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A Qualitative Study on Refractory Dyspnea

Updated on February 10, 2017

Introduction

Research into the treatment of refractory dyspnea is designed to improve quality of life. As such, research in this field is highly qualitative and relies on patient reports to determine effective intervention. For the purposes of scientific study, researchers will often use semi-quantitative methods to manage the qualitative data and attempt to draw correlations. Such methods can be asking patients to rate their level of discomfort or comparing what the patients report to visible signs of symptoms. The article by Currow et al. (2011) follows this method of data management for the qualitative research done in examining the benefits of opioids to patients with refractory dyspnea. This article shows sound scientific reasoning and use of qualitative methods that does not corrupt the quantitative data present or violate any rules about the treatment of such data.

Problem Statement

It is known that morphine is an effective treatment for refractory dyspnea. Morphine has certain drawbacks to its use due to its addictive nature and the harmfulness of the medication. Therefore, it is important to know the minimum dose of morphine that is still effective at reducing the symptoms of refractory dyspnea. Morphine is often given for dyspnea as a form of palliative care, however, if the medication causes harm to the patient, this can be seen as a violation of the hippocratic oath. Furthermore, not all patients on morphine for dyspnea are near death. Many patients still have a quality of life and are capable of functioning to some extent in society. The effects of morphine can make these patients less functional than they otherwise would be.

Currow et al. (2011) state clearly that refractory dyspnea is a distressing symptom and describe it as something that “threatens a person’s very existence.” This strong wording serves to show the audience of the research article why they should care about this issue and why it is worth studying. The field of palliative care is shown in this article to be one which addresses human suffering in an attempt to improve quality of life.

Purpose and Research Questions

The primary research question being asked in this study is: What is the minimum effective dose of sustained release morphine to treat refractory dyspnea? A secondary consideration would be the question: Is this minimum dose safe? The research is focused on limiting the negative effects of morphine for patients receiving regular morphine treatment for dyspnea. The researchers acknowledge that the minimum effective dose might still be found to be clinically unsafe for patients.

These questions of dosage and safety are clearly related to the problem this study addresses. This study’s purpose is clearly laid out by the authors as reducing risks to patients taking morphine by identifying the lowest dose necessary. Qualitative research methods play a large part in this study. Though the researchers employ quantitative means such as measuring dosages, the heart of the study involves getting feedback from patients about the effects of their condition and whether or not the dyspnea has improved. Without knowing the participants’ subjective responses, the researchers cannot know if a dosage is effective.

Literature Review

The authors cited a number of both qualitative and quantitative research as references to support their claims. Much of what is cited is not similar studies to their own work, but rather act as a groundwork from which they have based their research. These other articles serve to frame the work of Currow et al. (2011) in a larger scope. In addition to research pieces, the authors also cited published articles on the anatomy and physiology of the pulmonary system to provide backing for how morphine is able to have a positive effect on refractory dyspnea.

Most of the quantitative studies are current for the time this research was done. One piece by Abernathy et al. (2003) is older than five years from the time of publication. This piece seems to be justified in its inclusion as Currow was a major contributor to it, and therefore can vouch for its relevance to the current study. It is likely that the current research is an extension of this earlier work, and therefore it is only logical to include a reference to it within this piece. The qualitative studies on average, are older than the quantitative ones, with one such study dating from 1964.

The authors did not go into detail analyzing the merits of the research cited. The presence of most of these articles seems to be to provide theoretical backing for their own research. Additionally, many of the articles provide facts or data that is relevant to the research study. Together, this information does lay the groundwork for a logical argument.

Theoretical Framework

The researchers do not clearly state a specific perspective from which they developed this study. It is clear in their objectives that they believe that morphine is beneficial but dangerous and should be used in the lowest dose possible to get results. The researchers maintain a neutral tone through most of the paper, only adding in colorful language to demonstrate the suffering of individuals experiencing refractory dyspnea. For this reason, they do seem to be in favor of using palliative measures. Nothing more conclusive can be said about their initial perspectives or biases.

Diagrams were used to demonstrate certain facets of the research, however, these diagrams do not seem to represent the grounded theory method of qualitative research. As such, they are not discussed here.

Conclusion

The research by Currow et al. (2011) is a prime example of a qualitative study that shows academic rigor and proper management of the data acquired. The study creates a foundation using relevant literature and justifies itself by the importance of the problem at hand. The research is laid out clearly to be examined and scrutinized by peers, with research objectives and methods following a logical course and having a clear connection to the problem which they address.

References

Currow, D. C., Mcdonald, C., Oaten, S., Kenny, B., Allcroft, P., Frith, P., . . . Abernethy, A. P (2011). Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study. Journal of Pain and Symptom Management, 42(3), 388-399.

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