Research into the Information Requirements of People Affected by Breast Cancer

Introduction

 This essay is about the evaluation of two research articles.  Throughout the essay the author will discuss and critically evaluate both articles following a self-adaptation of Cormack’s (2000) framework. This will include evaluation and comparison of research methods, sample selection processes, data collection methods and methods of data analysis, ethical considerations and future research and learning.  The author will not attempt to decide which particular article is best as they will both have strengths and weaknesses.                

Chosen area of research

The area of practice for this assignment is the information requirements of people whose lives are affected by breast cancer.  The author has a strong interest in this area of nursing and its effects upon sufferers’ lives.  It is vital for all health care professionals to remain aware of the extending affects of this disease.  A diagnosis of breast cancer does not just have medical effects but also emotional and psychological effects.  The diagnosis will affect every aspect of a patient’s life and the lives of their families, (Odling, Norberg, Danielson, 2002).

Literature search

The author carried out a literature search in order to select suitable research articles for this assignment.

 The search was carried out using the CINAHL database.  The keywords entered were: breast cancer, experiences and method.  These were each limited to the years 1998 – 2004 and limited to articles that had the full text available.  All three results were then combined giving a total of 265 hits.

 The two research articles to be reviewed were selected from these 265 articles. 

Articles selected

The first of the two articles that have been selected for review is from the Journal of Advanced Nursing and is entitled ‘The information concerns of spouses of women with breast cancer: patients’ and spouses’ perspectives’, (Rees, Bath and Lloyd-Williams, 1998), (Appendix 1).

 The Journal of Advanced Nursing is a quality peer reviewed journal.  This means that before an article is published it is reviewed by experts in the relevant field; they look at factors such as clarity, originality, relevance and the evidence base in order to improve the quality of the publications.  All articles published are double-blind reviewed; medical statisticians also review articles that include statistical content, (Journal of Advanced Nursing, 2003).

 The second of the two articles is entitled ‘Information needs of women with non invasive breast cancer’ it was written by Brown, Koch and Webb, (Brown, Koch and Webb, 2000), (Appendix 2).

 This article was published in the Journal of Clinical Nursing which is an international scientific journal that aims to promote the development and exchange of knowledge that is specific to all aspects of nursing practice.  They publish only high-quality papers significant to clinical nursing.  All articles submitted for publication are double-blind refereed, (Watson, 2004).

 Throughout this assignment the author will refer to the articles as article 1 or article 2 respectively in the order above.

Critical evaluation

The purpose of critical evaluation is mainly to ensure that if implementation of findings is proposed the patients will derive genuine benefits.  Therefore a critical review must identify the strengths and weaknesses in a piece of research and this should be carried out in a systematic manner, (Eachus, 2003).             

Titles

Article titles should be concise but they should also give a good indication of the content of the report, (Eachus, 2003).

Article 1’s title is fairly concise and to the point.  It draws the readers’ attention to the area of study and also makes reference to the population of people being studied.  It is not to long and therefore does not confuse the reader, (Parahoo, 1997).

  Article 2’s title is very short but does state the area of study (information needs and breast cancer) and the population being studied (women with non-invasive breast cancer).

There is no real right or wrong title, only a misleading or confusing one, (Parahoo, 1997).

Authors

The Cormack (2000) framework asks whether the authors have appropriate academic qualifications and whether they have appropriate professional qualifications and experience.

The authors of article 1 are: Charlotte Rees, BSc (Hons) and is a PhD student at the centre for Health Information Management Research, University of Sheffield.  Peter Bath, BSc (Hons) MSc PhD a lecturer at the School for Health and Related Research, University of Sheffield.  And Michael Lloyd-Williams, BSc (Hons) MBCS CEng a lecturer at the University of Sheffield in the Department of Information Studies, (Rees, Bath and Lloyd-Williams, 1998). 

The authors of article 2 are Marina Brown, BN, RN, a research assistant for The Royal District Nursing Service, South Australia.  Tina Koch, PhD, RN, who is The Royal District Nursing Services chair in Domiciliary Nursing, Flinders University of South Australia.  And Christine Webb, PhD, RN, a professor of Health Studies at the University of Plymouth.

Eachus (2003) tells us that the authors of a research article may or may not be well known in the field and that only experience will tell you this.  The institute to which they are attached may give an indication of the likely quality of the article, (Eachus, 2003).

Abstracts

An article abstract or summary should be a concise statement that gives the reader a clear idea of what the researchers were trying to achieve, how they were trying to achieve it and whether it was achieved, (Eachus, 2003).

 Article 1 has a short abstract in which the authors tell the reader what type of study was carried out and where and why it was carried out.

 It briefly explains how the study was performed and how the data were gathered.  The reader is told how the findings produced several important issues, how the validity was established and what implications these findings may have.

