Meta-synthesis Of Qualitative Studies Research Articles

Facilitators and barriers for lifestyle change in people with prediabetes: a meta-synthesis of qualitative studies

BackgroundThe increasing prevalence of type 2 diabetes worldwide is a major global public health concern. Prediabetes is a reversible condition and is seen as the critical phase for the prevention of type 2 diabetes. The aim of this study is to identify and synthesize current evidence on the perceived barriers and facilitators of lifestyle change among people with prediabetes in terms of both initial change and lifestyle change maintenance.MethodsA systematic literature search in six bibliographic databases was conducted in April 2021. Potential studies were assessed for eligibility based on pre-set criteria. Quality appraisal was done on the included studies, and the thematic synthesis approach was applied to synthesize and analyse the data from the included studies.ResultsTwenty primary studies were included, containing the experiences of 552 individuals. Thirteen studies reported participants perceived facilitators and barriers of lifestyle change when taking part in community-based lifestyle intervention programs, while seven studies reported on perceived facilitators and barriers of lifestyle change through consultations with health care professionals (no intervention involved).Three analytical themes illuminating perceived barriers and facilitators for lifestyle change were identified: 1) the individual’s evaluation of the importance of initiating lifestyle change, 2) the second theme was strategies and coping mechanisms for maintaining lifestyle changes and 3) the last theme was the significance of supportive relations and environments in initiating and maintaining lifestyle change.ConclusionAwareness of prediabetes and the perception of its related risks affects the motivation for lifestyle change in people at risk of type 2 diabetes; but this does not necessarily lead to lifestyle changes. Facilitators and barriers of lifestyle change are found to be in a complex interplay within multiple ecological levels, including the interpersonal, intrapersonal, environmental and policy level. An integrated understanding and analysis of the perceived barriers and facilitators of lifestyle change might inform people with prediabetes, healthcare professionals, and policy makers in terms of the need for psychological, social, and environmental support for this population.

The experience of loneliness among people with a \u201cpersonality disorder\u201d diagnosis or traits: a qualitative meta-synthesis

BackgroundLoneliness is prevalent among people with a “personality disorder” diagnosis or who have related personality traits, but the experience of loneliness among people with “personality disorder” diagnoses/traits has not been well described. A qualitative approach has potential to help understand the experience of loneliness among people with “personality disorder” diagnoses/traits, and to develop interventions that promote recovery. We therefore aimed to synthesise the qualitative literature relevant to this topic.MethodWe conducted a meta-synthesis of qualitative studies exploring the subjective experience of loneliness as reported by people with “personality disorder” diagnoses/traits. We searched four databases using pre-formulated search terms, selected eligible articles, appraised the quality of each, and analyzed data from eligible studies using thematic synthesis.ResultWe identified 39 articles that described the experience of loneliness in people with “personality disorder” diagnoses/traits. From extracted data, we identified seven themes: (1) disconnection and emptiness: a “haunting alienation”, (2) alienation arising from childhood experiences, (3) thwarted desire for closeness and connection, (4) paradox: for both closeness and distance, (5) experiences of existential loneliness, (6) recovery, embedded in a social world, and (7) group therapy: a setback. Our results suggest that for our sample early alienating and traumatic experiences may pave the way for experiences of loneliness, which further exacerbate “personality disorder” symptoms and distress.ConclusionDespite describing a need to belong and efforts to cope with unmet social needs, people with “personality disorder” diagnoses/traits (particularly “emotionally unstable personality disorder”) report experiencing an intense disconnection from other people. This seems rooted in early adversities, reinforced by later traumatic experiences. Given the apparent salience of loneliness to people with “personality disorder” diagnoses/traits, interventions focused on helping people connect with others, which may include both psychological and social components, have potential to be beneficial in reducing loneliness and promoting recovery.

Social recovery in substance use disorder: A metasynthesis of qualitative studies.

IssuesIn substance use disorder, connection to social communities plays a significant role in the recovery process. The aim here has been to identify and synthesise the qualitative research examining the process of social recovery from a first‐person perspective and how social communities assist in this process.ApproachMetasynthesis using the following databases: CINAHL, Embase, MEDLINE, PsycINFO, Scopus, SocIndex and Web of Science. The search returned 6913 original articles, of which 18 met the following criteria: examining the experience of social recovery from a first‐person perspective and how social communities support this process, age of 18+, recovery of at least 12 months, in an English‐language peer‐reviewed journal. Review protocol registration: PROSPERO (CRD42020190159).Key FindingsThe persons in recovery emphasised communities that they perceived as being safe and non‐stigmatising. These are qualities that contributed to positive self‐change, and these communities were perceived as suitable arenas in which to confront responsibility and trust. Additionally, participants found that their relationship skills were improving due to the new social bonds forged in these communities. A sense of citizenship was gained along with a regaining of social dignity through voluntary work and giving back to society.ImplicationsThe pivotal role of the social community identified in this review underscores the importance of recognising and supporting persons in recovery's needs when connecting with such communitiesConclusionWe propose a four‐stage model to guide research into social recovery from a first‐person perspective and how social communities support this process.

