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Table 3 Method for data collection and analysis, participants’ characteristics, and main findings

From: Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies

Study authorsData collection (length of interview) and recruitment methodSample size and characteristics / Age (mean, range), Gender, Level of experienceData analysisMain findings related to the research purpose of the review
1Noor Abdulhadi et al. [21]Semi-structured interviews
Length: 1 h (on average)
Sampling: purposeful sampling + participants from a prior observational study
N = 26: 19 doctors, 7 nurses
Age: Mean of doctors: 40 years (range: 22–55); mean of nurses: 30 years (range: 25–40)
Gender: 15 females, 11 males
Level of experience:
> 3 years in health care
Qualitative content analysisBarriers affecting care: 1) work load; 2) frustration with lack of a teamwork approach—doctors perceiving nurses as lacking knowledge and qualifications; 3) poor patient adherence—participants were dissatisfied with the patients’ poor adherence to a healthy diet, exercise and medicines, including refusal of insulin and reluctance to be referred to secondary or tertiary care.
2Boström et al. [22]Five semi-structured focus group interviews
Length: 50–90 min (median 67 min)
Sampling: not recorded
N = 29: diabetes nurses
Age: mean of 51 years
Gender: 27 females, 2 males
Level of experience:
15–41 years’ experience working as a nurse; 2–19 years as a diabetes nurse
Qualitative content analysis (Graneheim & Lundman, 2004)Perceptions of diabetes specialist nurses’ regarding their professional role are presented in five themes: “striving to be an expert,” “striving to be a fosterer,” “striving to be a leader,” “striving to be an executive,” and “striving to be a role model.” Diabetic nursing is a multifaceted profession with roles that cannot be easily combined.
3Brown, Bain, Broderick and Sully
Semi-structured individual interviews
Length: not recorded
Sampling: convenience sampling
N = 16: 5 renal nurses, 5 emergency nurses, 6 palliative nurses
Age: not recorded
Gender: 14 females, 2 males
Level of experience:
6 months-30 years
Thematic analysis (Dey, 1993).Renal nurses engage in significant amounts of emotional labor; co-workers are important. They experienced less emotionally confronting situations compared with the two other nursing groups interviewed in the study.
4Craven, Simons and de Groot
1 focus group (N = 5); 5 individual interviews and 13 home-based interviews
Length: not recorded
Sampling: purposive
N = 22: 9 medical residents (primary care physicians and endocrinology fellows), 7 nurses (certified diabetes educators), 4 dietitians, 2 pharmacists
Gender: 16 females, 6 males
Age: Mean of 43 years
Level of experience:
average number of years of clinical practice: 13.2 (SD 13.8)
Grounded theory (Corbin & Strauss, 2008)HCPs reported both positive and negative sides of treating diabetes patients. Several common themes were identified as contributing to distress: patient adherence, negative emotional experiences, emotional fatigue, lack of clear role definition, and work environment concerns. HCPs may experience diabetes-related burn-out.
5Crawford [25]In-depth semi-structured face-to-face interviews Length: around 60 min
Sampling: purposeful sampling
N = 7: 3 respiratory nurses, 2 lung cancer nurse specialists, 2 respiratory physicians
Gender: not recorded
Age: not recorded
Level of experience:
Not recorded, but participants required to have experience communicating with patients at the end of life
Thematic analyses (Edwards & Titchen, 2003)Anxiety and emotional
cost emerged in the face of uncertainty of prognosis and its effects on interactions with patients. The uncertain trajectory increased anxieties for health professionals in initiating discussion.
There was a tendency to soften the impact of information given to the COPD patients about death, and HCPs felt unprepared and described anxiety and discomfort.
6Crowshoe et al. [26]In-depth semi-structured telephone interviews
Length: 1 h
Sampling: purposive and convenience sampling
N = 28: GPs (3 indigenous family GPs, 21 non-indigenous GPs, 4 diabetes specialists).
Gender: 17 males, 11 females
Age: not recorded
Level of experience: not recorded; (but graduated from medical school between 1970 and 2009)
Thematic analysis and constant comparison analysis using NVivo 9 softwarePhysicians care were based on humility by acknowledging the limits of their expertise. Feeling guilty not being able to do more. Challenges in building trust, when no continuity of care. Frustrated approximately colleagues not taking into account the sociocultural and political contexts of patients.
7Huber et al.
