Sheila Hawker

Appraising the Evidence: Reviewing Disparate Data Systematically

The authors describe a method of systematically reviewing research from different paradigms. They draw on the methods adapted, developed, and designed during a study concerned with the delivery of care across professional boundaries. Informed by the established method of systematic review, the authors undertook the review in distinct stages. They describe the methods developed for each stage and outline the difficulties encountered, the solutions devised, and the appraisal tools developed. Although many of the problems encountered were related to the critical assessment of qualitative research, the authors argue that the method of systematic review can be adapted for use with different data and across disciplines.

Family Diversity and Change in Britain and Western Europe

The authors examine recent changes in family relationships in Britain and other countries in Western Europe. To begin with, the authors focus on demographic change, in particular the increased diversity in peoples partnership behavior. In considering theoretical accounts that have been given for these changes, the authors explore the ways in which the character of partnership commitment is altering. Particular attention is paid to the growth of cohabitation and the effect this has on cultural understandings of marital commitment. The implications for wider kinship solidarities of changing practices around partnership commitment are discussed. A key theme within this concerns the diversity and complexity of the manner in which family and kinship are negotiated and constructed.

A systematic review of the use and validation of health-related quality of life instruments in older cancer patients

AIM The aim of this paper is to systematically review the use and validation of HRQOL instruments in older cancer patients. METHOD A systematic review of 5 databases and 3 research registers identified studies reporting the use and validation of HRQOL instruments in cancer patients aged over 65 years from 1995 to mid 2007. RESULTS Thirty-one studies reported the use of HRQOL measures in older people, using a range of generic and disease-specific instruments. Little work was reported in patients aged over 80 years. All studies exhibited methodological limitations. Fourteen studies were identified with variable evidence on the psychometric properties and clinical usefulness of identified instruments. CONCLUSION Our review identified that the development, validation and use of HRQOL instruments often ignore the specific needs of older people. This review highlights the need for a HRQOL instrument specifically designed to capture the issues and concerns most relevant to older cancer patients.

End of life care in community hospitals: the perceptions of bereaved family members

Objectives: The perceptions of bereaved family members were obtained to evaluate the nature and quality of end-of-life care in community hospitals. Design: During organizational case studies in six community hospitals in the South East and South West of England, bereaved family members were asked to participate in semi-structured interviews. Participants: Fifty-one interviews were conducted with family members of patients who had received end-of-life care in a community hospital within the previous year. Results: Respondents were very positive about the care they and the patient had received. They valued the convenience of access for frequent and long-stay visiting and the familiarity of the local hospital. Comparisons were made with more negative experiences at their nearest District General Hospital. Issues raised included the noise at the community hospitals, and the lack of contact with qualified nurses. Discussion: The results of this study have implications for UK government initiatives, such as the National Framework for Older People,1 and the Department of Healths ‘Keeping the NHS Local’2.

Paying clinicians to join clinical trials: a review of guidelines and interview study of trialists

BackgroundThe motivations of clinicians to participate in clinical trials have been little studied. This project explored the potential role of payment for participation in publicly funded clinical trials in the UK. The aims were to review relevant guidelines and to collate and analyse views of clinical trialists on the role of payments and other factors that motivated clinicians to join clinical trials.MethodsReview of guidelines governing payments to clinicians for recruitment to trials. Semi-structured interviews with a range of NHS clinical trial leaders, analysed using qualititative methods.ResultsWhile UK guidelines had little to say specifically on payments linked to recruitment, all payments have become highly regulated and increasingly transparent. Interview participants believed that expenses arising from research should be covered. Payments in excess of expenses were seen as likely to increase participation but with the risk of reducing quality. Motivations such as interest in the topic, the scope for patients to benefit and intellectual curiosity were considered more important. Barriers to involvement included bureaucracy and lack of time.DiscussionLimited scope exists for paying clinicians over-and-above the cost of their time to be involved in research. Most trialists favour full payment of all expenses related to research.ConclusionPayment of clinicians beyond expenses is perceived to be a less important motivating factor than researching important, salient questions, and facilitating research by reducing bureaucracy and delay.

Professional territories and the fragmented landscape of elderly care.

This paper examines the problems and dilem mas involved in delivering care to older people. In particular it seeks to identify the processes that facilitate or hinder communication and collaboration between those involved in care that has to be both reliable and expeditious to ensure that high quality care is provided. To do this the paper draws on a recent international systematic review of the relevant research lit erature which is briefly described. A geo graphical analogy is employed to help map dif ferent organisational and professional territo ries of care. It will be argued that these territo ries have their own priorities, patterns of working and perceptions of older people. The paper concludes by considering a potential way to merge territorial interests by reconfig uring the map of care around the older per son.

Conclusion: Change and Continuity

A key theme of recent family sociology, including this book, is that family life is diverse. Moreover this diversity is itself multifaceted. One consequence of this is that any discussion of ‘the family’ reifies the practices that different families generate at different times. In this regard, families are always changing, sometimes slowly, sometimes more radically. As the personal and life course positions of a family’s members — however defined — alter, so the patterning of the emergent interactions and the consequent relationships involved change. But equally, as Hareven’s (1982) conceptualisation of change highlights, change also occurs historically and not just at the individual or life course level. That is, as different social and economic conditions develop, across time the resultant practices that different families collectively construct generate a new sense of what is acceptable and normal within family life. In this regard, the greater tolerance of diversity now found in the construction of family life reflects a historic shift in understandings of the boundaries between private and public spheres.