A Qualitative Analysis of Acute Skin Toxicity among Breast Cancer Radiotherapy Patients - Essay Example

A qualitative analysis of acute skin toxi among breast cancer radiotherapy patients Julie B. Schnur, Suzanne C. Ouellette, TerryA. DiLorenzo, Sheryl Green and Guy H. Montgomery Source: Psycho-Oncology, Vol. 20, pp. 260-268 (2011) This essay will be giving an overview of my feelings on how this article was effective of achieving their aims and whether it was used efficiently furthermore if their results, findings and conclusion confirming the whole discussion and structure of the article and its reliability, strength and feasibility. This critical appraisal of a qualitative research article focuses on a study about what breast cancer patients experience when they get skin toxicity as a side effect of external beam radiotherapy. Although there have been several studies about breast cancer before, the authors claim that this is the first qualitative study that probes into the insights of the patients themselves as they go through the painful side effect of skin toxicity affecting their quality of life (QOL). Abstract: From the abstract, readers can have a glimpse of what the study entailed from the objectives to the methods used to the results and conclusions of the study. Each part of the abstract was clearly and succinctly explained. Although enough details were provided, the way it was written still makes readers want to read more. Introduction: The introduction was very short considering it was the part that gave the background literature, the rationale of the study as well as the problem statement. It did not beat around the bush by giving related but not relevant information but went straight to the point. Although this was effectively done, it still seemed as if it can do with more information about breast cancer, what patients usually experience, what radiotherapy is and how it works on cancer patients, as well as its side effects. After providing the general information, then it could focus on the main topic of the study. Krippendorff (2004) contends that existing theories or practices as well as the experience or knowledge of experts and previous research provide an abundance of developed constructs related to the topic. That is the reason why a comprehensive review of literature is necessary in any study (Elo & Kyngas, 2008). Although the authors were concise in their writing, they did not waste words with deviating from the topic at hand. They were judicious in the choice of sources, having used a variety, ranging from the 1990’s to the present. Points were explained clearly. That way, the reader is equipped with the necessary knowledge to understand the research better. The authors were clear on the goal of the study, which is “to use in-depth interviews and thematic analysis to provide a more explicit elaboration of the impact of skin toxicity” (p. 260). The information derived will be useful in understanding patient behaviours in response to radiotherapy and develop interventions to help ease their suffering. The interview gives participants the opportunity to express their own point of view regarding certain situations (Cohen et al., 2000). This would include their personal feelings, opinions, experiences and interpretations (Milena, Dainora & Alin, 2008). Such qualitative data derived may not be accessible in the methods of observation or questionnaire (Blaxter, Hughes & Tight, 2006). The qualitative interview tries to access this everyday life world. In addition, interviews allow respondents to give voice to their own experiences and understanding of their world. These analyzed experiences are then used to construct understandings of the social world. However, qualitative researchers need to be careful with the disadvantages of using the interview as a research method. As Robson (2002) mentioned, the interview process can be time-consuming, as it involves making arrangements, often having to reschedule appointments, the interview itself, and then writing up notes or transcribing the interview. One major disadvantage in any interview situation is the possibility of bias (Grinnell & Unrau, 2008). Interviewers may unwittingly divulge their opinions or expectations by their tone of voice or in the way they ask questions. Even when interviews are recorded, the researcher should remain aware of bias and its possible effect on how answers are understood and transcribed. Methods: Meticulous details for each component were provided in the methodology. Orb et al. (2000) contend that ethics in health research require such details in reporting the appropriateness of the research design to the topic being studied, the specific methods used as well as the behaviours in reporting data. The selection criteria for the participants were discussed clearly, walking the readers through the process of how they responded to the invitation to participate in the study. Purposive sampling was used. All 20 participants were recruited from the radiation oncology practice of a large urban teaching hospital. They reflected the core characteristics of the study population as indicated by Patton (1990). Among the requirements for participation were: receiving radiotherapy for Stage 0–III breast cancer, English speaking, over age 18, and being willing to participate in an interview. Exclusion criteria were any comorbid major psychiatric diagnoses