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. 2017 Aug 1;17(1):116.
doi: 10.1186/s12874-017-0392-7.

A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain

Fran Toye  1   2 , Kate Seers  3 , Erin Hannink  4 , Karen Barker  4   5
Affiliations

A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain

Fran Toye et al. BMC Med Res Methodol. .

Abstract

Background: Each year over five million people develop chronic non-malignant pain and can experience healthcare as an adversarial struggle. The aims of this study were: (1) to bring together qualitative evidence syntheses that explore patients' experience of living with chronic non-malignant pain and develop conceptual understanding of what it is like to live with chronic non-malignant pain for improved healthcare; (2) to undertake the first mega-ethnography of qualitative evidence syntheses using the methods of meta-ethnography.

Methods: We used the seven stages of meta-ethnography refined for large studies. The innovation of mega-ethnography is to use conceptual findings from qualitative evidence syntheses as primary data. We searched 7 bibliographic databases from inception until February 2016 to identify qualitative evidence syntheses that explored patients' experience of living with chronic non-malignant pain.

Results: We identified 82 potential studies from 556 titles, screened 34 full text articles and included 11 qualitative evidence syntheses synthesising a total of 187 qualitative studies reporting more than 5000 international participants living with chronic pain. We abstracted concepts into 7 conceptual categories: (1) my life is impoverished and confined; (2) struggling against my body to be me; (3) the quest for the diagnostic 'holy grail'; (4) lost personal credibility; (5) trying to keep up appearances; (6) need to be treated with dignity; and (7) deciding to end the quest for the grail is not easy. Each conceptual category was supported by at least 7 of the 11 qualitative evidence syntheses.

Conclusions: This is the first mega-ethnography, or synthesis of qualitative evidence syntheses using the methods of meta-ethnography. Findings help us to understand that the decision to end the quest for a diagnosis can leave patients feeling vulnerable and this may contribute to the adversarial nature of the clinical encounter. This knowledge demonstrates that treating a patient with a sense that they are worthy of care and hearing their story is not an adjunct to, but integral to health care.

Keywords: Meta-ethnography; Pain; Patient experience; Qualitative evidence synthesis; Qualitative research; Systematic review.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

FT, KS and KB authored two of the qualitative evidence syntheses out of the 11 included in this mega-ethnography. There are no other competing interests to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
First, Second, Third and Fourth Order constructs in qualitative analysis. This figure illustrates conceptual levels in qualitative analysis: first, second, third and fourth order constructs
Fig. 2
Fig. 2
Systematic Search findings. This figure shows the records identified, screened and included in the mega-ethnography
Fig. 3
Fig. 3
Line of argument – the imperative of the diagnostic ‘holy grail’. This figure presents our line of argument which hinges on a quest for the diagnostic ‘holy grail’. This quest is instigated by a life impoverished and confined. I am struggling against my body to be me. I take up the quest for the diagnostic ‘holy grail’ and am failing this quest. This means that I have lost personal credibility. I am therefore trying to keep up appearances and need to be treated with dignity. Deciding to end the quest for the grail is not easy
See this image and copyright information in PMC

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