Essay: Appraisal following CASP checklist & Caldwell framework

Trinder and Reynolds (2000) state that Evidence Based Practice (EBP) has emerged from the 1990s and since has had a major impact on UK healthcare and practices, this has created a significant impact on improving patient, client and user care (Lipscomb, M. 2016). Evidence based practice relies on practitioners being able to critically appraise evidence to distinguish between high and low quality research as well identifying both strengths and weaknesses within a research study and from this, as well as wider concepts in care, guide future clinical practices and policies (Craig, J.V. & Smith, R.L. 2012). The EBP is therefore a result of the critical analysis of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions (LoBiondo-Wood & Haber, 2010).
There are many different approaches to a critical appraisal and a checklist of criteria is one such method. Barbour (2001) suggests “Checklists have played an important role … on qualitative research in convincing potential sceptics of its thoroughness” One such checklist approach to critical appraisal is known as the Critical Appraisal Skills Programme (CASP) (CASP, 2014) and although generic assessment tools can be beneficial in critical appraisal, users should be aware that they can miss slight differences in research methods and result in less robust approach to critical appraisal explain Craig & Smith (2012). This appraisal will follow the CASP checklist but also incorporate features set out by Caldwell, Henshaw and Taylor (2010) in the Caldwell framework designed for qualitative research to explore aspects of the study that may be missed by a generic checklist appraisal tool as noted above and explained by Craig & Smith (2012). The critiqued paper will be “Patients’ and emergency clinicians’ perceptions of improving pre-hospital pain management: a qualitative study” Iqbal, M., Spaight, P.A., and Siriwardena, A.N. (2012).
Was there a clear statement of the aims of the research?
As noted by R. Carnwell (1997) the first step to critiquing a research project should be to assess the quality of the title. The quality of the title can be affected by the approach that the researcher takes to the study that they are undertaking (Flick, U. 2007). One such method for a researcher to design their research title follows the PICO framework, this framework is designed to focus the researchers question to cover their aims and make a clear guiding to their research, the PICO framework covers Patient, Intervention, Comparison, Outcome (Lai, N. 2009).
Using the PICO approach the study outlines the patient group as the “patients’” that have experienced pain or the “emergency clinicians’” that have managed the pain, the intervention would be the “pain management” that has been provided, the comparison can be judged as the “perceptions” from the “patients’” and the “emergency clinicians’” and the outcome would be the evaluation of how the pain could be “improved” Iqbal, M., Spaight, P.A., and Siriwardena, A.N. (2012). Trinder and Reynolds (2000) explain how the clinical question should be focused in its approach, for example by clarifying if the patient is a child or elderly, looking back it can now be seen that there could still be improvements made to the clinical question, a specific patient group or cause of pain could be added, this is also ratified by both Holloway & Wheeler (2010) and also Mantzoukas (2008) who states the validity of the research project is dependent on how the researcher is able to conclude the research and answer the aims from the question.
Caldwell, K., Henshaw, L. and Taylor, G. (2010) state that the researchers should hold suitable academic qualifications as well as a professional link in the field they are researching, the interviewers both had professional links in the clinical field although it has not been expressed that this is pre-hospital experience as one is noted as a non-practicing medical doctor and the other a physiotherapist. The lead researcher on the other hand does have both “primary and pre-hospital health care” (University of Lincoln, 2016) experience adding to the credibility of the research.
Is a qualitative methodology appropriate?
Gerrish & Lathlean (2015) explains how the decision to select the correct methodologies used for the research is one of the most important processes as it ultimately affects all the other processes used. They go on to explain that for a study where the data is based on “themes, relationships and concepts’ a qualitative design would be the most appropriate. This method allows the researcher to explore the phenomena and to develop theories and trends. For this study the researchers want to study a ‘perception’ and understand an event, as this data would be the opinion of the subjects it would need to be gathered through a qualitative study (Barker J.H, 2013)
Was the research design appropriate to address the aims of the research?
A study that is designed to explore experiences, attitudes and feelings as this study does should be based around asking questions explains Ellis (2013). These questions can be asked in a variety of formats, such as, unstructured interviews, semi-structured interviews, structured interviews and focus groups (Holloway & Wheeler 2010). The study explains that they will be using focus groups first followed by semi-structured one-to-one interviews. They explain that they will explore issues that have been identified from the focus groups in the one-to-one interviews, they further go on to explain that this is due to a limitation that focus groups where by they can be dominated by some participants (Holloway & Wheeler 2010). The researchers do not specifically identify the reasons for choosing to conduct focus groups although it could be due to one known strength of this type of interview being the social interactions (Stewart & Shamdasani, 2007). With the experiences of the participants being up to 6 months ago the social interaction allows for the research subjects to interact and elicit thoughts that may otherwise have been forgotten (Holloway & Wheeler, 2010).
