Qualitative Study: Making Decisions For Individuals With Dementia (essay).

Write about the Introduction to Health Science and Research for Qualitative Study.

In the first research a qualitative study has been conducted on making decisions for individuals who have dimentia and lack capacity. Their objectives included identifying the common major decisions that care providers had to produce information regarding ways to overcome barriers. The aim of the sampling was to enhance the validity of the findings by ensuring that the study includes carers from a variety of sociodemographic backgrounds as well as achieved maximum variation. The study is conducted in a community setting in London whereby a total of  43 family carers were involved as the participants regarded as individuals with dementia in focus groups (Clauw, 2014). Apart from that,  46 carers, who had already made such decisions were also interviewed.

The study above being a qualitative study allows the author of the current study to conduct a critical analysis of the study as per the study tools. Besides, the study has properly listed objectives which are to identify common and difficult decisions carried by the family carers regarding persons with dementia. The study by Livingston et al. (2010) already proves to be a changer in the management of various dementias whereby we have no idea as to why it occurs and how to best manage such patients who are not able to give their consent on something. The study will facilitate the care providers to overcome barriers to decisions which will allow them to overcome these challenges that impact on the implementation of dementia healthcare.

There is a clarity in the aims of this paper which forms an essential basis of qualitative research ad recommended to the critical appraisal skills programme. The author of the current study considered what the goal of the study was, the importance as well as its relevance to the study. Additionally, the author of the current study believes in a qualitative research methodology and it's capacity to give proper results in a study. The author of the current study considered how the author sought ought to interpret the data obtained. This would allow illumination of the actions as well as subjective experiences of research participants.

A qualitative methodology when composed appropriately with the right methodology for addressing the research goal is an effective tool for research. In the first phase, there is the presence of focus groups whereby participants were allocated time to allow them to focus on groups and the basis of shared experience. This was one of the ways the study ensures homogeneity in the study membership. The study remained relevant to its objectives as it set out having participants that would help it achieve its targets. The various groups were divided into people caring for parents which were made up of individuals living in care homes (8), spouses (14), individuals with young-onset dementias (6), and individuals in primary care settings (10) (Livingston et al., 2010).

Objectives

To control the discussions during data collection, a topic guide was deployed to allow one to understand the experiences, attitudes, feelings, and beliefs of the carers of the demented patients. In the second phase, the study also conducted individual interviews whereby they reviewed focus groups to ensure that the subject under study was well covered in the course of the data collection phase. The authors had then discussed the personal accounts of the partcipants when making decisions in the five areas. These five areas were identified by using semi-structured schedules, as the most common and problematic areas in individual interviews. The schedules of interview had covered barriers, facilitators andd choices in reigious, cultural and spiritual beliefs aong with their decision makin practices.

Carers all gave informed consent to the study along with anonymous quotations and recordings. Their transcript was read and approved and the materials were provided. We ensured that none of the sample can be identified since non-specific demographic information was provided. In both individual interview stage and focus groups, the interviews as well as the  analysis were parts of an process. The study team agreed to perform a preliminary coding frame by conducting  initial interviews along with a broadly thematic content analytic approach.The data obtained fromfocus groups was analyzed and all the views on the current and required provision of information was assessed. The analysis commenced after completing the first two focus groups. We also implemented the early stage analysis during the analysis of the individual interviews.

Potkins et al. (2000) report that a carer is described as an adult family member or friend providing support for the demented persons. According to Wald et al. (2003), carers who have taken dicisions while supervising an heathcare user who was suffeing from dimentia were chosen as samples. The study authors also explain why they covered the range of experiences, which allowed the research to select a purposive sample for people with diverse socioeconomic characteristics ranging from sex, age, level of education, religion, and ethnicity.

During the individual interviews, the participants were drawn from various healthcare settings around the city London. These comprised four general practices, three memory clinics in mental health services and five communitity clinics and a specialist neurology dementia clinic for individuals with a typical dementia. The research design selected by the authors proves to be effective in handling the aims and objectives. In this case, the research design gave a better chance in a generation of data and analysis to test the hypothesis as well as answer the research questions.

