Paper Info
| Page count | 2 |
|---|---|
| Word count | 1563 |
| Read time | 6 min |
| Topic | Health |
| Type | Coursework |
| Language | 🇺🇸 US |
Summary
The Meta Synthesis authored by Mary Ann Meeker and Mary Ann Jezewski investigating family participation in making decisions warranting withdrawal and/or withholding of life-sustaining treatment for their ill family member is a well-structured and researched article. According to Polit & Beck (2012), clinical decisions concerning patient care and administration of treatment should be examined via qualitative research. The meta-synthesis has been conducted using several studies that satisfied the inclusion criteria set up by the researcher. The study utilized the grounded theory to synthesize information obtained from all qualitative studies, used to investigate the participation of family members to withdraw special treatment in critically ill patients.
What research question or focus of investigation did the metasynthesis address? | |||
| What is best? | Where do I find the information? | Questions to answer | |
| The main question being addressed should be clearly stated. The scope should be broad enough to fully capture the phenomenon of interest but sufficiently focused to yield findings that are meaningful to clinicians, other researchers, and public policymakers. | The Title, Abstract or final paragraph of theIntroductionshould clearly state the question or phenomenon of interest.. If you still cannot ascertain what the focused question is after reading these sections, search for another paper! | Did the report clearly state the research problem/question? Is the topic important for nursing? Were concepts and variables, or phenomena adequately defined? Was the integration approach adequately described? Was the integration approach appropriate? | |
| This paper: Yes No Unclear Comment: The purpose and the research questions underpinning the study were clearly stated in the research article, especially in the abstract, introduction, and key information setting out the purpose of the study. The research question was to assess the process according to which the family members take part in decisions, involving the withdrawal of treatment among patients who are critically ill. However, the research question does not state clearly the expected outcome and some of the relevant variables that aid in the study. | |||
F – Is it unlikely that important, relevant studies were missed? | |||
| What is best? | Where do I find the information? | Questions to answer | |
| The starting point for the comprehensive search for all relevant studies is the major bibliographic databases (e.g., Medline, Cochrane, EMBASE, etc) but should also include a search of reference lists from relevant studies, and contact with experts, particularly to inquire about unpublished studies. The search should not be limited to the English language only. The search strategy should include both MESH terms and text words. | The Methodssection should describe the search strategy, including the terms used, in some detail. The Results section will outline the number of titles and abstracts reviewed, the number of full-text studies retrieved, and the number of studies excluded together with the reasons for exclusion. This information may be presented in a figure or flow chart. | Did the report clearly describe the criteria for selecting primary studies? Were those criteria reasonable? Were bibliographic databases used by reviewers identified? Were they appropriated and comprehensive? | |
| This paper: Yes No Unclear Comment: A systematic process was set out to find research reports that could help to arrive at a comprehensive analysis of the topic. All bibliographic sources were listed which included CINAHL Medline, EBM Reviews and PsycINFO. The search terms were clear and were restricted to English. Because of the comprehensive nature of the study’s phenomenon, the researchers included epistemological and methodological frameworks from various qualitative studies (Mateo & Kirchhoff, 2009). The inclusive criterion was stated, which showed that the articles searched were those published between 1995 and 2007. However, the study did not indicate the exact number of articles consulted during the analysis. The search strategy combined keywords, such as withholding treatment, passive euthanasia, decision-making, and qualitative research (Polit & Beck, 2012). | |||
A – Were the criteria used to select articles for inclusion appropriate? | |||
| What is best? | Where do I find the information? | Questions to answer | |
| The inclusion or exclusion of studies in a systematic review should be clearly defined a priori. The eligibility criteria used should specify the patients, interventions or exposures and outcomes of interest. In many cases, the type of study design will also be a key component of the eligibility criteria. | TheMethodssection should describe in detail the inclusion and exclusion criteria. Normally, this will include the study design. | Were keywords identified? Exhaustive? Did reviewers use adequate supplementary efforts to identify relevant studies? Was a flow chart included to summarize the search strategy and results? Were studies integrated that used different research traditions? Was this appropriate? | |
| This paper: Yes No Unclear Comment: The inclusion criteria were represented with the study, identifying all the key factors in the study. The study gave precise and clear definitions of key terms that underpinned the study. The search for keywords was well attended since all articles found on the reference lists with the keywords were included in the study. | |||