 Likewise article 2 has a summary in which the aim is clearly identified.  The reader is told who the study participants were, how the data were gathered and analysed and that several key issues were identified from the data.  The summary briefly mentions the impact these findings may have on the role of the nurse and the contributions that can be made by the study.

 Both article 1 and 2’s abstract or summary appear to include all the necessary information, they are concise and give the reader a good idea of what the articles contain.

Introduction

 An introduction needs to be just that, it should introduce to the reader the aims of the study, identify the problem or issue being researched and give a rationale for the study being carried out, (Cormack, 2000).

 Article 1 has a short introduction that gives a basic background about breast cancer, citing findings from other research about this subject.  There is a section specifically for the aims further on in the article so this is not mentioned in the introduction.

 Article 2 has a more detailed introduction; it gives a background on breast cancer.  The introduction of this article tells us the reason the researchers had for carrying out this study.  The authors state that ‘it was thought valuable to discover what information was needed by women both in terms of content and delivery’ and that ‘the present study builds on this earlier research by learning from women about their needs and experiences, particularly focusing on issues surrounding information’, (Brown, Koch and Webb, 2000).

Literature Review

 A literature review examines and summarises articles about a chosen topic, this is an essential stage in any research process.  It should be done in order to find out what has already been written and researched about the chosen topic, that way research will not be repeated unnecessarily, (Hek, Judd and Moule, 2002).

 Article 1 has an extensive literature review which appears very detailed and brings forward many previous findings of cancer and breast cancer research.  However what stands out most is that there is no reference to how the search for literature was carried out, i.e., what databases did they use?

 Article 2 also has a large literature review; it does state which databases were used and what other information sources they used.  The authors have then presented their review findings under three headings.

Methodology

 When selecting a research design the methods used may be the personal preferences of the researchers.  Quantitative is often selected over qualitative due to its scientific nature and surveys conducted using questionnaires may well be selected over interviews due to factors such as cost and time.  However short-cuts should not be made if the best knowledge is to be gained, (Parahoo, 1997).

 Article 1 uses a qualitative approach with focus group methodology.  The researchers held four single sex focus group discussions, there were three groups of women, each age-stratified, which simply means they were put into groups according to their age, this was done in order to achieve relatively homogeneous groups, and one group of men.

 Article 2 also uses a qualitative approach with a constructivist approach.  The researchers felt that with this approach it was best to use participant interviews. 

The focus group approach to research may be defined as group discussions organised to explore a specific set of issues.  This discussion process serves to generate data for analysis, (Lane, McKenna, Ryan and Fleming, 2001). 

 The idea of focus group methodology is that the group process can aid people in the exploration of their views in ways that would be less easily accessible in a one-to-one interview, (Webb and Kevern, 2001).

 Mansell, Bennett, Northway, Mead and Moseley (2004) believe that focus groups provide valuable opportunities to explore the thoughts and feelings of research participants in more depth than would be possible in a questionnaire, survey or through personal one-to-one interviews, (Mansell, Bennett, Northway, Mead and Moseley, 2004).

 They are not alone in this belief as Lane et al (2001) also state that the interaction between participants may reveal information that would be difficult to obtain in an individual interview, (Lane et al, 2001).

 However it is thought that the breadth and depth of information that it is possible to obtain in one focus group sitting is limited, also the discussion may be dominated by certain participants.  This may mean that if one-to-one interview techniques are used the moderator may have more control, (Lane et al, 2001).

 In article 2’s method of one-to-one interviews the researchers used open-ended questions during the interviews with a few leading questions as prompts rather than direct questioning.  They give some examples of the questions used.

 Interviews are characterised by letting interviewees say in their own words what is important to them about the subject.  This technique of semi or unstructured interviewing of different people allows a build up of themes and categories of experiences that can be used to develop theories about peoples experiences of health care, (Cormack, 2000).

 A drawback of this ‘loose’ type of interview is the lack of control the researcher has compared to a structured interview.  The interviews of article 2 lasted between 40 minutes to just over two hours.  It is unlikely that a topic could be explored in any depth in less than 30 minutes however interviews that last over two hours will tire the researchers and the interviewee therefore casting doubt on their ability to concentrate fully on what they are doing, (Parahoo, 1997).

Sample Selecting

 Article 1 uses a purposive sampling technique to recruit participants.  They were selected on the basis of several predetermined characteristics; the potential participants were all selected from a Sheffield-based support group.  The researchers were granted permission to contact the potential participants by the support group chairperson.  The group members were then contacted via letter inviting them and/or their spouses to participate in the study. 

