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Solving methodological challenges using a theory-driven evaluation in the study of complex patient care

Solving methodological challenges using a theory-driven evaluation in the study of complex patient care
Solving methodological challenges using a theory-driven evaluation in the study of complex patient care
This article draws on two research designs, which were used in a study of the palliative management of malignant wounds, to demonstrate the inherent challenges in producing generalizable knowledge from a complex subject. The designs included quasi-experimentation and a form of theory-driven evaluation. The focus of the study was the performance of dressings to reduce the impact of the wounds on daily life. The convention for evaluating the outcomes of interventions is a controlled study design. This approach is considered the valid way of producing evidence that is generalizable. An experimental design was therefore adopted to conduct a series of n = 1 quasi-experiments on wound dressing performance with qualitative methods to explore individual experiences. Problems with the methods, in particular the failure to capture complex inter-relationships between clinical problems and patient experiences, forced the researcher to abandon the experimental design. An alternative approach to measurement was adopted to maintain the study focus, the TELER® system of treatment evaluation, which includes indicators of patient-centred outcomes of care. The philosophical position of the study was reviewed. Consensus emerged as an unalterable, major influence on the design and paradigmatic assumptions of the study. A 'system of reasoning' was adopted to overcome the inherent relativist position of knowledge derived from this approach. The system abstracts general issues from case study data to construct theoretical explanations that may be consistent with, or challenge, current knowledge. This article is based on the evolution of one particular study. However, it makes a more general contribution to evaluation research by explaining the rationale for a form of theory-driven evaluation that uses evidence, reason and theory to develop generalizable explanations from complex, individual case study data. The methodology is proposed for other complex situations where specific and rigorous evidence, capable of generalization is needed.
306-321
Grocott, P.
b40aff9b-97fe-4067-8226-b099fb40921d
Cowley, S.
4c833870-69f9-4123-b651-2ecbafdb5a11
Richardson, A.
a5adbf25-d0c1-4169-9a96-6186d1bbef5a
Grocott, P.
b40aff9b-97fe-4067-8226-b099fb40921d
Cowley, S.
4c833870-69f9-4123-b651-2ecbafdb5a11
Richardson, A.
a5adbf25-d0c1-4169-9a96-6186d1bbef5a

Grocott, P., Cowley, S. and Richardson, A. (2002) Solving methodological challenges using a theory-driven evaluation in the study of complex patient care. Evaluation, 8 (3), 306-321. (doi:10.1177/135638902401462457).

Record type: Article

Abstract

This article draws on two research designs, which were used in a study of the palliative management of malignant wounds, to demonstrate the inherent challenges in producing generalizable knowledge from a complex subject. The designs included quasi-experimentation and a form of theory-driven evaluation. The focus of the study was the performance of dressings to reduce the impact of the wounds on daily life. The convention for evaluating the outcomes of interventions is a controlled study design. This approach is considered the valid way of producing evidence that is generalizable. An experimental design was therefore adopted to conduct a series of n = 1 quasi-experiments on wound dressing performance with qualitative methods to explore individual experiences. Problems with the methods, in particular the failure to capture complex inter-relationships between clinical problems and patient experiences, forced the researcher to abandon the experimental design. An alternative approach to measurement was adopted to maintain the study focus, the TELER® system of treatment evaluation, which includes indicators of patient-centred outcomes of care. The philosophical position of the study was reviewed. Consensus emerged as an unalterable, major influence on the design and paradigmatic assumptions of the study. A 'system of reasoning' was adopted to overcome the inherent relativist position of knowledge derived from this approach. The system abstracts general issues from case study data to construct theoretical explanations that may be consistent with, or challenge, current knowledge. This article is based on the evolution of one particular study. However, it makes a more general contribution to evaluation research by explaining the rationale for a form of theory-driven evaluation that uses evidence, reason and theory to develop generalizable explanations from complex, individual case study data. The methodology is proposed for other complex situations where specific and rigorous evidence, capable of generalization is needed.

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Published date: 2002

Identifiers

Local EPrints ID: 69093
URI: http://eprints.soton.ac.uk/id/eprint/69093
PURE UUID: 28356d57-d37c-4bc6-9243-7836ff486e61

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Date deposited: 02 Dec 2009
Last modified: 13 Mar 2024 19:18

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Contributors

Author: P. Grocott
Author: S. Cowley
Author: A. Richardson

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