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International Journal of Clinical Pharmacy

, Volume 38, Issue 3, pp 695–704 | Cite as

Meta-synthesis of qualitative research: the challenges and opportunities

  • Mohammed A. MohammedEmail author
  • Rebekah J. Moles
  • Timothy F. Chen
Research Article

Abstract

Synthesis of qualitative studies is an emerging area that has been gaining more interest as an important source of evidence for improving health care policy and practice. In the last decade there have been numerous attempts to develop methods of aggregating and synthesizing qualitative data. Although numerous empirical qualitative studies have been published about different aspects of health care research, to date, the aggregation and syntheses of these data has not been commonly reported, particularly in pharmacy practice related research. This paper describes different methods of conducting meta-synthesis and provides an overview of selected common methods. The paper also emphasizes the challenges and opportunities associated with conducting meta-synthesis and highlights the importance of meta-synthesis in informing practice, policy and research.

Keywords

Healthcare and pharmacy practice research Meta-synthesis Qualitative research Research methodology 

Notes

Funding

None.

Conflicts of interest

None.

References

  1. 1.
    Ring NRK, Mandava L, Jepson R. A guide to synthesising qualitative research for researchers undertaking health technology assessments and systematic reviews. 2011. http://www.nhshealthquality.org/nhsqis/8837.html.
  2. 2.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Soc Adm Pharm. 2005;1(4):546–64.CrossRefGoogle Scholar
  3. 3.
    Chui MA, Mott DA, Maxwell L. A qualitative assessment of a community pharmacy cognitive pharmaceutical services program, using a work system approach. Res Soc Adm Pharm. 2012;8(3):206–16.CrossRefGoogle Scholar
  4. 4.
    Joanna Briggs Institute Reviewers’ Manual: 2014 edition. Systematic review; protocol; effectiveness; qualitative; economic; and methods. http://joannabriggs.org/assets/docs/sumari/ReviewersManual-2014.pdf.
  5. 5.
    Carter SR, Moles R, White L, Chen TF. Exploring patients’ motivation to participate in Australia’s Home Medicines Review program. Int J Clin Pharm. 2012;34(4):658–66.CrossRefPubMedGoogle Scholar
  6. 6.
    Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009;9:59.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mays N, Pope C, Popay J. Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy. 2005;10(Suppl 1):6–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Atkins S, Lewin S, Smith H, Engel M, Fretheim A, Volmink J. Conducting a meta-ethnography of qualitative literature: lessons learnt. BMC Med Res Methodol. 2008;8:21.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ring N, Jepson R, Ritchie K. Methods of synthesizing qualitative research studies for health technology assessment. Int J Technol Assess Health Care. 2011;27(4):384–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, et al. Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Sci Med. 2003;56(4):671–84.CrossRefGoogle Scholar
  11. 11.
    Sandelowski M, Docherty S, Emden C. Focus on qualitative methods. Qualitative metasynthesis: issues and techniques. Res Nurs Health. 1997;20(4):365–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Walsh D, Downe S. Meta-synthesis method for qualitative research: a literature review. J Adv Nurs. 2005;50(2):204–11.CrossRefPubMedGoogle Scholar
  13. 13.
    Britten N, Campbell R, Pope C, Donovan J, Morgan M, Pill R. Using meta ethnography to synthesise qualitative research: a worked example. J Health Serv Res Policy. 2002;7(4):209–15.CrossRefPubMedGoogle Scholar
  14. 14.
    Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol. 2006;6:35.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, et al. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005;61(1):133–55.CrossRefPubMedGoogle Scholar
  16. 16.
