Doing qualitative research: a practical handbook, by David Silverman, Los Angeles, Sage, 2010, 456 pp., AU$65.00, ISBN 978-1-84860-033-1, ISBN 978-1-94960-034-8. Available in Australia and New Zeal...

Doing qualitative research: a practical handbook

Although the risk of malpractice suits differs by specialty, some physicians are sued more often than others even within a particular discipline If the risk is in fact related to a substantial degree to patients being dissatisfied with physician behaviors, care, and treatment, it might be possible to create a monitoring system that could alert physicians to their risk of being sued The authors hypothesized that unsolicited patient complaints can distinguish physicians at high and at low risk of malpractice even after adjusting for such factors as specialty area, gender, and years in practice A retrospective cohort study enlisted 645 general and specialist physicians who were members of a large US medical group Longitudinal follow-up from early from 1992 to early 1998 totaled 2546 physician-years of care One third of the physicians were surgeons and the others were in general medicine, pediatrics, or neurology Computerized records of unsolicited complaints were recorded and compared with each physician's risk management records during this period More than one third of the physicians (37%) received no complaints during the study period More than half of all complaints were generated by 9% of the physicians, and 5% accounted for nearly one third of complaints The mean number of complaints for all group members was approximately 8 (53 for nonsurgeons and 130 for surgeons) Complaints correlated positively with the volume of clinical activity, as did risk management data On logistic regression analysis, factors related to total patient complaints after adjusting for clinical activity included opening of a risk management file (RMF), file openings with expenditures, and lawsuits Surgeons named in a single lawsuit generated significantly more complaints that surgeons who were never named Female physicians were relatively less likely to be involved with RMFs or lawsuits For both surgeons and nonsurgical practitioners, frequent complaints and high clinical activity correlated significantly with having an RMF Surgeons received complaints related to care and treatment, billing, communication, access/availability, and "humaneness" more often than did nonsurgeons In this retrospective longitudinal study, unsolicited patient complaints correlated positively with physicians' experience of risk management This association would seem to offer an excellent opportunity to address causes of patient dissatisfaction that might lead to malpractice lawsuits

Patient complaints and malpractice risk

The application of the Universal law on migrants in documents of the United States Conference of Catholic Bishops

From the time of diagnosis through either survivorship or end of life, communication between healthcare providers and patients or parents can serve several core functions, including fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient/family self-management. We systematically reviewed all studies that focused on communication between clinicians and patients or parents in pediatric oncology, categorizing studies based on which core functions of communication they addressed. After identifying gaps in the literature, we propose a research agenda to further the field.

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Communication in pediatric oncology: State of the field and research agenda.

BACKGROUND: When children are seriously ill, parents rely on communication with their clinicians. However, in previous research, researchers have not defined how this communication should function in pediatric oncology. We aimed to identify these communication functions from parental perspectives. METHODS: Semistructured interviews with 78 parents of children with cancer from 3 academic medical centers at 1 of 3 time points: treatment, survivorship, or bereavement. We analyzed interview transcripts using inductive and deductive coding. RESULTS: We identified 8 distinct functions of communication in pediatric oncology. Six of these functions are similar to previous findings from adult oncology: (1) building relationships, (2) exchanging information, (3) enabling family self-management, (4) making decisions, (5) managing uncertainty, and (6) responding to emotions. We also identified 2 functions not previously described in the adult literature: (7) providing validation and (8) supporting hope. Supporting hope manifested as emphasizing the positives, avoiding false hopes, demonstrating the intent to cure, and redirecting toward hope beyond survival. Validation manifested as reinforcing “good parenting” beliefs, empowering parents as partners and advocates, and validating concerns. Although all functions seemed to interact, building relationships appeared to provide a relational context in which all other interpersonal communication occurred. CONCLUSIONS: Parent interviews provided evidence for 8 distinct communication functions in pediatric oncology. Clinicians can use this framework to better understand and fulfill the communication needs of parents whose children have serious illness. Future work should be focused on measuring whether clinical teams are fulfilling these functions in various settings and developing interventions targeting these functions.

