Critique Of A Research Article


Every patient deserves a good and effective health and healthcare. But, how do physicians, patients, and their families know whether a health intervention is truly good and effective? From time immemorial, practitioners in the healthcare sector around the world have depended on research studies to ascertain the effectiveness of the interventions they intend to apply to a patient before even making use of them. In doing so, according to Balzer et al (2016), they depend on various tools; one of them being the critical appraisal skills program (CASP) to enables them to conduct a systematic evaluation of the relevance, and trustworthiness of a research paper on the intervention they intend to apply. As Burns & Grove (1997) and Douglas et al (2014) explain, this reference is especially necessary and vital because whereas many interventions are designed with good intentions, some of them turn out to be ineffective, may harm the patient or turn out to be a waste of resources.

The main aim of this paper is to conduct an analysis of a research paper using the CASP framework (Appendix 1). The paper will evaluate the study by Lamahewa et al (2017) on decision-making difficulties at the end of life of people with dementia, based on the philosophy that an effective intervention must be implemented through knowledge sharing and application of clinical procedures in a multi-disciplinary and non-hierarchical manner. In doing so, there will be a stepwise analysis of various sections of the selected research paper with the first section discussing the application of research on professional practice if healthcare. Thereafter, there will be a detailed analysis of the six section of the paper before ultimately making comments on the implications of the study to professional practice.


The Concept of Evidence-Based Practice

Dr. David Sackett, quoted by Balzer et al (2016) defines evidence-based practice (EBP) “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Hence, from the stated definition, EBP involves an integration of the physician’s clinical knowledge, skills and expertise with evidence from research studies to help make clinical decisions during patient care. However, as argued by Ilianna et al (2017), EBP also entails giving a consideration to the patient’s preferences, expectations, values, and concerns which much be integrated with the physician’s skills, experience and education during the decision-making process. Therefore, evidence-based practice is a composite of three major elements namely: the clinical expertise of the physician, the patient’s preferences and values, and relevant research evidence acquired through sound and effective research methodology (Elo & Kyngas, 2008; Tanner, 2003).

Against this background, this paper’s main concern is to evaluate how sound the evidence by Lamahewa et al (2017) is. The study’s soundness will be identified by evaluating different elements of the research methodology including the study design, data collection methods, ethical considerations, data analysis, results presentation, and the selection of study subjects/samples. Ideally, this process should yield a detailed account of the appropriateness of the study for application and whether the study makes any practical sense.

Critique of the Study:

According to CASP (2018), the first step of critiquing the study is to evaluate whether the results are valid. Herein, this will be achieved by comparing the study’s aims, objectives and research questions with to its ultimate results.

The Research Objective/Aim/Question

Lamehewa et al (2017) clearly state that their study’s main aim was to identify various difficulties experienced by family carers and practitioners during the end of life stage of patients with dementia. Their study is informed by the fact dementia being a progressive condition, the patient’s cognitive and functional abilities are ever on a decline and therefore the practitioners and the patient’s family members play a role in making major decisions especially when the patient is facing an end-of-life situation. Similar remarks are made by McCarthy et al (1997) that dementia patients, just like other patients with a terminal illness such as cancer, find it difficult to make important decisions and therefore their family members, as well as practitioners, must step up to make these decisions. Yet, in the UK, health policies and regulations such as the Mental Capacity Act 2005 require that these decisions must be made in the best interest of the patients with careful considerations to their personal rights (Department of Health, 2005).

Therefore, more often than not, the practitioners, as well as the patient’s family members, find themselves in a tough situation while trying to make these decisions. Based on this background, the study by Lamehewa et al (2017) is therefore relevant and helpful to practitioners and families who find themselves in similar situations. Even if family members are not able to access this article, the clearly stated aim and the evidence-supported findings of this study can be used by clinicians for reference during practice. Noteworthy, Lamehewa et al (2017) considers various studies to inform their literature review in an attempt to provide a background on their study and inform the reader why their study is justified. For instance, they make a reference to Department of Health (2012) McCarthy et al (1997) (both of which are qualitative and quantitative studies respectively) to highlight on situations surrounding the end of life decision making and the timelines defining the end of life. Hence, based on the background and the evidence they provide, Lamehewa et al (2017) were justified to conduct their study.

