At Medright consulting, one of our services comprises critical appraisal of qualitative, quantitative, and mixed-methods research articles. Our target clients are reviewers of clinical practice guidelines, policymakers, and researchers intending to determine the value of including specific studies in their work.

When contracting us to do the work, you specify the article you need us to critically appraise and indicate your intended use, then we select the most appropriate checklist to appraise the article and write a paper that gives you candid and justified feedback on the quality and utility of the research article in your project.

In this article, we will show you a sample of what we deliver in a critical appraisal task. We critically appraised a qualitative study entitled “End-of-life care: a qualitative study comparing the views of people with dementia and family carers“ by Poole et al. (2018). We used the CASP (Qualitative) Checklist by Critical Appraisal Skills Programme when critically appraising the article. We used the Harvard formatting style to cite sources, prepare reference list, and structure the paper. Read on.

Summary of the Study

Poole et al. (2018) conducted a qualitative study that entailed collecting views of people with dementia and family carers for comparison. The study focused on optimal end-of-life care as perceived by people with dementia and their carers. Poole et al. (2018) collected data from 11 people with early-stage dementia living at home in northeast England and 25 current and bereaved carers from six end-of-life care services in England through interviews and a focus group discussion, then subjected the data to thematic analysis. Among the key themes that emerged include the need for receiving care, ensuring comfort, and the value of a skilled care team. This paper is a critical appraisal of the article following the CASP checklist for qualitative research (CASP, 2018).      

Validity of the Results

Clear Statement of the Aims of the Research

The goal of the research was to improve care management and service delivery to people with dementia through an understanding of their perspectives for integration into their plans of care (Poole et al., 2018). The research was thought important because it was addressing a recommendation by the 2016 World Alzheimer’s Report for an urgent need to explore perspectives of people with dementia towards enhanced person-centered care (Prince et al., 2016). It is relevant because dementia is increasingly becoming common due to the rapidly aging population, and the need to provide end-of-life care to people with dementia is getting substantial recognition (Poole et al., 2018). 

Appropriateness of Qualitative Methodology

A qualitative method is appropriate for the study because Poole et al. (2018) sought to illuminate the subjective experiences of the people with dementia and family carers. It is the right methodology to address the research goal of investigating views of people with dementia and family carers since views are based on subjective experiences. As Majid and Vanstone (2018) indicate, people’s perspectives are best captured in qualitative research.

Appropriateness of the Research Design to Address Aims

Poole et al. (2018) have justified the research design as underpinned by the social constructivist epistemological stance, which is vital in the gathering of what is real for individuals as expressed in views and interpreted by finding areas of agreement for the identification of facts (Boyland, 2019). The use of face-to-face interviews and focus group discussions facilitated the collection of in-depth data suitable for the exploration of the topic. The application of the Q-sort methodology prior to the interviews may have influenced the expression of views by people with early stages of dementia. Q-sort methodology collects data by having participants rate statements (Rost, 2021), thus the statements may have altered the views of the participants in the subsequent interview or focus group discussion.

Appropriateness of the Recruitment Strategy to the Aims of the Research

Poole et al. (2018) have explained that they recruited the 11 people with dementia through convenience sampling via a national register and a Clinical Research Network. They further indicate that they applied convenience sampling to recruit the 25 family carers from six participating services in England. Convenience sampling is appropriate for the study since the identification of specific individuals with the rich experience required and ready to express it is critical in qualitative research (Knechel, 2019). The researchers have justified the appropriateness of the selected participants in providing the knowledge sought by the study. For example, they indicate that the decision to recruit people with early stages of dementia only was informed by the inappropriateness of qualitative interviews for people with advanced dementia (Poole et al., 2018).

The researcher has discussed the recruitment realities such as the Q-sort methodology that preceded the qualitative study they conducted. The reality of four family carers requesting to take part in a focus group discussion is also described in the article (Poole et al., 2018). Data saturation was not applied as a sampling strategy since sampling was convenient, not purposive (Bhardwaj, 2019).  