4 focus groups
Length: 45–60 min
Sampling: 4 head nurses recruited participants from among their staff
N = 23: nurses
Gender: 22 females, 1 male
Age: mean of 38 years (range: 23–50)
Level of experience: mean of 12.9 years (range: 1–30)
Thematic content analysisThe burden for nurses: lack of information from physicians, low patient acceptance of the disease, caring for elderly patients incapable of decision-making about their care who thus transfer the responsibility to nurses, and varying availability of expertise and levels of competence among the nurses.
8Kim et al.
Individual in-depth interviews Length: 60–90 min
Sampling: purposive sampling
N = 14: nurses working at 2 hemodialysis centers
Gender: 14 females
Age: 33–47 years
Level of experience: 8–23 years (with hemodialysis patients: 1.5–18 years, average of 6 years)
Thematic analysisNurses were feeling pity for patients and had a continuous efforts to establish a good relationship with the patients. Feeling sadness regarding clients’ lives and lifestyles. Feeling that it is important to make an effort to maintain amicable and therapeutic relationships, but feel burdened by maintaining these relationships in the long term.
9Matthews and Trenoweth
Individual semi-structured interviews
Length: not recorded
Sampling: purposive sampling (discontinued due to time restriction)
N = 10: staff nurses at the renal ward
Gender: not recorded
Age: not recorded
Level of experience:
6 months-16 years
3-level coding strategy (Corbin and Strauss, 2008)Nurses experiences high level of responsibility, felt a lack of control and trust in patients’ capacity to self-manage. Experienced stress and anxiety if things go wrong in a patient’s treatment and lack of knowledge and support regarding self-management, lack of time. Threatened by the expert patient.
10Pooley, Highfield and Neal [30]Individual semi-structured interviews
Length: 33–81 minutesutes (mean: 55 min)
Sampling: emails sent to departments nephrologists from the team psychologist
N = 7: nephrologists
Gender: 7 males
Age: 48 years (mean)
Level of experience: mean of 11 years (range: 1–23)
Interpretative phenomaleso-logical analysis (Smith et al., 2009)Discussing themselves as being more than a doctor, they found the acute scenarios of saving lives the most rewarding aspect.
Three main themes: “defining my professional identity,” “relating to the patient,” and “coping with the job.”
11Risør et al. [31]21 focus group discussions (FGD). Each country performed 3 FGDs with new participants each time: FGD1—GPs;FGD2—respiratory physicians; FGD3: a mix of GPs and respiratory physicians’
Length: 1–2 h
purposeful sampling
N = 142: urban and rural GPs
Gender: not recorded
Age: not recorded
Level of experience
approximately 14 years (50% reported)
Grounded theory, using NVivoThe management of acute COPD exacerbations was handled within a range of concerns, from “dealing with comorbidity” through “having difficult patients” to “confronting a hopeless disease.” Difficulty balancing an approach to a disease that confronts the GP with his professional limits (i.e. concerning curing and saving lives), and with the patient’s existential deterioration at all stages.
12Stuij [32]Individual interviews with qualitative and narrative design
Length: 30 min to 2 h (average: 1 h)
Sampling: purposive in nature.
N = 24: 8 physiotherapists, 9 nurses, 2 GPs, 1 internist, 1 dietician, 1 exercise coach, 1
exercise expert, 1 health specialist
Gender: 7 males, 17 females
Age: mean of 44 years (range: 25–64)
Level of experience: average of 15 years (range: 1–40)
Iterative process - aligning with a narrative approach.
Data were coded using Max QDA, version 12.0
Two areas of tension regarding physical activity counseling: (1) the understanding of patient behavior; and (2) professionals’ views on responsibilities, including their own (as professionals), and on who is responsible for behavior change. HCPs expressed ambivalent feelings about these themes.
13Svenningsson, Hallberg & Gedda [33]7 focus groups and goal 3 individual
Length: 30–60
initially open, then
N = 20 (13 nurses, four physicians, two dieticians, one physiotherapist)
Age: Not recorded
Gender: Not recorded
Level of experience:
>  15 years of working experience
Grounded theoryAmbivalences and uncertainties as to how to coach. Feeling down when failure occurs or there is no change in lifestyle to lose weight. HCPs’ main goal: to give professional individualized care and to find the right strategy for each individual with diabetes and obesity.
14Tam-Tham et al. [34]Individual semi-structured telephone interviews
Length: 30 min
Sampling: purposive sampling (snowball); principle of saturation)
N = 27: primary care physicians (PCPs)
Gender: 15 males, 12 females
Age: <  40: 2; 40–60; 15; > 60: 10
Level of experience: >  20 years: 14; <  10 years: 5; 10–20: 8
Content analysis; reflexive and iterative analysis processBarriers found were managing patient and family expectations of CKD; challenges associated with managing patients jointly with specialists.