Study Design and Methodology

According to Robinson (2002) and Bentz & Shapiro (1998), Research design and methodology identifies the procedures followed by the researcher in achieving their research aim. The qualitative study by Lamehewa et al (2017) applied both semi-structured interviews and focus groups to collect data which were then analysed through thematic analysis. As opposed to quantitative methodology that is most appropriate when probability or general information on the preferences and attitudes of research subjects is sought, qualitative research methodology is used in situations when a researcher wants to identify the experience, perspectives, and opinions from the participant’s standpoint about a particular phenomenon under investigation (Lacey et al, 2016). Indeed, the use of qualitative research methodology by Lamehewa et al (2017) is justified because the study’s main aim was to seek the experiences, perspectives, and opinions of family carers and practitioners on the difficulties they encounter when making decisions about dementia patients at their end of life stages of the condition.

However, there are several disadvantages that characterize qualitative study methodology which could have affected the results obtained by Lamehewa et al (2017). For instance, the inability of Lamehewa et al (2017) to verify the objectivity of the data collected through interviews could have affected the accuracy of the results (Barbour 2000). Another set of disadvantages related to qualitative research that Lamehewa et al (2017) might have experienced is the labour-intensive and time-consuming nature of qualitative studies (Bowen, 2006; Wood et al 2006). Equally, the qualitative study by Lamehewa et al (2017) involved participants from a small section of London, Essex and greater Essex, and therefore the results obtained may not be generalized to apply to entire England. This implies that the decision-making difficulties experienced by practitioners and family of dementia patients at their end of life stage may not be the same difficulties experienced by their counterparts in other parts of the United Kingdom such as Scotland and Wales.


Sampling refers to a purposeful selection of a representative population to participate in the study (Polit & Beck 2006). This selection process should be detailed and highlighted by the researcher in the study to inform the readers of the nature of the source of data collected. Taking a keen look at the study by Lamehewa et al (2017), it is noted that the study included one focus group of 4 former carers besides a semi-structured interview that involved family members who were not comfortable with participating in focus groups. Moreover, the study involved four focus groups with 4, 5, 3, and 7 individuals who had an experience in caring for end of life dementia patients. The four focus groups were purposefully sampled and this bears several advantages and disadvantages to the study. For instance, according to Valente (2003), this type of sampling enables the researcher to have a quicker reach of the targeted sample because it provides options for the kind of participants that needs to be reached based on the objective of the study.

However, purposive sampling brings the problem of proportionality of the data because its main aim is to acquire as much data as possible from the participants deemed to be the best source of the required information – within the shortest time possible. This implies that in the study by Lamehewa et al (2017), the use of purposive sampling to select the 4 focus groups led to imbalanced proportions of data. For example one group contained 7 individuals while the other only had three individuals. Equally, whereas the data in the opinions of Lamehewa et al (2017) seemed valid, the use of purposive sampling meant that they might have consciously or unconsciously been biased while collecting the data, thereby affecting the validity of the results. According to Younus (2014), this is because purposive sampling largely depends on the researcher. However, it is important to appreciate the fact that Lamehewa et al (2017) notes and describes their selected sampling process in their study.

Data Collection Methods

Letts et al (2007) argue that a good qualitative research should give the reader a sense of personal experience in the data being collected. Applying this argument to the case of Lamehewa et al (2017), the data collected should be a depiction of the participant’s opinions, perspectives, and experiences in regards of practitioners and decision-making difficulties they experience when handling dementia patients at their end of life condition. Perhaps, this explains why Lamehewa et al (2017) give a clear detail of their study’s participants by mentioning their backgrounds (current carers, former carers, and those with experience in end of life care for dementia patients). To evaluate this phenomenon further, it emerges that the use of participants with different backgrounds played a major role in giving valid and comparable data to Lamehewa et al (2017) upon which they made their conclusions.