Is the selection of participants described and the sampling methods identified?
The researchers have explained that they will be using purposive sampling to select the patients as well as other methods for the clinicians. Unlike quantitative research, qualitative projects do not need to have a random selection process, this is so that the researchers are able to gain an understanding of a certain phenomenon through the recruitment of participants that have had similar experiences and are able to contribute further to the research topic (Hennink, M, Hutter, I, Bailey, A, 2010). The researchers decided to use a random sampling technique for the ambulance clinicians, this was done through the use of identification numbers on the staff database, ambulance clinicians are subjected to pain management as part of the daily job and so all clinicians should be able to contribute to the study. One issue that has been identified by Given (2008) is that there is a possibility of a “gatekeeper’ during the recruitment process, it is possible that the researchers may have been faced with this and as such bias unknowingly introduced into the study. A gatekeeper is someone who has influence over the research subjects; in this study the hospital clinicians were selected through consultation with the consultant – the gatekeeper.
Is the method of data collection auditable and is the method of data analysis credible and confirmable?
There is a perception in qualitative data that fewer data points are collected die to the small size. This is in fact incorrect explain Pope & Mays (2008), qualitative data can yield large amounts of data rich data. Due to this there needs to be an audit trail so that the reader can judge the quality of the research, the audit trail was developed by Lincoln & Guba (1985) from the initial ideas of E.S. Halpern and from this Rodgers and Cowles (1993) have suggested that four types of documentation should be made available to the reader, Contextual, Methodological, Analytic and Personal response. These documents allow the reader to have an incite into the decision making process that has occurred during the research. The research article has made good use of the audit process and provided the reader with the information that they need to make an informed decision into the validity of the research. The researchers provide an appendix that has anonymous quotations from participants showing the context, they provide reasoning as to the design and methodology of the research They have also provided the coding system in the appendix that shows analysis of the data and insights gained as well as a final paragraph on limitations to demonstrate self awareness and bias reduction.
Have ethical issues been taken into consideration?
Ethical and legal frameworks have been put in place throughout the twentieth and twenty-first centuries due to horrific medical experimentation that has taken place with little thought for the participants, such guidance can be found in the Nuremburg Code, Declaration of Helsinki and the U.S. Belmont Report (Noble, J.H. & Sharav, V.H. 2008) (Israel, M. & Hay, I. 2006). In recent history ethics have now taken to the forefront of research and as such ethical approval must be obtained prior to undertaking any study. The Economic and Social Research Council (ESRC) have released its Research Ethics Framework (REF) that sets out the ESRC’s expectations and good practice for social science research (Economic and Social Research Council (ESRC) 2016). Ethical approval should be sought from an ethics committee as well as institutions that are involved in the field of research; this could include a University Research Ethics Committee (UREC) (Israel, M. & Hay, I. 2006). Approval for this study has been gained from the Nottingham Research Ethics Committee and University of Lincoln; three NHS Trusts further support this. Although there is no mention in the article of gaining consent, the recruitment process began by letter of invitation; this would have given the participants to option to opt-out. Confidentiality has also been upheld as the participants have been given an ID number and all quotations are in speech marks with no personal identifying data.
Is there a clear statement of findings?
There are many ways in which you can present the findings of your research study (Flick, U. 2009). One method would follow the Strauss Model where you aim to develop a theory from the data (Strauss 1987) where another method is the use of ‘Tails from the field’ where the data is presented to illustrate factual relationships through the use of quotation (van Maanen 1988), in this case the researchers have used the latter method. The researchers have clearly identified 5 themes that have come up during the course of the research, from here they have then gone on to discuss in detail each of these 5 themes from the perspective of all involved in the study through the use of quotation. The study then goes on to summarise its findings in a final paragraph; this created a clear and in-depth understanding of the studies findings.
How valuable is the research?
The study discusses that their findings match findings in other similar studies conducted by Fosnocht, D.E. et al, (2004) and Beel, T.L. et al, (2000) where pain management is a subjective phenomenon where both patients and practitioners understand the importance of early management. Further to this they have also identified a lack of options available in certain situations. The researchers have gone on to explain that the findings could be used to guide future policies or guidelines although further research would be needed into the specific methods of pain assessment and management (McManus J.G. & Sallee, D.R. 2005). The research has followed well-respected methods of design, saturation and audit adding to the validity and credibility of the project. Fisher, W.P. & Stenner, A.J. (2011) however explains how the use of the mixed methods approach by integrating both qualitative and quantitative methods in phenomenological research could have the ability to not only add meaningfulness to research but also mathematical value.