or significant cognitive impairment (Schur et al., 2011). The participants were very appropriate to the study as they were directly involved in the situation being studied. All ethical considerations were given to the participants who came to the research fully knowing what to expect. They were aware that the study was to benefit them because it was designed to understand their experiences of skin toxicity due to the radiotherapy. This was their chance to express themselves and to maybe make a difference for others who are suffering from the same predicament. What makes this study all the more credible is the fact that they sought and were given approval by the Institutional Review Board as well as compliance to requirements in conducting studies with human participants. The interviews conducted were semi-structured, with some general questions asked and then discussions were free-flowing. Frey and Mertens-Oishi (1995) comment how the participation of the interviewee can be enhanced by being sensitively guided in the questioning process so that they may be able to answer the questions with ease. The first question asked was about the patient’s experience with skin changes as a result of radiotherapy. This was followed by the following topics probed which were “about pre-treatment expectations, the course of the symptoms, effects on physical well-being, effects on emotional well-being, effects on social well-being, effects on functional well-being, body image, satisfaction with prescribed management approaches (e.g. creams), feelings about treatment interruptions due to skin toxicity, and future expectations” (p. 261). Finally, they were asked if there was still anything they would like to share regarding skin toxicity during radiation treatment. This was to cap the interview as well as to make sure that all bases were covered. The evolution of technology makes it more convenient for qualitative researchers in the painstaking process of transcription. This study made use of a computer program called CLAN which allows linkages of the digitized audio record of the interview to the transcript. It added authenticity to the transcripts, unlike in the past when transcripts were prone to human error. The analysis of the data gathered from the interviews was likewise scientifically designed to keep the objectivity of the study even if it involved very subjective responses. Every step taken, including the decision-making processes, was reported, making the researchers very transparent in the way they conducted the study. It is noteworthy how reflective the researchers were as they candidly reported all possible factors that may affect the validity and reliability of the data such as their own saturation points in the analysis. They also reported how they prevented those factors from spoiling their efforts at keeping the study credible. They chronicled the deductive approach used to sort the responses into just three major themes namely: “distress associated with skin toxicity, individualizing the experience, and self-management strategies” (p. 263). The methodology used was appropriate for the purpose of the research, as it provided the relevant themes and subthemes intended to fill the meat of the data. The interviews were free flowing, although the researchers tried to stay within the themes to meet the information they set out in their goals. Breast cancer patients suffering from skin toxicity indeed were the best people to report their subjective experiences with this side effect from radiotherapy in terms of how it affects their quality of life. For this reason, the qualitative method of inquiry was most appropriate. Bryman (2008) summarizes the major common features of qualitative methodology. Firstly, the focus on meanings and understanding the culture of those being studied implies that qualitative researchers, as far as possible, work in natural settings. This suggests a preference for observation and informal interviews, rather than experiments and standardized interviews. Secondly, qualitative research aims to generate theories from the data that emerge. The data is analyzed and interpreted simultaneously with the ongoing process of collecting data. Thirdly, qualitative research is likely to be concerned with process, rather than outcomes, and attempts to provide a contextual understanding of complex issues and interrelationships (Bryman 2008; Denzin & Lincoln 2005). Results: In sorting the responses of the participants into categories, it was easier to organize the reporting of the results in a way that flows from one theme to another. Quoting representative verbalizations of the participants made the issues more real that readers can vicariously experience their pain. The words of the participants were honest and eloquent and they were framed very well within the able descriptions of the authors. The discussion of the patient experience was riveting since not all readers are familiar with the details of what they go through. Interpretive research allows the individual to shape reality using its own interpretations, meanings and understanding (Kvale & Brinkmann 2009). In this research emphasis is placed on the active involvement of people in reality construction (participants of the study). The participants brought up several issues that most readers will take for granted since they are not in the position to care about it. One