Appropriateness of Data Collection to the Research Issue

The setting for the data collection was justified since it was based on the participants’ preferences. Every participant was at liberty to choose whether to be interviewed at the university, the care service, or their home (Poole et al., 2018). The process of data collection is clear since the interviewers are identified and the approach to collect the data is stated as an audio recording of the interview and the focus group discussion. Although Poole et al. (2018) have not justified the audio recording, it is appropriate since Busetto, Wick, and Gumbinger (2020) describe it as useful in qualitative data analysis. The recording makes the researcher remember the interviewee and the interview situation during analysis. The methods chosen are explicit for transparency; they facilitate the appraisal of the research process. Furthermore, the researchers have described the modification to include a focus group in data collection based upon a request by some participants but the justification is not provided. Poole et al. (2018) have discussed saturation of data by indicating that it was reached when no new themes emerged from the analysis.

Consideration of the Relationship between the Researcher and Participants

The article does not describe how the researchers engaged the participants during data collection, hence it is not clear whether they leveraged rapport to align empathic moments between them and the participants (Prior, 2018). There is no evidence that the researchers questioned their interests, motivations, and assumptions (Reid et al., 2018), meaning a reflexive approach may not have been applied. Although the roles of the various researchers have been outlined, their influence and potential biases are not discussed. There are also no reports of any events other than the request for a focus group by some participants that needed the response of the researchers in the study. The implications of introducing the focus group in the data collection have not been discussed in the article.

The Results

Ethical and Legal Aspects of the Study

The article only indicates that written consent was obtained from the participants; there is no indication that it involved sufficient explanation of the study’s details to them. The vulnerability of the people with dementia regarding the ability to express their views was considered during recruitment; the inclusion of only people with early-stage dementia ensured that people who could not express their views were not subjected to the interviews. The researchers have not expressed how they protected data and ensured confidentiality; they have also not discussed data protection and confidentiality or safeguarding of rights. Nevertheless, since they got ethical approval from the NRES Committee North East & North Tyneside, they must have catered for the various ethical aspects that they have not described in the article.

Sufficiency of the Rigor of the Data Analysis

The analysis process is described in detail for transparency. Poole et al. (2018) compared the views of the participants on the core aspects of end-of-life care by creating a table for side-by-side comparisons, which increases transparency. They applied thematic analysis by first reading the data to familiarize themselves with it, noting areas of interest, and generating potential themes independently. Then they discussed the emergent themes in workshops before collectively agreeing on a thematic framework and following it to synthesize their individual ideas in consideration of literature to develop themes (Poole et al., 2018).  

The main strength of the analysis method is that it followed a thematic framework developed and agreed upon by the interviewers. The framework ensured that all the views were considered in the generation of themes and that they were contextualized to the existing information in the literature. The researchers have not explained the selection of data presented to demonstrate the analysis; they have presented themes and described them, then displayed the verbatim quotes that support the themes.

The verbatim quotes presented sufficiently demonstrate the generation of themes (Eldh, Årestedt, and Berterö, 2020). Contradictory data are amply taken into account. For example, although a theme of trust in healthcare professionals emerged due to the majority of views indicating that decision-making should be left to healthcare professionals, the researchers included verbatim quotes that showed views of people with dementia indicating healthcare professionals should only advise rather than make decisions (Poole et al., 2018). Notably, the researchers have not critically examined their own role, potential bias, and influence during the analysis and selection of data for presentation (Johnson, Adkins, and Chauvin, 2020). 

Clear Statement of Findings

Results are divided into seven distinct themes presented in a table and discussed in prose with supporting verbatim quotes (Poole et al., 2018). The findings are explicit since the generalizations are consistent with the verbatim quotes presented to support themes. Evidence for and against the researcher’s arguments is discussed, which further justifies the choice of themes and strengthens the evidence in their support (Johnson, Adkins, and Chauvin, 2020).   

Poole et al. (2018) have discussed the credibility of findings by exploring the strengths and limitations of their study. Triangulation is evident in the article since multiple interviewers who were also the data analysts were involved in generating the themes and synthesizing them in the context of existing literature (Noble and Heale, 2019). Respondent validation is not evident in the research since there is no indication that the findings were returned to participants who generated the data to ascertain that they represented their views (Bleiker et al., 2019). The involvement of five analysts whose independently synthesized findings were openly considered reduced bias. The discussion of each of the seven themes entailed comparing the views of the people with dementia and carers from the perspective of end-of-life care, hence it was fulfilling the aim of the study.

