Assignment – Critique of research article, “life after cancer; Living with the risk” Word count 2500 (excluding refs)
Submission date – 6th July 2012
The purpose of this essay aims to provide a critical evaluation of a research article titled life after cancer; living with risk (Wilkins and Woodgate, Cancer Nursing 2011 vol 34, no 6, P487-494) it will be structured according to the recommendations of the critique guidelines of Parahoo, 1988. Parahoo states that the title should not be long and complicated and should reflect as much as possible what the research is about (Parahoo and Reid 1988, P69). The title in this case meets this criteria, it is concise but clear and suggestive of the content and context. It does not presume to validate or invalidate the research; again this is a recommendation of Parahoo 1988.
The title is 2 parts, Life after cancer; this could be interpreted as life of a carer or relative after a cancer patient has died or indeed life for a cancer patient after successful treatment. The second part of the title (living with risk) goes someway to qualify the first and elicit that the subject matter discusses living with risk after cancer treatment. It does not however explain in the title what “the risk” refers to. This perceived risk could be research into a possibility that cancer survivors take more risks in everyday life than non-cancer survivors as they have faced their the harsh reality of their own morbidity and overcome this. It is not until reading the full text that it becomes apparent that the risk refers to the risk of being diagnosed with a secondary form of cancer.
The researchers of the study have a strong affiliation to the field and both possess recognised formal qualifications, unusually both in the fields of nursing and medicine making both very credible. No conflicts have been disclosed again adding credibility to the study and findings as unbiased.
The abstract of the does provide an overview of the intentions of the study, the sample used, an overview of the results, conclusions and the implications for practice. The abstract lists key area’s under the bullet points of, “background, objective, method, results and conclusions.” Making the study easy to follow and read in a logical and accepted format.
The abstract is suitably brief but enticing with a word count of 225 words, this word count is an average size for an abstract but goes slightly over the 150-200 words recommended the book entitled, “the art of abstracting”, (Cremmins, Edward, The Art of Abstracting 2nd Edition, Info Resources Press, April 1996)
The objective attempts to explain the rationale for the study and is neatly and subsinctly summarised in one sentence. The method of the study is of an interprative, qualitative nature examining in some depth the feelings perceptions and views of cancer survivors though a descriptive approach using face to face semi structured interviews. The interviews took place in the subjects own homes, this would suggest that the subject was comfortable and at ease leading to an open, frank and honest interview providing valuable and unbiased data. An interview guide was used during the interview to assist participants to articulate their thoughts; the study does not go into any further detail to clarify what was contained within the interview guide and how this may affect any results obtained from questions throughout the interview process.
The results data was analysed by the constant comparative method of data analysis. This method of data analysis lends itself to complex and sensitive situations allowing the researcher to gain the trust of the subjects. (Method of Qualitative Analysis, Barney G. Glaser, Social Problems, Vol.12, No. 4, 1965, pp. 436-445) The conclusion summarises the key findings and recommendations contained within the study and is to the point leading onto the implications for practise which are summarised in context with the study. There is an acknowledgement within the implications that the findings are a foundation which is subjective that further research would be beneficial to build on findings of the subject with the objective of improving detection, treatment and views on secondary cancer.
The literature review discusses numerous previous studies on the subject matter and references 11 others containing both qualitative and quantitative research giving a broad background into the study. The vast majority of previous studies appear to be of a quantitative nature which adds validity to the alternative qualitative approach chosen for this study. All of this indicates that the authors have researched the topic and acknowledge previous work contributed by other researchers in the study area. This strongly suggests a high awareness of the topic and gives due credit to other researchers, it is mentioned in the data collection methods section of the study that the literature review influenced the interview guide developed to assist with data collection which further acknowledges previous research. It does not appear within the context of the study that the literature review has bias or undue influence on the findings but rather to support their validity as the method of the study and findings of this study are presented from a different perspective.
However to maintain a balanced perspective we should consider the reasons that to date only one previous study has been a qualitative study with almost 10 times that amount of previous quantitative studies in the area, the rationale for this is approach is discussed and addressed with good effect in the last paragraph of the literature review. An argument for using qualitative a method for this study is that quantitative studies can be criticised for attempting to reduce a highly complex situation into a simple cause and effect paradox. Therefore the rationale for using qualitative methods does seem highly relevant and would support the data collection method chosen and the survey design. As interviewing allows the researcher to gain unique insight into other perspectives about the phenomenon being researched (Glesne and Peskin 1992) the argument put across is a rather compelling one to support further research using the method chosen to give a balanced view with evidence from both qualitative and quantitative data research rather than from just one perspective.
