Chapter 3_done.docx

22 CHAPTER 3 Research Methodology

Research Design This study utilized qualitative approach in obtaining in-depth understanding of cancer patients who have completed chemotherapy as a phenomenon within their natural setting. It attempted to set aside biases and preconceived assumptions about human experiences, feelings, and responses to the diseasetreatment situation.

It conceded to delve into the perceptions, perspectives,

understandings, and feelings of those cancer patients who have experienced or lived the phenomenon or life undergoing chemotherapy. In line with this, the study assumed Husserlian descriptive phenomenology wherein it captures the phenomenon or the cancer experience after completing chemotherapy in its purest state as possible (Abalos, 2016). Consequently, he came up with the method he called the phenomenological reduction. It is a process whereby empirical subjectivity is suspended, so that pure consciousness may be defined in its essential and absolute being (Scott, 2003). Through Husserl’s descriptive approach of phenomenology, the study intended to explicate ‘‘pure essences’’ of human experiences through phenomenological description in the context of reduction.

Research Locale The domain of the study was within Cebu, to include cities and municipalities, and certain support group. Cebu has a line of cancer institutions

23 that cater to the needs of cancer patients from diagnosis to rehabilitation. And this support group is a non-governmental, non-profit organization working for the wellbeing of indigent people in the locale, especially children afflicted with cancer. Through education and health care, this foundation helps in raising the quality of life and instill in the minds of the destitute the nobility of human life. This is a multi-centered study on sites agreed upon by the participant and the researcher. The interview was conducted in a quiet and conducive space for reflection and conversation which include the respective houses of the participants or counselling rooms.

Research Participants The participants were composed of seven participants who possessed the following inclusion criteria, 18 years old and above, either male or female, diagnosed with cancer of any type at any stage regardless if it is in remission or not or has received any other mode of treatment, have completed chemotherapy, able to generate thoughts and communicate, and knowledgeable of their diagnosis and present condition. Patients who possessed the following exclusion criteria were not be admitted participating in the study such as those with cognitive impairment, unable to communicate, unable to provide written consent and about to start or ongoing chemotherapy. Since, it is part of the participant’s rights to withdraw any time within the study period, the participant may be eliminated if he ought to do so or if medical or psychological emergency that would manifest during the study with the need to submit the participant to the health care facility.

24 Sampling Technique. Participants were gathered utilizing a nonprobability sampling method, specifically purposive sampling following the set inclusion and exclusion criteria. Suitable participants were also gathered by referral may be outside of the support groups. This study aimed to have as many participants until data saturation was attained after six participants. This was validated by adding one more participant to the study after saturation was attained.

Research Instrument A researcher-made interview-guide with three questions were utilized during the inquiry. These questions include the introductory questions which aimed to establish rapport with the participant; second is the main question that tackled on how it is to live into the phenomena; and lastly, the probing question. These are follow-up questions based on the answers given for the second question. It intends to build deeper understanding on the lived experience encountered. Pilot testing on the tool was done to two cancer patients who are undergoing chemotherapy. This is to check the tool’s clarity and validity. Field notes were filled out by the researcher during the interview jotting down observations and key notes, while audio recorder was also utilized in documenting contextual information all throughout the interview procedure.

Bracketing As part of the Husserlian nature of phenomenology, the researcher went through the bracketing phase or the method of epoché (Beyer, 2016). In this

25 segment, the researcher is to suspend the preconceived notion or the question of real existence on the experiences of cancer patients undergoing chemotherapy. This process entails that in order to grasp the essential lived experience of those being studied, the researcher should shed all prior knowledge related to the phenomenon being studied (Lopez & Willis, 2004). This technique is not to eliminate the existence of that prior knowledge but to allow the bracketing of knowledge (Lauer, 1958). By bracketing the data from the inquiry, is to be able to get at the “pure” phenomena from the cancer patient’s point of view.

