Bonny Method of Guided Imagery and Music

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CHAPTER: 2 SYSTEMATIC REVIEW: DESIGN AND METHODS

INTRODUCTION

This chapter presents a systematic mixed studies review on the BMGIM intervention in cancer care. Health care decisions have many socioeconomic ramifications, and need to be based on the best available research evidence. Evidence-based practice implies that prevailing health care decisions and practices are based on knowledge that has been acquired through sound research. This research base should not comprise too few studies. The lower the number of studies in a body of research, the higher the risk that particular study limitations, methodological weaknesses or conflicting findings will lead to injudicious applications of findings (Centre of review and dissemination [CRD] 2009:v). A systematic review is required to identify, evaluate and summarise the findings of previous research studies, and to help assess the quality of these studies. In this way, systematic reviews facilitate a clearer representation of the topic of interest. Health care decisions and practices can then be influenced by the comprehensive interpretations and understanding that a systematic review offers (CRD 2009:v).
A systematic review follows a scientific process to locate and synthesize research that is pertinent to a particular research question. This is done through the methodical implementation of organised, transparent and replicable procedures at each step of the systematic review process (Littell, Corcoran & Pillai 2008:1). A systematic review not only synthesizes relevant research but also involves the appraisal and documentation of the methodological qualities of the studies. The same principles and expectations of rigor that undergird primary research should also underpin every systematic review. Thus, a systematic review stands to provide comprehensive insight into the evidence and findings that relevant studies on a particular topic provide (Littell et al. 2008:4).
The aim of my study was to implement the BMGIM in selected cancer interim homes in Gauteng, and to evaluate its effects (complementary to those of the existing care regime) on the physical, psychological and spiritual wellbeing of participating patients. In order to identify existing research and best practices to support and inform the implementation of the BMGIM in cancer care contexts, a systematic review was conducted. This review formed Phase 1 of this study and thus informed the implementation of the BMGIM, which was Phase 2. Phase 1 of this study was guided by the study’s first objective, namely:
To conduct a systematic review to identify methods that have been used to implement the BMGIM in other health care settings, and evaluate the reported effectiveness of the BMGIM in cancer care contexts.
Because the systematic review included studies with quantitative, qualitative and mixed methodologies, a Systematic Mixed Studies Review (SMSR) has been conducted.

SYSTEMATIC MIXED STUDIES REVIEW

Systematic mixed studies reviews involve the assimilation of quantitative, qualitative and mixed-methods studies (Pluye & Hong 2014:30). A synthesis of the findings of studies with diverse research designs may contribute to a more comprehensive understanding of a topic than a synthesis of the findings of either quantitative or qualitative studies alone (Pluye, Gagnon, Griffiths & Johnson-Lafleur. 2009:530; Pluye & Hong 2014:36). Furthermore, a rich, detailed and practical understanding of complex interventions can only be gained through a systematic mixed studies review (Pluye et al. 2009:532). This is considered to be an important development for evidence based health care as the wider range of evidence presented in a systematic mixed studies review will allow for better utilisation and greater applicability of that intervention (Joanna Briggs Institute [JBI] 2014:6).
A systematic mixed studies review was considered most appropriate as a foundation for this study as BMGIM therapy is explorative and descriptive in nature, yet its effect can also be quantitatively measured. Whilst quantitative studies yield the empirical data that facilitate measurement of the intervention’s effectiveness, qualitative studies give a voice to research participants (Pluye & Hong 2014:31). The latter is particularly appropriate in the context of a BMGIM study as patients are actively participating in the therapy and are addressing their health needs during each BMGIM session. It is therefore important to consider the human aspects of patients’ experiences and opinions along with statistical evidence.
A systematic review involves an intricate process of locating relevant studies, assessing their credibility, and integrating them with the findings of previous studies. Prior to commencement of any systematic review, a detailed plan or protocol should be developed which stipulates the question, objectives, concepts and methods underpinning the review (Littell et al. 2008:1).
The writing of the systematic mixed studies review for this study proceeded according to a series of standard steps. These included writing a review question, defining inclusion criteria, strategizing and undertaking an extensive search of multiple information sources, identifying potentially relevant studies, selecting relevant studies, appraising the quality of included studies, and synthesizing the findings of these studies (Pluye & Hong 2014:36). These steps will be discussed in detail in this chapter.

THE SYSTEMATIC REVIEW PROCESS

I developed a systematic review protocol to guide the process of the systematic review. The review team comprised of two reviewers who were involved in devising the search strategy, assessing the quality of articles found, and extracting data from relevant articles. I was the first reviewer; the second was an information specialist who is qualified and experienced in searching for and reviewing academic materials. The supervisor and co-supervisor of the study were on the advisory team for the systematic review. The advisory team also included experts in systematic reviews and the BMGIM, who were consulted at various points during the systematic review process. The development of the systematic review protocol and the systematic review process was guided by relevant literature (CRD 2009; JBI 2011; Littell et al. 2008; Pluye & Hong 2014).
The title of the systematic review was, ‘Bonny Method of Guided Imagery and Music (BMGIM) in caring for oncology patients: A Systematic Mixed Studies Review’. The objective, Participants, Intervention, Comparison and Outcome (PICO) / Participants, Phenomena of Interest and Context (PICo) formulation, review question, inclusion criteria, data extraction, quality assessment and data synthesis processes which were specified in the systematic review protocol will be defined and described in the following sections. The application of the specified process will also be discussed.