Local Application of the Results

The findings are consistent with the recommendations of Alzheimer’s Europe on end-of-life care for people with dementia. For example, the views expressed in the article are consistent with the recommended aim of treatment by Alzheimer’s Europe, which is to maximize the level of comfort of the person with dementia and maximize their quality of life (Gove et al., 2010). Optimizing the end-of-life care for people with dementia based on the findings of the study by Poole et al. (2018) may not be costly since it is consistent with existing recommendations. However, the researchers have not featured a cost-benefit analysis when discussing the implications of their study.

Nevertheless, Poole et al. (2018) highlight areas where resources, training, or support is needed to optimize care delivery to dementia patients. The researchers identify new areas where further research is necessary such as the identification of the best way to seek the views of people with dementia in different stages. Transferability of the findings is discussed since the researchers have cautioned that their findings may not be generalizable to more diverse populations due to reasons such as the failure to capture views of people with dementia without family carers.

References

Bhardwaj, P., 2019. Types of sampling in research. Journal of the Practice of Cardiovascular Sciences, 5(3), p.157.

Bleiker, J., Morgan-Trimmer, S., Knapp, K. and Hopkins, S., 2019. Navigating the maze: Qualitative research methodologies and their philosophical foundations. Radiography, 25, pp.S4-S8.

Boyland, J.R., 2019. A social constructivist approach to the gathering of empirical data. Australian Counselling Research Journal, 13(2), pp.30-34.

Busetto, L., Wick, W. and Gumbinger, C., 2020. How to use and assess qualitative research methods. Neurological Research and practice, 2(1), pp.1-10.

Critical Appraisal Skills Programme (CASP). (2018). CASP (Qualitative) Checklist. [online] Available at: https://casp-uk.b-cdn.net/wp-content/uploads/2018/03/CASP-Qualitative-Checklist-2018_fillable_form.pdf. Accessed: 30/05/2022.

Eldh, A.C., Årestedt, L. and Berterö, C., 2020. Quotations in qualitative studies: Reflections on constituents, custom, and purpose. International Journal of Qualitative Methods, 19, p.1609406920969268.

Gove, D., Sparr, S., Dos Santos Bernardo, A.M.C., Cosgrave, M.P., Jansen, S., Martensson, B., Pointon, B., Tudose, C. and Holmerova, I., 2010. Recommendations on end-of-life care for people with dementia. The journal of nutrition, health & aging, 14(2), pp.136-139.

Johnson, J.L., Adkins, D. and Chauvin, S., 2020. A review of the quality indicators of rigor in qualitative research. American Journal of Pharmaceutical Education, 84(1).

Knechel, N., 2019. What’s in a sample? Why selecting the right research participants matters. Journal of Emergency Nursing, 45(3), pp.332-334.

Majid, U. and Vanstone, M., 2018. Appraising qualitative research for evidence syntheses: a compendium of quality appraisal tools. Qualitative health research, 28(13), pp.2115-2131.

Noble, H. and Heale, R., 2019. Triangulation in research, with examples. Evidence-Based Nursing, 22(3), pp.67-68.

Poole, M., Bamford, C., McLellan, E., Lee, R.P., Exley, C., Hughes, J.C., Harrison-Dening, K. and Robinson, L., 2018. End-of-life care: a qualitative study comparing the views of people with dementia and family carers. Palliative Medicine, 32(3), pp.631-642.

Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M. and Karagiannidou, M., 2016. World Alzheimer report 2016: improving healthcare for people living with dementia: coverage, quality and costs now and in the future.

Prior, M.T., 2018. Accomplishing “rapport” in qualitative research interviews: Empathic moments in interaction. Applied Linguistics Review, 9(4), pp.487-511.

Reid, A.M., Brown, J.M., Smith, J.M., Cope, A.C. and Jamieson, S., 2018. Ethical dilemmas and reflexivity in qualitative research. Perspectives on medical education, 7(2), pp.69-75.

Rost, F., 2021. Q‐sort methodology: Bridging the divide between qualitative and quantitative. An introduction to an innovative method for psychotherapy research. Counselling and Psychotherapy Research, 21(1), pp.98-106.

Our Charges

Writing such a critical appraisal (about 6 pages long) costs $180 if you give us at least 7 days to complete it. For urgent orders, contact us to check our availability and the costs before placing the order. We also train students to conduct critical appraisals via zoom. A 40-minutes session costs $30. If you need us to teach a group in a physical classroom, contact us to arrange timing and discuss costing.