Recent publications
Meadows K. (2021). Interpreting Patient-Reported Outcome Measures: Narrative and the Fusion of Horizons; Philosophy of Medicine, 2(2). 1-14 Abstract: Patient-reported outcome measures (PROMs) are valued in healthcare evaluation for bringing patient perspectives forward, and enabling patient-centered care. The range of evidence permitted by PROMs to measure patients’ quality of life narrowly denies subjective experience. This neglect is rooted in the epistemic assumptions that ground PROMs, and the tension between the standardization (the task of measurement) and the individual and unique circumstances of patients. To counter the resulting methodological shortcomings, this article proposes a hermeutical approach and interpretive phenomenology instead of generic qualitative research methods. Read more Meadows K.A. (2021). A philosophical perspective on the development and application of patient-reported outcomes measures (PROMs). Qual Life Res. (6):1703-1709 Abstract: Questionnaires are a common method in healthcare and clinical research to collect self-reported data on patients' behaviour and outcomes rather than the clinician's perspective. As a consequence there is a plethora of questionnaires and rating forms developed to measure a range of concepts such as health-related quality of life and health status. Given that these measures have been developed within a nomothetic paradigm to enhance our understanding of peoples self-perceived health status by translating complex personal feelings and experiences into a simple numeric score, the patient's illness narrative is lost along the way. This commentary discusses the limitations of the nomothetic approach as completion of a questionnaire is a social and contextually orientated activity and that their development is best viewed within the philosophical tradition of pragmatism, based on sound qualitative methods and rigorous psychometric testing. The commentary discusses the philosophical orientation underpinning PROM development and argues the case for a pragmatic epistemology based on a mixed methods research paradigm which goes beyond the current practice of informing the content validity of a PROM in the early phase of its development but to work towards developing a more composite and holistic picture through mixed methods in the interpretation of a patient's PROM score. Therefore, it is argued that the quality of data obtained will be enhanced but, also importantly and rightly places the participant at the centre of the research. Read more Meadows K.A .Phenomenology: A Method for the Interpretation of Patient-Reported Outcomes. Clinical Nursing Research. 2024;0(0). Abstract: Patient-reported outcome measures (PROMs) play a central role in clinical research and patient care resulting in a plethora of standardized PROMs to measure a range of constructs, including disease symptoms, health-related quality of life, and health status (Meadows/Reaney) used in a range of settings, including the nursing environment. However, the use of PROMs in drug development and their use in healthcare evaluation do not easily marry together. In drug development, standardization of measurement is key to the interpretation of the formation at a population level with minimal biases. However, in health care, the individual patient perspective, priority, and needs should be taken into account whereas, in the clinical encounter, one has to also deal with what is particular and unique. The purpose of this paper is to describe the characteristics of the phenomenological method as a means within a mixed-method framework, to supplement participants’ patient-reported outcome numeric scores with a more in-depth commentary on the essence of the lived health experiences. Read more Other relevant publications Meadows K. Patient-reported Outcome Measures – A Call for More Narrative Evidence. Journal of Patient Experience. October 9th 2021. Read more Meadows K. Do Patient-Reported Outcome Measures Tell Us the Full Story? Clinical Nursing Research. 2022;31(2):159-162. Read more K A Meadows & M Reaney (2023) Bringing the patient’s perspectives forward in drug development and health-care evaluation, Expert Review of Pharmacoeconomics & Outcomes Research Read more |
Introduction
Patient-reported outcome measures (PROMs) play a central role in clinical research and patient care resulting in a plethora of standardized PROMs to measure a range of constructs, including disease symptoms, health-related quality of life, and health status. However, in the clinical encounter, one has to also deal with what is particular and unique to the patient, which currently standardized PROMs fail to encompass. To address this problem the focus of my research is to work with the tools and concepts of philosophy to understand patient experience and facilitate the use of phenomenology in qualitative health care research and clinical practice. Phenomenology offers a rich theoretical and conceptual understanding of human existence and the specific aim of the research is to work with the phenomenological method as a means within a mixed-method framework, to supplement participants’ patient-reported outcome numeric scores with a more in-depth commentary on the essence of the lived health experiences and bring human existence into clinical practice and research. How is this done? We work with the tools of applied philosophy, such as devices, principles, methods and theories as well as adapting phenomenological concepts such as subjectivity, experience, empathy, the lived body, and the life world that can be integrated into health care research and practice. What is applied philosophy? The UK Society for Applied Philosophy states that applied philosophy is: philosophical study and research that has a direct bearing on areas of practical concern. [The Society] arose from an increasing awareness that many topics of public debate are capable of being illuminated by the critical, analytic approach characteristic of philosophy, and by direct consideration of questions of value. These topics come from a number of different areas of social life—law, politics, economics, science, technology, medicine and education are among the most obvious (1). Applied philosophy spans a wide range, from analytic philosophy, Critical Theory, and hermeneutics to phenomenology and psychoanalytically inspired philosophy, to name but a few of the philosophical methods used in applied philosophy (2). See the German critical theorist Jürgen Habermas and his work on “postmetaphysical thinking.” Metaphysics is here a general term for “totalizing thinking,” a philosophical standpoint that strives to give an all-encompassing explanation of reality.* If you are interested to find out more contact me here *Jürgen Habermas, “Themes in Postmetaphysical Thinking,” in Habermas, Postmetaphysical Thinking (Cambridge, MA: mit Press, 1996), 33. |