Abstract
This paper provides a critical review of the article by Jones, Nowels, Sudore, Ahluwalia, and Bekelman (2015), which is entitled “The Future as a Series of Transitions: Qualitative Study of Heart Failure Patients and Their Informal Caregivers.” The purpose of this assignment is to elaborate and critique several principal aspects of the article in order to conclude on its scientific quality and reliability of its results as well as the significance for clinical practice. The paper is divided into five sections that reflect essential aspects of any research: the problem statement, observation of the literature review conducted by the authors, research design and procedures, presentation of data and analysis of the findings, and, finally, principal conclusion and implications of the article. In general, the authors strive to prove the hypothesis about the critical significance of past and present transitions as the tool for advanced care planning. The authors conducted a qualitative study, which provides important insights into the use of transitional theory in both clinical and informal caregiving for patients with heart failure.
Introduction
First of all, it is essential to observe the basic premises of the authors’ research, which include the problem statement, research questions, research objectives, hypothesis, and main results. It could be noted that the authors provide a profound background for the problem that defines its significance. Jones et al. (2015) argue that in recent decades numerous researchers have identified the growing need among heart failure patients not only to focus on life-sustaining treatment but also to extend the caregiving process to future concerns and goals of patients.
The Problem
Therefore, the problem is stated in the following way: patients are not receiving enough support in decision-making about their future, which is considered uncertain in the context of heart failure. The practical importance of this problem is evident since both in clinical and informal circumstances a psychologically supporting approach would significantly improve the patients’ quality of life. Accordingly, the primary objective of the research is “to identify how patients with heart failure and their informal (family) caregivers perceive their future” (Jones et al., 2015, p. 176). It is important to mention that research questions were not clearly formulated in the article.
The purpose of this study was to conduct qualitative research on patients with heart failure and their informal caregivers in order to understand how they cope with their disease and what could be improved. The initial hypothesis was that transitions (and transitional theory in general) play a significant role in the patients’ perception of their condition. However, it is worth mentioning that the key terms of the article were not explicitly defined by the authors. Concerning the results of the study, it should be observed that the authors developed a four-stage framework of transitions as a tool for coping with the condition of heart failure. The following sections will discuss particular aspects of the article since the general information is provided.
Review of the Literature
It is critical to discuss the literature that was used by the authors in the process of their research. Jones et al. (2015) dwell upon considerably reliable, relevant, and pertinent sources as scholarly support of their work. They employ studies focused on such topics as heart failure in the context of patients coping with the condition, transition theory, advance care planning, palliative care, and several others. It should be noted that all of the sources provide direct concise support for the authors’ reasoning, making the literature review of the article not too narrow or too broad. The majorities of the references are recent, with few exceptions (several referenced articles were written in the late 90s). Also, the authors do not demonstrate any bias in terms of their choice of literature.
Design and Procedures
In general, the authors conducted their research based on the qualitative approach. The choice of methodology is largely determined by the initial purpose of the study: qualitative methods appear to be significantly more efficient for retrieving information about the perceptions of the future by patients and their informal caregivers. Particularly, the authors performed a cross-sectional qualitative study. The research is based on a sample of 33 patients diagnosed with New York Heart Association (NYHA) class II-IV heart failure and 20 informal caregivers, primarily wives and daughters of patients. Jones et al. (2015) conducted an original study that was not replicating any of the previous studies in a similar area of concern.
Further, measurement tools and procedures structure should be discussed. Due to the qualitative nature of the study, measurement tools are limited to the authors’ interpretation of the results gathered during in-depth, semi-structured interviews with patients and caregivers. Therefore, it is appropriate to focus more on how the interviews were structured. As is mentioned by Jones et al. (2015), they strived to retrieve meaningful and profound information, and thus, interviews lasted for 60 to 90 minutes. The participants were asked “several open-ended questions about major concerns and needs” as well as questions that covered “physical, psychological, social, cultural, and spiritual” aspects of palliative care (Jones et al., 2015, p. 177). The questions were developed in order to maximize the clarity of understanding and depth of the participant’s response. It is also worth mentioning that, once again, due to the qualitative nature of the research under discussion, the pilot study was not conducted, and also there were no variables used in the process.
Another aspect that should be elaborated on is the process of sampling. As the authors state, they used “a purposive sampling strategy to include patients within a range of ages and health statuses” (Jones et al., 2015, p. 176). The rationale for such sampling strategy could be explained by the authors’ intention to include in their study patients with such characteristics as age and severity of the illness that are common for the current clinical practice. In general, it is possible to observe that the authors chose the most suitable sampling method for implementing the study’s objectives.
Data analysis and Presentation
The process of data analysis was conducted in accordance with the qualitative methodology. As it is stated by the authors, they employed “a team-based, inductive approach to synthesize and contextualize the interview data” about the patients’ perceptions of their future (Jones et al., 2015, p. 177). Members of the research team individually reviewed and analyzed data from interviews and then they developed analytic memos and notes that derived from team discussions (Jones et al., 2015). The findings that were retrieved from the analysis support the initial hypothesis and purpose of the research to a significant extent. Also, the authors observed the weaknesses and limitations of their study. The primary limitation of the research is a relatively small sample size that does not necessarily reflect the clinical situation in the country at large, and it could be improved by including a more diverse population into the sample.
Conclusions and Implications
Finally, it is appropriate to discuss the study’s conclusions and implications. It could be stated with certainty that the article’s conclusions based on the findings of the analysis are fully compatible with the original purpose of the research. It is found by Jones et al. (2015) that patients use transition as the primary means of talking about their future. In accordance with transition theory, a four-stage framework of transitioning from shock and denial to acceptance was developed. The authors mention the implication of their research as well, stating that transitions could be efficiently used in advance care planning by clinicians. Overall, the implementation of the transition approach could facilitate the patients’ perception of delivered care, its purpose along the desired amount of control over the situation. Further research on the effects of the transition approach in the context of a more diverse population could be conducted.
Therefore, it could be stated that the results of the study will primarily affect patients with heart failure condition, who are going through clinical treatment of informal care provided by their relatives or significant ones. Additionally, the findings of the study affect clinical practitioners and informal caregivers since the authors provide them with a significantly helpful guide of transition stages through which heart failure patients are going. The authors recommend that decision-making about care planning should be shared by patients and their caregivers.
Finally, it is appropriate to provide an overall evaluation of the paper. In my opinion, the article is significantly helpful because it provides important insights into how people cope with such conditions as heart failure. The article is written in an academic manner, yet it is not difficult to understand the authors’ logic and the article’s primary conclusions. It is possible to conclude that the article is profound and critical enough to use it as a guide in the advance care planning process as well as in informal care provision.
Reference
Jones, J., Nowels, C. T., Sudore, R., Ahluwalia, S., & Bekelman, D. B. (2015). The future as a series of transitions: Qualitative study of heart failure patients and their informal caregivers. Journal of General Internal Medicine, 30(2), 176-182.