Qualitative metasynthesis, developed as an interpretative and inductive methodology, is increasingly influenced by standards from evidence-based medicine, established as a strategy to support policy decisions and guidelines. Currently, principles and procedures from the format developed for systematic reviews are often applied for review and synthesis of all kinds of evidence, including results from qualitative studies. In this article, I substantiate these claims, discussing benefits to be harvested and warnings to be given when qualitative metasynthesis approaches the evidence-based medicine methodology. Situating my exploration in the context of clinical practice, I contrast missions and values of these methodologies regarding review and synthesis of research literature, highlighting potential mismatches between ontology and epistemology, emphasizing challenges regarding sample, analysis, and transferability. Approving systematic and transparent strategies as generic for such purposes, I warn against the idea that methodology developed for evidence-based medicine is a universal gold standard for synthesis of research evidence.
AlvessonM.SköldbergK. (2009). Reflexive methodology: New vistas for qualitative research (2nd ed.). Los Angeles: Sage.
2.
Aspirin after myocardial infarction [Editorial]. (1980). The Lancet, 315, 1172–1173. doi:10.1016/S0140-6736(80)91626-8
3.
AtkinsS.LewinS.SmithH.EngelM.FretheimA.VolminkJ. (2008). Conducting a meta-ethnography of qualitative literature: Lessons learnt. BMC Medical Research Methodology, 8, Article 21. doi:10.1186/1471-2288-8-21
4.
Barnett-PageE.ThomasJ. (2009). Methods for the synthesis of qualitative research: A critical review. BMC Medical Research Methodology, 9(1),. doi:10.1186/1471-2288-9-59
5.
BondasT.HallE. O. C. (2007). A decade of metasynthesis research in health sciences: A meta-method study. International Journal of Qualitative Studies on Health and Well-being, 2, 101–113. doi:10.1080/17482620701251684
6.
BossuytP. M.ReitsmaJ. B.BrunsD. E.GatsonisC. A.GlasziouP. P.IrwigL. M.. . . de VetH. C. W. (2003). Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. BMJ, 326(7379), 41–44. doi:10.1136/bmj.326.7379.41
7.
BrittenN.GarsideR.PopeC.DipJ. F.CooperC. (2017). Asking more of qualitative synthesis: A response to Sally Thorne. Qualitative Health Research, 27, 1370–1376. doi:10.1177/1049732317709010
8.
CampbellR.PoundP.PopeC.BrittenN.PillR.MorganM.DonovanJ. (2003). Evaluating meta-ethnography: A synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Science & Medicine, 56, 671–684. doi:10.1016/s0277-9536(02)00064-3
9.
Canadian Task Force on the Periodic Health Examination. (1979). The periodic health examination. Canadian Task Force on the Periodic Health Examination. Canadian Medical Association Journal, 121, 1193–1254.
10.
ChalmersI.BrackenM. B.DjulbegovicB.GarattiniS.GrantJ.GülmezogluA. M.. . . OliverS. (2014). How to increase value and reduce waste when research priorities are set. The Lancet, 383, 156–165. doi:10.1016/S0140-6736(13)62229-1
11.
ChamberlainK. (2000). Methodolatry and qualitative health research. Journal of Health Psychology, 5, 285–296. doi:10.1177/135910530000500306
12.
Cochrane Collaboration. (2011). Cochrane handbook for systematic reviews of interventions: Version 5.1.0. Available from http://handbook.cochrane.org/
13.
Dixon-WoodsM.AgarwalS.JonesD.YoungB.SuttonA. (2005). Synthesising qualitative and quantitative evidence: A review of possible methods. Journal of Health Services Research & Policy, 10, 45–53. doi:10.1177/135581960501000110
14.
Dixon-WoodsM.BoothA.SuttonA. J. (2007). Synthesizing qualitative research: A review of published reports. Qualitative Research, 7, 375–422. doi:10.1177/1468794107078517
15.
Dixon-WoodsM.CaversD.AgarwalS.AnnandaleE.ArthurA.HarveyJ.. . . SuttonA. J. (2006). Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, Article 35. doi:10.1186/1471-2288-6-35
16.
DobrowM. J.GoelV.UpshurR. E. (2004). Evidence-based health policy: Context and utilisation. Social Science & Medicine, 58, 207–217. doi:10.1016/S0277-9536(03)00166-7
17.
DoyleA. C. (2004). A case of identity. In PearsI. (Ed.), The adventures of Sherlock Holmes and the memoirs of Sherlock Holmes. London: Penguin Classics.
18.
EakinJ. M.MykhalovskiyE. (2003). Reframing the evaluation of qualitative health research: Reflections on a review of appraisal guidelines in the health sciences. Journal of Evaluation in Clinical Practice, 9, 187–194.
19.
FranceE. F.RingN.ThomasR.NoyesJ.MaxwellM.JepsonR. (2014). A methodological systematic review of what’s wrong with meta-ethnography reporting. BMC Medical Research Methodology, 14(1). doi:10.1186/1471-2288-14-119
20.
