School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
Palliat Med. 2011 Dec;25(8):774-81. doi: 10.1177/0269216311419883. Epub 2011 Aug 24.
Complex, incrementally changing, context dependent and variable palliative care services are difficult to evaluate. Case study research strategies may have potential to contribute to evaluating such complex interventions, and to develop this field of evaluation research.
This paper explores definitions of case study (as a unit of study, a process, and a product) and examines the features of case study research strategies which are thought to confer benefits for the evaluation of complex interventions in palliative care settings.
Ten features of case study that are thought to be beneficial in evaluating complex interventions in palliative care are discussed, drawing from exemplars of research in this field. Important features are related to a longitudinal approach, triangulation, purposive instance selection, comprehensive approach, multiple data sources, flexibility, concurrent data collection and analysis, search for proving-disproving evidence, pattern matching techniques and an engaging narrative. The limitations of case study approaches are discussed including the potential for subjectivity and their complex, time consuming and potentially expensive nature.
Case study research strategies have great potential in evaluating complex interventions in palliative care settings. Three key features need to be exploited to develop this field: case selection, longitudinal designs, and the use of rival hypotheses. In particular, case study should be used in situations where there is interplay and interdependency between the intervention and its context, such that it is difficult to define or find relevant comparisons.
复杂、渐进式变化、依赖于上下文且多变的姑息治疗服务很难评估。案例研究策略可能具有为评估此类复杂干预措施和发展评估研究领域做出贡献的潜力。
本文探讨了案例研究的定义（作为研究单元、过程和产品），并研究了案例研究策略的特点，这些特点被认为有利于姑息治疗环境中复杂干预措施的评估。
本文从该领域的研究范例中讨论了被认为有助于评估姑息治疗中复杂干预措施的十个案例研究特征。重要的特征与纵向方法、三角测量、有目的的实例选择、全面方法、多种数据源、灵活性、同时进行数据收集和分析、寻找证明或反驳证据、模式匹配技术和引人入胜的叙述有关。还讨论了案例研究方法的局限性，包括主观性的潜在风险以及其复杂、耗时且可能昂贵的性质。
案例研究策略在姑息治疗环境中评估复杂干预措施具有巨大潜力。需要开发该领域的三个关键特征：案例选择、纵向设计和使用对立假设。特别是，应该在干预措施与其背景之间存在相互作用和相互依存关系的情况下使用案例研究，使得难以定义或找到相关比较。