OBJECTIVE OF THE SYSTEMATIC REVIEW

The objective was to conduct a systematic review to compare the effectiveness of the BMGIM to that of other care methods with respect to the physical, psychological and spiritual wellbeing of oncology patients.

REVIEW QUESTION

A systematic review should be guided by clearly set questions, the answers to which will provide meaningful solutions as to whether the best evidence is available in order guide decision making (CRD 2009:6). In a systematic review, the PICO and PICo guide the development of the review question. PICO is a mnemonic for Participants, Intervention, Comparison and Outcome (CRD 2009:8). The following PICO was formulated for the systematic review:
Participants:   Adult oncology patients, male and female
Intervention:  Bonny Method of Guided Imagery and Music (BMGIM)
Comparison:    Methods of care other than the BMGIM
Outcome:   Physical wellbein
Psychological wellbeing
Spiritual wellbeing
Because this systematic review includes both quantitative and qualitative studies, it was necessary to formulate a PICo as well. PICo is a mnemonic for Participants, Phenomena of Interest and Context (JBI 2011:22) and is used to guide the formulation of a qualitative review question. The following PICo was formulated for this review:
Participants:  Adult cancer patients, male and female
Phenomena of Interest: Experiences of patients undergoing BMGIM
Context:  Oncology care
Based on the PICO/PICo formulated above, the following review questions emerged for the systematic review:

1. What are the effects of the BMGIM, compared to those of other cancer care methods, on the physical, psychological, and spiritual wellbeing of adult oncology patients?
2. What are the experiences of adult cancer patients receiving BMGIM?

Following the formulation of these questions, the search strategy was developed.

INCLUSION CRITERIA

The search strategy for a systematic review requires the formulation of specific inclusion criteria that will guide decisions regarding whether studies should be included in or excluded from the systematic review (Littell et al. 2008:35). These criteria are specified in the systematic review protocol. Study design, population, interventions, comparisons and outcome measures of published studies are just some of the aspects considered during the specification of inclusion criteria (Littell et al. 2008:35). In addition to guiding the search for relevant articles, inclusion criteria also prevent reviewers from selecting articles based on their own personal preferences or convenience, thus protecting against selection bias. Furthermore, the formulation of clear inclusion criteria allow for replication of the systematic review process (Littell et al. 2008:35).
The inclusion criteria for this review specified the population, intervention and comparison, outcomes measures, timeframe, language and study designs of the articles which could be included for review. These aspects are considered in more detail below.

Participants

According to Littell et al. (2008:36), participants are the individuals, families, organisations, communities or social groups who received a particular intervention treatment, or who were the sources of data collected in the primary studies included in the systematic review. The CRD (2009:8) further emphasise that the included population should be comparable with the population to which the systematic review findings will be applied. In the current systematic review, studies on participants who met the following criteria were included in the systematic review:
diagnosed with cancer;
aged 18 years or older (i.e. adult, male and female);
implementation of the BMGIM intervention took place in any health care setting (e.g. hospitals, clinics, rehabilitation centres, hospice care, outpatient care).
Following these criteria, six reports qualified for data extraction for the purposes of the systematic review. Though participants could have been male or female, it transpired that all selected reports had only female participants. With regards to health care setting, the reports selected for inclusion in this review documented interventions that took place in the private practice rooms of a therapist or in the home of the participant.

Intervention and comparison

According to Littell et al. (2008:37), the intervention of interest should be specified in the inclusion criteria for a systematic review. The comparison is the conditions or treatments that are compared to the treatment or intervention of interest (Littell et al. 2008:38). Reviewers use the descriptions of the intervention and comparison to guide the search for and selection of articles for the systematic review. To ensure that the reviewers had an understanding of the concepts involved, the intervention and comparison were defined and described in the systematic review protocol.
In this systematic review the intervention under review was the Bonny Method of Guided Imagery and Music (BMGIM) which, as already mentioned in Chapter 1, is “a music-assisted transformational therapy that offers participants an opportunity to integrate the mental, emotional, physical, and spiritual aspects of themselves. It is characterized by the use of specially sequenced western classical music designed to stimulate and sustain a dynamic unfolding of imagery experiences. Sessions in this one-to-one modality are conducted by facilitators who are formally trained in The BMGIM,’ (Association of Music and Imagery 2008:1). To qualify for inclusion in this systematic review, articles had to document the implementation of the BMGIM according to the standard procedure described in Chapter 1 of this dissertation.
Since this systematic review could have included quantitative, qualitative or mixed method studies, it was important to define the concept “comparison group” as studies with a quantitative methodology may have had a comparison group to which findings were compared. A comparison group is defined by Littell et al. (2008:174) as ‘a group that is compared with a treatment group and receives either another treatment or no treatment’. For the purposes of this review, studies that had comparison groups whereby standard care, music interventions or music therapy were offered to (oncology) patients were included. Furthermore, interventions that did not involve music (i.e. non-music interventions) as well as wait list control groups were also considered as valid comparison groups and could have been included in the systematic review. The following definitions of “standard care”, “wait list control group”, “music intervention” and “music therapy” guided the decisions of whether particular studies should be included in or excluded from the systematic review.
Standard care is also referred to as “usual care” (Kinser & Robins 2013:2). Harlapur and Shimbo (2013:2021) state that, ‘the definition of usual care has not been standardised, it can include [any] routine care received by patients for prevention and treatment of diseases’. Studies that had a comparison group which received standard care could also have been included in this systematic review.