The hypnosis attempts to establish the perceived risks of a secondary diagnosis of cancer following successful treatment and attempts to obtain the views of the participants in relation to screening for the well-established increased medical risk, the hypothesis sets out to demonstrate that views are conflicting and wide ranging; throughout the text this hypothesis becomes well established.
The overall approach of the study as previously discussed was an interpretive, descriptive qualitative design although the purpose states that this is part of a larger mixed method study aimed at establishing themes and patterns through the views and opinions of participants that had been specifically selected for inclusion due to their previous diagnosis, treatment and subsequent survival of various forms of cancer. The sample group was a relatively small number using only 22 participants (16 women and 6 men, it could be argued that this was a female dominated sample group that may have implications on the results) however using the qualitative format the sample group was of an acceptable size, the focus of the qualitative data is on the quality of the data collected as each participant is a source of a large volume of data. (Boswell and Cannon, Introduction to nursing research, qualitative research meathods, chapter 8, page 196.)
The sample group was specifically selected to fit the inclusion criteria (Cancer survivors who were 5 or more years out from the initial cancer diagnosis, at least 19 years old at the time of the interview, resident to the area of the interviews and could speak and understand English) The nature of the selection and inclusion was purposive in nature, this is perfectly acceptable as the objective is to explore and describe the phenomena and not generalise the findings as qualitative research by its nature is not specifically designed to be representative of the general population. (Holloway and Wheeler, 2010, p 138)
The research method chosen was specifically designed to be an emic perspective to describe the thoughts and feelings of post cancer patients, this method is ideal to understand and describe complex and sensitive information. Purposive sampling has been used as the participants have all been selected due to specific criteria. The primary goal in purposive sampling is not to generate a sample that is representative but rather one that is selected to represent certain subject characteristics that are relevant to the investigation. (Stommel and Wills, Clinical research, concepts and principles for advanced practice nurses, p302-303) A clear description of the sampling rationale and recruitment process is evident, (Bluff 1997).
To maximise variation participants were selected that had differing ages at the time of the initial diagnosis and different types of cancer. This demonstrates an excellent cross section of variables to maximise results. Participants were recruited exclusively from a central cancer registry and hospital based database, the study goes on to state that this register is “largely untapped” meaning that the participants would not have preconceived ideas or previous experience of prior studies of this kind. Non eligible potential participants were excluded from the study prior to recruitment to ensure validity of the study.
The age range was 19 – 87 years, however with the upper age range it could be concluded that the perceived risk of secondary cancer and subsequent screening views may vary vastly from younger participants due to the age difference. Fifteen of the participants were employed (full or part time) and the remaining participants were either retired or disabled, it could be argued that unemployed and disadvantaged people were not represented in the sample group who may have had differing views from the sample group interviewed. This assumption could also be continued that as all participants were white, ethnic groups were under represented and again may have differing views due to racial, cultural or social backgrounds. An argument that only white participents were deliberately selected for the study is a moot point as cancer is not a racially or culturally specific disease as perhaps a study into something like sickle cell crisis would be. The age range was wide and the average age is listed as 40 years old at the time of diagnosis however we know that some participants were far from the average age at the time of diagnosis but this maximises variation in the study.
The data was collection method for the study was done using a semi structured interview technique; the same researcher (Krista Wilkins, PhD, RN) completed all of the 23 face to face interviews. By using the same researcher we can assume continuity of the interview with the same structure being followed throughout. It is noted that 1 participant was interviewed twice because the first interview had ended early, the study does not elaborate as the reasons why the first interview ended early. By being interviewed twice an argument could be put that the data collected should not be included as the participant may have had time to think about, discuss and research the upcoming questions in the repeat interview which could potentially affect the validity of the findings, this presumably was not considered to be an issue as the participant and data were not excluded from the study or conclusions drawn.
