title: The evaluation of complex interventions in palliative care: an exploration of the potential of case study research strategies.
abstract: BACKGROUND
  Complex, incrementally changing, context dependent and variable palliative care services are difficult to evaluate. Case study research strategies may have potential to contribute to evaluating such complex interventions, and to develop this field of evaluation research.
  
  
  OBJECTIVE
  This paper explores definitions of case study (as a unit of study, a process, and a product) and examines the features of case study research strategies which are thought to confer benefits for the evaluation of complex interventions in palliative care settings.
  
  
  RESULTS
  Ten features of case study that are thought to be beneficial in evaluating complex interventions in palliative care are discussed, drawing from exemplars of research in this field. Important features are related to a longitudinal approach, triangulation, purposive instance selection, comprehensive approach, multiple data sources, flexibility, concurrent data collection and analysis, search for proving-disproving evidence, pattern matching techniques and an engaging narrative. The limitations of case study approaches are discussed including the potential for subjectivity and their complex, time consuming and potentially expensive nature.
  
  
  CONCLUSIONS
  Case study research strategies have great potential in evaluating complex interventions in palliative care settings. Three key features need to be exploited to develop this field: case selection, longitudinal designs, and the use of rival hypotheses. In particular, case study should be used in situations where there is interplay and interdependency between the intervention and its context, such that it is difficult to define or find relevant comparisons.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK. catherine.walshe@manchester.ac.uk
authors.forename: Catherine
authors.initials: C
authors.lastname: Walshe
mesh_terms: D005069:Evaluation Studies as Topic; D006801:Humans; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D010166:Palliative Care / Q000379:methods*; D015397:Program Evaluation; D012107:Research Design