GeertzC. (2000). The interpretation of cultures: Selected essays. New York: Basic Books.
GoughD.OliverS.ThomasJ. (2012). An introduction to systematic reviews. London: Sage.
23.
GreenhalghT. (2012). Why do we always end up here? Evidence-based medicine’s conceptual cul-de-sacs and some off-road alternative routes. Journal of Primary Health Care, 4(2), 92–97.
24.
GreenhalghT.RussellJ. (2009). Evidence-based policymaking: A critique. Perspectives in Biology and Medicine, 52, 304–318. doi:101353/pbm00085
25.
GuyattG.OxmanA. D.VistG. E.KunzR.Falck-YtterY.Alonso-CoelloP.SchunemannH. J. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336, 924–926. doi:101136/bmj39489470347AD
26.
HannesK. (2011). Critical appraisal of qualitative research. In NoyesJ.BoothA.HannesK.HardenA.HarrisJ.LewinS.LockwoodC. (Eds.), Supplementary guidance for inclusion of qualitative research in Cochrane systematic reviews of interventions. Available from http://cqrmg.cochrane.org/supplemental-handbook-guidance
27.
HannesK.BoothA.HarrisJ.NoyesJ. (2013). Celebrating methodological challenges and changes: Reflecting on the emergence and importance of the role of qualitative evidence in Cochrane reviews. Systematic Reviews, 2(1), Article 84. doi:10.1186/2046-4053-2-84
28.
HannesK.MacaitisK. (2012). A move to more transparent and systematic approaches of qualitative evidence synthesis: Update of a review on published papers. Qualitative Research, 12, 402–442. doi:10.1177/1468794111432992
29.
HarawayD. (1991). Situated knowledges: The science question in feminism and the privilege of partial perspective. In HarawayD. (Ed.), Simians, cyborgs, and women: The reinvention of nature (pp. 183–201). New York: Routledge
30.
JanesickV. J. (1994). The dance of qualitative research design: Metaphor, methodolatry, and meaning. In DenzinN. K.LincolnY. S. (Eds.), Handbook of qualitative research (pp. 209–219). Thousand Oaks, CA: Sage.
31.
KastnerM.AntonyJ.SoobiahC.StrausS. E.TriccoA. C. (2016). Conceptual recommendations for selecting the most appropriate knowledge synthesis method to answer research questions related to complex evidence. Journal of Clinical Epidemiology, 73, 43–49. doi:10.1016/j.jclinepi.2015.11.022
32.
KvaleS. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage.
33.
LevinA. (2001). The Cochrane Collaboration. Annals of Internal Medicine, 135, 309–312. doi10.7326/0003-4819-135-4-200108210-00035
34.
LewinS.GlentonC.Munthe-KaasH.CarlsenB.ColvinC. J.GülmezogluM.. . . RashidianA. (2015). Using qualitative evidence in decision making for health and social Interventions: An approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Medicine, 12(10), e1001895. doi:10.1371/journal.pmed.1001895
35.
LiberatiA.AltmanD. G.TetzlaffJ.MulrowC.GotzscheP. C.IoannidisJ. P.. . . MoherD. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Journal of Clinical Epidemiology, 62(10), e1–e34. doi:S0895-4356(09)00180-2[pii]10.1016/j.jclinepi.2009.06.006
36.
LoderE.GrovesT.SchroterS.MerinoJ. G.WeberW. (2016). Qualitative research and The BMJ. BMJ, 352. doi:10.1136/bmj.i641
37.
MajorC. H.Savin-BadenM. (2010). An introduction to qualitative research synthesis. Managing the information explosion in social science research. London: Routledge
38.
MalterudK. (2001a). The art and science of clinical knowledge: Evidence beyond measures and numbers. The Lancet, 358, 397–400. doi:S0140-6736(01)05548-9[pii]10.1016/S0140-6736(01)05548-9
39.
MalterudK. (2001b). Qualitative research: Standards, challenges, and guidelines. The Lancet, 358, 483–488. doi:101016/S0140673601056276
40.
MalterudK. (2012). Systematic text condensation: A strategy for qualitative analysis. Scandinavian Journal of Public Health, 40, 795–805. doi:10.1177/1403494812465030
41.
MalterudK. (2016). Theory and interpretation in qualitative studies from general practice: Why and how?Scandinavian Journal of Public Health, 44, 120–129. doi:10.1177/1403494815621181
42.
MalterudK. (2017). Kvalitativ metasyntese som forskningsmetode i medisin og helsefag [Qualitative metasynthesis as a research method for medicine and health sciences] (in Norwegian). Oslo, Norway: Universitetsforlaget
43.
MalterudK.BjellandA. K.ElvbakkenK. T. (2016). Evidence-based medicine–An appropriate tool for evidence-based health policy? A case study from Norway. Health Research Policy and System, 14(1), doi:10.1186/s12961-016-0088-1
44.
MalterudK.GuassoraA. D.ReventlowS.JutelA. (2017). Embracing uncertainty to advance diagnosis in general practice. British Journal of General Practice, 67, 244–245. doi:10.3399/bjgp17X690941
45.