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Communication in Pediatric Oncology: A Qualitative Study

A mixed-method, exploratory design was used to examine 101 cases of sexual violations in medicine. The study involved content analysis of cases to characterize the physicians, patient-victims, the practice setting, kinds of sexual violations, and consequences to the perpetrator. In each case, a criminal law framework was used to examine how motives, means, and opportunity combined to generate sexual misconduct. Finally, cross-case analysis was performed to identify clusters of causal factors that explain specific kinds of sexual misconduct. Most cases involved a combination of five factors: male physicians (100%), older than the age of 39 (92%), who were not board certified (70%), practicing in nonacademic settings (94%) where they always examined patients alone (85%). Only three factors (suspected antisocial personality, physician board certification, and vulnerable patients) differed significantly across the different kinds of sexual abuse: personality disorders were suspected most frequently in cases of rape, physicians were more frequently board certified in cases of consensual sex with patients, and patients were more commonly vulnerable in cases of child molestation. Drawing on study findings and past research, we offer a series of recommendations to medical schools, medical boards, chaperones, patients, and the national practitioners database.

https://journals.sagepub.com/doi/pdf/10.1177/1079063217712217

Sexual Violation of Patients by Physicians: A Mixed-Methods, Exploratory Analysis of 101 Cases.

Policies by the National Institutes of Health and the National Science Foundation, as well as scandals surrounding failures to reproduce the findings of key studies in psychology, have generated increased calls for sharing research data. Most of these discussions have focused on quantitative, rather than qualitative, research data. This paper examines scientific, ethical, and policy issues surrounding sharing qualitative research data. We consider advantages of sharing data, including enabling verification of findings, promoting new research in an economical manner, supporting research education, and fostering public trust in science. We then examine standard procedures for archiving and sharing data, such as anonymizing data and establishing data use agreements. Finally, we engage a series of concerns with sharing qualitative research data such as the importance of relationships in interpreting data, the risk of re-identifying participants, issues surrounding consent and data ownership, and the burden of data documentation and depositing on researchers. For each concern, we identify options that enable data sharing or describe conditions under which select data might be withheld from a data repository. We conclude by suggesting that the default assumption should be that qualitative data will be shared unless concerns exist that cannot be addressed through standard data depositing practices such as anonymizing data or through data use agreements.

Is it time to share qualitative research data

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.

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Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008-2016.

Data sharing maximizes the value of data, which is time and resource intensive to collect. Major funding bodies in the United States (US), like the National Institutes of Health (NIH), require data sharing and researchers frequently share de-identified quantitative data. In contrast, qualitative data are rarely shared in the US but the increasing trend towards data sharing and open science suggest this may be required in future. Qualitative methods are often used to explore sensitive health topics raising unique ethical challenges regarding protecting confidentiality while maintaining enough contextual detail for secondary analyses. Here, we report findings from semi-structured in-depth interviews with 30 data repository curators, 30 qualitative researchers, and 30 IRB staff members to explore their experience and knowledge of QDS. Our findings indicate that all stakeholder groups lack preparedness for QDS. Researchers are the least knowledgeable and are often unfamiliar with the concept of sharing qualitative data in a repository. Curators are highly supportive of QDS, but not all have experienced curating qualitative data sets and indicated they would like guidance and standards specific to QDS. IRB members lack familiarity with QDS although they support it as long as proper legal and regulatory procedures are followed. IRB members and data curators are not prepared to advise researchers on legal and regulatory matters, potentially leaving researchers who have the least knowledge with no guidance. Ethical and productive QDS will require overcoming barriers, creating standards, and changing long held practices among all stakeholder groups.

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Are we ready to share qualitative research data? Knowledge and preparedness among qualitative researchers, IRB Members, and data repository curators.

Qualitative data provide rich information on research questions in diverse fields. Recent calls for increased transparency and openness in research emphasize data sharing. However, qualitative data sharing has yet to become the norm internationally and is particularly uncommon in the United States. Guidance for archiving and secondary use of qualitative data is required for progress in this regard. In this study, we review the benefits and concerns associated with qualitative data sharing and then describe the results of a content analysis of guidelines from international repositories that archive qualitative data. A minority of repositories provide qualitative data sharing guidelines. Of the guidelines available, there is substantial variation in whether specific topics are addressed. Some topics, such as removing direct identifiers, are consistently addressed, while others, such as providing an anonymization log, are not. We discuss the implications of our study for education, best practices, and future research.

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Heidi Walsh

Papers

Sexual Violation of Patients by Physicians: A Mixed-Methods, Exploratory Analysis of 101 Cases.

Is it time to share qualitative research data

Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008-2016.

Are we ready to share qualitative research data? Knowledge and preparedness among qualitative researchers, IRB Members, and data repository curators.

Examining Data Repository Guidelines for Qualitative Data Sharing