Bridging the gap between qualitative and quantitative research

Bridging the gap between qualitative and quantitative research: A randomised controlled pilot and feasibility study of the effectiveness of music therapy in improving the quality of life of palliative care patients. Professor Joanne Reid

Introductions who you are, where you are from, how comfortable are you using both qualitative and quantitative research methods (very, somewhat, not at all)?

Qualitative and quantitative research – key differences The obvious difference – numerical v. textual data; numbers v. words

Why use both qualitative and quantitative research methods? You have a question that has rarely been asked or has been asked with questionable results You want the strength of multiple methods - triangulation Some, and only some, of your variables are easily quantifiable at this stage of inquiry To “illuminate the black box” of relationships defined only in statistical terms To hear from those who are rarely reached effectively by typical quantitative approaches

How to combine qualitative and quantitative research methods Multi-methods research E. g. more than one qualitative method Mixed – methods research Both qualitative and quantitative methods of data collection and analysis MRC guidance 2008 included a process evaluation

Mixed Research processes method type Examples Explanatory Quantitative data are sequential collected analysed first, then qualitative data are collected analysed to help explain quantitative data QUAN →  QUAL AIM: Identify levels of stress among new graduate registered nurses (RNs) working in emergency room (ER) settings QUAN: National survey of new RNs working in ER settings measuring levels of workplace stress QUAL: Personal interviews with 15– 20 new RNs working in ER settings to discuss their experiences with stressful workplace situations SYNTHESIS: Sequential QUAL data help explain QUAN data Exploratory sequential Qualitative data are collected analysed first, then quantitative data are collected and used to test findings empirically QUAL →  QUAN AIM: Identify highest sources of workplace stress for new RNs working in hospital ERs QUAL: Focus group data collected from newly registered RNs working in hospital ERs within a local area health service to discuss workplace stress QUAN: QUAL data used to create a national survey administered to all RNs working in ERs about sources of workplace stress experienced within their first year of practice SYNTHESIS: Sequential QUAL data inform collection of QUAN data, which verify QUAL data Parallel Qualitative and quantitative data collected analysed concurrently QUAL + QUAN AIM: Identify sources of stress for RNs working in ER settings, personal coping strategies used and types of programmes or support systems provided by hospitals QUAN: National survey of all RNs working in ER departments, based on the literature, to identify common sources of stress and methods of support used by employers to reduce RN stress QUAL: Focus groups and interviews with a random selection of RNs working in ERs to broaden understanding of different sources of stress and personal coping strategies used SYNTHESIS: Data integration during interpretation phase after QUAN and QUAL data analyses Nested Can be either QUAL or QUAN main design with the alternative paradigm embedded within the study to answer a complementary question QUAL + quan or QUAN + qual AIM: Test an online peer support programme designed to reduce workplace stress for new RNs working in ERs QUAN: RCT to test online programme effect on stress levels and intention to remain working in the ER QUAL: Interview nested in the RCT, focused on user experiences of the online programme SYNTHESIS: QUAL analysis embedded within the main QUAN study

Case study: A randomised controlled pilot and feasibility study of the effectiveness of music therapy in improving the quality of life of palliative care patients: J. Reid, 1 T. Mc. Connell, 1 M. Clarke, 4. L. Graham, 2 M. Mc. Keown, 2 J. Regan, 2 K. Mc. Grillen, 2 J. Leitch, 2 N. Hughes, 3 & J. Kirkwood, 3 S. Porter 5 1 School of Nursing and Midwifery, Queen’s University Belfast 2 Marie Curie Hospice Belfast 3 Every Day Harmony Music Therapy 4 School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast. 5 Social Sciences and Social Work, Bournemouth University

What is music therapy? https: //www. youtube. com/watch? v=1 NF 73 a 9 l. PJY

Music therapy Use of music and sounds to facilitate the development of a relationship between patients and professionally trained therapists with the aim of supporting relaxation and improving both physical and emotional well-being Used in palliative care for more than a decade

Background Anecdotal evidence strongly supports music therapy as a palliative therapy, with the primary aim of improving people’s quality of life ……. . However the evidence base is weak ……. Research challenging in this area

Study aims Aim – the feasibility of conducting a phase III pragmatic RCT Primary objectives o Outcome measures o Intervention duration o Recruitment and attrition rates Secondary objectives o Indicative outcomes related to Quality of life o Inter-familial communication (data not available until results unlocked)

Method UK-based, single-centre, pilot RCT Two parallel arms (randomised 1: 1) Participants (n>52) 18 -bed specialist palliative care inpatient unit in Northern Ireland Eligibility criteria - ECOG≤ 3, AMT≥ 7 Mc. Gill Quality of Life Questionnaire (MQOL), and socio-demographic data. Baseline (before randomisation), one, three and five-week follow-up Qualitative data collection – patients and focus groups HCPs to examine impact and context

Analysis MQo. L questionnaire - evaluated at each data collection point - feedback on the questionnaire’s appropriateness and level of burden The viability of delivering a 3 -week music therapy intervention assessed by the number of patients completing the intervention and reasons for attrition Recruitment and attrition figures - power calculation for definitive RCT The potential effectiveness of music therapy- change in the outcome variables from baseline Qualitative methods, in particular interviews and focus groups, will be used to assess impact, interfamilial communication and contextual factors

Intervention Format Individual, inpatient unit setting 2 x › 45 minute sessions, for 3 consecutive weeks, in addition to care as usual Family may be present • • Delivery Content Delivered by an HCPC certified music therapist • Involving live and recorded music • ‘Receptive’ and ‘recreative’ • A standardised yet tailored intervention • May include song composition, life review, active music making, listening to familiar music, creating legacy recordings

Quantitative results Recruited our target sample Determined the viability of the intervention delivery period Ascertained the acceptability of the Qo. L measure (content and level of burden) Clarified the primary end point for data collection Potential effectiveness - most notably, improvement in psychological and existential well-being sub-measures of MQo. L

Practitioner perspective One of our patients, he never would have spoken about feelings and stuff, and he composed a whole song for his wife and literally handed her the CD and was like “Listen to that on the way home”, and she was just like “That’s the nicest thing you’ve ever done for me”, and it was all about her, so it was lovely. (AHP 5)

Family perspective Was a bright spark in a dark environment. A wonderful experience. Great comfort to see XX having fun. (Husband) Helped to see mum happy and having good time. (Daughter and son)

Patient perspective • Music therapy helped • Joy to have lovely girl come in and we bonded through the music • Was amazing - the relationship, got on so well • Something to look forward to • I chose the music – uplifting • Overwhelming how this girl was sent to us • It was a wonderful experience. Never would’ve dreamt it could be so wonderful

Group work What are the challenges and advantages of combining qualitative and quantitative research methods? Example Challenges Need to have expertise in both qualitative and quantitative research Advantages Can explore aspects of the topic quantitative tool can’t get to

Email: j. reid@qub. ac. uk Webpage – Musi. Qual