MalterudK.SiersmaV. D.GuassoraA. D. (2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26, 1753–1760. doi:10.1177/1049732315617444
46.
McWhinneyI. R. (1989). “An acquaintance with particulars ….”Family Medicine, 21, 296–298.
47.
MoherD.GlasziouP.ChalmersI.NasserM.BossuytP. M.KorevaarD. A.. . . BoutronI. (2016). Increasing value and reducing waste in biomedical research: Who’s listening?The Lancet, 387, 1573–1586. doi:10.1016/S0140-6736(15)00307-4
48.
NagelT. (1986). The view from nowhere. New York: Oxford University Press.
49.
NoblitG. W.HareR. D. (1988). Meta-ethnography: Synthesizing qualitative studies. Newbury Park, CA: Sage.
O’RourkeH. M.DugglebyW.FraserK. D.JerkeL. (2015). Factors that affect quality of life from the perspective of people with dementia: A metasynthesis. Journal of the American Geriatrics Society, 63, 24–38. doi:10.1111/jgs.13178
52.
O’RourkeK. (2007). An historical perspective on meta-analysis: Dealing quantitatively with varying study results. Journal of the Royal Society of Medicine, 100, 579–582. doi:10.1258/jrsm.100.12.579
53.
OxmanA.GuyattG. H. (1993). The science of reviewing research. Annals of the New York Academy of Sciences, 703, 125–133; discussion 133–124.
54.
PatersonB. L.ThorneS. E.CanamC.JillingsC. (2001). Meta-method. In PatersonB. L.ThorneS. E.CanamC.JillingsC. (Eds.), Meta-study of qualitative health research (pp. 70–91). Thousand Oaks, CA: Sage.
55.
PetticrewM. (2015). Time to rethink the systematic review catechism? Moving from “what works” to “what happens.”Systematic Review, 4, Article 36. doi:10.1186/s13643-015-0027-1
56.
PopayJ.RogersA.WilliamsG. (1998). Rationale and standards for the systematic review of qualitative literature in health services research. Qualitative Health Research, 8, 341–351. doi:10.1177/104973239800800305
57.
RieseH.CarlsenB.GlentonC. (2014). Qualitative research synthesis: How the whole can be greater than the sum of its parts. Anthropology in Action, 21(2), 23–30.
58.
SackettD. L.RosenbergW. M.GrayJ. A.HaynesR. B.RichardsonW. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71–72. doi:10.1136/bmj.312.7023.71
59.
SackettD. L.WennbergJ. E. (1997). Choosing the best research design for each question. BMJ, 315, 1636.
60.
SainiM.ShlonskyA. (2012). Systematic synthesis of qualitative research. Oxford, UK: Oxford University Press.
61.
SandelowskiM. (1996). One is the liveliest number: The case orientation of qualitative research. Research in Nursing & Health, 19, 525–529. doi:10.1002/(SICI)1098-240X(199612)19:6<525::AID-NUR8>3.0.CO;2-Q[pii]
62.
SandelowskiM.DochertyS.EmdenC. (1997). Focus on qualitative methods. Qualitative metasynthesis: Issues and techniques. Research in Nursing & Health, 20, 365–371.
63.
SchünemannH. J.FretheimA.OxmanA. D. (2006). Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation. Health Research Policy and Systems, 4(1), Article 25. doi:10.1186/1478-4505-4-25
64.
SmithR.RennieD. (2014). Evidence-based medicine—An oral history. The Journal of American Medical Association, 311, 365–367. doi:10.1001/jama.2013.286182
65.
SternP. N.HarrisC. C. (1985). Women’s health and the self-care paradox: A model to guide self-care readiness. Health Care for Women International, 6, 151–163. doi:10.1080/07399338509515689
66.
StigeB.MalterudK.MidtgardenT. (2009). Toward an agenda for evaluation of qualitative research. Qualitative Health Research, 19, 1504–1516. doi:10.1177/1049732309348501
67.
ThorneS. (2008). Interpretive description. Walnut Creek, CA: Left Coast Press.
68.
ThorneS. (2015). Qualitative metasynthesis: A technical exercise or a source of new knowledge?Psycho-oncology, 24, 1347–1348. doi:10.1002/pon.3944
69.
ThorneS. (2017a). Advancing the field of synthesis scholarship: A response to Nicky Britten and colleagues. Qualitative Health Research, 27, 1377–1379. doi:101177/1049732317711902
70.
ThorneS. (2017b). Metasynthetic madness: What kind of monster have we created?Qualitative Health Research, 27, 3–12. doi:10.1177/1049732316679370
71.
TongA.FlemmingK.McInnesE.OliverS.CraigJ. (2012). Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Medical Research Methodology, 12, Article 181. doi:10.1186/1471-2288-12-181
72.
WongG. (2016). Knowledge synthesis approaches-spoilt for choice?Journal of Clinical Epidemiology, 73, 8–10. doi:10.1016/j.jclinepi.2015.08.031
