Transcript 07 2016 Wolf and Garlid Hope (final)

Rev. Airin Wolf, Primary Investigator
Rev. Catherine Garlid, Co-investigator
Qualitative Research Interest Group meeting
July 21, 2016
Define Research Problem
Initial interest started from review of literature looking at the
effects of spirituality on likelihood of psychiatric patients to
commit suicide and the role of chaplains in relationship to these
patients…
• Hopelessness and faith emerged from this literature as
potential research material
• A pattern of “no hope” and “no coping skills” to escape
mental and/or physical pain observed in psychiatric patients
and patients with chronic illnesses
Defining Research Problem (cont’d)
• Noted high incidence of suicide rate with
physicians, 28-40 per 100,000 vs. 12.3 in general
population (Miller, 2000)
• Topic emerged of investigating hope with patients
in psychiatry and long term illness
• Keeping physician support in mind
Literature Search and Review
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Background literature on concept of hope read to develop “a working definition of
hope”
Key words used in literature search: concept of hope, physicians, hope, hopelessness,
suicide, chaplains, spirituality
Data bases used: Ovid, CINAHL, Pubmed, Psychinfo, and Academic Search
Complete; beginning June 2015 – January 2016
11 books, 131 journal articles, 8 on-line materials/websites… Medical, Psychiatric,
Nursing, Chaplaincy, Palliative Care
The references were currently published ranging from 2004 to 2015 with the
exceptions of one in 1981 and in 1996.
Journal articles and books were read and notes made on tables compared, contrasted
and summarized the evidence from scholarly literature.
Articles reviewed focused on the concept of hope, as understood by adult patients
who are very ill, parents of terminal children, physicians, and nurses
Research Question
How does the physician’s concept of hope
inform how they interact with patients?
(Formulated from gaps in the literature)
Research Definition of Hope
Hope is a process of seeing a pathway
with anticipation that involves the
interaction of thinking, acting, feeling
and relating, moving from where the
person is now and taking steps on the
path toward a future fulfillment that is
personally meaningful (Stephenson,
1991; Fiske, 2008).
Research Design
• Descriptive, qualitative research design
• Using one-to-one interviews and qualitative content analysis methods
• Qualitative analysis is mainly inductive, letting themes emerge, as well as the inferences
drawn from them, in the data (Zhang, 2005)
Institutional Review Board (IRB)
• IRB alerted that proposal would be submitted: late October
• Proposal submitted for review: 12/3/15
• Approved on 12/3/15: Exempt, IRB #4730
• Study subjects were consented verbally; waiver of signed informed consent was granted
Data Collection
• The study subjects were individually invited via e-mail on 2/10/16 an e-mail was sent to
12 physicians; 11 accepted the invitation for an interview in a location that was
convenient for them
• Convenience sample of 10 physicians were interviewed
• Personal semi-structured interviews with physicians from different specialties within
hospital
• Interview length 35-55 minutes
• Names and other identifiable information were destroyed
• The interviews were recorded and transcribed verbatim
Interview questions
Four questions were asked during the interview:
1. What does hope mean to you?
• How did hope change over the course of your practice?
2. What role does hope play in making decisions for the care of your patients?
3. How do you listen to know that a patient has hope?
4. What resources, medical or other professionals do you utilize to support your own
perspectives on hope?
• These questions were supplemented with interspersed probing questions to
deepen the discussion and clarify the study subjects’ thoughts
Steps of Content Analysis
Decision was made to analyze the data manually (no software)
1. Copy and read through the transcript making brief summary notes in margin called
“open coding.”
2. Write notes from margins in list form citing transcript and page number
3. Read through lists and categorize items – from 20 pages of open coding lists, 5 were
identified plus miscellaneous
4. Each item on list was cut into strips which were sorted into these categories
5. Compare and contrast the categories
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10.
The first 5 steps were repeated for all 10 transcripts which totaled 174 pages
Each category is being examined in detail and described in writing
Once transcript data is categorized into minor and major categories/themes,
themes that emerge, are then reviewed for accuracy
Categories are reviewed to see if they can be merged or more subcategories
created
Return to original transcripts to ensure all the information has been categorized
(http://libweb.surrey.ac.uk/library)
Category Selection
Reorientation to key components of the research
question in analyzing data:
“How does the physician’s concept of hope inform
how they interact with patients?”
1. Physician’s concept of hope
*antecedents to the concept
2. Interactions with patients
• Assessment (what do you look for?)
• Interventions (what do you do when you are with
patients?)
• Outcomes (what happened to the patient?)
