Critique of “Exploring the spiritual needs of people dying of lung cancer or heart failure” by Murray et al. (2004)

This is a critique of a qualitative empirical study by Murray,
Kendall, Boyd, Worth, and Benton (2004)
that I wrote on 2017-11-01 for the class, EDF 7475: Qualitative Research in Education taught by David Boote, Ph.D. at University of Central Florida. Note that all three critiques of qualitative articles I wrote for this course were articles I personally selected.

EDF 7475 Article Critique Three
Richard Thripp
University of Central Florida

Article Citation

Murray, S. A., Kendall, M., Boyd, K., Worth, A., & Benton, T. F. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers. Palliative Medicine, 18, 39–45. https://doi.org/10.1191/0269216304pm837oa

Summary

The authors interviewed Scottish patients (n = 40) and carers, longitudinally with quarterly, in-home interviews over a one-year period (each of 40 to 120 minutes in length). Patients all suffered terminal, inoperable lung cancer or advanced heart disease. This article focuses on interviewees’ spiritual needs while dealing with their illnesses, both mentally and physically. The authors used semi-structured interviews, ostensibly in the narrative tradition evidenced by prominent placement of interviewees’ quotes and resultant themes. Findings were that spiritual needs are important yet often go unfulfilled, in particular for heart failure patients, although this is often due to reluctance to seek help from chaplains and others.

Contribution to the Field

Terminally ill patients are a difficult population to gain access to. Despite this, the authors managed to interview 40 such patients from two different disease trajectories (inoperable lung cancer and heart failure), with multiple follow-ups and, in this article, a focus on spiritual needs which, by itself, is a difficult field of inquiry. Consequently, the authors’ research has a strong intrinsic contribution. While it joins a chorus of research saying that health professionals have too high a patient load and not enough time to provide individualized care, here, it is patients’ worth, dignity, and spiritual fulfillment that is on the line—intangibles that are complementary to medicine. A small but potentially important contribution is Patient 10’s complaint on Page 42 about bedrails and dignity—other research has shown bedrails are ineffective at preventing serious falls, and in the past decade they have been disappearing.

Strengths and Weaknesses

A primary weakness of this article is that the longitudinal element was not employed. On Pages 40–41 the authors outline attrition at each interview—the modal cause was death, with 18 of 28 attritions decimating the sample size from 40 in the first interview to 12 in the fourth interview. However, quotes, the narrative, and the discussion all talk about participants in general terms, with no indication of participants’ gender, Scottish heritage, how spirituality changed between interviews, or whether spirituality was different for survivors as compared to the 18 subjects who passed away during the study. This seems like a large, missed opportunity. The authors claim to follow the “techniques of narrative analysis” (p. 41)—and yet, do not weave together the different interviews of subjects at three-month intervals into cohesive narratives. What we have is more of an ad-hoc selection of quotes and themes that fails even to effectively delineate or allow comparisons between the narratives of carers and patients. Moreover, spiritual needs were just one of several foci for the authors’ interviews—although this facilitates multiple publications, it does not give us a holistic picture of the participants. Another weakness is the authors say “the social context of each interview was considered in the analysis of the resulting data” (p. 40) but with no elaboration—“trust us” is the implication.

A strength is that the authors elucidated stark contrasts between lung cancer and heart failure patients. Their underlying methodology to recruit 20 patients from each group was well-documented and contributed to these findings. Ethical concerns were admirably addressed with approval and informed consent at multiple levels, including written consent before each quarterly interview. Occasionally, the authors distilled the interviews into generalizations, such as heart failure patients being less spiritually fulfilled due in part to not knowing when they will die, unlike terminal lung cancer patients. Fortunately, these generalizations were backed up with thick description of themes derived from patient and carer quotes. In particular, interviewing many participants simultaneously with their carers revealed that carers may be harsh—for example: “I think he probably needs a gun”… [carer turns toward patient] … “if you were a horse, they would shoot you” (p. 43) was shocking. It would have been nice to see more from these informal, primarily family or spouse carers on what patients were like before their diagnosis, which health professionals would not typically know firsthand. Nonetheless, a big strength of this article is simply that this is a difficult and sensitive population to gain access to.

Contribution to My Understanding

This article helped me understand that qualitative research can be combined with quasi-experimental grouping. Here, the groups were terminal lung cancer and heart failure patients. Today, I talked with my doctoral adviser about dissertation designs in financial education—my area of interest. He suggested developing a training program with pre- and post-questionnaires to different populations—or, alternately, simple survey research—for instance, tax-advantaged investing could be surveyed and/or taught to low-, mid-, and high-income participants. The underlying thread of studying different groups is similar. This article had good examples of theory-guided thematic analysis, semi-structured interviewing techniques (see “useful prompts”; p. 40), and comparison and contrast of two groups (i.e., lung and heart patients). Although my research will mainly be quantitative, many principles remain the same (e.g., use of theory and avoiding loaded prompts). In particular, the “intermingling” of hope and despair (p. 42) among terminal patients may also be seen among the financially challenged, although less acutely. Finally, the authors drew on their connections, expertise and social acumen to gain access to this population. Because finance is a sensitive topic, there are parallels with my research interests.

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