Methodology

The author of the current study asserted this by testing whether the researcher made valid justification of the research design. Additionally, the researchers also gave an account of how they came to settle on their choice of methodology. Interestingly, the recruitment strategy deployed by the researchers was effective as per the aims of the research (Ablin et al., 2013). The study considered how the study selected the participants for the study and evidence of how they were selected. Additionally, the study also tested if they explained why the selection at hand was the most suited for the research at hand. The current write-up understands that the selected tools were the most suited for the study at hand to enable it to attain its targets. The authors indicated whether the data collected addressed the issue at hand whereby testing for the data collection was justified. The study also tested how the study data was collected whether through semistructured interviews as well as focus groups (Mist, Firestone & Jones, 2013). 

Several individual interviewees had made several identified decisions, whereby the authors had taken 107 interviews that covered the five decisions. From the focus groups, there was five core problematic area which proves important in decision making during dementia care. Participants consistently described their difficulties while taking decisions as well as reponsibility of an elderly patient with dimentia (Matsumoto et al., 2011). In reference to Selwood et al. (2007), there exist circumstances where long time pattans as well as roles of authority are reversed and confidence levels are breached. This in turn, has made decisions for the family members burdened with difficulty. The decicion making process was highly influnced by factors associated with all the protagonists.

The caring experence wa found to vary on the basis of relationship between the carer andf rthe healthcare service users, level of formal care and the arragement of accomodation provided. However, as per Shah et al. (2009), the decision that a close relative should go into a care home provoked challenges. An acknowledgment exists, where a rupture in the relationshipof a carer and an healthcare service user has been noticed. In such cases, a feeling of betrail accompanies the feeling of being cared.

As reported by Wald et al. (2003) there are various barriers to and facilitators of decision making by carers included patient barriers, denial of the problem, rejecting of professional help, delayed diagnosis, confidentiality and data protection. Other additional barriers include psychological as well as role conflict. The discussion about end of life was ofted found to be influenced by the thoughts of people who suffered from dementia or any other kind of illness. The author goes an extra step to give an account of how the study participants went ahead to conduct resuscitation as well as come up with difficult decisions such as the end of life decisions (Flodin et al., 2015).

Results

Family cohesion was found to reduce emotional conflicts along with facilitating decisions to assisting usefull interventions. Carers emphasized the emotional as well as the practical cruuciality of the perspective of other family members along with the support from voluntary as well as professional organizations in making decisions (Sañudo et al., 2011). While some of the carers were able to find information and support, others were not able to do the same. Several care giver sinformed that to them this was their first opportunity to discuss the difficulties while making decisions. The care giverers aree therefore found to value the interviews and questioned why were they not priovided the oppertunit earlier.

The research leaves the door open for future research by proposing key study areas with little literature such as the role of family conflict in making the treatment decisions more difficult. The data analysis was vigorous as the authors in questions wrote a description of an in-depth analysis process. The researchers has explained the process by which the data presented in the research paper were selected from the original sample to demonstrate the analysis process (Arnold et al., 2012). However, the current write up feels that there should have been sufficient data that is presented to support the findings.

The qualitative study provided a clear statement of the research findings. The findings were discussed as per the research questions whereby the authors tried to get answers on the topic at hand. The researchers also have to discuss the credibility of their study using factors such as respondent validation and triangulation of the data. Considering the fact that the author had indicated that the interview was continued till analysis had indicated that data saturation has been achieved, the study finings were credible (Macfarlane et al., 2016).

 In the analysis phase, the discussions and interviews were recorded and transcribed whereby identifying information was removed in order to observe anonymity. The study used Atlas. ti 5.2 which is a qualitative research software programme which allows easier management, coding as well as analysis of data. The results after the interviews were later on sent to the relevant participants which have been proved as a proper strategy in validation as well as quality control (McBeth et al., 2012). Additionally, the study was in this way able to preserve the genuity of the data collected without bias. 

The current write up proves that there is validity in terms of applicability in the target population who is people living with dementia. According to the evidence gathered, the relationship between the participants and the researcher seems clear as the researcher was able to examine their role on a critical note to prevent potential bias as well as influence formulation of the research question (Huang et al., 2011). This also included sample recruitment as well as a choice of location. At this juncture, the authors also gave a considerable consideration on the ethical issues surrounding ethical issues. This was tested through the models followed by the current study analyzing whether there were ethical standards maintained throughout the various stages of the research such as participant recruitment.

