title: Mixed methods research in the development and evaluation of complex interventions in palliative and end-of-life care: report on the MORECare consensus exercise.
abstract: BACKGROUND
  Complex interventions are common in palliative and end-of-life care. Mixed methods approaches sit well within the multiphase model of complex intervention development and evaluation. Generic mixed methods guidance is useful but additional challenges in the research design and operationalization within palliative and end-of-life care may have an impact on the use of mixed methods.
  
  
  OBJECTIVE
  The objective of the study was to develop guidance on the best methods for combining quantitative and qualitative methods for health and social care intervention development and evaluation in palliative and end-of-life care.
  
  
  METHODS
  A one-day workshop was held where experts participated in facilitated groups using Transparent Expert Consultation to generate items for potential recommendations. Agreement and consensus were then sought on nine draft recommendations (DRs) in a follow-up exercise.
  
  
  RESULTS
  There was at least moderate agreement with most of the DRs, although consensus was low. Strongest agreement was with DR1 (usefulness of mixed methods to palliative and end-of-life care) and DR5 (importance of attention to respondent burden), and least agreement was with DR2 (use of theoretical perspectives) and DR6 (therapeutic effects of research interviews). Narrative comments enabled recommendation refinement. Two fully endorsed, five partially endorsed, and two refined DRs emerged. The relationship of these nine to six key challenges of palliative and end-of-life care research was analyzed.
  
  
  CONCLUSIONS
  There is a need for further discussion of these recommendations and their contribution to methodology. The recommendations should be considered when designing and operationalizing mixed methods studies of complex interventions in palliative care, and because they may have wider relevance, should be considered for other applications.
authors.affiliation: 1 Primary Care Unit, Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge , Cambridge, United Kingdom .
authors.forename: Morag
authors.initials: M
authors.lastname: Farquhar
authors.forename: Nancy
authors.initials: N
authors.lastname: Preston
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Evans
authors.forename: Gunn
authors.initials: G
authors.lastname: Grande
authors.forename: Vicky
authors.initials: V
authors.lastname: Short
authors.forename: Hamid
authors.initials: H
authors.lastname: Benalia
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Chris
authors.initials: C
authors.lastname: Todd
mesh_terms: D032921:Consensus; D004739:England; D005069:Evaluation Studies as Topic; D006801:Humans; D010166:Palliative Care; D012107:Research Design / Q000592:standards*; D013727:Terminal Care