. It is vital where there is no abstract and during article searches from databases. The title grabs the attention and therefore, it must be accurate, informative and complete as possible (Writing titles and abstracts, 2014).
The authors included an abstract in the study.
The abstract identified the study purpose. The researchers aimed to investigate cancer chemotherapy patients’ current perspectives on fatigue with a focus on communication with healthcare workers, self-care interventions and their perceived effectiveness and outcomes. In addition, the purpose of the study provided additional information on how fatigue affected most chemotherapy patients. In most cases, the experience was distressing, but previous studies failed to provide information and education on cancer chemotherapy fatigue. Moreover, it showed that many patients were engaged in self-care interventions but there were no clear guidelines for such activities or their effectiveness.
The abstract included the study methodology, but not the design. The methodology showed that the study was “a qualitative one with 19 participants who met selection criteria from a Swiss tertiary care hospital’s oncology outpatient clinic” (Spichiger et al., 2011, p. 166). It noted that data were collected through individual interviews after the third treatment. Finally, “the researchers applied the “Grounded Theory methodology in data analysis” (Spichiger et al., 2011, p. 166).
Results of the study were summarized at the abstract. For instance, patients learned about fatigue from their physicians. There were diverse forms of fatigue based on illnesses and life situations, and patients were willing to endure them to complete treatment and improve their conditions. Many patients engaged in self-care to mitigate fatigue and there was virtually no communication between healthcare workers and patients during treatment.
Finally, the study abstract also included the conclusion. The authors concluded that patients require adequate and systematic information on fatigue and self-care at the start chemotherapy, as well as regular evaluation and guidance to patients throughout chemotherapy cycles.
The abstract has accounted for important elements of the study with minimum details in a structured format as required in scientific journals (Writing titles and abstracts, 2014). The abstract has helped the authors to “summarize the study, make the study clear and facilitate assessment of the article” (Writing titles and abstracts, 2014).
Abstract is the most read part of an article.
Confidence in the Findings of the Report
The authors of the article have diverse qualifications and experiences in the field of nursing and biomedical. Elisabeth Spichiger has published over 18 articles and co-authored more than 36 others in the field of Ophthalmology and Nursing. Currently, she works at the Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland. Christa Müller-Fröhlich concentrates on the field of medicine and nursing. She is currently associated with the University of Basel and she has authored and coauthored several research articles. Evelyn Rieder has interests in nursing and medicine at the University of Basel. Annemarie Kesselring is the director of Swiss Institute for Nursing Research and professor at Institute for Nursing Science University of Basel. She is also a representative at several nursing boards and affiliations.
The authors have referred to Institute of Nursing Science, Faculty of Medicine, University of Basel to show their affiliation with the institution. This is clear evidence that they are qualified to conduct this study and provide reliable and valid outcomes.
The article was published in a referred journal, European Journal of Oncology Nursing, which contains peer-reviewed scholarly articles. This implies that the article was peer-reviewed and reviewers decided that it met quality standards of a scholarly journal article.
Statement of the Problem
Although there was no clearly marked subtitle for the statement of the problem, the introduction section had the study problem. The researchers clearly identified a phenomenon of interest as fatigue associated with chemotherapy. Patients, however, do not always report their experiences to physicians. In addition, physicians rarely evaluated and treated such conditions. Hence, many cases of fatigue are unreported, unrecognized and untreated. Many patients engage in various forms of self-care without guidelines or known outcomes. In addition, the available information and findings on chemotherapy fatigue were published more than a decade ago. Hence, there are no new findings. The study problem recognized changes in healthcare such as availability of information to patients and physicians’ practices, but there are no current studies to inform such developments.
The researchers did not clearly express why a qualitative study was adopted. Nevertheless, the nature of the study required them to explore fatigue and self-care activities in order to develop concepts about these phenomena of interest. Hence, they used Grounded Theory methodology.
The research is based on past studies and therefore, the researchers described philosophical underpinnings of the study. For instance, based on the previous studies, they showed that the etiology of fatigue was not yet clear while the range and effectiveness of interventions were limited.
From the statement of the problem, readers can discern the challenges faced by the researcher, which lacked a clear solution, including current findings, peer-reviewed sources or reliable theoretical underpinnings (Ellis & Levy, 2008).
Purpose of the Study
The researchers identified the purpose of the study at the introduction section. The study purpose showed that researchers focused on exploring cancer chemotherapy patients’ current perspectives about fatigue, specifically communication with physicians, self-care activities and their outcomes and effectiveness.