    Smith LK, Pope C, Botha JL. Patients’ help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet. 2005;366(9488):825–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Flemming K. The use of morphine to treat cancer-related pain: a synthesis of quantitative and qualitative research. J Pain Symptom Manag. 2010;39(1):139–54.CrossRefGoogle Scholar
  18. 18.
    McInnes RJ, Chambers JA. Supporting breastfeeding mothers: qualitative synthesis. J Adv Nurs. 2008;62(4):407–27.CrossRefPubMedGoogle Scholar
  19. 19.
    Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J. Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS Med. 2007;4(7):e238.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Burgess SV, Mabasa VH, Chow I, Ensom MH. Evaluating outcomes of alternative dosing strategies for cefepime: a qualitative systematic review. Ann Pharmacother. 2015;49(3):311–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Rashid MA, Edwards D, Walter FM, Mant J. Medication taking in coronary artery disease: a systematic review and qualitative synthesis. Ann Fam Med. 2014;12(3):224–32.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Dohnhammar U, Reeve J, Walley T. Patients’ expectations of medicines—a review and qualitative synthesis. Health Expect. 2016;19(2):179–93.CrossRefPubMedGoogle Scholar
  23. 23.
    Tong A, Morton R, Howard K, Craig JC. Adolescent experiences following organ transplantation: a systematic review of qualitative studies. J Pediatr. 2009;155(4):542–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Boyce MB, Browne JP, Greenhalgh J. The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual Saf. 2014;23(6):508–18.CrossRefPubMedGoogle Scholar
  25. 25.
    Mhatre SK, Sansgiry SS. Development of a conceptual model of health-related quality of life among hepatitis C patients: a systematic review of qualitative studies. Hepatol Res. 2016;46(1):29–39.CrossRefPubMedGoogle Scholar
  26. 26.
    Marcilly R, Ammenwerth E, Vasseur F, Roehrer E, Beuscart-Zéphir M-C. Usability flaws of medication-related alerting functions: a systematic qualitative review. J Biomed Inform. 2015;55:260–71.CrossRefPubMedGoogle Scholar
  27. 27.
    Kelly M, McCarthy S, Sahm LJ. Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: a review of qualitative literature. Eur J Clin Pharmacol. 2014;70(12):1423–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of qualitative research on the contributory factors leading to medicine-related problems from the perspectives of adult patients with cardiovascular diseases and diabetes mellitus. BMJ Open. 2014;4(9):e005992.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hughes-Morley A, Young B, Waheed W, Small N, Bower P. Factors affecting recruitment into depression trials: systematic review, meta-synthesis and conceptual framework. J Affect Disord. 2014;172c:274–90.Google Scholar
  30. 30.
    Anderzen-Carlsson A, Lamy ZC, Tingvall M, Eriksson M. Parental experiences of providing skin-to-skin care to their newborn infant—Part 2: A qualitative meta-synthesis. Int J Qual Stud Health Well-Being. 2014;9:24907.PubMedGoogle Scholar
  31. 31.
    Darvishpour A, Joolaee S, Cheraghi MA. A meta-synthesis study of literature review and systematic review published in nurse prescribing. Med J Islam Repub Iran. 2014;28:77.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Petriwskyj A, Gibson A, Parker D, Banks S, Andrews S, Robinson A. A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care. Int J Evid Based Healthcare. 2014;12(2):87–104.CrossRefGoogle Scholar
  33. 33.
    Cullinan S, O’Mahony D, Fleming A, Byrne S. A meta-synthesis of potentially inappropriate prescribing in older patients. Drugs Aging. 2014;31(8):631–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Laging B, Ford R, Bauer M, Nay R. A meta-synthesis of factors influencing nursing home staff decisions to transfer residents to hospital. J Adv Nurs. 2015;71(10):2224–36.CrossRefPubMedGoogle Scholar
  35. 35.
