title: The use of Grounded theory in palliative care: methodological challenges and strategies.
abstract: BACKGROUND
  The need for research methods that are suited to evaluate important issues and phenomena in palliative care has established different qualitative research approaches during the last years. This article describes the use and adaptation of a qualitative research methodology in a palliative care setting.
  
  
  CONCLUSIONS
  The wish for hastened death of terminally ill patients is an important end-of-life issue. Proponents of palliative care have argued that good palliative care would prevent the wish for hastened death. However, this wish is stated by a few patients receiving palliative care, raising a challenging dilemma for patients, relatives and caregivers involved. In order to investigate the motivations of the patients asking for hastened death, we conducted a qualitative study using Grounded theory (GT). This article aims to illustrate the use of a flexible, less burdening qualitative research method and the adaptation of the research process of GT in a palliative care research setting. This is based on experiences and illustrated by examples from the qualitative study on the wish for hastened death in patients receiving palliative care.
  
  
  CONCLUSIONS
  GT allowed a systematic understanding of patients' experiences and attitudes and careful in-depth exploration of this vulnerable population. Conducting a GT study needs high staff resources, a great catchment area for participant recruitment and realistic inclusion and exclusion criteria to allow for theoretical sampling. The use of GT should be facilitated by an experienced researcher familiar with this method because of high methodological requirements and rather complex analysis procedures.
authors.affiliation: Department of Palliative Medicine, RWTH Aachen University, Aachen, Germany. sstiel@ukaachen.de
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stiel
authors.forename: Martina
authors.initials: M
authors.lastname: Pestinger
authors.forename: Albine
authors.initials: A
authors.lastname: Moser
authors.forename: Guy
authors.initials: G
authors.lastname: Widdershoven
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lüke
authors.forename: Guido
authors.initials: G
authors.lastname: Meyer
authors.forename: Raymond
authors.initials: R
authors.lastname: Voltz
authors.forename: Friedemann
authors.initials: F
authors.lastname: Nauck
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
mesh_terms: D001293:Attitude to Death; D001294:Attitude to Health; D003625:Data Collection / Q000379:methods; D003627:Data Interpretation, Statistical; D005240:Feasibility Studies; D005858:Germany; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008962:Models, Theoretical; D009042:Motivation; D010166:Palliative Care / Q000523:psychology; D018579:Patient Selection / Q000941:ethics; D036301:Qualitative Research; D012107:Research Design; D035842:Research Subjects / Q000523:psychology / Q000600:supply & distribution; D012962:Sociology, Medical; D035862:Vulnerable Populations / Q000523:psychology