The researchers did not include the significance of the study to the work of nursing in the purpose statement. Nevertheless, the significance of the study was presented at the conclusion.
This qualitative study was based on the Grounded Theory methodology.
Data collection method was compatible with the qualitative research. Data were collected from participants by using interviews. The study questions were intended to guide the research but not to restrict or confine patient responses.
The method of data collection was adequate to address fatigue and self-care activities among chemotherapy patients. Hence, the researchers could collect data and identify details to increase insights and develop concepts of the phenomenon.
Interview is a well-suited data collection methodology for researching phenomena of interests in qualitative studies. It captures participants, processes, activities, outcomes, and effectiveness of such activities in contextual situations. Consequently, researchers were able to explore “patients’ fatigue-related interactions with professionals during chemotherapy, patients’ strategies to deal with the symptom and the perceived outcomes of their self-care activities” (Spichiger et al. 2011, p. 166).
The researchers also identified the setting of the study as an oncology outpatient clinic of a Swiss tertiary care hospital. Hence, the results reflected a real hospital setting where oncologists evaluated the observed side effects, nurses administered chemotherapy and follow-ups were possible for researchers.
The researchers described the selection of participants and included a table with demographic and clinical characteristics of participants (Spichiger et al., 2011, p. 166). The study participants were aged 18 years or older. All participants were patients with various cancer conditions, including against lymphomas, breast, lung or colorectal cancer at various stages of their illnesses.
The study informants were suitable for the study based on their demographic and clinical characteristics. They were at various stages of cancer, were cognitively intact and could survive more than three months based on physicians’ assessments. Both men and women with diverse educational and occupational backgrounds, living alone or cohabitating and from all diagnostic groups took part in the study to ensure that variations in fatigue experiences were captured.
Data collection focused on human experiences. That is, fatigue experiences of patients with cancer undergoing chemotherapy. The researchers noted that data collection involved “interviews with each participant after his/her third chemotherapy cycle” (Spichiger et al. 2011, p. 166).
The researchers described data collection strategy. They noted that patients were interviewed in different room at the outpatient clinic. Trained research assistants who were experienced oncology nurses assisted in the interviews.
Researchers addressed the protection of human subjects in their study. They noted that all eligible research participants were informed about the study interview on fatigue experiences (Spichiger et al., 2011, p. 166). Research participants also provided “additional written informed consents to take part in the qualitative research” (Spichiger et al., 2011, p. 166). The Ethics Committee of Basle, Switzerland approved the study (Spichiger et al., 2011). The researchers recognized the importance of a well-founded informed consent, which requires study participants to understand the significance of the process. In some cases, negligence of informed consent has led to unethical procedures, loss of subjects’ rights, and even deaths (Pelias, 2006).
The researchers described data saturation. However, they did not achieve data saturation or developed a theory (see study limitation). Nevertheless, they achieved rich data. The process of data collection lasted between 30 and 65 minutes and was comprehensive to ensure that all required data were gathered. Open-ended questions were used to “elicit accounts of fatigue experiences and fatigue-related communication with health professionals, how they coped with their fatigue, their strategies to reduce it, why they chose these measures, and the outcomes of their choices” (Spichiger et al., 2011, p. 166). In addition, the interviewers also encouraged interviewees to explore appealing experiences as fully as possible.
The researchers explicitly described the procedure for data collection. For instance, they showed that data were collected through interviews using open-ended questions in separate rooms. The process lasted between 30 and 65 minutes. The research assistants who collected the data were trained oncologists. Interviews were tape recorded and transcribed verbatim in German, while specific quotations were identified and translated into English, edited to enhance readability and finally evaluated and reviewed by a bilingual nurse researcher (Spichiger et al., 2011). The researchers also noted that they collected large data to provide demographic and clinical data, including outcomes on fatigue and depression because of their possible relations.
The researchers’ strategy for data analysis was based on the Grounded Theory methodology. The Grounded Theory was effective for analysis of qualitative data (Clarke, 2005). The researchers used open coding, focused comparison, axial coding and mapping of data to investigate the study purpose effectively with the aim of identifying concepts, different perspectives and categories. The researchers used axial coding and mapping to assess and identify the relations among categories and concepts (Spichiger et al., 2011). They also wrote memos to support data analysis processes. The researchers used the software program ATLAS.ti 5 for data storage and coding.
