Using qualitative research to overcome the shortcomings of systematic reviews when designing of a self-management intervention for advanced cancer pain

Objectives: To identify the key components for a self-management intervention for advanced cancer pain using evidence drawn from systematic reviews of complex interventions and syntheses of qualitative research. Methods: Evidence from up-to-date systematic reviews was prioritised. Searches were initially undertaken to identify systematic reviews of effectiveness in Cinahl, Medline, Embase, PsycInfo and the Cochrane Database of Systematic Reviews from 2009-June 2014, using validated search terms. Subsequent searches to identify qualitative systematic reviews were undertaken in Cinahl, Medline, Embase, and PsycInfo from 2009- January 2015. The results of the two sets of reviews were integrated using methods based on constant comparative techniques. Results: Four systematic reviews examining interventions for the self-management of advanced cancer pain were identified. Whilst each review recommended some attributes of a pain management intervention, it was not possible to determine essential key components. Subsequent searches for qualitative evidence syntheses identified three reviews. These were integrated with the effectiveness reviews. The integration identified key components for a self-management intervention including: individualised approaches to care; the importance of addressing patients’ knowledge, skills and attitudes towards pain management; and the significance of team approaches and inter-disciplinary working in the management of pain. Conclusion: Implementing the findings from systematic reviews of complex interventions is often hindered by a lack of understanding of important contextual components of care, often provided by qualitative research. Using both types of data to provide answers for practice demonstrates the benefits of incorporating qualitative research in reviews of complex interventions by ensuring the strengths of qualitative and quantitative research are combined and that their respective weaknesses are overcome.