Evidence-based medicine favors quantitative research over qualitative research. How do you feel about the latter instead?
In health care, qualitative research is actually emerging and gaining a prominent status and increasing interest from those who wish to publish using innovative methods that are more consistent with the expectations of the modern scientific community. Gli studi qualitativi, in particolare in ambito assistenziale, sono un ambito proficuo per l’applicazione della ricerca scientifica in medicina. Il processo di scrittura di un articolo scientifico relativo ad una ricerca qualitativa utilizza oggi come oggi raccomandazioni e linee guide (ad esempio alla linea guida COKEQ) di certo non inferiori in alcun modo a quanto esiste per la ricerca quantitativa, anche se dal mio punto di vista non è utile proporre un concetto di confronto o alternativa tra i due approcci bensì di unificazione e complementarietà.
Some aspects, however, are more amenable to interest from qualitative research, I am thinking, for example, of the evaluation of the impact and benefits of a new drug treatment, an issue to which I have always devoted particular attention.
What do you think of Narrative Medicine as qualitative research?
As I mentioned earlier, methodological approaches have been attempted over the years in the scientific field that were new and attempted to break away from the generalizations mythologized by quantitative research. Narrative Medicine is an example of these attempts not to detach from the observed object in interpreting a phenomenon, applying the principles of a method called “Grounded Theory,” which differs from the quantitative method in that it does not involve a hypothesis to be tested as a result of the perturbation of a system under study, as is classically the case in scientific experiments, but simply by observing without bias how many things occur in the system itself through observation and information gathering. Certainly for the analysis of social phenomena and in cases where the role of the observer is crucial (such as in the doctor-patient relationship) the research operated by narrative medicine represents an irreplaceable and particularly accurate method.
How do you feel about mixed methods using quantitative and qualitative research?
Currently in the field of research in Multiple Sclerosis, the pathology I have been involved with for more than 20 years, the mixed method is favored, although outcomes involving the use of qualitative tools such as patient reported outcomes (PROs) remain secondary to quantitative ones related to the assessment of disease activity through the calculation of new lesions or the number of new relapses and from the elaboration of more or less sophisticated statistical curves… despite this, the scientific community is increasingly using assessment tools that take into account the patient’s experience and self-analysis, which gain particular value in certain areas, such as the identification of disease progression and the impact of long-term therapeutic monitoring. The decision to use quasi-quantitative methods in such a complex and advanced research field as Multiple Sclerosis is certainly a sign of great interest in such an approach.
How to abolish prejudices about qualitative research and Narrative Medicine in such a quantitative society?
I imagine that the most common bias about qualitative research is the belief that it is of poor quality or value because it is closely related to the specific condition/environment/sample under observation. In reality, qualitative research can produce a remarkable range of data regarding details that are difficult to capture by other methods. A holistic analysis of the socio-cultural, personal and value context of the participants would deserve attention and interest, while still sometimes being downplayed and deemed negligible compared to other aspects of inquiry.
Looking at the needs of modern society and the prevailing dynamics, it might seem utopian to promote this type of research, but suffice it to observe that even in the most formal medical settings the attention of colleagues is drawn more to the narrative of clinical cases and strategies deployed by the physician to optimize therapy and disentangle the many options and certainly not to the succession of tables and histograms because despite what a young physician might perceive from current approaches to care (guidelines, protocols, decision trees, and so on…) Medicine remains an art that requires high technical and humanistic skills. Continuing education must take into account the need to implement personal skills in empathy and communication, and qualitative research is a fundamental and irreplaceable tool for this purpose.