DECLARATION 
DEDICATION 
ACKNOWLEDGEMENTS 
ABSTRACT 
CHAPTER 1 OVERVIEW OF THE STUDY
1.1 INTRODUCTION AND BACKGROUND
1.2 PROBLEM STATEMENT
1.3 SIGNIFICANCE OF THE STUDY
1.4 RESEARCH QUESTION
1.5 AIM AND OBJECTIVES
1.6 CONCEPT CLARIFICATION
1.6.1 Music therapy
1.6.2 Bonny Method of Guided Imagery and Music
1.6.3 Physical wellbeing
1.6.4 Psychological wellbeing
1.6.5 Spiritual wellbeing
1.6.6 Interim home
1.7 PHILOSOPHICAL ASSUMPTIONS
1.7.1 Ontological assumptions
1.7.2 Epistemological assumptions
1.7.3 Methodological assumptions
1.8 RESEACH DESIGN AND METHODS
1.8.1 Intervention research
1.8.2 Research process
1.9 QUALITY ASSURANCE
1.9.1 Measures to ensure validity and reliability
1.9.2 Measures to ensure trustworthiness
1.10 ETHICAL CONSIDERATIONS
1.10.1 Principle of beneficence
1.10.2 Principle of respect for human dignity
1.10.3 Principe of justice
1.11 ORGANISATION OF THE STUDY
1.12 CONCLUSION
CHAPTER 2 SYSTEMATIC REVIEW: DESIGN AND METHODS
2.1 INTRODUCTION
2.2 SYSTEMATIC MIXED STUDIES REVIEW
2.3 THE SYSTEMATIC REVIEW PROCESS
2.4 OBJECTIVE OF THE SYSTEMATIC REVIEW
2.5 REVIEW QUESTION
2.6 INCLUSION CRITERIA
2.7 STUDY SELECTION
2.8 DATA EXTRACTION
2.9 QUALITY ASSESSMENT
2.10 DATA SYNTHESIS
2.11 DOCUMENTATION OF SEARCH
2.12 BIAS
2.13 CONCLUSION
CHAPTER 3 SYSTEMATIC REVIEW: FINDINGS AND DISCUSSION
3.1 INTRODUCTION
3.2 DATA EXTRACTION AND QUALITY ASSESSMENT
3.3 DATA SYNTHESIS FINDINGS
3.4 SELF-REALIZATION
3.5 CHANGE IN MOOD
3.6 CHANGE IN QUALITY OF LIFE
3.7 PERCEPTION OF MUSIC
3.8 DISCUSSION
3.9 LIMITATIONS
3.10 CONCLUSION
CHAPTER 4 RESEARCH DESIGN AND METHODS OF THE EMPIRICAL STUDY
4.1 INTRODUCTION
4.2 INTERVENTION RESEARCH
4.3 THE INTERVENTION RESEARCH PROCESS
4.4 CONCLUSION
CHAPTER 5 QUANTITATIVE DOMAIN: FINDINGS AND DISCUSSION
5.1 INTRODUCTION
5.2 DESCRIPTION OF PARTICIPANTS
5.3 FINDINGS OF THE STUDY
5.4 CONCLUSION
CHAPTER 6 QUALITATIVE DOMAIN: FINDINGS
6.1 INTRODUCTION
6.2 OVERVIEW OF PARTICIPANTS
6.3 QUALITATIVE FINDINGS
6.4 THE ESSENCE OF THE FINDINGS
6.5 CONCLUSION
CHAPTER 7 QUALITATIVE DOMAIN: DISCUSSION OF FINDINGS
7.1 INTRODUCTION
7.2 DISCUSSION OF FINDINGS
7.3 THE ESSENCE OF THE FINDINGS
7.4 CONCLUSION
CHAPTER 8 CONCLUSIONS, RECOMMENDATIONS AND LIMITATIONS
8.1 INTRODUCTION
8.2 AIM AND OBJECTIVES OF THE STUDY
8.3 SUMMARY OF MAIN FINDINGS
8.4 ESSSENCE OF THE FINDINGS
8.5 RECOMMENDATIONS
8.6 CONTRIBUTION TO THE FIELD OF NURSING
8.7 LIMITATIONS
8.8 FINAL CONCLUSIONS
REFERENCES
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