Data Gathering Procedure The study was presented to the Cebu Normal University - Ethics Review Committee (CNU-ERC) for ethical review. Once certified by the ERC and approval from the evaluator to conduct is secured, a transmittal letter was submitted and addressed to the different heads of cancer support groups. From the group, chosen participants based on the inclusion criteria set was then presented with the Patient Information and Informed Consent Form. Once the consent was voluntarily signed by the patient, he was then considered an active participant of the study and plotting of the suitable venue was agreed with the researcher where the interview process commenced. Throughout the entire data gathering process, the participants were solely interviewed by the researcher using the guide questions at their most comfortable environment. The interview lasted for around 45 minutes to an hour. Simultaneously, the researcher took down field notes and record the conversations

26 using an audio tape recorder. All of these, instruments were oriented to the patient upon acquiring consent. Furthermore, the researcher was constantly reminded of himself to eliminate her preconceived thoughts about cancer patients undergoing chemotherapy knowledge to prevent taking down contextual notes during the interview. Upon the termination of the inquiry, debriefing was done by the researcher and each participant was given a token to serve as an appreciation to his participation to the study.

Data Analysis The study is grounded on the Husserlian way which is defined as the very central core of reality (Abalos, 2016). Based on this understanding, in order to concentrate on the contribution of consciousness, Husserl wanted to capture it in the purest state possible thus he came up with the phenomenological reduction (Speziale & Carpenter, 2007). After the data reaching saturation, data were analyzed from the actual interview until the transcription of audio files. Every after each interview, transcription was done verbatim regardless of the language being used. From the transcription of each participant, thematic analysis was done without translation of the participants’ language. This was done to maintain the content and integrity of the participants’ words. Themes were conceptualized out from the participants’ experiences. Each theme is constituted by each participant’s experiences.

27 This study utilized Colaizzi’s method of data analysis which focuses on eliciting exhaustive description about the phenomenon regarding cancer patients who have completed chemotherapy and their coping strategies used to accommodate with the various changes occurred after that therapy. This method follows these seven steps (Speziale & Carpenter, 2007; Shosha, 2012): Initially, each transcript was read several times to gain a sense of the whole content. During this stage, any thought, feeling, and idea that arose by the researcher due to her previous exposure with cancer patients were added to the bracketing diary. This helped in exploring the phenomenon as experience by the participants themselves. Secondly, this time significant statements and phrases that are highly significant to the experience were extracted from the transcript. These were written in a separate sheet and coded based on transcript, page, and line numbers. After which meanings were formulated from the significant statements. Each underlying meaning were coded in one category as they reflect an exhaustive description. Extensive reading Identifying significant statements Formulating meanings Clustering into themes Developing an exhaustive description Reduction to essential meaning

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Validation by the interviewee

Figure 1. The seven steps of analysis as proposed by Colaizzi. Fourth step, categorization was then established. After having an agreement toward all formulated meanings, the process of grouping all these formulated meanings into categories that reflect a unique structure of clusters of themes were initiated. Each cluster of themes was coded to include all formulated meanings related to that group of meanings. After that, groups of clusters of themes that reflect a particular vision issue were incorporated together to form a distinctive construct of theme. Indeed, all these themes are internally convergent and externally divergent; meaning that each "formulated meaning" falls only in one theme cluster that is distinguished in meaning from other structures (Mason, 2002). The fifth step aims to reaching the point of exhaustion. At this stage of analysis, all emergent themes were defined into an exhaustive description which held the position of the phenomenon. Next, decluttering was done on the gathered notion. In this step a reduction of findings was done in which redundant, misused or overestimated descriptions were eradicated from the overall structure. It seems that such attempt was realized to emphasize on the fundamental structure. Amendments were made to generate clear relationships between clusters of themes and their extracted themes. Lastly, the researcher informed the participants with the research findings in groups and discuss the results with them. Participants' views on the study results

29 were obtained directly as they verify the results which entirely reflect their feelings and experiences.

