Patient-Centered Research: Mixed Methods Studies, and Fair Study Design

One of the world’s first methodical clinical trials was conducted aboard a ship, by a Scottish Surgeon, known as Dr James Lind1. During this time, sailors faced a perilous journey across the seas - beleaguered with many obstacles. One of the most pressing challenges of the day, Scurvy, continued to threaten the lives of sailors. On the HMS Salisbury, Dr Lind designed a study to compare six of the treatment options available for Scurvy. To create a fair test, he controlled for variables such as diet, stage of the disease, and the environment. Today, over two hundred years later, we appreciate the value of critically appraising study designs for fairness and accuracy, in answering pressing health questions.

However, for some, years later we may still wonder about the experiences and implications of the perspectives of the sailors studied. Did they prefer the oranges or lemons as treatment options? What were their concerns regarding the scurvy treatments studied? Would they be more likely to take certain dosing regimens, as say juice or solids, in their state of illness?

Saving lives is arguably the most important doctrine of healthcare. Yet, if we are to advance medicine as an ethical and social science - which evaluates research within a patient-centered context – the field may benefit from creating greater capacity for substantive mixed methods clinical trials2. Designs which, at their core, integrate participant voices and experiences.

Mixed methods research has in the past bridged the gap between ‘paradigm wars’, offering greater validity in certain research agendas, and more robust answering of complex research questions2,3. If healthcare research is to evolve from its past paternalistic model of medicine, to one that espouses the principles of patient-centeredness - it is the pragmatic and merged-perspectives that could offer the answer to creating stronger translational studies. Studies that are evidently better suited to the needs and concerns of patients, and the communities studied.4 Especially if these needs are inclusively, fairly assessed from the ground up - and not exclusively from the seat of the researcher.

 

Dr. Nabeela Kajee is a medical doctor, Rhodes Scholar, and reading for a DPhil Psychiatry at the University of Oxford. Her doctoral research at the Department of Psychiatry, Oxford Mindfulness Centre (OMC), is investigating the use of Mindfulness-Based Cognitive Therapy (MBCT) as a toolkit for wellbeing in undergraduate medical education.

 

References

[1] Lind J. A treatise of the scurvy. Three Parts. Containing an Inquiry into the Nature, Causes and Cure, of that Disease. Together with a Critical and Chronological View of what has been Published on the Subject. 1753.

[2] Creswell JW. A concise introduction to mixed methods research. SAGE publications; 2014 Mar 31.

[3] Johnson RB, Onwuegbuzie AJ. Mixed methods research: A research paradigm whose time has come. Educational researcher. 2004 Oct;33(7):14-26.

[4] Askham J, Chisholm A. Patient-Centred Medical Professionalism: Towards an agenda for research and action.