Barriers and Facilitators of Decision-Making

The researcher discussed issues raised by the study in relation to confidentiality as well as observing informed consent during and after the study. Besides all, the study must have sought approval from a valid ethic and regulatory committee (Lin et al., 2013). Although leaflets were produced to help with the issues which were raised by relatives, the impact of the leaflets is yet to be evaluated in real life. In all settings, a researcher called the carers a few days after the information sheet had been sent, asking wheather they were prepared for a meeting. Those who agreed to this were considered to have given informed consent therefore allowed to participate.

The relevant research ethics and development committees had approved the study. According to CASP (2018), in a qualitative study, one can assess the validity of the researcher through checking the contribution of the study to the current policies. In the case at hand, the authors in the qualitative study gave an account of the essence of the study results to the existing knowledge in dementia management. This also explains how the findings of the research can be transferred to other populations. According to  Livingston et al. (2010), the other population include the healthcare service users, the primary carer, the social care as well as the health care professionals, and finally the voluntary sector. It has been found that,the  relationships between them  are not always comfortable and encompasses love,  bewildered resignation and duty. In several cases, the journey towards a decision was directed by a lack available alternatives and by a mixture of fatigue (Yeung et al., 2012). The participants related a complex and distressing journey in negotiating an appropriate mixture of care as well as control within the healthcare system. 

The first segment of the current write-up tests on whether the results were valid whereby the trial did address the focus issue comprehensively. The idea to know the focused study may result from population-based, intervention based, comparator is given as well as the kinds of outcomes considered. The study ensures that it stays relevant to its cause by developing outcome measures to allow hypothesis testing and reproducibility. In the revised fibromyalgia impact questionnaire has changed scores at 24 weeks compared with baseline (Wang et al., 2018). From the secondary outcomes, changes of scores in  global assessment, depression, coping an d self eficicacy of the patient has been found out. According to the emerging evidence, tai chi mind-body practice imposes short term therapeutic benefits not only for chronic musculoskeletal pain, but also for mental health conditions.

Family Cohesion and Emotional Support

From three randomized  and three non-randomized trial, it has been found that tai chi not only eradicates pain but also improves physical as well as  mental health of patients who are suffering from fibromyalgia. However, more rigorous and larger trials are needed to confirm the results. Moreover, the benefits of tai chi over  aerobic exercise, which is a currently recommended core of standard care, and the ideal dose (duration and frequency) for treating fibromyalgia is still unknown. According to this study,  when it comes to tai chi mind-body treatment for fibromyalgia, the mentioned treatttment has greater benefits comparred to the  standard care treatment. It has been also found that longer duration tai chi treatment is more benificial than shorter duration tai chi treatment (Lavretsky et al., 2011). The therapeutic benefits of the tai chi treatment were consistent in a large sample of patients who were suffering from fibromyalgia. This finding has provided more support for generalizability to other settings as well as to the population of the patients.

The 1^st objective was to find out the effectiveness of the tai chi intervations compared to that of the aerobic exercise which is a current core standard treatment in healthcare service users  with fibromyalgia.  The second objective is to find out if the effectiveness of the tai chi intervention depends on its duration and dosage. The study had been design as a 52 week, randomized and  single-blind  comparative effectiveness trial. The study had been conducted in an urban tertiary care academic healthcare home  in the United States between the time range of March 2012 to September 2016. As participants, 226 adults suffering from fibromyalgia were assessed. 151of the sample were assigned to one of four tai chi groups and the rest participants were assigned in an aerobic exercise group.

Participants were followed for 52 weeks. They was encouraged in person as well as by telephone. The current study mainly deploys threw questions to test the validity of the RCT in question. These include assessing the validity of the study, assessment of the results as well as learning whether the results would be advantageous locally.

In reference to CASP (2018), there is need to assess the treatment effect whereby the current author gave an account of the outcomes they measured and what results were obtained for each outcome. The current write-up also analyzed the confidence limits in order to understand the precision of estimating the treatment effect. FIQR scores was found to be  improved in all five treatment groups. However, from the in FIQR scores at 24 weeks, the combined tai chi groups ad been found to improve more significantly than the aerobic exercise group (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005) (Wang et al., 2018).