example is the patient’s concerns about the appearance of their breasts due to the skin irritations and worry if their breasts will look normal again. Another issue is the use of bras under various conditions and the detail to which such issue bothered them was impressive. The breadth and depth of the issues and concerns shared by the participants in the interviews will not have surfaced had the methodology not been a qualitative one such as in this current study. Strauss and Corbin, (1990) states that qualitative research, is any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification. If quantitative researchers look for causal determination, prediction, and generalization of findings, qualitative researchers look for clarification and understanding to similar situations. Therefore, qualitative analysis may result in a different kind of information than does quantitative inquiry. Straus and Corbin (1990) claim that qualitative methods can be used to better understand any phenomenon about which little is yet known. They can also be used to find new insights on things about which much is already known, or to gain more in-depth information to those that may be difficult to convey quantitatively, or where the researcher has determined that quantitative measures cannot truly describe or interpret a specific phenomenon. For most of the experiences shared by the participants in the study, readers would find them as phenomenon due to the fact that they will not be able to relate to the actual experiences of the breast cancer patients, but nevertheless, it is worthy to know and understand what they go through. Not only would it serve as information gained, but more importantly, it will help them now understand where such patients are coming from and not stand to judge them outright when it seems that their complaints are too annoying to take. In terms of the validity of data gathered in qualitative research, Eisner & Peshkin (1990) argue, “In the case of the human sciences it [validity] is the congruence of our text of understanding with the lived reality of persons” (pp. 97-98). This means that validity would depend on how well we represent the perceptions, feelings, thinking, experience of persons, the breadth, depth and interrelations of issues, concerns and themes (Butt, 1992). This particular study seem to adhere to Heron’s (1988) more formal definition of validity in human research, which is the coherence of knowledge derived from research to the experiential knowledge of the participants and its coherence to the practical knowledge of how one acts in specific situations and contexts. Conclusion: Having ensured that the research was tightly packed, the researchers tied all the loose ends and came up with a very organized conclusion. Summing up everything concisely, the authors discussed the information learned and gave practical applications. Aside from learning about the subjective experiences of breast cancer patients in their ordeal with skin toxicity, another significant learning derived from this research is how they cope with it. Such management strategies are valuable to readers especially other breast cancer patients who might be faced with the same predicament. A number of recommendations were drawn up based on the interviews. These were for the Radiation treatment team, The Psychosocial care providers and for radiation researchers. The recommendations were what the participants would want for themselves in their future dealings with such people. The researchers may consider this as the contribution of their work to the literature. It may even spur other researchers or health practitioners to collate such toxicity management techniques into an intervention program that may be recommendable to other patients undergoing similar situations. In general, the qualitative study seemed to check out on all the criteria for good qualitative research. The researchers took all efforts to comply to high standards in the process of doing the study to come up with an impressive work worthy of emulation by other qualitative researchers. References Blaxter, L., Hughes, C., & Tight, M. (2006). How to research (3rd ed.). Open University Press. Bryman, A. (2008). Social research methods. Oxford: Oxford University Press. Butt, (1992) On Being Personal About the Collective. A paper presented at A.E.R.A., San Francisco, April 20-24, 1992. Cohen, L., Manion, L., & Morrison, K. (2000). Research methods in education (5th ed.) London, England: Routledge Falmer. Denzin, N.K. & Lincoln, Y.S. (2005). 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R., Dainora, G. & Alin, S (2008) Qualitative Research Methods: A Comparison Between Focus-Group And In-Depth Interview. Annals Of The University Of Oradea, Economic Science Series, 2008, Vol. 17 Issue 4, p1279- 1283 Orb, A., Eisenhauer, L. & Wynaden, D. (2000) Ethics in Qualitative Research, Journal Of Nursing Scholarship, 33:1, 93-96. Patton M.Q. (1990) Qualitative Evaluation and Research Methods procedures and techniques. (2nd ed.) London: Sage. Robson, C. (2002). Real world research (2nd ed.). Oxford: Blackwell. Schnur, J.B., Ouellette, S.C., DiLorenzo, T.A., Green, S. & Montgomery, G.H. (2011) A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients, Psycho-Oncology, Vol. 20, pp. 260-268 Strauss, A. & Corbin, J. (1990). Basics of qualitative research: Grounded theory. London: Sage Read More