Dispositivos para determinar la presencia del tren

4.3.1 Reason one: The exploratory nature of the research subject and the need to generate descriptive data on social context and human perceptions and experiences

Given the gaps in knowledge regarding access to APDC, the research question, and sub-questions could be seen as being exploratory in nature. Therefore, addressing these questions would involve the generation of data which would need to describe the human experiences, perceptions and social context which influence whether access occurs. Further as stated on page 27 results were likely to be used by policy makers. Therefore, providing local contextual information would be important (Murphy 2001, p. 44) especially in light of the variability in service models which exist in APDC services in the UK (Myers and Hearn 2001, p. 4, Copp et al. 1998, p. 164, Higginson et al. 2000, p. 279-280).

researchers such as Sale et.al (2002, p. 48-50) which argue against the use of mixed methodology research for the purpose of validation seem definitive. However, they are perhaps best interpreted as words of caution to researchers employing mixed methods. This is echoed by Silverman (2000, p. 99) who states that care should be taken when using mixed methodological research for the purpose of validation of results by triangulation of methods.

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Qualitative methods assist with the meeting of the above needs. In particular qualitative interviewing and observational58 methods have the ability to obtain: “rich” descriptions of “everyday” social contexts, and health care processes (Miles and Huberman 1994, pp. 1, 10; Green and Britten 1998, p. 1230; Bowling 2002, p. 35). Qualitative methods are also recognised as being “potential” sources of local service organization and delivery information (Pope et al. 2002, p. 150).

It is acknowledged that experiences can be gathered by the use of other interviewing methods, including structured quantitative survey methods (Britten 2006, p. 13). However, these methods have not been as effective in providing deeper insights into persons’ health related behaviours (Bowling 2006, p. 35).

As it relates to theory development, qualitative methods are more likely to assist in developing theory in studies which are focussed on phenomenon (like access to APDC) that are poorly understood or defined (Britten et al. 1995, p. 105). In fact, as stated by Murphy in cases when a phenomenon is not well understood, using quantitative methods may be difficult, and may even present a potential waste of resources (Murphy 2001, p. 44).

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Observations is one of the most commonly used methods of qualitative research, for obtaining an understanding of what persons do as opposed to what they say they do. Therefore this method was considered in this study as a primary data collection tool, however, it was not used. Various factors including the ethics around maintaining patient and carer privacy; and the effect of the researcher on the observed phenomenon informed the decision not to use observation methods. These are presented in detail in Appendix 3, page 289.

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4.3.2 Reason two: The sensitive nature of the research topic and the involvement of vulnerable participant groups.

The discussion of issues surrounding death and dying is recognised as being a sensitive research

subject (Burr 1996, pp. 173, 177). Palliative patients are also classified as a vulnerable patient group by research ethics committees (Watson et al. 2005, p. 32) as they might be experiencing physical,

emotional, social, and or spiritual distress, in addition to the possibility of imminent death.

While designing this work, it was considered that in obtaining deep descriptive data, participants may need to reflect on, and or give accounts of, situations which might potentially cause emotional distress (to both the researcher and the participant). Qualitative methods such as semi-structured in-depth interviews are recognised as being useful when dealing with sensitive topics (Bowling 2002, p. 379, Bloom and Crabtree 2006, p. 315) and were used as the primary data collection method in this work. The interview schedule consisted of open ended questions. Framing questions in an open ended way has been shown to be a very effective means of collecting the type of data needed in this study, as this sentence structure provides participants with the opportunity to expand and express themselves.

The semi-structured in-depth form of interview also offers flexibility which assists in rapport building (Dickson–Swift et al. 2006) (rapport building facilitates the development of trust between the

participant and the researcher. Such trust can facilitate the collection of sensitive data (Britten et al. 1995, p. 105)).

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Semi-structured in-depth interviews are also flexible in that they allow for the alteration of the order or phrasing of questions, in addition to the use of prompts and probes in response to a participant’s comfort level (Bowling 2002, p. 385). Having this flexibility was important, as it was likely that some patient participants would have functional deficiencies related to their age or health condition.

Therefore, being able to clarify, expand, simplify, and redirect questions in response to participants’ cues was important. It is unlikely that such flexibility would have been offered by quantitative methods (Britten 1995, p. 251), given the “rigidity” often associated with these (Ziebland and MacPherson 2006). Thus using qualitative methods provided participants with the opportunity to share the insights and experiences which they alone have, without having to conform to preset or limited modes of expression (Ziebland and MacPherson 2006).

4.3.3 Reason three: The need for flexibility in the overall research design

In addition to the benefits in flexibility offered by semi-structured in-depth interviews, a qualitative methodology also provides flexibility in the overall approach to the various aspects of research design e.g. sampling, data collection, and analysis (Miles and Huberman 1994, p. 10, Bryman 1984, p. 78, Green and Thorogood 2004, pp. 20-21). Such flexibility was important given the exploratory and sensitive nature of this work, and was an important means of ensuring that detailed data were collected from the most appropriate sources.

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4.4 Summary regarding the philosophical paradigms and methodologies which have shaped this