Use of serial qualitative interviews to understand patients' evolving experiences and needs | The BMJ http://www.bmj.com/content/339/bmj.b3702.full.print 1/8This site uses cookies. More info Close By continuing to browse the site you are agreeing to our use of cookies. Interviewing patients over the course of their illness can give a much better picture of their experience than single interviews, but the approach is rarely used. Scott Murray and colleagues explain how to get the most from itLongitudinal qualitative research offers considerable advantages over the more typical single "snapshot" techniques in understanding patients' changing experience of illness. Serial qualitative interviews are a convenient and efficient approach to developing an ongoing relationship between the participant and researcher, thereby facilitating discussion of sensitive and personal issues while also allowing exploration of changing needs and experiences.Serial interview studies are widely used by social science researchers in anthropology, criminology, education, psychology, and social policy.1 2 3 4 5 6 However, they remain underused in medicine.7 Using our experience with the technique, we suggest when researchers might wish to use serial interviews and discuss the methods, the data generated, and how to avoid potential pitfalls. When to use serial interviewsSerial interviews are suitable for research that aims to explore evolving and complex processes or when time is needed to develop a relationship between researcher and participants. We have used the approach to study the changing experiences and needs of people with lung and brain cancers, heart failure, severe chronic obstructive pulmonary disease, and spiritual distress, and access to care for south Asian patients at end of life (table⇓).8 9 10 11Others have shown the value of this approach in, for example, understanding childhood asthma, exploring stigma related to HIV infection, reconstruction of self identity after diagnosis of chronic fatigue syndrome, complex clinician-1

Use of multiperspective qualitative interviews to understand patients' and carers' beliefs, experiences, and needs | The BMJ http://www.bmj.com/content/339/bmj.b4122.full.print 1/7This site uses cookies. More info Close By continuing to browse the site you are agreeing to our use of cookies.

Person-centered goal setting within stroke rehabilitation is both possible and rewarding but often does not occur. Goal setting contributes to the post-stroke rehabilitation experience and can be positively or negatively influenced by practitioners. Maintaining hope and a sense of forward momentum in recovery after stroke is perceived by stroke survivors as important and could be supported using goal setting that is tailored to the individual's needs and preferences. Future research should focus on refining individualized methods of goal setting in stroke rehabilitation and the role of the practitioner in this, including what skills are needed and how they can be acquired. The identified gaps in the literature about family members' and unpaid carers' experiences, and the role of goal setting in self-management, warrant further research.

These contrasting illness narratives affect and shape the experiences, thoughts, and fears of patients and their carers in the last months of life. Palliative care offered by generalists or specialists should be provided more flexibly and equitably, responding to the varied concerns and needs of people with different advanced conditions.

BackgroundThe experiences of people with cancer and organ disease have been described across different dimensions of need as they approach death. Such information is lacking for frail older people approaching death, but could highlight how a palliative approach might be relevant for this population.MethodsCognitively intact, community dwelling adults considered to be moderately or severely frail were recruited from a medical day hospital. Those recruited nominated an informal carer and case-linked professional. Qualitative in-depth serial interviews with older people and their informal carers were conducted over an 18 month period, and single interviews with case-linked healthcare professionals. Interviews were recorded, transcribed and narrative analytical techniques were used to compile case studies.ResultsThirty-four participants (13 patients, 13 informal carers and 8 healthcare professionals) completed 40 individual, 14 joint and 8 professional interviews. Five patients died during the study. The analysis highlighted a dynamic balance between losses and adaptations. Three typical patterns of multi-dimensional change emerged. 1) Maintenance of psychological and existential well-being with a gradual social decline mirroring the physical deterioration. 2) a gradual reduction in both psychological and existential well-being. 3) a marked downturn in social, psychological and existential well-being before death. Frail older people sustained their well-being through maintaining a sense-of-self, garnering support from carers and community structures, and focusing on living from day to day. Their well-being lessened when they lost their sense-of-self, feeling alienated from the world, and confused over the cause of their circumstances. Death remained distant and ‘undiagnosed’. Social and community frameworks were essential for supporting their well-being.ConclusionsMultidimensional end-of-life trajectories for frail older people differed from those with other conditions. Alleviating psychological, social and existential distress should be a priority of care as frail older people reach the end of life. The current palliative care model is problematic for this group. Care should address future concerns and not necessarily involve a focus on death or place of death.

Physiotherapists perceived that collaborating with patients in goal setting was important but challenging. Goal setting interactions with other professionals, patients and families were perceived as complex, difficult and requiring significant effort. The importance of individuality and temporality were recognized suggesting that the goal setting approach needs to be adapted to the context and the individuals involved.

BackgroundVirtual reality (VR) technology as a therapeutic intervention has been gaining attention in healthcare settings in recent years. Studies suggest that using the technology can help alleviate symptoms such as pain and anxiety and induce positive emotions for people in hospital. Managing symptoms and promoting emotional and psychological well-being are core palliative care goals of relieving suffering of people with life-limiting illness. Accordingly, VR may be highly beneficial for use in hospice care yet remains underdeveloped in such settings. This qualitative study aimed to trial the technology and consider what benefits may emerge for hospice in patients.MethodsA one-off VR session was offered to patients at a hospice in Scotland. Sessions were observed by a researcher and followed by qualitative semi-structured interviews to discuss the experience with those who took part. Interviews were audio recorded, transcribed and thematically analysed.ResultsNineteen hospice patients successfully tried an immersive VR experience. VR sessions were acceptable for people within the hospice environment. The majority of participants enjoyed the experience. Many expressed joy and delight at the process. VR holds possibilities for relieving symptoms such as pain and anxiety frequently experienced by people in hospices. Furthermore, the technology offers the capacity to reconnect with a previous sense of self and to allow respite through the capacity to transcend current reality and connect with another meaningful reality. This exploratory study offers a starting point for larger studies to investigate the utility of VR for hospice patients.

People are living longer, but with increased age comes greater frailty and multi-morbidity. This secondary data analysis examines transcripts from interviews with 11 frail older people and 6 informal carers to explore emotion in relation to frailty and deteriorating health. Anger and frustration were frequently experienced with declining functional ability; sadness occurred with social isolation, loss of autonomy and independence; anxiety was evident when transition to a care home was discussed; and contentment was described when connecting with others. Reluctant acceptance emerged as a coping strategy. Insights gained from analysing emotion may inform communications training courses for community nurses, though further research is required.