As mentioned previously in the literature review key themes that had been discovered in the literature review were included to develop an interview guide. This suggests that all of the interviews were conducted not only by the same researcher but also following the same structure (or semi structure) with the interview guide being used as an “aide memoir” to keep the interviews on track and relevant. A person centred open ended approach was used as research shows that people respond well to this type of questioning ensuring that the information elicited was detailed, personal and rich in information.(Geer JG, Public opinion quarterly, volume 52, issue 3, p356-357)
The interviews took place in the participants own homes which would establish both comfort and confidence in a familiar and “safe” environment encouraging an open, honest and useful interview and eliminating the desire for social acquiescence however we must remind mindful of participant reactivity to the researcher in this technique. The interviews lasted generally no longer than an hour, the timeframe given is credible and suggestive that the participant was allowed sufficient time to relax and “open up” within the interview ensuring rich data collection but without the effect of feeling rushed or exhausted discussing a potentially stressful, personal and emotive topic.
However no upper or lower time limit was set so that if the data being collected at the point of an hour was valuable the participant was not cut short and valuable data excluded. Field notes were taken immediately after the interviews and included observations about the setting and impressions including non-verbal communications. This could be criticised as being a subjective observation and no reference is made to indicate the qualifications of the interviewer to make meaningful conclusion from observations of this type. All interviews were digitally recorded (with the participants consent) the recordings and field notes were later transcribed verbatim which supports the validity and credibility of the study immensely.
There was no evidence of a pilot study to add further validity to this study. In this study all proper ethical principles have been adhered to, ethical permission was granted by gaining informed consent from all participants and from local university and hospital ethical review committees. The process lead to a delay between the study being carried out and publication with the study taking place between July 2008 and July 2009 and publication in issue 34 of the publication, Cancer nursing in Nov – Dec 2011. (Wilkins and Woodgate, Life after cancer – living with the risk, Cancer nursing, issue 34, p487 – 494, Dec 2011) but this length of time is not uncommon.
The importance of gaining ethical approval is so that no harm comes to participants and the research community as a whole is not affected by the negatives of publicity which bring the research community into disrepute and go against the very objective of research to improve evidence based practice (Blaber, A. 2008, Foundations for Paramedic Practice, a Theoretical Perspective). The data analysis in this case forms the main body of the study and gives numerous personal experiences and thoughts to form the findings, all quotes have been annomalised to maintain the dignity and privacy of the participants. The data is broken down in a logical format helping the reader to understand the conclusions reached by the researchers and go a long way to help understand how the findings were reached.
The limitations of the study are readily acknowledged and openly state that the findings are not generalised to all cancer survivors, it goes on to state that the data was only collected at one time point, this could be addressed by further studies and perhaps a longitudinal study would be beneficial to broaden the picture. The study failed to reveal any risk perceptions due to different variables for example age, type of cancer etc. To its credit the limitations does acknowledge that ethnic variability may have revealed additional information.
The discussion is an in depth appraisal of the study as a whole including the findings, the conclusion is brief and does not introduce any new information, rather it summarises the previous sections of the study and draws the reader to an informed conclusion.
Blaber, A. (2008) Foundations for Paramedic Practice, a Theoretical Perspective. Open University Press, pg 49.
Boswell, C and Cannon, S. (2011) Introduction to nursing research, qualitative research methods, Jones and Bartlett publishers, chapter 8, pg 196.
Cremmins, E. (1996) The Art of Abstracting 2nd Edition, Info Resources Press, pg. 46
Geer JG, (2005) Public opinion quarterly, volume 52, issue 3, Lawrence Erlbaum associates publishers, p356-357
Glaser, B. (1965) Method of Qualitative Analysis, Social Problems, Vol.12, No. 4, pp. 436-445
Holloway, I. and Wheeler, S. (2010) Qualitative Research in Nursing and Healthcare. 3rd ed. West Sussex, UK: Wiley-Blackwell, pg. 6, pg.138.
Parahoo, K. (1988) Research Skills, Number 5. Critical Reading of Research. Nursing Times, 84 (43),pg 69-72
Stommel, M and Wills, C. (2004) Clinical research, concepts and principles for advanced practice nurses, Lippincott Williams and Williams, p302-303
Wilkins, K and Woodgate, R. (Dec 2011) Cancer nursing, Life after cancer – living with the risk, Lippincott Williams and Williams, issue 34, p487 – 494.