Future Research

It has been foud that Tai chi treatment  and aerobic exercise has the same intensity and duration (24 weeks, twice weekly) . However Tai Chi treatment has greater benefit (between-group difference in FIQR scores=16.2 points, 8.7 to 23.6, P =0.007). No significant enhancement in benefit for groups who received tai chi twice weekly compared to the group who had taken it once weekly, has been noticed. Participants were found to attend the tai chi training sessions more compared to  participants who attended aerobic exercise. The effects of tai chi were found to be consistent amongst the instructors. No serious negetive events associated with the interventions were reported (Wang et al., 2018).

The results can be applied to the local population as the researchers covered patients who represent the kind of conditions experienced in the environment. It is also essential to consider the kind of clinically important outcomes and whether the kind of information availed meets your criteria. The absence of the desired information does not change the relevance of the study findings. According to Wang et al. (2015), it is not harmful to try out taichi and assess the benefits in management of fibromyalgia. Besides, it is a neurological painful condition which cannot be managed using pharmaceutical products alone, such natural remedies offer the most suitable outcomes and improvement in quality of life.

Tai chi mind-body treatment as found to provide similar or greater improvement in symptoms when compared to aerobic exercise. According to Häuser et al. (2010)  the tai chi treatment is the most common nondrug treatment for patients with fibromyalgia. According to Fitzcharles et al. (2011), more is the duration of tai chi more is the improvement. Busch, Webber and Brachaniec (2011) argue that this mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

The assignment of patients to treatments was randomized whereby the current write-up set out to understand how the study was carried out. In reference to CASP (2018), it is also important to understand whether the model of allocation was concealed from researchers and the patients. The current study also assessed whether all the patients who entered the trial properly accounted for in the conclusion of the study. This section found that the trial might have been stopped earlier but the patients were still analyzed in the groups which they were randomized in.

CASP (2018) states it is also important to understand whether the patients, health workers as well as the study personnel were blind to treatment. In this case, it was a genuine study with a trial registration named ClinicalTrials.gov NCT01420640 (Wang et al., 2018). Additionally, the current study used factors such as sex, age, social classes affect the similarity of the groups at the start of the trial. It is also important to understand whether the groups were all treated equally 

Conclusion

References 

Ablin, J., Fitzcharles, M. A., Buskila, D., Shir, Y., Sommer, C., & Häuser, W. (2013). Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evidence-Based Complementary and Alternative Medicine, 2013.

Arnold, L. M., Clauw, D. J., Dunegan, L. J., & Turk, D. C. (2012, May). A framework for fibromyalgia management for primary care providers. In Mayo Clinic Proceedings (Vol. 87, No. 5, pp. 488-496). Elsevier. DOI: https://doi.org/10.1016/j.mayocp.2012.02.010

Busch AJ, Webber SC, Brachaniec M, et al. (2011). Exercise therapy for fibromyalgia. Curr Pain Headache Rep; 15:358-67. 10.1007/ s11916-011-0214-2 

Clauw, D. J. (2014). Fibromyalgia: a clinical review. Jama, 311(15), 1547-1555.

Critical Appraisal Skills Programme (2018). CASP (insert name of checklist i.e. Randomised Controlled Trial) Checklist. [online] Available at:  URL. Accessed: Date Accessed.08.05.2018

Critical Appraisal Skills Programme (2018). CASP (insert name of checklist i.e. Qualitative) Checklist. [online] Available at:  URL. Accessed: Date Accessed.08.05.2018

Fitzcharles M-A, Ste-Marie PA, Gamsa A, Ware MA, Shir Y (2011). Opioid use, misuse, and abuse in patients labeled as fibromyalgia. Am J Med;124:955-60. 10.1016/j.amjmed.2011.05.031 

Flodin, P., Martinsen, S., Mannerkorpi, K., Löfgren, M., Bileviciute-Ljungar, I., Kosek, E., & Fransson, P. (2015). Normalization of aberrant resting state functional connectivity in fibromyalgia patients following a three month physical exercise therapy. NeuroImage: Clinical, 9, 134-139. Retrived from: https://www.sciencedirect.com/science/article/pii/S2213158215001394

Häuser W, Klose P, Langhorst J, et al. (2010). Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther; 12:R79. 10.1186/ar3002 

Huang, C. K., Shabbir, A., Lo, C. H., Tai, C. M., Chen, Y. S., & Houng, J. Y. (2011). Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25–35. Obesity surgery, 21(9), 1344-1349. Retrieved from: https://link.springer.com/article/10.1007/s11695-011-0408-z

