Methodology

As mentioned in one of the previous post I will split up the literature review in three parts. The first literature study will be about the various terms that are used to identify a clinical pathway. In this blog post I will mention the newest update after a meeting with my mentor and I will present you the method that I will use during this literature study. Also the research question for the time being is presented together with the involved supervisors for reviewing the literature review.

During the last meeting with Pieter Van Gorp the following things were discussed. It is possible that my literature review about clinical pathways can be published if it has the quality of publication and it has enough added value to the existing literature. Why do I focus on clinical pathways? Because a pathway is a description of a process and it is perfect for modeling (which will be done in a later stage of this project). What I have found so far, and what Pieter knows from experience, is that there is not much literature about clinical pathways and a description about the various definitions. So the opportunity that my literature review will be published is present. Pieter advised me to use the expertise of Irene Vanderfeesten, because she supervised the four OML-minor students who did an initiating literature study about clinical pathway definitions and its synonyms. They made a taxonomy to identify the differences, and I will use this taxonomy as a basis for my literature review. Further Pieter advised me to look for help from two other students Pieter is supervising. They will start their master thesis next year, but it will be helpful for them to have a clear overview of the existing definitions. They will work on another project, where these definitions will be used too. If I would like to publish my literature review then it should be finished before the 6^th of May.

So the question is: how am I going to do this? The used method is based on the paper by Vanwersch et al. (2011) and consists of a five-step plan. Before these five steps are done, first the research context, the purpose, and the organization involved in this literature review are specified.

The research context is to discover whether there are similarities and/or differences between the various used terms to identify a clinical pathway. To do this an explorative literature review is done to identify the most frequently used terms, and to identify the similarities or differences.

Next the purpose of this literature review is described, which describes the research objective, defines the research scope, and finally a research question is formulated. The research objective is to discover whether the used definitions about clinical pathways are synonyms or not, and if not; what are the differences in that case. This literature review focusses on the definitions of the various terms, and therefore it is important that a paper elaborates on the definition(s) used. If a paper does not explain the used definition(s), the paper is excluded from the literature review. If a paper is describing a specific medical process or is written for a medical trained audience, then the paper is also excluded from the literature review too. The described objective and scope lead to the following research question:

What are the main differences and similarities between the various definitions about clinical pathways and its synonyms?

The organization involved consists of a project coordinator, a review team, and one or more people with an advising role (Vanwersch et al., 2011). Since I am the author I will be the project coordinator and together with Dr. P.M.E. Van Gorp I will form the review team. Dr. Ir. I.T.P. Vanderfeesten is asked for the advising role, because she has supervised a group of four students with a literature study about pathways.

Now the five-steps described by Vanwersch et al. (2011) will be mentioned, and each step will be explained only very briefly.

1.  Primary search (use search key to find as many papers which look helpful to answer the research question)
2. Secondary search (Look in the list of articles discovered in the primary search, and check their relevance and quality)
1. Relevance screening (formulate the inclusion and exclusion criteria about the relevance of the paper with respect to the research question)
2. Quality screening (formulate the inclusion and exclusion criteria about the quality of the paper)
3. Data extraction (extract only the relevant information to answer the research question)
4. Data synthesis (In this stage the extracted definitions are compared. In this case it is chosen to make the comparison in a table to provide the reader with an easy to interpreted overview)
5. Writing (I would like to do this in such a way that it has the quality to be published in a journal)

Currently I’m about to finalize the first step. The used search key used to search Google Scholar is a combination of the following elements:  

• Definition
• Defining
• Pathway
• Care pathway
• Clinical pathway

What I haven’t done, and that is a bit of a problem, is to keep up which result I found with which search key and put it in a spreadsheet. I am not sure what to do about this…

Further I manually added the literature found via the linked group European Pathway Association, and the papers Pieter Van Gorp gave to me he ran into or he has read. This latter also concludes reports written by students Pieter supervised.

So I have lots of things to do before I’m able to present a table with all the differences/similarities about the various definitions. However, I will keep you updated when I have news about the method used, the results of the literature review, or anything else that is worthwhile to post. In the meantime, you can read this post or any of the previous posts and leave behind your comments/suggestions/ideas. Any kind of feedback is appreciated a lot!

References:
Vanwersch, R. , Shahzad, K. , Vanhaecht, K. , Grefen, P. , Pintelon, L. , Mendling, J. , van Merode, G. , et al. (2011). Methodological support for business process redesign in health care: a literature review protocol. Intl J Care Pathw, 15(4), 119-126. Royal Society of Medicine Press Ltd.