Critical Appraisal of a Qualitative Research

The Article

Pesut, B., Wright, D., Thorne, S., Hall, M., Puurveen, G., Storch, J., & Huggins, M. (2021). What’s suffering got to do with it? A qualitative study of suffering in the context of Medical Assistance in Dying (MAID). BMC Palliative Care20(1). doi: 10.1186/s12904-021-00869-1


Pesut et al. (2021) article title is suggests the research study’s critical phenomenon, although it does not mention the group of the audience being studied. It does not clearly show that a group of nurses is under study for that particular research. One could easily assume that suffering in Medical Assisted in Dying (MAID) is being studied under patients instead of nurses because patients and families also suffer. Nevertheless, it clearly states what is being studied, in this case, suffering in the context of MAID. This is excellent as one could easily recognize the variable and speculate about the research. The first question in the title, which asks what suffering has to do with MAID, is essential in setting up the context of the study (Pesut et al., 2021). It automatically introduces a reader to what the study is all about.

The abstract clearly and concisely explains the main features of the article. According to Walsham (2006), an abstract should be independent of the article and self-contained. This means it should be a summary of the research article that can stand on its own such that when one reads it, they can quickly get a grasp of the whole paper. The abstract clearly summarizes the paper’s basics, such as the background, method, results, conclusion, and keywords. By reading it, one can quickly summarize the whole paper as all the crucial details of a research paper are stated. For example, one can identify the participants, the methods used, the sample size, and the findings.


The problem statement is ambiguously stated, and it is not easily identifiable. Although one can relate that the problem is difficulties in identifying the extent of suffering that would result in MAID, the introduction part does not clearly state that (Pesut et al., 2021). However, after reading the background part of the article and identifying the problem, one is easily persuaded that there is a need for the current study. In other words, the problem statement builds a robust argument and justifies the need for the current study. The problem is also significant in nursing because nurses are pivotal in making decisions concerned with suffering in MAID. They are one of the primary people who are significant in deciding and helping patients in MAID situations (Pesut et al., 2021). The research problem matches the methods because the problem can be addressed or explored by interacting freely with participants to gain their insights. It can best be addressed by involving in conversations with the participants, such as through semi-structured interviews, which is what the research used.

The research questions are explicitly stated in the background section of the article. For example, a question about the nature and normative function of suffering is asked, who determines if patients are suffering, and the therapies employed in different types of suffering. In addition, the questions are consistent with the study’s conceptual framework, philosophical basis, and ideological orientation. For example, the main ideas presented in the study are about suffering and what it has to do with MAID. Based on this, one of the research questions asks the parties that determine if patients are suffering (Pesut et al., 2021). In this example, the question is consistent with the idea because someone has to determine the extent of suffering for MAID to be decided.

The existing body of knowledge or the literature review adequately presents a solid basis for the new study. For example, it discusses many sub-topics about suffering and MAID, such as the suffering of death, types of suffering like existential suffering, standardized, and the specific type of suffering that results in MAID. The basics of a literature review are analyzing information critically by pointing out the limitations and strengths while formulating areas that could be researched further (Boell & Cecez-Kecmanovic, 2015). The article has done this as it has cited many theories and critiqued them. It also provides conceptual underpinnings providing readers with a new way of thinking about suffering in MAID. For instance, instead of just thinking about the patient’s suffering, the study posits that the MAID process itself is also a type of suffering (Pesut et al., 2021). Medical practitioners suffer while deciding to help a patient in MAID. Lastly, the ideological orientation, conceptual framework, philosophical ideas, and underlying tradition are appropriate because they try to define the problem while providing the surrounding literature to address it adequately.

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The participants’ rights were protected because no external review was involved, and they were asked to sign off a consent letter. The study minimized risks to participants because they were interviewed through a phone call, meaning they were not subjected to security issues (Pesut et al., 2021). The study could have incorporated diverse participants such as of different genders, sexual orientations, physical abilities, and education levels to address diversity.