The researchers remained true to the data. They noted that data analysis paralleled and fueled data collection. For instance, when they discovered new themes during data analysis processes, the researchers expanded the interview guide questions to capture such themes in subsequent data collection stages.
Informed readers could understand the procedures used in data analysis. The researchers applied analysis methodologies used in the Grounded Theory, which included coding, comparison and mapping of results. To ensure rigor of the analysis, the researchers applied the accepted standards used in qualitative studies as described by different studies (Denzin & Lincoln, 2000). The researchers strived to use simple terms, which lay readers could understand.
The results are meaningful to individuals who are not involved in the research. The researchers presented their study findings in simple language. For instance, they noted that out of 21 patients approached to take part in the study, only 19 accepted. They have also indicated patients’ characteristics and scores in simple language. All results were presented in the form of themes such as being informed about fatigue; experiencing fatigue; enduring fatigue; experiencing fatigue in relation to life and illness circumstances; experiencing or lacking support; fatigue-related self-care; and handling fatigue in the absence of advice from health professionals.
Findings of the study are presented within the study context. The study findings showed how patients were informed about fatigue and chemotherapy, and their experiences of symptoms (Spichiger et al., 2011). In addition, the researchers described factors that influenced participants’ experiences, fatigue as a process of treatment and support. Findings also reflected self-care activities and lack of communication between patients and physicians during treatment.
The reader is able to apprehend the essence of the experience of the report of the findings. First, the researchers used verbatim to demonstrate real experiences of the patients. In addition, the researchers presented a comprehensive discussion of their research findings. In the discussion, they were able to present current perspectives of cancer chemotherapy among patients based on their experiences of “fatigue, fatigue-related communication with health professionals, self-care activities, and these measures’ perceived effectiveness” (Spichiger et al., 2011, p. 169).
The researchers’ conceptualization of results is true to the data. Based on the previous findings, several patients reported getting insufficient preliminary information on chemotherapy-related fatigue from physicians and family members could not understand outcomes. Today, however, much published information is readily available to patients and the public on fatigue-related experiences from cancer chemotherapy. In addition, Spichiger et al. (2011) noted that patients in their study reported fatigue experiences similar to those identified in past studies (Potter, 2004; Gledhill, 2005). Hence, the study interpretation is true to the data.
Nevertheless, there were study limitations such as the sample was intentionally heterogeneous, sample size was limited, results were not discussed with patients, failure to achieve saturation and to develop a theory.
Conclusion and Future Recommendations
The conclusion provided a context in which to use the findings. The researchers showed that their findings should be implemented into clinical practice to “integrate evidence-based interventions against chemotherapy-related fatigue effectively into standard practice” (Spichiger et al., 2011, p. 170).
The study conclusion reflected the findings of the study. For instance, patients and families were informed of fatigue, patients did not sufficiently communicate with their physicians, physicians did not make follow-ups and patients did not understand why they chose some activities to cope with fatigue.
The researchers offered recommendations for future studies. They noted that such studies were necessary to “integrate evidence-based interventions against chemotherapy-related fatigue effectively into standard practice” (Spichiger et al., 2011, p. 170).
The significance of the study to nursing was explicit. The researchers challenged oncologists and oncology nurses to adopt available knowledge into care and recommended standardization of fatigue-related processes to overcome communication challenges noted between patients and physicians.
Clarke, A. E. (2005). Situational Analysis: Grounded Theory after the Postmodern Turn. Thousand Oaks, CA: Sage.
Denzin, K., & Lincoln, S. (Eds.). (2000). Handbook of Qualitative Research (2nd ed.). Thousand Oaks, CA: Sage.
Ellis, T. J., & Levy, Y. (2008). A framework of problem-based research: A guide for novice researchers. Informing Science Journal, 11, 17-33.
Gledhill, J. (2005). A qualitative study of the characteristics and representation of fatigue in a French speaking population of cancer patients and healthy subjects. European Journal of Oncology Nursing, 9, 294-312.
Pelias, M. K. (2006). Human Subjects, Third Parties, and Informed Consent: A Brief Historical Perspective of Developments in the United States. Community Genet, 9(2), 73-77.
Potter, J. (2004). Fatigue experience in advanced cancer: a phenomenological approach. International Journal of Palliative Nursing, 10(1), 15-23.
Spichiger, E., Rieder, E., Müller-Fröhlich, C., & Kesselring, A. (2011). Fatigue in patients undergoing chemotherapy, their self-care and the role of health professionals: A qualitative study. European Journal of Oncology Nursing, 16(2012), 165-171. Web.
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