Ethical Considerations of the Study The study caters sensitive issue thus the researcher was very keen in observing ethical issues that could destroy or loosen the study. First and foremost, transmittal letters were given to the head of the institution included in the study attached with the approval letter and research protocol to obtain permission for the conduct of study. As stated on the transmittal letter, the researcher briefly explained the objectives of the study and executed understanding on the lived experience and perception of the respondent. Prior to data collection the Patient Information and Patient Consent Form was given to each participant, identifying the purpose of the study, the time and nature of the questions involved, assurance of confidentiality, anonymity, and the right to withdraw without repercussions. Consent form is guaranteed voluntarily signed by the participant before any further interactions or conduct of study to occur. Information conveyed orally and written in a form of language was assured appropriate to the person’s level of understanding. The prospective participants were informed by repetition and explanation, by answering their questions as they arise, and by ensuring that each individual understands each activity. Each participant was given as much time is needed to reach a decision, including time for consultation with family members or others.

30 The participant can choose whether to be in this study or not without coercion. If he volunteered to be in this study, he may withdraw at any time without consequences of any kind. He may exercise the option of removing his material from the study. He may also refuse to answer any questions he does not want to answer and remain in the study. The participant may withdraw his consent at any time and discontinue participation without penalty. The participants were not waiving any legal claims, rights or remedies because of his participation in this research study. He also has the right to access his own data per demand, as he is free to add or eliminate the data he wishes to. After the completion of the study, he was informed of the findings related to him. The participants are considered diagnosed with a chronic condition making them vulnerable in the present state. They are treated with utmost care and empathy from recruitment up to the termination of the study. Due to the nature of the study, considering the low-risk undertakings of the participant, the researcher would not be held liable in cases of physiologic complications brought about by the concurrent disease condition of the participant. However, the researcher will readily attend to the immediate needs of the participant during the interview process such as shortness of breath, feeling of inconvenience, light headedness and the like. The researcher shall perform initial rescue intervention within the scope of a nurse researcher and will immediately seek medical intervention when the need arises.

31 Participants were also informed of the risks and inconveniences to them as a result of involvement in the study. The study may ground the participant to a feeling of being uncomfortable with the questions, anxiety and depression with the thought of how it is to live a life having cancer undergoing chemotherapy. Thus, the participants had the freedom not to answer these questions or limit the topic being discussed during the conversation. Since the nature of the study may cause emotional and psychological stress, the researcher oriented the participant prior to the interview and counselling will be done by a psychiatrist, Dr. Dolores O. Largo, when the need arises. On the other hand, the study served as a good avenue for the participant to ventilate all his feelings, thoughts and concerns that he wanted to share regarding his condition and experience of being diagnosed with cancer who have completed chemotherapy. The study also enlightened different people of a better understanding on the experiences of patients diagnosed with cancer who completed chemotherapy in the context of patients with the said condition. The output of the study will be filed at Cebu Normal University Library, which will be beneficial to other students and researcher as well. Confidentiality is utmost recognized as their identification were collected during the interview however this was only present on the raw data and interview materials such as the field notes, interview guide per participant and audio tape record. Other than that, from transcription to publication, anonymity was practiced all throughout. Each participant’s identity was labeled with its corresponding

32 pseudo-name. Moreover, it was assured that they will not appear on photos taken during the interview for documentation purposes. Only the researcher will have access to the material with no identifying evidence, such as names on cassettes, document files, and computer printouts. After each interview has been recorded and transcribed, it undergone a series of steps to analyze concepts within the dialogue. Every consenting participant’s data such as interview notes, transcriptions and audio tape record were part of the study and kept by the researcher unless the participant withdraws herself and her entry from the study. All these data had its back-up for incidence of loss which were both kept in a password encrypted storage accessible only to the researcher. These will be discarded after 24 months of storage after the results have been made public and/or when reasonable time has passed for verification of research results. It is ensured that all participants of the study are treated regardless of economic status, disabilities and capabilities. There shall be no special treatment on participants with personal connection to the researcher. Each informant was also given the same compensation all throughout the study. In handing the informed consent, there was no coercion nor bribery to gain interest from possible participants. For questions and inquiries regarding the study and participants’ rights, a contact number of the researcher was placed on the consent form.