The study method was longitudinal; hence, the researchers spent adequate time with the study participants. Besides, it enabled the researchers to unfold an early understanding of the topic. The design was also flexible because researchers had time to adjust anytime they wished. However, the number of contacts is not mentioned but could be inadequate since the interviews were held via phone.

The population and sample were not adequately described as their ages, genders, positions, and other information were not provided. Snowballing and purposive sampling were used to recruit participants; hence, the approach was appropriate (Pesut et al., 2021). Besides, the methods enhanced information richness as they reached out to experienced nurses recommended by other participants or selected purposively. The sample size was 50; hence, it was adequate, and saturation was reached because the purposive sampling enabled enough data collection.

Triangulation was not achieved because only semi-structured interviews were used. However, the method was appropriate because the interviews were informal. The questions asked were appropriate because they were about suffering and nurses’ understanding of suffering in MAID. They were also recorded appropriately because the interviews were done over the phone, including a storage system. Collecting the data via phone might not have allowed for enough data collection. Hence, the data might not be sufficient.

Data recording procedures were adequately described because the article states they were audio-recorded, transcribed, checked for accuracy, and downloaded. However, no distortions were made to the audio to minimize bias. About the training of staff who recorded the data is not mentioned. There were no methods used to enhance the trustworthiness of the data, and no description was given about them.

The data analysis methods were sufficiently described. For example, investigators read the data and constructed codes, which were then compared to identify patterns of commonalities. Essentially, the description is well outlined. The analysis strategy was consistent with the type of data gathered because different nurses have different experiences. Thus, comparing their results was vital in coming up with a conclusion. The analysis yielded a theme: to understand suffering. It is crucial to understand it from the nurses’ experiences. The procedures did not suggest any bias possibility.

The findings were effectively summarized because the discussed themes were revisited. The researcher also conceptualized the meaning of data because the interpretation sufficiently applies to the context. Also, the analysis yielded a picture of suffering in MAID because it was done considering the varying opinions of participants where they were contrasted.

The themes are logically connected. For example, the theme of the types of suffering that determine MAID is related to the theme of who determines if patients are suffering. The person determining must understand and know the types of sufferings that qualify MAID. Hence, the themes are connected. No maps, figures, or models summarized the conceptualizations; thus, they were not used effectively. The themes in the study are linked to the conceptual framework in that they support the researcher’s assumption (Pesut et al., 2021). They explain what suffering has to do with MAID by discussing the types of suffering, eligibility, what exactly suffering is, and administering MAID to the right person at the right time.

Findings are interpreted within an appropriate frame of reference, which is the extent to which suffering has influenced MAID. They are interpreted to show how MAID is dependent on the type of suffering and who determines the suffering. Besides, they are consistent with the study’s limitations in that they only address nurses’ opinions and ignore those of families and patients. The issue of transferability of findings is not addressed. 

The researchers discussed the study’s implications, stating that they are crucial for nurses. They would help them know when to administer or decide for MAID assistance and understand the suffering and dying context and story. About the presentation, the research was well written, organized, and detailed as it provides all the necessary information to understand the basics of suffering in MAID. Except for the methods, the interpretation and findings were sufficiently discussed.

The authors’ experience and qualifications enhance confidence in the findings because they are all studying nursing in different recognized universities around the world. Due to this, the findings appear trustworthy. Also, the study received ethical approval, making its findings more confidential. The issue of suffering is critical in deciding on MAID. The study contributes meaningfully to the nursing practice by enhancing the topic of what suffering has to do with MAID.


Boell, S., & Cecez-Kecmanovic, D. (2015). On being ‘systematic’ in literature reviews. Formulating Research Methods For Information Systems, 48-78. doi: 10.1057/9781137509888_3

Pesut, B., Wright, D., Thorne, S., Hall, M., Puurveen, G., Storch, J., & Huggins, M. (2021). What’s suffering got to do with it? A qualitative study of suffering in the context of Medical Assistance in Dying (MAID). BMC Palliative Care20(1). doi: 10.1186/s12904-021-00869-1 Walsham, G. (2006). Doing interpretive research. European Journal Of Information