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 Article 2 chose their participants on a convenience basis.  The participants were recruited via one consultant breast surgeon at a South Australian teaching hospital.  Potential participants were identified from medical records and telephoned by the surgeon’s practice manager who enquired whether they would be willing to be approached by the researchers.  If the woman agreed she was again contacted by telephone to have the research further explained to her, then she was sent an introductory letter and consent form by post.  Each woman was assured that they could withdraw at any time.  The sample size was intended to be between 5 and 10 women.

 Researchers have many sampling choices available to them that stem from theory or method or from simple practicalities such as time and money.  A sample therefore should be chosen purposefully and many sampling strategies can be used.  Sample sizes can be affected by the researcher’s time, budget and geographical location.  The number of participants that are needed should be determined by the researchers as there is no single correct sample size, (Byrne, 2001).

 The sampling section of article 1 is very short and simply states the sampling method used, the selection criteria for potential participants, where they were selected from and how they were contacted.  There is no mention of the sample size although this is given in the abstract.  There is no reason given for the sample method used or the sample size chosen.  Article 2 gives the reason for the small sample size as being that they were not trying to gain a large amount of information that could be generalised but rich data that would generate understanding.  Article 2 also gives selection criteria and the reasons for the criteria.

Although the sample size of article 2 was quite small and restricted the author feels that it was a good enough sample to achieve what the researchers had stated they wished to do.  If they had wished to generalised their findings then the researchers would have needed a representative sample from different ethnic, social and age groups however this undertaking would have been unrealistic, (Byrne, 2001).

 It is also important that although they have stated that it was not their intention to generalise their findings they have still explained their sampling method and reasons so that readers can assess whether or not the findings can be useful in other settings, (Parahoo, 1997).

 As the researchers in article 1 were aiming at exploring the information concerns of women or spouses of women with breast cancer it would make sense for them to choose their participants from a population that would include people from different social, ethnic and age groups, (Parahoo, 1997).

 However as their participants were all selected from one area and from one single support-group the likeliness of having a true representative sample is slim, this was given as a limitation of the study.

 The sampling method used in this article was purposive; this is the most common method of sampling used by qualitative researchers.  It involves the researcher deliberately choosing which participants to include in the study on the basis that those selected can most likely provide the necessary data, (Parahoo, 1997).

Data Collection

 There are many ways to collect research information, the choice of data collection method is influenced by the research approach used and the research question being addressed.  The validity and reliability of the data collection method are very important as this gives the research findings their credibility, (Hek, Judd and Moule, 2002).

 Validity underpins the entire research process and refers to the degree to which an instrument measures what it is supposed to be measuring and reliability is the degree of consistency or accuracy with which an instrument measures the attribute under investigation, (Cormack, 2000).

 Article 1 fully describes the focus group interview procedure and clearly states what role the researcher/moderator held within each group session.  We are told how the discussions were guided and which direction they took, that each interview was audio-taped, and also that each participant was given a demographic questionnaire to complete.  The validity was established by participant evaluation; all of the participants were sent a copy of the results along with an evaluation sheet, 56.8 % of the participants responded.  All of those who responded thought the results were a fair interpretation of the discussions.

 Article 2 explains what their method of data collection was (interviews) and briefly explains how they were carried out; again we are told what role the researcher/interviewer held.  We are given two examples of the leading questions used. The article tells us that the interviews lasted between 40 minutes and 2 hours, that they were audio-taped and that they took place in each woman’s own home.  However no part of this article tells us how they validated their findings.

Ethical Considerations

 There is great emphasis on documenting any risks, benefits, and safe-guards of humans used for research.  Researchers should show any precautions taken for protecting human subjects and meeting ethical research standards.  A researcher should also ensure that it is possible for a participant to with-draw at any time, (Valente, 2003).

 It is essential that all research participants give their voluntary informed consent, consent is vital as it respects the autonomy of individuals, their right to privacy and their right to choose, (Tingle and Cribb, 2002).

 As a result of the Nuremberg trials of Nazi war crimes the World Health Organisation (WHO) developed the Declaration of Helsinki.  All nursing research carried out in the U.K should comply with the fundamental principles within this declaration.  The 1975 revision of the declaration recommended codes of practice for researchers; this resulted in guidelines being developed by national bodies such as the Royal College of Nursing, (Tingle and Cribb, 2002).              

 Article 1 has a section on consent where we are told that all participants were asked to sign a consent form granting permission for the group discussions to be audio-taped.  The participants were also asked to sign an anonymity clause to prevent them disclosing the discussion content outside of the group; offering the participants guarantees of discretion and anonymity.  There is however no mention of ethical committee approval being requested.

 Article 2 gained approval for the study from the Social and Behavioural Ethics Committee and the Royal District Nursing Service.  Prior to commencing all participants received information so they were able to give informed consent.  The researchers also considered aspects such as each person’s physical and psychological wellbeing whilst discussing potentially disturbing issues.  If problems had arisen the researchers were prepared to discuss referral to sources of help and information.