3. Self-care to maintain hope
Example of preliminary study findings
Physician’s Concept
of hope:
First Antecedents to the concept:
(Qualities that enable hope to develop in the context of the
physician/patient relationship)
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Time and effort in building a relationship of trust
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Empathy
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Community
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Medical information that change is possible
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Overall well-being including spirituality
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Support
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Insight
Concept of hope
5 (partially overlapping) themes emerge:
1. Hope is part of life, of human experience; connected to suffering;
connected to facing not knowing; and existential realities such as
“death is a part of life”
"Hope to me is really one of the essential experiences of life that allow us to
endure the suffering that is also a part of life and is really inseparable from the
human experience." Study Subject #8, pg. 1, lines 8-9
Concept of hope
2. Hope is believing that the final result will be better than the start
(abstract improvement)
"Taking medications, going to counseling…educating themselves…those are all
actions that somebody has to feel there is a reason to do. And most often, the
reason that a patient is willing to do those things, is hope that by doing those
things their life will be better." Study Subject #8, pg. 2, lines 9-14
Concept of hope
3. Hope is looking for technical advances, having specific goals and
wishes, getting medically better, medical outcomes, effective
treatment, cure, tied to concrete things toward which life is
oriented, a speedy death or a “good death,” a legacy
"Hope means that there is something to strive for that could improve a person's
position in their life whether it be better health, better financial situation,
goals…that there is something to look forward to." Study Subject #7, pg. 1, lines
9-12
Concept of hope
4. Hope is an abstract quality, that which carries us on the path,
predisposition for some people, optimistic orientation to life, cup
half full, gut instinctual orientation, most people wanting to be
happy most of the time, not primarily cognitive, cannot be
transmitted, a general paradigm (not a plan or knowledge but can
inform either), whatever happens will be a good thing, “a gift”
"Take this out of clinical practice and just say if I send you a letter and say,
'Greetings, I hope this message finds you well.' I hope this message finds you
well. It's a genuine paradigm of viewing how you are, or thinking of you
positively…" Study Subject #6, pg. 1, lines 8-11
Concept of hope
5. Hope is looking to the future (fulfillment/meaning), time related,
evolves/changes over time, dynamism and forward movement,
accumulating life experience and quality of life
"But I think that the challenge of getting at the nature of hope and whether it's
possible to hope for something else that's a little bit like you are putting a future
fulfillment that's personally meaningful. Even if that means they are not getting
cured. But is there something else to sort of have faith in and orient your life
towards, that's I think the challenge. And what I think we are all trying to figure
out, basically." Study Subject #10, pg. 3, lines 29-33
Interpretation and Report Writing
Next steps:
• Further data analysis and identification of findings
• Tables and figures as necessary to capture data
• Citations, references, footnotes
• Study dissemination (article and presentations)
• Abstract to be submitted: Palliative Care, Medical, Psychiatric, Chaplaincy journals
• Report results internally IRB, subject participants, medical library, spiritual care and
medical staff and other interested parties
Issues or questions emerging along the way
1. With the convenience sample there is no way to assess the impact on study
subjects of medical specialty, age, life experience, etc.
2. It would have been interesting to actually ask the research question of the study subjects:
Does the way you think about hope influence the way you practice medicine?
3. The last question about self-care in connection to physician suicidality points to a related
but separate question when analyzing data
References
Bourneman, et al, (2014) Death Awareness, feelings of uncertainty, and hope in advanced lung cancer
patients: can they coexist? Intl. J. of Palliative Nursing 20(6)
Fiske H. (2008) Hope in Action. New York, NY: Routledge
Keene Rader, E.A. and Serwint, J.R. (2009, July 6) Until the Last Breath: Exploring the Concept of
Hope for Parents and Health Care Professionals during a Child’s serious illness. JAMA 163(7)
Kylma J. & Vehvilainen-Julkunen K. (1997) J of Adv. Nursing 25, 364-371
Marshall, M. (1996) Sampling for Qualitative Research. Family Practice 13, 522-525
Miller, Merry N., et al, (2000) The Painful Truth: Physicians are Not Invincible. Southern Med. J., 93 (10)
1-5
Rosseau P. (2000, Aug) Hope in the terminally ill. West J. Med. 173(2) 117-118
Sargeant, J. (2012) Qualitative Research Part II: Participants, Analysis, and Quality Assurance. J. of
Graduate Medical Education, March, 1-3
Shenton, A. (2004) Strategies for ensuring trustworthiness in qualitative research projects. Education for
Information 22, 63-75
Stephenson C. (1991) The Concept of hope revisited for nursing. J of Adv. Nursing 16, 1456-1461
Zhang, Yan and Wildemuth, Barbara M., (2005) Qualitative Analysis of Content, School of
information, University of Texas, Austin
http://libweb.surrey.ac.uk/library
Thank you!
Contact information:
Airin Wolf
E-mail: [email protected]
Phone: 210-4539
Contact Information:
Catherine Garlid
E-mail: [email protected]
Phone: 662-2352