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Egenis · People

Ms. Mila Petrova

Egenis Research Student

Telephone

01392 725140

Fax

01392 724676

Email

mp320@exeter.ac.uk

Room

FF10

Building

Byrne House

Biography

My PhD project is entitled '. I aim to describe philosophically the units of information used in research synthesis and the fundamental processes at play in such studies. I suggest that our current synthesis methods and conceptualisation of these are dysfunctionally ‘locked’ by history, unexamined assumptions, and the invisibility of the repetitive and automatic. These need to be challenged so that the rigour and variety of synthesis methods can be improved.

The field of research synthesis is unfamiliar to the philosophy of science and the other meta-scientific fields (e.g. sociology, history, psychology of science). The approach I am taking has some unusual components as a result. For instance, I used ideas from the philosophy of science, sociology of science and general psychology to develop a framework for analysing empirical papers on the health of humans. The framework contains over 200 parameters. I apply it in a case study of 30 recent research papers on cancer.

I use the case study to explore:

- what of the information in an empirical health-of-humans research paper is reusable - this will suggest what types of synthesis studies can be developed;

- what ‘holds’ findings in their original contexts - this will suggest how far we can go in decontextualising findings and what meta-information needs to accompany them when ‘taken out’ if rigour is to be ensured;

- what processes are under way during data extraction - both mental and practical processes of manipulating and often transforming information. This will give us a more accurate appreciation of the overall reliability and validity of research synthesis studies and suggest ways of enhancing these.

Expolring research synthesis critically is important as such studies are the primary formal way through which research affects clinical practice and health policy. Each of us benefits or suffers from the consequences of research synthesis in the healthcare we receive. For instance, every guidance of the UK National Institute for Health and Clinical Excellence is based on systematic reviews, the exemplar health research synthesis method. The academic impact of research synthesis, in terms of the structure and priorities of health research, is also enormous.

Before starting my PhD I was a research fellow at the Health Sciences Research Institute of Warwick Medical School, the University of Warwick (I continue to be an associate fellow there). I worked in applied primary care research and methodological research concerning a new approach to clinical practice - Values-Based Practice.

My work on the Values Project involved developing search strategies for identifying publications on health-related values in electronic databases. Values was understood very broadly, to also include issues such as patients’ and other stakeholders’ perceptions, preferences, beliefs, experiences, satisfaction, quality of life, etc. My other projects were in palliative care for cancer patients (evaluation of the Gold Standards Framework rollout in England and Northern Ireland, in over 1300 general practices); on the emerging role of health care assistants in general practice; and in international health policy (on the philosophy and changes in the organisation of general practice across Europe, Bulgaria case study).

My background is in Psychology (BA in Psychology; MA in Clinical and Counselling Psychology; MA in Work and Organisational Psychology – Sofia University “Sv. Kliment Ohridski”, Bulgaria; 1996-2001), Philosophy and Ethics of Mental Health (Chevening scholar - The University of Warwick; 2002-2003) and English Language and Literature (minor - Sofia University; 1998-2001).

Publications

Petrova, M, Sutcliffe, P. Fulford, K.W.M. and Dale, J., VaST (Values Search Tools): A manual for searching electronic databases for publications on health-related values, version 3, March 2012. Petrova M, Sutcliffe P, Fulford KWM, Dale J. ‘Search terms and a validated brief search filter to retrieve publications on health-related values in MEDLINE: a word frequency analysis study’, Journal of the American Medical Informatics Association, 2012; 19(3): 479-488.

Vail L, Bosley S, Petrova M, Dale J. 'Health care assistants in general practice: a qualitative study of their experiences'. Primary Health Care Research & Development, 2010; 12(1): 29-41. doi:10.1017/S1463423610000204´╗┐

Petrova M, Vail L, Bosley S, Dale J. ‘Benefits and challenges of employing health care assistants in general practice: A qualitative study of GPs’ and practice nurses’ perspectives’. Family Practice, 2010; 27(3): 303-311. http://fampra.oxfordjournals.org/content/27/3/303.abstract´╗┐