Results

 Cormack (2000) asks whether the results are presented clearly and whether enough detail is given to enable the reader to judge how reliable the findings are.

 Article 1’s findings section has a clear table of results of the participant’s demographic characteristics.  The rest of the results are broken down and described under three headings.  Each section has direct quotes given from the discussions, these quotes are coded to the focus group they came from.  Incidentally most of the quotes come from focus group three.  This section is clear and easy to read with findings and conclusions throughout.

 Article 2’s section of data presentation is far lengthier, the information is given under eight headings.  These headings were those used to identify clusters of significant statements representing similar experiences.  Quotes are used with pseudonyms, there are slightly fewer quotes used in this article although it feels as though much more information is given.

 The method used to present data depends on a number of factors such as the type of data, the target readers, and the study design.  It is essential that findings are presented in such a way that they are clearly understood, (Cormack, 2000).

 Results that are given in written format, as is the case for both articles here, are particularly efficient when trying to describe a situation or event that is emotional.  Text format also has the potential to convey large amounts of data and considerable detail in a compact format.  Also data gained from the demographic questionnaire was best summarised in tabular form as these types of data are not well presented in text format, (Cormack, 2000).

Data Analysis

 In article 1 the discussions were transcribed fully as four separate documents.  Data analysis was executed using a manual, cut-and-paste method of theme analysis and the constant comparative method.  Analysis followed several stages: the analytical stage which involved the identification of strong themes running through the data, the next stage was the identification of information units and the last stage involved categorising the information units.  All data was then coded across the groups.  Finally themes were established and corresponding verbatim quotations were used to support all themes.  The responses from the demographic questionnaire were analysed using the Statistical Package for the Social Science (SPSS).

 Article 2 followed five steps of analysis for each interview.  Step one was to read fully each transcript to gain a feeling for it.  Step two was to extract significant statements relating directly to the experiences of information.  Step three was the development of clusters by comparing statements in each interview that represented similar experiences.  Step four was to provide a summary of each experience using the individual clusters and step five was to compare and contrast stories providing a summary of the similarities and differences of experiences.  This five step analysis was an adaptation of Colaizzi’s (1978) framework.

 Hewitt-Taylor (2001) believes that qualitative data requires systematic analysis and that a variety of data analysis procedures are commonly used, (Hewitt-Taylor, 2001).

 Both of the articles under review use a systematic approach to analysis although they both use different methods.

 The constant comparative method used on article 1 is a method of analysing qualitative data where the information gathered is coded into emergent themes or codes, the data is then constantly revisited until it is clear no new themes are emerging, (Hewitt-Taylor, 2001).

 The constant comparative method is also known as grounded theory where as the framework in article 2 is a phenomenological method of data analysis.  Whether the grounded theory method or the phenomenological method is used the task of analysing qualitative data is arduous and demanding, (Parahoo, 1997).

 Qualitative findings are reported textually and supported by relevant quotes from participants.  Qualitative research is about the importance of describing the experience of people from their own points of view, (Parahoo, 1997).

Limitations, Conclusions and Recommendations

 Article 1 acknowledges several limitations in their study.  As already mentioned all the participants came from a support-group, this introduced a self-selection bias.  Only one person carried out the analysis, and the use of focus groups limited the sample size of the study.  The authors suggest that the findings be viewed with caution and point out that they are not representative of the wider population.  The conclusions are a good summary of the findings and give ideas for future research areas.  The authors also tell us how they are addressing their findings in a large-scale quantitative follow-up study.  There is a list of nursing implications given for readers to remember in their practice.

 Article 2 has a summary and conclusion which gives an outline of the key findings and relates how these could affect nursing practice.  We are told that the study both reinforces previous research on this topic and adds new information that highlights areas for practice development.  Article 2 gives no limitations or recommendations for future research.

 Valente (2003) tells us that when evaluating research the conclusions and implications should summarise the major findings and conclusions and there application to practice, research, theory and knowledge development.  Implications for further research should be given and cautions about generalising findings should be considered.  The implications need to describe how the research findings can be applied to nursing practice, can suggest future research studies and can improve theory and knowledge, (Valente, 2003).

Conclusion

 It should be remembered that good practice is based on evidence and the best evidence comes from high-quality research.  It should also be remembered that not all research is high-quality.  Therefore evaluation is a must; this should start from evaluating the quality of the publishing journal right through to the conclusions.  The author feels that it is vital to remember that it takes time and practice to become skilled in the critical evaluation of research and one of the ways to achieve this skill is by continually reading research and reflecting (with the use of a framework) upon the strengths and weaknesses of each article read.  This essay has tried to highlight strengths and weaknesses of two articles and highlight the areas that are important in good critical evaluation.

REFERENCE PAGE

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