Lavretsky, H., Alstein, L. L., Olmstead, R. E., Ercoli, L. M., Riparetti-Brown, M., Cyr, N. S., & Irwin, M. R. (2011). Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. The American Journal of Geriatric Psychiatry, 19(10), 839-850 doi:  10.1097/JGP.0b013e31820ee9ef

Lin, H. Y., Huang, C. K., Tai, C. M., Lin, H. Y., Kao, Y. H., Tsai, C. C., ... & Yen, Y. C. (2013). Psychiatric disorders of patients seeking obesity treatment. BMC psychiatry, 13(1), 1. Retrieved from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-1

Livingston, G., Leavey, G., Manela, M., Livingston, D., Rait, G., Sampson, E., Bavishi, S., Shahriyarmolki, K., and Cooper, C. (2010). Making decisions for people with dementia who lack capacity: qualitative study of family carers in UK. BMJ, 1-9. doi:10.1136/bmj.c4184

Macfarlane, G. J., Kronisch, C., Dean, L. E., Atzeni, F., Häuser, W., Fluß, E., ... & Dincer, F. (2016). EULAR revised recommendations for the management of fibromyalgia. Annals of the rheumatic diseases, annrheumdis-2016. doi:10.1001/archinternmed.2011.555

Matsumoto, S., Shimodozono, M., Etoh, S., Miyata, R., & Kawahira, K. (2011). Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia. Complementary therapies in clinical practice, 17(3), 162-166.

McBeth, J., Prescott, G., Scotland, G., Lovell, K., Keeley, P., Hannaford, P., ... & Beasley, M. (2012). Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Archives of internal medicine, 172(1), 48-57. Retrived from: https://ard.bmj.com/content/early/2016/07/04/annrheumdis-2016-209724?utm_source=trendmd&utm_medium=cpc&utm_campaign=bjo&trendmd-shared=1&utm_content=Journalcontent&utm_term=TrendMDPhase4

Mist, S. D., Firestone, K. A., & Jones, K. D. (2013). Complementary and alternative exercise for fibromyalgia: a meta-analysis. Journal of pain research, 6, 247.

Potkins D, Bradley S, Shrimanker J, O’Brien J, Swann A, Ballard C. (2000). End of life treatment decisions in people with dementia: carers’ views and the factors which influence them. Int J Geriatr Psychiatry;15:1005-8.

Sañudo, B., Galiano, D., Carrasco, L., de Hoyo, M., & McVeigh, J. G. (2011). Effects of a prolonged exercise programme on key health outcomes in women with fibromyalgia: a randomized controlled trial. Journal of rehabilitation medicine, 43(6), 521-526. Retrived from: https://www.ingentaconnect.com/contentone/mjl/sreh/2011/00000043/00000006/art00011?crawler=true

Selwood A, Katona C, Lyketsos C, Johnston K, Livingston G. (2007). A systematic review of the effect of psychological approaches to family caregivers of people with dementia. J Affect Disord;101:75-89.

Shah AK, Heginbotham C, Fulford B, Banner N. (2009). The application of the Mental Capacity Act 2005 among geriatric psychiatry patients: a pilot study. Int Psychogeriatr 2009;5:922-30.

Wald C, Fahy M, Livingston G, Walker Z. (2003). What to tell dementia caregivers—the rule of threes. Int J Geriatr Psychiatry;18:313-7.

Wang C, McAlindon T, Fielding RA, et al. (2015). A novel comparative effectiveness study of Tai Chi versus aerobic exercise for fibromyalgia: study protocol for a randomized controlled trial. Trials;16:34. 10.1186/s13063-015-0548-x 

Wang, C., Schmid, C.H., Fielding, R.A., Harvey, W.F., Reid, K.F., Price, L.L., Driban, J.B., Rones, R., and McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ, 1-14. doi:org/10.1136/bmj.k851

Yeung, A., Lepoutre, V., Wayne, P., Yeh, G., Slipp, L. E., Fava, M., ... & Fricchione, G. L. (2012). Tai chi treatment for depression in Chinese Americans: a pilot study. American journal of physical medicine & rehabilitation, 91(10), 863-870. doi: 10.1097/PHM.0b013e31825f1a67