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ERICH Masterclass
Case Study Methods in Healthcare Chaplaincy
Research
George Fitchett, DMin, PhDRush University Medical Center
Steve Nolan, PhDPrincess Alice Hospice
Outline
2
• Why case studies matter
• Step-by-step through a case study
• Exercise: Studying a Case
• To publish or be damned?
Flow chart
• New developments in case study
research
• Q&A
• Finish
19.68
6.56
22.08
11.58
0
10
20
30
Baseline Anxiety Discharge Anxiety
Mean
An
xie
ty S
co
re (0-6
3)
Intervention Gp (N=25) Control Gp (N=24)
p=0.05
Effect of Chaplain Care on Emotional Distress
COPD patients in RCT of chaplain daily visits
Source: Iler et al., 2001
From Czajkowski et al.,2015
The ORBIT Model for Behavioral
Treatment Development
Why Are Case Studies Important?
• Case studies and chaplaincy research• Developing evidence about chaplains’ spiritual care
begins with detailed case studies, not clinical trials
• Case studies and chaplaincy education
• Case studies and educating others• health care colleagues
• health care decision-makers
• the public
Is it ethical to publish chaplain case
studies?
• Confidentiality would seem to say no
• Disclosure of case information not for patient’s benefit
• Balance: reasons to publish vs. risk
Are case studies subject to ethical/legal
constraints of human research?
• At one level, the answer seems straightforward▪ Most IRBs: single case study not research
▪ Hence no legal need for elaborate informed consent
• More deeply, case study/research parallels▪ Risks imposed, however minimal
▪ Not for patient benefit
▪ Points to importance of permission, protection
▪ Hence “case study subjects”: a reminder term
Should chaplains always seek and obtain
patient’s permission?
• Permission is often the real-life entry point for ethical perplexity
• Multiple, plausible reasons for hesitation
• Obtaining permission: the default in view of imposition of risks, respect for subjects, rights of autonomy
• “Informed permission” preferred
• Difficult circumstances will require discernment
What about disguising patient
identity/information?
• Minimizing risk requires protecting identity
• Anonymity and appropriate disguise are means of protection
• Permission and protecting identity go together—are not discrete alternatives
• Key issue = balancing act
▪ Achieving adequate disguise vs. providing enough information to achieve case study purposes
10
Spiritual Care in Practice:
Case Studies in Healthcare
ChaplaincyGeorge Fitchett and Steve Nolan,
Editors 2015, Jessica Kingsley Publishers
http://www.jkp.com/usa/spiritual-care-in-practice.html
Where can I find chaplain case studies?
• Journal of Health Care Chaplaincy
4 case studies, with critical responses
Cooper, 2011; King, 2012; Risk, 2013; Nolan, 2016
• Journal of Health and Social Care Chaplaincy, 2017, Vol 5(2), special issue
6 case studies
• Spiritual Care in Practice, Vol. 2
Forthcoming, 2018
10 case studies
Case Studies in Our History
http://www.metro.inter.edu/facultad/esthumanisticos/anton_boisen.htm
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
supervision and verbatim reporting
chaplains are a repository of
rich data on spiritual care
case studies: extension of reflective practice
imagine: team meeting
what do we want to know?What did she do?
Why did she do it?
What was the result?
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
supervision and verbatim reporting
chaplains are a repository of
rich data on spiritual care
case studies: extension of reflective practice
imagine: team meeting
what do we want to know?What did she do?
Why did she do it?
What was the result?
InterventionAssessment
Outcome
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
all used to telling our stories
oral and informal forms of case study
to become ‘case study’ the oral
and informal needs to become
formal and written
modulating story to case study: four aspects
IntensionMethod
AnalysisWriting
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
Intension
the research question!
something about this particular relationship
intrinsic interest
instrumental interest
changes the dynamics of the relationship
need to know something about:
the SUBJECTthe CHAPLAIN
the CONTEXT
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
autoethnography
‘observer effect’researchers implicated in their research
‘researcher reflexivity’incorporate own experience into writing
about the other
‘narrative of the self’
Method
verbatim reportsmemos, reflections
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
Analysis
(self-)observations, verbatims, (field) notes,
memos: all so much data
must be analysed and interpreted
back to our three questions:
Intervention
Assessment
Outcome
What did she do?
Why did she do it?
What was the result?
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
Writing
keep your reader in mind!
tell your story
use a structure:
Conclusion
Assessment Intervention Outcome
Discussion
History of the case
Background
Introduction
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
Studying a case
Craig
Intervention
Assessment
Outcome
What did the chaplain do?
Why did the chaplain do it?
What was the result?
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&AWrite up the case with any
and all sensitive or identifying
Is it
possible to suitably
anonymize the case ? Yes
Get signed permission to
publish from the subject or
their relative
Is the subject able
to give consent?
The subject is alive
AND has capacity
The subject is alive BUT
DOES NOT have capacityThe subject has DIED
Yes No
No
Do not
publish
Explain the project, its
purpose and how the findings
will be disseminated
Is it
appropriate to ask
subject for
consent ?
Yes
No
Is the
subject or their
relative willing to give
consent?
Yes
Is it
possible to suitably
anonymize the case ?
Yes
The subject is
UNTRACEABLE
Is it
appropriate to ask
subject’s relative for
consent ?
NoDo not
publish
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
Submit for
publication
No
Do not
publish
Write up the case with any
and all sensitive or identifying
details suitably anonymized
Submit the case to be read by
PAH Research Committee,
which may request edits
or changes
Make the necessary edits or
changes and resubmit
Get signed permission to
publish from the subject or
their relative
Are
edits or changes
required?
Is it
possible to suitably
anonymize the case ? Yes
No
Do not
publish
No Yes
Are
the edits or changes
acceptable?
Yes
Get final ‘sign off’ from the
subject or their relative and
PAH Research Committee
No
Do not
publish
Is the
subject or their
relative willing to give
consent?
Yes
Is it
possible to suitably
anonymize the case ?
Yes
NoDo not
publish
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
a
Case study
keɪs ˈstʌdi/noun
Start where we are
chaplains are (in the
main) used to reflective
practice
Case studies: form of
research almost all
chaplains can engage
with
- intention: the research
question!
- method:
autoethnography
- analysis: the
intellectually
demanding part of the
work
- writing: a challenge to
us all
Studying a case
Decision making
flowchart
Q&A
George Fitchett DMin PhD
Rush University Medical Center
Steve Nolan PhD
Princess Alice Hospice, The University of Winchester