The experience of patients with an implantable cardioverter-defibrillator: a systematic review and meta-synthesis of qualitative studies.

The indication for implantable cardioverter-defibrillators (ICDs) to prevent sudden death is now consolidated. However, there is no unanimous agreement on how patients experience certain aspects of their lives after an ICD implant. Various clinical studies have evaluated the impact of ICDs on patient mortality, survival, and their beneficial effects. Given the growing number of qualitative studies, a synthesis of qualitative evidence became desirable. To explore and synthesize the results of qualitative studies addressing the experiences of patients with an ICD. We employed a systematic review and meta-synthesis. PubMed, CINAHL, and PsycINFO were systematically searched to identify qualitative studies published between January 2005 and October 2020, which investigate the experience of patients living with an ICD. Selected studies were assessed for quality by two reviewers independently. A total of 24 papers were selected. Six themes emerged: fear and insecurity, the need for information, new impacts on life, living with ICD shocks, gender differences, and the role of the family. These results could help clinicians and researchers to develop new strategies and interventions to improve the quality of life in these patients. This meta-synthesis underlines the difficulties experienced by patients with ICD implants. Despite the advanced therapeutic management programmes for this type of intervention, it is necessary to adopt and implement the current post-discharge care plans, where the family's involvement is essential to help patients adapt to their new lifestyle.

Designing a Supportive Program based on the Real Needs of Mothers with Children Undergoing Hemodialysis: A Qualitative Study.

Background:Mothers with children undergoing hemodialysis play the role of primary caregivers for their child and fully sacrifice themselves for care, leading to social isolation, suffering, stress, and negative effects on their health. Therefore, this study was conducted to design a supportive program based on the real needs of mothers with children undergoing hemodialysis.Materials and Methods:This qualitative study was conducted in the Hemodialysis Division of Doctor Sheikh Pediatric Hospital in Mashhad City, Iran, from September 2016 to February 2019. The research included phenomenological study, meta-synthesis of qualitative studies, focused group, and nominal group. Participants were selected based on purposive sampling. Eleven mothers with children undergoing hemodialysis and seven key people related to these mothers participated in the study. MaxQDA software was used to facilitate data management.Results:The six main areas including information needs, how to deal with the child, maintaining the mother's physical and functional health, maintaining family relationships, income earning and maintaining financial resources, and emotional-psychological support were extracted. Based on the needs of mothers, 28 support strategies were presented; then, 19 ideas were presented to screen the needs, and finally, the best idea was selected for each need.Conclusions:According to the findings of this study, mothers with children undergoing hemodialysis need support in various physical, psychosocial, informational, economic, and functional dimensions. The supportive program designed provides a systematic framework for screening the needs of these mothers and providing multifaceted support measures with the participation of a multidisciplinary care team.

What Are the Common Themes of Physician Resilience? A Meta-Synthesis of Qualitative Studies.

In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians’ experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.

Dementia-Related Care in Acute Care Settings: A Qualitative Meta-Synthesis of Patient and Family Perspectives

Researchers have long emphasized the importance of a person-centered approach to health care, especially regarding the treatment of individuals living with dementia. However, the fast pace of acute care settings can be a difficult place to provide such care to patients, where there are tensions between the emphasis on efficient treatment of acute medical co-morbidities and person-centered dementia care. This paper is a meta-synthesis of qualitative studies examining perspectives of patients and their family members regarding their acute care experiences. It takes an interpretive approach, using primarily inductive reasoning to generate themes across available studies’ findings. Emergent themes are organized under two major dimensions of the hospital environment: the physical environment, including sensory and tangible elements, and the social environment, including the hospital atmosphere and communication practices. Persons with dementia feel overly stimulated by the busy physical environment of the hospital, yet they are often left to languish alone, sometimes even physically restrained. Patients reported feeling lonely, fearful, and confused, identifying diverse physical and social environmental attributes like physical clutter, noise, and lack of empathy from care providers as contributors. Based on acute care experiences and reports from patients and family members, although the acute condition is treated, persons with dementia often leave the acute care environment in worse functional condition than when they entered. Given the increasing prevalence of persons with dementia in acute care settings, it is clear that we must prioritize innovations and programs aimed at improving hospital practices, educating staff, and creating more dementia-friendly environmental designs.