Facilitators were to establish patient and family expectations of CKD early; to preserve continuity of care;
utilizing a multidisciplinary
team approach.
15Tierney et al. [35]4 focus groups and 13 interviews (11 by telephone + 2 face-to-face)
Length: focus groups: 40–80 min; interviews: 40–75 min
Sampling: purposive sampling, snowballing later employed to support theoretical sampling
N = 36: 13 nurses, 7 doctors, 6 podiatrists, 5 assistants, 3 dietitians, 2 administrative staff
Gender: 29 females, 7 males
Age: not recorded
Level of experience:
1 month-36 years
(with type 2
Constructivist approach (Charmaz, 2014);
NVivo used after focused codes were developed
HCPs needed to work in a setting that supported them in their efforts to provide compassionate care. The compassionate care flow could be enhanced by “defenders” (e.g. having supportive colleagues, seeing the patient as a person, drawing on their faith) or depleted by “drainers” (i.e. competing demands on time and resources).
16Tonkin-Crine et al. [36]Semi-structured telephone interviews
Length: not recorded
Sampling: purposive sampling;
principle of saturation; 353 UK GPs were invited to participate
N = 19: GPs
Gender: 12 males, 7 females
Age: 46 (31–60)
Level of experience Mean years in practice: 16 (range: 3–32)
Inductive thematic analysis, with NVivoLimited experience with patients led to a lack of confidence managing patients without input from specialists. The difficulty of explaining the diagnosis to patients concerning the asymptomatic nature of CKD. The GPs’ felt managing patients in primary care was preferable and they postponed referrals or felt unsure referring older patients with comorbidities whom they perceived to be unlikely to benefit from dialysis.
17Walker, Abel & Meyer [37]Semi-structured telephone interviews
Length: approximately 1 h
Sampling: purposive sampling
N = 11: nurses (almost all pre-dialysis nurses, working in New Zealand)
Gender: not recorded
Age: not recorded
Level of experience: 2–9 years; 6 participants had some form of post-graduate qualification
Thematic analysis and general inductive approach (Thomas, 2006)Nurses need to have time to provide adequate education and support. Problems with inter-professional relationships and professional autonomy: “role trouble” with regards to making decisions for patients, a lack of facilities and a lack of support from doctors. Difficulty getting promoted to nurse practitioner role and feeling excluded from planning on a strategic level.
18Wens et al. [38]Focus group interviews
Length: <  2 h
Sampling: purposeful sampling
N = 40: GPs
Gender: 26 males, 14 females
Age: mean of 45.3 years (SD 10.5)
Level of experience Mean years of practice: 18.4 (SD 10.3)
Content analysisGPs may get angry when they think the patients do not appreciate their expertise. Frustration leads to a paternalistic attitude. GPs often go along with the patients’ complaints and questions and miss a more structured approach to diabetes. The GPs often feel they have too little time to give detailed advice or explanations.
19Wollny et al. [39]In-depth narrative interviews
Length: 28 to 80 min (mean: 47 min)
Sampling: randomly selected GPs from a larger mixed methods study
N = 20: GPs
Gender: 14 males, six females
Age: mean of 53.5 years (SD 7.2)
Level of experience: mean years of practice: 17.3 (SD 6.6)
Conventional (i.e. inductive) content analysisGPs feel personally affected by conflicts with their patients. Unable to reach their aims, they suffer from feelings of failure and defeat. The GPs claim to know what is best for their patients but have a difficult time to understand why their advice is not being followed.
20Zakrisson and Hägglund
Individual interviews, consisting of narratives about nurses’ experiences educating patients with COPD
Length: 20–30 min
Sampling: not
N = 12: asthma/COPD nurses, 8 had specialist education in asthma or COPD at university levelGender: not recorded
Level of experience:
median: 7 years
(with asthma/COPD)
Qualitative content analysis method (Graneheim and Lundman, 2004)Asthma/COPD nurses’ experience of patient education fluctuated between insecurity and security. Nurses need the support of colleagues and management and more knowledge on patient education methods to be secure. The feeling of being important to the patient is important.
  1. GP general practitioner, CKD chronic kidney disease, HCP health care professionals, Nvivo software for organizing categorize and classify data from qualitative and mixed-methods data