Details of interviews

5.5.2.1 Number and timing of interviews

Having decided on an unstructured interview approach for the study, I then had to consider the number and timing of the interviews that I

110 proposed to conduct. When addressing these issues I had to take into consideration not only the study aims and research questions that I had to answer, but also the patient sample that I intended to recruit. I had decided to conduct the study in patients with advanced lung cancer. Taking into consideration that the majority of patients with lung cancer present with advanced disease (Corner et al. 2005), and from previous clinical experience working with this patient group, I knew that many of the participants recruited to the study would be frail, experiencing a high symptom burden and nearing the end of life. Therefore, I felt that asking them to participate in one in-depth interview that could potentially last for two hours may be too onerous for them and therefore ran the risk of the interview being terminated early. I therefore decided that in order for me answer my research questions and gain an in-depth exploration of the participants‟

experiences, whilst at the same time addressing issues such as participant burden, that I would conduct two interviews with the participants, 3-5 weeks apart. As stated by Flowers (2008:25), the use of multiple interviews „may relate to “pragmatic” concerns. These may include, for example, participant characteristics such as their availability, health (e.g. people with respiratory conditions), or

“attentional capacity” (e.g. children)‟. This approach to interviewing has also been advocated for use in patients with progressive diseases and, as stated by Murray and Sheik ( 2006):

111 A single interview or focus group, especially with ill people, might be inadequate to fully explore issues, especially if addressing a sensitive or complex area. Returning for further rounds of data collections, not only allows participants to disclose information at their own pace, but also permits trust, empathy and a deeper understanding to emerge (Murray and Sheikh 2006:901).

Furthermore, this approach to interviewing had previously been used in studies utilising IPA (Flowers 2008; Dickson et al. 2008; Smith 1999).

The timing between interviews was selected to facilitate an iterative approach between the first and second interview (detailed in the following section) without unduly burdening the patient and in light of the high levels of attrition commonly reported in this patient group (Sherman et al. 2005; Murray et al. 2004).

5.5.2.2 Setting of interviews

The setting for the interviews was determined jointly by myself and the participants. I provided them with the option of being interviewed at home or in a quiet room in the hospital.

112 5.5.2.3 Interview schedule

As stated above, unstructured interviews were selected as the method of data collection for this study. In this type of interview, the researcher traditionally starts with a single core question which then directs the rest of the interview (Smith et al. 2009a). According to Smith et al. (2009a), IPA studies „attempt at the research question

“sideways”‟. This occurs because most research questions are situated at an abstract level, which are not suitable to be posed directly to the patient. Instead, interview questions are developed to facilitate the discussion of relevant topics which will allow the research question to be answered.

I therefore decided to start the first interview with each of the participants by asking „What does cancer mean to you?‟ This question was selected in light of the core role that meaning plays in the illness experience (Thorne 1999; Johnson Taylor 1995; O'Connor et al. 1990; Kleinman 1988a; Good and Good 1980; Mishler 1979;

Frankl 1959), with particular relevance to the symptom experience (Krishnasamy 2000; Ferrell and Dean 1995; Kleinman 1988a; Good and Good 1980). It was anticipated that asking this question would facilitate the open the discussion of relevant topics with an appreciation of the participants‟ priorities, to allow the aims and objectives of the study to be met.

113 The participants‟ response to this initial question posed in the first interview was viewed as reflecting an overall summary of what they wished to talk about and was used to set a participant-led agenda. I therefore returned to each issue in turn, probing downwards from the general to the specific. The interview was facilitated by me reflecting and probing, asking questions such as „Can you tell me more about that?‟, „What were you thinking at the time?‟, and „How did you feel about that?‟. My main role in the interview process was to stimulate discussion and allow the participant to talk freely and comfortably about their experiences.

Taking into consideration the iterative approach adopted by the study, the aim of the second interview was to explore in more detail some of the issues that were not probed in the first interview, in order to clarify details and to ask new questions based on close reading of the first interview transcript. I therefore started the second interview by asking „Is there anything from our last interview that you would like to talk about?‟ Once again I used the same probing techniques. I used verbatim quotes from the first interview when asking participants to elaborate on a topic previously discussed.

Using this format, the aims of the second interview did appear to be met allowing more in-depth exploration of points that had been

114 previously raised and the uncovering of „new‟ issues which were not discussed in the first interview.

All interviews were recorded following consent being provided by the participants at the start of each interview. Following each interview, field notes and reflexive accounts were maintained to assist in any subsequent interviews and data analysis. The interviews were transcribed verbatim by one of the members of the study support team. I checked each transcript with the digital recordings to ensure that all the information had been recorded correctly and made some minor modifications to them where required. I securely stored all recordings and transcripts in a locked filing cabinet.