A meta-synthesis of qualitative studies on stress urinary incontinence in women for the development of a Core Outcome Set: A systematic review.

Given the high variation of perceptions of women with stress urinary incontinence (SUI), qualitative meta-synthesis in this field appears warranted. We aimed to synthesize evidence on women's experiences of SUI by analyzing qualitative data. A literature search of Medline, Embase, Scopus, PsycInfo, and CINAHL databases was performed by a CHORUS Working Group, from inception to August 2020. Qualitative studies on women's perspectives on SUI were included. Thematic analysis was used as a conceptual approach to analyze the data and develop a set of overarching themes. The quality of studies was assessed based on the Critical Appraisal Skills Program tool. Seven studies were included. Six themes encompassing women's perspectives on SUI emerged: experiencing SUI, awareness of SUI, treatments for SUI, sexuality, communication, and psychosocial effects. The quality appraisal of the studies showed good coherence. This study revealed six overarching themes, of which treatment had the highest prevalence. Assessment of women's perceptions of SUI in the context of a qualitative meta-synthesis may inform policy and practice around this condition, may guide and help set research priorities, and will ideally contribute to the development of a Core Outcome Set for SUI.

Posttraumatic growth experiences of refugees: A metasynthesis of qualitative studies.

Although forced displacement may lead to many adverse psychological problems, this experience may also result in positive psychological consequences. Given the increasing disturbance in countries, many people are forcibly displaced, a comprehensive understanding of the posttraumatic growth (PTG) experiences of refugees is warranted. In this study, we examined 12 primary studies exploring PTG among refugees using the qualitative metasynthesis method. Our analysis of the primary studies consisting of 319 adults revealed four themes: (a) improved psychologic functioning; (b) enhanced interpersonal relationships; (c) reconstruction of the meaning of life; and (d) positive future direction. These findings indicate that no matter how traumatic experiences are painful, people can hold on to life, build a new life, and grow from adversity.

Health professionals and students\u2019 experiences of reflective writing in learning: A qualitative meta-synthesis

BackgroundReflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: “What are the experiences of health professionals and students in applying reflective writing during their education and training?”MethodsWe performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals’ and students’ experience using reflective writing during their academic and in-service training by performing a meta-synthesis.ResultsWe identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users’ experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one’s own and others’ emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified.ConclusionsThe use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.

A systematic review and meta-synthesis of qualitative studies that investigate the emotional experiences of staff working in homeless settings.

Homelessness is a pervasive issue in society, and government policies have highlighted the need to focus on the experience of front-line staff in homelessness settings. The aim of this meta-synthesis was to draw together the available research to further understanding of the experiences of staff working with homeless people. A systematic search was conducted across four electronic databases (ASSIA, PsycInfo, Sociological Abstracts and Web of Science) from the date of their inception. Qualitative research exploring the emotional experiences of staff working in homeless settings was identified. Identified studies were subject to quality assessment, and the data were synthesised using meta-ethnography. Ten studies were included in the synthesis following screening of 228 titles, 92 abstracts and 33 full texts. The concepts that were obtained from the analysis were building quality relationships, negotiating boundaries, carrying the emotional burden (self and others), accessing care and support (self-care and from others), individual advancement, advocating and contextual helplessness. An overarching theoretical construction of the internal experiences of support staff in managing the demands of the role along with their own needs was developed. This theory may provide the basis for testable hypotheses in future research and inform the development of support and training opportunities for staff working within homelessness settings.

The role of informal caregivers for patients with glioma: a systematic review and meta-synthesis of qualitative studies.

BackgroundThis study aimed to systematically review, appraise, and synthesize the current evidence on the experiences and needs encountered by informal caregiver of patients with glioma throughout the disease trajectory and to provide a set of practical implications for health professionals.MethodsSeven English databases and four Chinese databases were searched in this systematic review and meta-analysis. Additional manual searches were completed to identify primary studies, with the language limited by English and Chinese. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used to appraise the methodological quality of each study.ResultsThe systematic review included 16 papers that yielded 71 findings and 6 categories. Finally, 2 synthesized findings were extracted: (I) role transition of caregivers for glioma patients throughout the disease trajectory; (II) support and information need by caregivers of glioma patients. Accordingly, there is a need to recognize the importance of permanent and tailored support for caregivers by providing accurate, practical, and evidence-based information.DiscussionThis is the first attempt to systematically evaluate the breadth and quality of the literature concerning the experiences of caregivers with glioma patients. The results generated from the review may shed some light on problems encountered by glioma patients and their families. A limitation of this review is that in most selected studies, the reflexivity of interviewees is not addressed, which may influence the interpretation of the findings. Moreover, the selected studies were reported in English or Chinese, therefore, caution is needed in interpreting the results.

Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies

Objective: To capture qualitative research about the perspectives and reasoning of allied health professionals about variability in the use of clinical guidelines in stroke rehabilitation. Data sources: Ovid Medline, Psychinfo, Cochrane, Ovid Emcare, Scopus and Web of Science. Method: The review protocol followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Qualitative or mixed methods research that provided qualitative data about use of clinical guidelines delivered by allied health professionals in stroke rehabilitation was included. Clinical guidelines included any evidence-based documents that guided allied health stroke rehabilitation practice. All studies were screened in duplicate at title and abstract and then at full text. Included studies were appraised using the McMaster Critical Appraisal Tool. Results: Data from 850 allied health professionals in 22 qualitative research studies from seven different countries were analysed and synthesised. Four themes were developed including: context necessitates strategy, all clients are different, systemic changes are needed and need a good reason to change something. The findings aligned with the four arms of evidence-base practice. Allied health professionals use clinical guidelines when they align with their reasoning and match the ‘sweet spot’ for client goals and circumstance. Clinical guideline use is attributed to sufficient resourcing, time and motivation and a strong research culture within health systems. Conclusions: Variabilities in clinical guideline use by allied health professionals are due to their clinical reasoning, contextual factors, client characteristics and enabling health systems.

Determinants of adolescent substance use in Africa: a systematic review and meta-analysis protocol

BackgroundAdolescent substance use continues to be a growing major public health concern in Africa. Recent studies infer an overall estimated prevalence of 42% among adolescents in sub-Saharan Africa. Unfortunately, this phenomenon is not adequately documented across many settings in the continent despite known negative health and social consequences on affected individuals and their communities. Little is known about the social context of substance use in Africa among this population. Our aim is to conduct a systematic review, exploring the determinants and associated factors that influence adolescent substance use in Africa.MethodsWe will search the following databases (from January 2000 onwards): PubMed, the Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and the World Health Organization (WHO) African Index Medicus. We will include population-based observational studies reporting on determinants and/or risk factors of substance use among adolescents (age 10–19 years) across Africa. Two reviewers will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion. Study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct a random-effects meta-analysis of data. We plan to conduct a meta-synthesis of qualitative studies where appropriateDiscussionThis review will describe the range of determinants and associated factors found to significantly influence adolescent substance use in Africa over the last two decades. Documenting this evidence is important as it can potentially inform comprehensive interventions and treatment programmes that are targeted at adolescents and their parents in these settings.Systematic review registrationPROSPERO CRD42020190158

Healthcare providers experiences of using uterine balloon tamponade (UBT) devices for the treatment of post-partum haemorrhage: A meta-synthesis of qualitative studies.

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and severe morbidity globally. When PPH cannot be controlled using standard medical treatments, uterine balloon tamponade (UBT) may be used to arrest bleeding. While UBT is used by healthcare providers in hospital settings internationally, their views and experiences have not been systematically explored. The aim of this review is to identify, appraise and synthesize available evidence about the views and experiences of healthcare providers using UBT to treat PPH. Using a pre-determined search strategy, we searched MEDLINE, CINAHL, PsycINFO, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996-2019, reporting qualitative data on the views and experiences of health professionals using UBT to treat PPH. Author findings were extracted and synthesised using techniques derived from thematic synthesis and confidence in the findings was assessed using GRADE-CERQual. Out of 89 studies we identified 5 that met our inclusion criteria. The studies were conducted in five low- and middle-income countries (LMICs) in Africa and reported on the use of simple UBT devices for the treatment of PPH. A variety of cadres (including midwives, medical officers and clinical officers) had experience with using UBTs and found them to be effective, convenient, easy to assemble and relatively inexpensive. Providers also suggested regular, hands-on training was necessary to maintain skills and highlighted the importance of community engagement in successful implementation. Providers felt that administration of a simple UBT device offered a practical and cost-effective approach to the treatment of uncontrolled PPH, especially in contexts where uterotonics were ineffective or unavailable or where access to surgery was not possible. The findings are limited by the relatively small number of studies contributing to the review and further research in other contexts is required to address wider acceptability and feasibility issues.