Role of the Investigator

33 As a researcher, she is to perform as the human instrument. He needs to describe the relevant aspects of self, including any biases and assumptions, any expectations and experiences to qualify her ability to conduct the research (Greenbank, 2003). The researcher has to keenly listen and observe to the thoughts and feelings of the participants as they disclose their unique experiences. Specifically, the researcher is to perform the semi structured interview, take down notes, record and transcribe the audiotape files. Concurrently, the researcher maintained to bracket out her preconceived notion regarding the phenomenon to prevent biases. More so, the analysis of data was also done solely by the researcher as the forehand receiver of the data collected. The investigator or the researcher must prepare herself to ensure self-awareness activity is done prior receiving conceived notions from the participants to assure credibility of the data.

Method of Verification To ensure trustworthiness, this study was inclined to Lincoln and Guba’s evaluative criteria. First, credibility was enacted by spending enough time with the participant while establishing relationship and rapport. The researcher oriented to the phenomenon investigated, the current situation of the participant as well as her capabilities and limitations. The researcher rose above her preconceptions and was able to build a trusting relationship with the participant. While doing the semistructured interview, the researcher made an attentive listening and keeping an update of the field note to make sure of the consistency in the data gathered. More so, triangulation of data was done to examine to firmness of the different input at

34 different time, space and participant. The study is multi-centered in nature, meaning to say, the data was collected from a wide variety of participant from different setting and different perspective. Although participants were recruited from a pool of cancer patients from a cancer support group, there were also participants who were gathered by referral and does not belong to any cancer support group. This is to prevent contamination of thoughts and communal experience brought about by the different therapies done within the cancer clinics. Also, there are numerous studies in international researches however, limited within the locale. This served as a key point to have a different view of the phenomenon. Lastly, Lincoln and Guba find member checking very vital in enhancing credibility. After data analysis and forming the implications, the researcher drew back to the transcript relating to the truthfulness of the raw data to the enhanced meaning. Furthermore, as part of Colaizzi’s steps in data analysis, the researcher verified the final output to the participants which suggested truthfulness of the outcome. Second, transferability or achieving external validity was determined by ensuring themes presenting a thick description formulated were carried from pure data saturation of all participants and to start with, sampling technique was put to over, once saturation from the interviews conducted is attained. Validation was done by adding one more participant to ensure saturation of data. Next, dependability is achieved by ensuring that the transcript is written verbatim from the audio recorder. Data are the collected transcript from the interview with the participant consisting of their experience being diagnosed with cancer and have

35 completed chemotherapy. Consistency was apparent with the participants’ verbal response and context from field notes. Also, the researcher drew back to the participants to confirm the objectivity of the context outlined from the whole inquiry. Researcher’s bias notions were drawn out of the line thus the research adviser together with the set of panels served as a moderator and checked that the research procedure and outcome were congruent, and biases were secluded. In terms of confirmability, the step-by-step research process undergone in the whole query is wholly presented in the study together with the outcome for each step. Such as the 7-step analysis of Colaizzi, every level of data treatment, methodological notes, data restructuring until the final definition of the phenomenon is transparently laid out in the study. Raw data were also kept in a password encrypted storage available up to 24 months and research outcome has been made public. Lastly, authenticity was sufficed as participants were gathered from support groups and individually outside the support group to attest for authenticity of the study. It is ensured that the study is saturated by the experience of cancer patients who have completed chemotherapy under a support group. Ontologically, the study stands as an instrument for the public in different aspect may be the health care, government, families and society to be firm in knowing, acknowledging the vulnerable group of cancer patients from diagnosis and to their survivorship after chemotherapy. This will also satisfy theoretical bodies in yearning good knowledge to learners and a source of debate for future researchers. In addition, the participants speak in behalf of all cancer patients that may this research be a good

36 avenue to disseminate their thoughts and sufferings for the society to bear with them as to promote a conducive and healthy environment for their rehabilitation.