Ideally, selecting current carers could have been useful in getting current and up-to-date data on the decision-making problems experienced in caring for dementia patients in end of life stage, while data collected from experienced practitioners was important in making a solid conclusion based on long years of caring for dementia patients. Moreover, information from experienced practitioners can be considered to be more credible thereby contributing to the overall credibility of the results.

Lamehewa et al (2017) write that their interviews were undertaken by a qualified and experienced researcher. This highlights the credibility level of their data collection process because as argued by Letts et al (2007), communicating the researcher’s previous experience and credentials in qualitative research and interviews as a data collection technique gives the reader some confidence in the results of the study.

Results and Data Analysis

Data analysis explains how the researcher obtained results from the data; and the quality of data analysis determines how credible the results are (Denzin & Lincoln, 2005). Lamehewa et al (2017) used the inductive approach to thematically analyse data collected from focus groups and individual interviews. According to Creswell (2006), the inductive approach is mostly used in qualitative research and involves the derivation of information and knowledge from data to form general conclusions and theories about the topic under investigation. It is opposed to the deductive approach which is mostly used in quantitative research and involves the use of general information to determine a specific outcome or test a particular hypothesis. The use of inductive approach in the study by Lamehewa et al (2017) is appropriate because, in its qualitative nature, it enables the understanding of the difficulties experienced by the practitioners and family carers when caring for dementia patients in the final stage of their condition. Ideally, the depending on the purpose of the study, using the inductive approach is appropriate due to its less-structured nature, enabling Lamehewa et al (2017) to the true difficulties faced by practitioners and family carers.

In summary, the results of this study reveal four major themes worth mentioning at this juncture. The first theme is that the decision-makers often encounter uncertainty over the needs of the patients, and internal and external conflicts when making decisions. They also encounter difficulties when comprehensive care, especially under dynamic systems conditions. Lastly, Lamehewa et al (2017) found that the decision-makers besides being unprepared for end of life of the patient, they also face communication challenges. These findings are reflective and consistent with the qualitative data as evidenced by the comments of different participants in the interviews. For instance, in regards to delivering comprehensive care under dynamic systems, a participant noted that it is difficult to make decisions at the best interest of the patient because for example in the case of quality of life, one needs to know what ‘quality of life’ the patient used to have earlier in order to determine their loss of quality of life due to dementia. Equally, in the case of internal and external conflict over the decisions, a respondent remarked that different decision-makers may have different views about the best medication and in making such a decision they may encounter conflict. Therefore, Lamehewa et al (2017) present findings that are consistent with the data they collected from interviews and focus groups.

Ethical Considerations

Lamehewa et al (2017) clearly describe the ethical considerations that they made during the study. Specifically, they mention that their ethics approval was obtained from the relevant committee besides providing the reference number of the ethics approval document. According to Simon (2011), obtaining ethical approval from relevant bodies contribute to the credibility of the study and makes it easier for the researcher to collect data from respondents who might require such approvals before participating. Lamehewa et al (2017) also indicate that they obtained informed consent from the participants before engaging in the research. This speaks the fact that the participants engaged in the study after having known the scope and other details that enabled them to make an informed decision to participate in the study. Another important ethical consideration made by Lamehewa et al (2017) was that the interview sessions took reasonable time durations (60 to 80 minutes) and therefore not much of the respondent’s time was consumed.

Conclusions and Implications

The findings of Lamehewa et al (2017) have several implications to the practice of care for dementia patients especially those who are at their end of life stage. It highlights the need for practitioners to give attention to other physical impacts of dementia apart from cognitive deterioration while making important decisions about care (NHS Dementia Guide, 2018). There is also a need for practitioners to be in constant consultation and engagement with the family carers of such patients especially if they wish to, in order to eliminate external conflict that may arise during intervention implementation (May et al, 2009). From these findings, I understand the idea that decision-making in the context of a dementia patient at their end of life stage is a collective activity which requires keen consideration and balancing of the needs, views, and opinions of all the involved decision makers.

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