Petrova M, Dale J, Munday D, Koistinen J, Agarwal S and Lall R. (2009) ‘The role and impact of facilitators in primary care: findings from the implementation of the Gold Standards Framework for palliative care’. Family Practice, 2010; 27 (1): 38-47. http://fampra.oxfordjournals.org/content/27/1/38.abstract

Munday D, Petrova M, Dale J. ‘Exploring preferences for place of death with terminally ill patients: a qualitative study of the experiences of GPs and community nurses’. British Medical Journal, 2009, 339:b2391

Dale J, Petrova M, Munday D, Koistinen-Harris J, Lall R, Thomas K. 'A national facilitation project to improve primary palliative care: the impact of the Gold Standards Framework on process and self-ratings of quality'. Quality and Safety in Health Care, 2009; 18 (3): 174-180

Petrova M, Dale J, Fulford KWM. 'Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence’. British Journal of General Practice, 2006; 56 (530): 703-709

In preparation

Research synthesis studies in the philosophy of science and philosophy of medicine

Presentations

'(How) Can Philosophical Debates on Variety of Evidence in Medicine Benefit Health Research Synthesis Studies?' at Philosophy of Medicine Roundtable, San Sebastian, 2-3 Nov 2011.'New and Emerging Synthesis Methods: In need of more attention?' – poster presentation at 19th Cochrane Colloquium, Madrid, 19-22 Oct 2011. 'Word frequency analysis of over a million words to support the development of search strategies on health-related values' – poster presentation at 19th Cochrane Colloquium, Madrid, 19-22 Oct 2011.

'Searching for pain – in keywords, in between the mental and the physical, and in recent psychological research' (contribution to a joint paper with Petar Petrov and Prof. Boycho Boychev) at 6th International Linguistics Conference, Medical University of Varna, Bulgaria, 7-8 Oct 2011.

'One Empirical Study, Three Tests of Translation, Many Questions on Biomedical Ontologies: Limited Contribution of MeSH Terms to Effective Literature Searches on Health-Related Values’ at the Doctoral and Postdoctoral Consortium, International Conference on Biomedical Ontology, University of Buffalo, USA, July 26-30 2011. http://ceur-ws.org/Vol-833/ (No 85)

'Mixed methods research and research synthesis on the philosophical-theoretical terrain' at 7th Mixed Methods International Conference, Leeds, 29 June - 2 July 2011.

Research Interests

I am in my third year as a PhD student. My dissertation takes a philosophy and sociology of science perspective towards “research synthesis” methods in the health sciences. These are a broad range of methods involving the identification of relevant primary studies through highly systematic literature searches and the integration of relevant findings into various combinations of a literature review and more ‘synthetic’ outcomes (e.g. summary statistics, middle-range theories, practice recommendations, etc.). Clinical care and health policy decisions claiming to be evidence-based typically draw on such integrated knowledge. In our interactions with the health system we are constantly stepping on the stones or in the muddy waters of research synthesis efforts.

In my work, I suggest that current synthesis methods and the directions in which novel ones are being developed are ‘locked’: 1) in history – of early successful examplars and the set of theoretical problems, concerns and solutions associated with them; 2) in form and media – in unchallenged vocabulary, rhetoric and reporting practices and in outdated technological capacities; and 3) in the invisibility of the repetitive, automatic and unavoidable. The practices and debates around research synthesis are solidifying so quickly and effectively that it will soon become impossible to see all the many paths not taken.

I am trying to examine if we could do at least some things in the field in radically different and more varied ways, with a view to substantially enhancing methodological rigour and exploratory creativity. The approach I am taking is in itself, by being an unusual combination of starting points and methods, a meta-comment on synthesis studies. Its main components are the use of ideas and patterns of analysis from the meta-scientific fields (primarily philosophy and sociology of science, and to a lesser extent psychology and history of science); ‘extreme analysis’ of publications in a way that is considered impossible in current synthesis work; and a certain randomness and breadth of selection in a field that is very careful in setting up delimiting criteria and strict selection mechanisms very early in the synthesis processes.

The context in which the above issues are examined is cancer. I analyse 30 recent publications on various types of cancer coming primarily from the behavioural and social sciences.