    Fleming A, Bradley C, Cullinan S, Byrne S. Antibiotic prescribing in long-term care facilities: a meta-synthesis of qualitative research. Drugs Aging. 2015;32(4):295–303.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Staneva AA, Bogossian F, Wittkowski A. The experience of psychological distress, depression, and anxiety during pregnancy: a meta-synthesis of qualitative research. Midwifery. 2015;31(6):563–73.CrossRefPubMedGoogle Scholar
  37. 37.
    Astin F, Horrocks J, Closs SJ. Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples’ experiences. BMC Cardiovasc Disord. 2014;14:96.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Santer M, Ring N, Yardley L, Geraghty AW, Wyke S. Treatment non-adherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers’ views. BMC Pediatr. 2014;14:63.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Smith M, Aguirre RTP. Reproductive attitudes and behaviors in people with sickle cell disease or sickle cell trait: a qualitative interpretive meta-synthesis. Soc Work Health Care. 2012;51(9):757–79.CrossRefPubMedGoogle Scholar
  40. 40.
    Franco MR, Tong A, Howard K, Sherrington C, Ferreira PH, Pinto RZ, et al. Older people’s perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature. Br J Sports Med. 2015;49(19):1268–76.CrossRefPubMedGoogle Scholar
  41. 41.
    Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Blacklock C, Ward AM, Heneghan C, Thompson M. Exploring the migration decisions of health workers and trainees from Africa: a meta-ethnographic synthesis. Soc Sci Med. 1982;2014(100):99–106.Google Scholar
  43. 43.
    Errasti-Ibarrondo B, Perez M, Carrasco JM, Lama M, Zaragoza A, Arantzamendi M. Essential elements of the relationship between the nurse and the person with advanced and terminal cancer: a meta-ethnography. Nurs Outlook. 2015;63(3):255–68.CrossRefPubMedGoogle Scholar
  44. 44.
    Selamat MH, Loh SY, Mackenzie L, Vardy J. Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications. PLoS ONE. 2014;9(9):e108002.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Smith TO, Purdy R, Lister S, Salter C, Fleetcroft R, Conaghan PG. Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography. Rheumatol Int. 2014;34(3):299–313.CrossRefPubMedGoogle Scholar
  46. 46.
    Gould GS, Munn J, Watters T, McEwen A, Clough AR. Knowledge and views about maternal tobacco smoking and barriers for cessation in Aboriginal and Torres Strait Islanders: a systematic review and meta-ethnography. Nicotine Tob Res. 2013;15(5):863–74.CrossRefPubMedGoogle Scholar
  47. 47.
    Tonkin-Crine S, Yardley L, Little P. Antibiotic prescribing for acute respiratory tract infections in primary care: a systematic review and meta-ethnography. J Antimicrob Chemother. 2011;66(10):2215–23.CrossRefPubMedGoogle Scholar
  48. 48.
    Franzel B, Schwiegershausen M, Heusser P, Berger B. Individualised medicine from the perspectives of patients using complementary therapies: a meta-ethnography approach. BMC Complement Altern Med. 2013;13:124.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Sandelowski M, Barroso J. Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women. Res Nurs Health. 2003;26(2):153–70.CrossRefPubMedGoogle Scholar
  50. 50.
    Hannes K, Macaitis K. A move to more systematic and transparent approaches in qualitative evidence synthesis: update on a review of published papers. Qual Res. 2012;12(4):402–42.CrossRefGoogle Scholar
  51. 51.
    Noblit GW, Hare RW. Meta-ethnography: synthesizing qualitative studies. Qualitative research method. London: Sage; 1988.Google Scholar
  52. 52.
    Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Arai L, Britten N, Popay J, Roberts H, Petticrew M, Rodgers M, et al. Testing methodological developments in the conduct of narrative synthesis: a demonstration review of research on the implementation of smoke alarm interventions. Evid Policy J Res Debate Pract. 2007;3(3):361–83.CrossRefGoogle Scholar
  54. 54.
    Kearney MH. Enduring love: a grounded formal theory of women’s experience of domestic violence. Res Nurs Health. 2001;24(4):270–82.CrossRefPubMedGoogle Scholar
  55. 55.
    Eaves YD. A synthesis technique for grounded theory data analysis. J Adv Nurs. 2001;35(5):654–63.CrossRefPubMedGoogle Scholar
