Interviews

6.2.3.1 Timing of interviews

As described in chapter 5, interviews were conducted with the participants at two time points: on recruitment to the study, and three to five weeks later. This timing of interviews was selected in order to meet the aim of this study but without unduly burdening the patient. All participants were interviewed three weeks apart, with the exception of the first participant who died before the subsequent interview could be conducted.

137

Following the conducting of the interviews I then reflected on the process to determine whether any changes should be made to the ensuing main study. The timing of the interviews did appear to facilitate the iterative approach intended with all of the participants taking part in the second interview being able to clearly recall what they had discussed in the previous interview and being able to elaborate on any points that were raised. However, one issue that came to light in relation to the timing of the interviews was the time taken for the transcriptions to be typed with some being transcribed only a few days before the second interview. This left the researcher with little time to prepare for the second interview and identify areas from the first interview which warranted further exploration. However, as the timing of the interviews did facilitate and meet the study objectives, it was felt that this aspect of the interview process should remain unchanged and that added administrative support would be accessed where possible to facilitate the typing of the transcripts throughout the main study.

The issue of attrition was also highlighted in the pilot study with the first participant dying before the second interview could be conducted. This issue is not new to research in people with advanced cancer and has been widely reported in the literature (Harris et al. 2008). Changing the timing of the interviews to minimise levels of

138

attrition throughout the study was therefore declined as this is a recognised factor when conducting research in people with advanced cancer. Furthermore, in light of the study sample, it was thought that reducing the time period between interviews may have resulted in high levels of participant burden.

6.2.3.2 Setting of interviews

The setting for the interviews was jointly determined by the researcher and participants. The majority of participants were interviewed in their own homes, with the exception of one lady where her first interview was conducted within a quiet room in the hospital due to a previous in-patient admission.

The interview setting did appear to meet the study requirements by providing participants with a place where they felt free to express and share their experiences with the researcher. However, within the hospital environment there were numerous interruptions, with staff accessing the room for equipment, which did interrupt the flow of the interview on a few occasions. Therefore, following the pilot phase, this issue was discussed with the local collaborator, and it was agreed that for any subsequent interviews conducted in the hospital setting,

139

a room outside of the ward setting would be selected, if appropriate, to minimise the chance of any disruption.

6.2.3.3 Interview schedule

As discussed in chapter 5, unstructured interviews were selected as the method of data collection employed in the pilot study. This therefore determined the type and number of questions asked in the interview. The opening question in the first interview was „What does cancer mean to you?‟ This question was well received by the participants; they appeared to understand what I was asking them and they could easily reply. In each case, this question evoked a number of replies which were then noted and use to set the participant-led agenda. The second interview started with the question „Is there anything from our last interview that you would like to talk about?‟ Using this question, the aims of the second interview did appear to be met allowing more in-depth exploration of points that had been previously raised and the uncovering of „new‟ issues which were not discussed in the first interview.

6.2.3.4 Interview technique

My interview technique was reviewed by my supervisory team once I had conducted the first two interviews. This entailed them reading

140

the transcripts and making a number of suggestions on how the interviews could be improved. Suggestions included:

The use of more probing questions to encourage discussion and gain greater depth and understanding of the participants‟ experiences (Why? How? Can you tell me more about that? Tell me what you were thinking? How did you feel?)

Reflecting, summarising and stating that I would like to go back and talk about issues raised in turn

Using and feeling comfortable with silences Not being afraid to „unpack the obvious‟

These techniques were used in subsequent interviews in the pilot study and assisted in the in-depth exploration of pertinent issues related to the topic under investigation. By using such probes, participants engaged in conversation about the meaning of their experiences and how they made sense of what was happening to them, fitting within the realms of the selected methodology and the aim of the study.

6.2.3.5 Confirming the perspectives of the patient

When planning my study, I wanted my interpretations of what had been said in the interviews to be confirmed by the participants as I

141

felt that this would act as measures of rigour (Yardley 2000) in the study. Therefore, in the pilot phase I provided the participants with an overview of what had been said in the previous interviews. Whilst the two participants who were interviewed twice did agree with the summaries I offered to them regarding what they had said, one of the interviewees did comment that she felt embarrassed when being informed about what she had talked about previously and felt that she was „moaning about their illness‟.

Forbat and Henderson (2005) have reported similar accounts in their paper on the „theoretical and practical reflections on sharing transcripts with participants. They report that „one sees not only empowerment and ownership but also surprise and embarrassment‟ and they call for a „more considered and reflexive approach to understanding the process of sharing transcripts with participants‟. However, they also state that this process may also be „extremely fruitful in achieving the desired research objectives, such as engaging participants to reflect further on their first interview and to check details or add to their initial conversation‟ (Forbat and Henderson 2005). On reflection, as the aim of the second interview was to explore in more detail some of the issues that were not probed in the first interview, to clarify details and to ask new questions based on close reading of the first interview transcript, I felt that this already

142

acted as a measure of the participants‟ agreements with what had been said previously. Providing participants with an additional summary of the previous interview was not thought to offer any additional benefit and had the potential to unduly embarrass or upset the participants. It was therefore decided that this process would be omitted in the main study.

6.2.3.6 My reflexive thoughts on the interviews

As stated in chapter 5, a reflexive journal was maintained by myself throughout the entire study. This included details on the daily schedule of the study, personal reflections, and a log for methodological decisions and accompanying rationales as advocated by Lincoln and Guba (1985). Throughout the pilot phase, the maintenance of a reflexive journal allowed me to explore my role in the research process. I found myself having to deal with the duality of the nurse researcher role; I identified myself with the work of Borbasi (2005), who reported that as a nurse she did not want to burden sick people with lots of questions but as a researcher wanted to extract as much information as possible (Borbasi 1996; Borbasi 1994). Furthermore, she noted that a number of patients wept during their conversations and she felt responsible for their anguish. Such feelings have also been reported by other nurse researchers conducting qualitative studies (Pellat 2003). With particular

143

reference to interviews in the pilot study, I did feel that these issues did prevent me from probing and further exploring pertinent issues raised. Through personal supervision and liaising with study supervisors/senior colleagues, these issues were discussed and a formal debriefing mechanism with senior colleagues was incorporated into the main study after each interview. I also ensured that the timings of the interviews were spaced out in the main study in order for me to have enough time to reflect on the previous interview.

Relative to the methods adopted in the study the reflexive journal allowed me to reflect on the unstructured approach which I had selected, the timing of the interviews and the questions that I had developed in order for me to address the aims of the study and the research questions posed. On reflection, no significant changes were made as I felt that the approach used facilitated the inductive bottom-up generation of data which I hoped to achieve. I felt that this approach provided the participants with the space and opportunity to talk about issues which were important to them in their lives, before talking in more depth about their experiences of symptom clusters. I felt that this approach allowed me to understand the context of the experiences of symptom clusters within the participants‟ lives, which, as a contextual constructionist (see

144

Chapter 4), I felt was crucial to me understanding the experience of symptom clusters in patients with advanced lung cancer.