A – Were the included studies sufficiently valid for the type of question asked? | |||
| What is best? | Where do I find the information? | Questions to answer | |
| The article should describe how the quality of each study was assessed using predetermined quality criteria appropriate to the type of clinical question (e.g., randomization, blinding and completeness of follow-up) | The Methodssection should describe the assessment of quality and the criteria used. The Results section should provide information on the quality of the individual studies. | Did the reviewers appraise the quality of the primary studies? Did they use a defensible and well-defined set of criteria or a well-respected quality appraisal scale? Did two or more people do the appraisals, and was the inter-rater agreement reported? Was the appraisal information used in a well-defined and defensible manner in the selection of studies, or the analysis of results? | |
| This paper: Yes No Unclear Comment: The research article included all the processes that were used to review the topic of the study. The researchers described each study’s sample size and the inclusion criteria of all the participants that were utilized in different studies. Randomization and data analysis were used as some of the key items in the checklist (Mateo & Kirchhoff, 2009). While the researcher mentioned that studies were supported by other previous studies, no clear indication of the quality tool was used. | |||
T – Were the results similar from study to study? | |||
| What is best? | Where do I find the information? | Questions to answer | |
| Ideally, the results of the different studies should be similar or homogeneous. If heterogeneity exists the authors may estimate whether the differences are significant (chi-square test). Possible reasons for the heterogeneity should be explored. | The Results section should state whether the results are heterogeneous and discuss possible reasons. The forest plot should show the results of the chi-square test for heterogeneity and discuss reasons for heterogeneity if present. | Was heterogeneity of effects adequately dealt with? | |
| This paper: Yes No Unclear Comment: Nearly all the studies used indicated that surrogates needed the help of the patients to help them make decisions to withdraw or withhold treatment. In addition, 14 of the studies reported that even in cases where patients took part, their information could not help them make decisive decisions. Based on the analysis, you could not tell the best interventions that could be used to increase the efficiency of the decision-making process between patients, surrogates and nursing prodders. | |||
How are the results presented? | ||
| What is best? | Where do I find the information? | Questions to ask |
| A metasynthesis provides a summary of the data from the results of several individual studies. | The Resultssection should provide charts, tables, or a narrative of the data. The Discussionsection may further describe, discuss, and/or explain the findings. | Did the reviewers describe the techniques they used to compare the findings of each study? Did they explain their method of interpreting their data? How much transformation of data was used? Was this appropriate? If a meta summary was undertaken, did the abstracted findings seem appropriate and convincing? Were appropriate methods used to compute effect sizes? Was the information presented effectively? In a metasynthesis, did the synthesis achieve a fuller understanding of the phenomenon to advance knowledge? Do the interpretations seem well-grounded? Was |
| Comment: The article does not report its results in simple or tabulated charts of the study. However, the article has clear results discussions, outlined by the authors. In the analysis, the results are arranged thematically to identify some of the common aspects that underscore the participation of family members in the decision making for treating critically ill patients. | ||
Are the results valid? | ||
| What is best? | Where do I find the information? | Questions to ask |
| The conclusion should summarize the purpose, methods, limitations, quality of individual studies and implications for practice and research in a clear and concise format | The Conclusion should summarize the purpose, limitations, and overall quality of the studies included along with implications for practice and further research. | Did the reviewers draw reasonable conclusions about the quality, quantity, and consistency of evidence relating to the research question? Were limitations of the review/synthesis noted? Were implications for nursing and further research clearly stated? |
| Comment: The article concludes by drawing the purpose of the study. Since the findings conform with the objectives of the study, it is evident that the results are consistent (Polit & Beck, 2012). Due to the contemporary nature of the phenomenon, future research should determine some of the interventions that can be utilized to determine how surrogate interventions can be used to enhance the clinical practice of family participation in making decisions. | ||
References
Mateo, M. A. & Kirchhoff, K. T. (2009). Research for Advanced Practice Nurse: From Evidence to Practice. New York: Springer Publishing.
Polit, D. F. & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams & Wilkins.