  56. 56.
    Dixon-Woods M, Booth A, Sutton AJ. Synthesizing qualitative research: a review of published reports. Qual Res. 2007;7(3):375–422.CrossRefGoogle Scholar
  57. 57.
    Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45–53.CrossRefPubMedGoogle Scholar
  58. 58.
    Teasdale E, Santer M, Geraghty AW, Little P, Yardley L. Public perceptions of non-pharmaceutical interventions for reducing transmission of respiratory infection: systematic review and synthesis of qualitative studies. BMC Public Health. 2014;14:589.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Gately C, Rogers A, Kirk S, McNally R. Integration of devices into long-term condition management: a synthesis of qualitative studies. Chronic Illn. 2008;4(2):135–48.CrossRefPubMedGoogle Scholar
  60. 60.
    Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, et al. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord. 2014;15:50.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Mohammed MA, Moles RJ, Chen TF. Medication-related burden and patients’ lived experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open. 2016;6(2):e010035.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Child S, Goodwin V, Garside R, Jones-Hughes T, Boddy K, Stein K. Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies. Implement Sci. 2012;7:91.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Jensen LA, Allen MN. A synthesis of qualitative research on wellness–illness. Qual Health Res. 1994;4(4):349–69.CrossRefGoogle Scholar
  64. 64.
    Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, et al. Patients’ experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review. Br J Gen Pract. 2013;63(617):e829–41.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Dixon-Woods M, Shaw RL, Agarwal S, Smith JA. The problem of appraising qualitative research. Qual Saf Health Care. 2004;13(3):223–5.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Prorok JC, Horgan S, Seitz DP. Health care experiences of people with dementia and their caregivers: a meta-ethnographic analysis of qualitative studies. Can Med Assoc J. 2013;185(14):E669–80.CrossRefGoogle Scholar
  67. 67.
    Russell CK, Bunting SM, Gregory DM. Protective care-receiving: the active role of care-recipients. J Adv Nurs. 1997;25(3):532–40.CrossRefPubMedGoogle Scholar
  68. 68.
    Varcoe C, Rodney P, McCormick J. Health care relationships in context: an analysis of three ethnographies. Qual Health Res. 2003;13(7):957–73.CrossRefPubMedGoogle Scholar
  69. 69.
    Campbell R, Pound P, Morgan M, Daker-White G, Britten N, Pill R, et al. Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research. Health Technol Assess. 2011;15(43):1–164.CrossRefPubMedGoogle Scholar
  70. 70.
    Daker-White G, Donovan J, Campbell R. Redefined by illness: meta-ethnography of qualitative studies on the experience of rheumatoid arthritis. Disabil Rehabil. 2014;36(13):1061–71.CrossRefPubMedGoogle Scholar
  71. 71.
    Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12:181.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Barbour RS, Barbour M. Evaluating and synthesizing qualitative research: the need to develop a distinctive approach. J Eval Clin Pract. 2003;9(2):179–86.CrossRefPubMedGoogle Scholar
  73. 73.
    Wong SS, Wilczynski NL, Haynes RB. Developing optimal search strategies for detecting clinically relevant qualitative studies in MEDLINE. Studies Health Technol Inform. 2004;107(Pt 1):311–6.Google Scholar
  74. 74.
    Barroso J, Gollop CJ, Sandelowski M, Meynell J, Pearce PF, Collins LJ. The challenges of searching for and retrieving qualitative studies. West J Nurs Res. 2003;25(2):153–78.CrossRefPubMedGoogle Scholar
  75. 75.
    Walters LA, Wilczynski NL, Haynes RB. Developing optimal search strategies for retrieving clinically relevant qualitative studies in EMBASE. Qual Health Res. 2006;16(1):162–8.CrossRefPubMedGoogle Scholar
  76. 76.
    Flemming K, Briggs M. Electronic searching to locate qualitative research: evaluation of three strategies. J Adv Nurs. 2007;57(1):95–100.CrossRefPubMedGoogle Scholar
  77. 77.
    Shaw RL, Booth A, Sutton AJ, Miller T, Smith JA, Young B, et al. Finding qualitative research: an evaluation of search strategies. BMC Med Res Methodol. 2004;4:5.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Estabrooks CA, Field PA, Morse JM. Aggregating qualitative findings: an approach to theory development. Qual Health Res. 1994;4(4):503–11.CrossRefGoogle Scholar
  79. 79.
    Jensen LA, Allen MN. Meta-synthesis of qualitative findings. Qual Health Res. 1996;6(4):553–60.CrossRefGoogle Scholar
  80. 80.
    LA Moher D, Tetzlaff J, Altman D, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Sinnott C, Mc Hugh S, Browne J, Bradley C. GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open. 2013;3(9):e003610.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Whalley Hammell K. Experience of rehabilitation following spinal cord injury: a meta-synthesis of qualitative findings. Spinal Cord. 2007;45(4):260–74.PubMedGoogle Scholar
  83. 83.
    Vanstone M, Rewegan A, Brundisini F, Dejean D, Giacomini M. Patient perspectives on quality of life with uncontrolled type 1 diabetes mellitus: a systematic review and qualitative meta-synthesis. Ont Health Technol Assess Ser. 2015;15(17):1–29.PubMedPubMedCentralGoogle Scholar
  84. 84.
    Disler RT, Green A, Luckett T, Newton PJ, Inglis S, Currow DC, et al. Experience of advanced chronic obstructive pulmonary disease: metasynthesis of qualitative research. J Pain Symptom Manag. 2014;48(6):1182–99.CrossRefGoogle Scholar
  85. 85.
    Knowles SE, Toms G, Sanders C, Bee P, Lovell K, Rennick-Egglestone S, et al. Qualitative meta-synthesis of user experience of computerised therapy for depression and anxiety. PLoS ONE. 2014;9(1):e84323.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Bergs J, Lambrechts F, Simons P, Vlayen A, Marneffe W, Hellings J, et al. Barriers and facilitators related to the implementation of surgical safety checklists: a systematic review of the qualitative evidence. BMJ Qual Saf. 2015;24(12):776–86.CrossRefPubMedGoogle Scholar
  87. 87.
    Norhayati MN, Surianti S, Nik Hazlina NH. Metasynthesis: experiences of women with severe maternal morbidity and their perception of the quality of health care. PLoS ONE. 2015;10(7):e0130452.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Tong A, Chapman JR, Kee T, Li PK, Tsai DF, Wong G, et al. Perspectives of transplant professionals on the values, ethics, and challenges of living kidney donor evaluation in Asia. Transplantation. 2015;99(7):1386–95.CrossRefPubMedGoogle Scholar
  89. 89.
    Butler AE, Hall H, Willetts G, Copnell B. Family experience and PICU death: a meta-synthesis. Pediatrics. 2015;136(4):e961–73.CrossRefPubMedGoogle Scholar
  90. 90.
    Shoemaker SJ, Ramalho de Oliveira D. Understanding the meaning of medications for patients: the medication experience. Pharm World Sci. 2008;30(1):86–91.CrossRefPubMedGoogle Scholar
  91. 91.
    Waibel S, Henao D, Aller MB, Vargas I, Vazquez ML. What do we know about patients’ perceptions of continuity of care? A meta-synthesis of qualitative studies. Int J Qual Health Care. 2012;24(1):39–48.CrossRefPubMedGoogle Scholar
  92. 92.
    Daker-White G, Hays R, McSharry J, Giles S, Cheraghi-Sohi S, Rhodes P, et al. Blame the patient, blame the doctor or blame the system? A meta-synthesis of qualitative studies of patient safety in primary care. PLoS ONE. 2015;10(8):e0128329.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Orri M, Farges O, Clavien PA, Barkun J, Revah-Levy A. Being a surgeon—the myth and the reality: a meta-synthesis of surgeons’ perspectives about factors affecting their practice and well-being. Ann Surg. 2014;260(5):721–8 (discussion 8-9).CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Mohammed A. Mohammed
    • 1
    Email author
  • Rebekah J. Moles
    • 1
  • Timothy F. Chen
    • 1
  1. 1.Faculty of PharmacyThe University of SydneySydneyAustralia

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