How Does Restorative Justice Work? A Qualitative Metatsynthesis

A systematic effort to answer in what ways and contexts the claims of restorative justice (RJ) prove persuasive is lacking. We address this gap through a metasynthesis of qualitative studies. Drawing on 26 studies identified through the systematic literature search, we identified three overarching themes to understand “how RJ works”: (1) opportunities for humanization, learning, and putting emotions of victims and individuals who committed a crime at the center of conflict-solving, (2) support networks and mechanisms for communication, and (3) life-changing journey enshrined in healing. We develop a line of argument showing how the micro-, meso-, and macro-elements of RJ interact with each other. While offering reflections on the limitations of existing literature around this key issue, we conclude with implications for advancing research of RJ.

How Does Restorative Justice Work? A Qualitative Metasynthesis

A systematic effort to answer in what ways and contexts the claims of restorative justice (RJ) prove persuasive is lacking. We address this gap through a metasynthesis of qualitative studies. Drawing on 26 studies identified through the systematic literature search, we identified three overarching themes to understand “how RJ works”: (1) opportunities for humanization, learning, and putting emotions of victims and individuals who committed a crime at the center of conflict-solving, (2) support networks and mechanisms for communication, and (3) life-changing journey enshrined in healing. We develop a line of argument showing how the micro-, meso-, and macro-elements of RJ interact with each other. While offering reflections on the limitations of existing literature around this key issue, we conclude with implications for advancing research of RJ.

A qualitative meta-synthesis of facilitators and barriers to tuberculosis diagnosis and treatment in Nigeria

BackgroundDespite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most of these numbers.Nigeria ranks 6th in the world for TB burden, with an estimated 4.3% multi-drug resistance in new cases. However, the country had one of the lowest case detection rates, estimated at 24% of incident cases in 2018 - well below the WHO STOP TB target of 84%. This rate highlights the need to understand contextual issues influencing tuberculosis management in Nigeria. Our synthesis was aimed at synthesizing qualitative evidence on factors influencing TB care in Nigeria.MethodsA three-stage thematic meta-synthesis of qualitative studies was used to identify barriers and facilitators to tuberculosis case finding and treatment in Nigeria. A search of eleven databases was conducted. The date of publication was limited to 2006 to June 2020. We analyzed articles using a three-stage process, resulting in coding, descriptive subthemes and analytical themes.ResultsOur final synthesis of 10 articles resulted in several categories including community and family involvement, education and knowledge, attitudes and stigma, alternative care options, health system factors (including coverage and human resource), gender, and direct and indirect cost of care. These were grouped into three major themes: individual factors; interpersonal influences; and health system factors.ConclusionCase finding and treatment for TB in Nigeria currently depends more on individual patients presenting voluntarily to the hospital for care, necessitating an understanding of patient behaviors towards TB diagnosis and treatment. Our synthesis has identified several related factors that shape patients’ behavior towards TB management at individual, community and health system levels that can inform future interventions.

Experiences of Front-Line Medical Staffs Fighting Against Coronavirus Disease 2019: A Meta-Synthesis of Qualitative Studies

Background: To explore the experiences of front-line medical staffs fighting against Coronavirus Disease 2019 (COVID-19) by synthesizing evidence from a meta-synthesis of qualitative studies.Methods: We conducted a meta-synthesis to integrate qualitative studies on experiences of front-line medical staffs fighting against COVID-19. Six databases were searched from inception to 1 November 2020, including PubMed, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and Scopus. The Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool was used to appraise the quality of included studies. Thematic synthesis was used to synthesize the data from included studies.Findings: A total of 26 studies were included and six themes were identified: (1) psychological and emotional experience in different stages; (2) social experience; (3) challenges and difficulties; (4) coping styles; (5) demands; (6) growth and transcendence.Interpretation: This meta-synthesis reflects diverse experiences of front-line medical staffs fighting against COVID-19. Appropriate psychological support and social support should be provided to front-line medical staffs. Managers should pay attention to needs of front-line medical staffs for improving professional capability and ensure sufficient supplies to respond to similar crisis.Funding Statement: This study received no specific grant from any funding agency in the public,commercial, or not-for-profit sectors.Declaration of Interests: We declare no competing interests.

Deciding to Enrol in a Cancer Trial: A Systematic Review of Qualitative Studies.

BackgroundClinical trials are essential for the advancement of cancer treatments; however, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice.MethodsA systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment.ResultsForty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure.ConclusionFindings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears similarities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials.