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World’s #1 Research Paper Generator

Over 5,000 research papers generated daily

Have an AI Research and write your Paper in just 5 words

See it for yourself: get your free research paper started with just 5 words, how smodin makes research paper writing easy, instantly find sources for any sentence.

Our AI research tool in the research paper editor interface makes it easy to find a source or fact check any piece of text on the web. It will find you the most relevant or related piece of information and the source it came from. You can quickly add that reference to your document references with just a click of a button. We also provide other modes for research such as “find support statistics”, “find supporting arguments”, “find useful information”, and other research methods to make finding the information you need a breeze. Make research paper writing and research easy with our AI research assistant.

Easily Cite References

Our research paper generator makes citing references in MLA and APA styles for web sources and references an easy task. The research paper writer works by first identifying the primary elements in each source, such as the author, title, publication date, and URL, and then organizing them in the correct format required by the chosen citation style. This ensures that the references are accurate, complete, and consistent. The product provides helpful tools to generate citations and bibliographies in the appropriate style, making it easier for you to document your sources and avoid plagiarism. Whether you’re a student or a professional writer, our research paper generator saves you time and effort in the citation process, allowing you to focus on the content of your work.

Free AI Research Paper Generator & Writer - Say Goodbye to Writer's Block!

Are you struggling with writer's block? Even more so when it comes to your research papers. Do you want to write a paper that excels, but can't seem to find the inspiration to do so? Say goodbye to writer's block with Smodin’s Free AI Research Paper Generator & Writer!

Smodin’s AI-powered tool generates high-quality research papers by analyzing millions of papers and using advanced algorithms to create unique content. All you need to do is input your topic, and Smodin’s Research Paper generator will provide you with a well-written paper in no time.

Why Use Smodin Free AI Research Paper Generator & Writer?

Writing a research paper can be a complicated task, even more so when you have limited time and resources. A research paper generator can help you streamline the process, by quickly finding and organizing relevant sources. With Smodin's research paper generator, you can produce high-quality papers in minutes, giving you more time to focus on analysis and writing

Benefits of Smodin’s Free Research Paper Generator

• Save Time: Smodin AI-powered generator saves you time by providing you with a well-written paper that you can edit and submit.
• Quality Content: Smodin uses advanced algorithms to analyze millions of papers to ensure that the content is of the highest quality.
• Easy to Use: Smodin is easy to use, even if you're not familiar with the topic. It is perfect for students, researchers, and professionals who want to create high-quality content.

How to Write a Research Paper?

All you need is an abstract or a title, and Smodin’s AI-powered software will quickly find sources for any topic or subject you need. With Smodin, you can easily produce multiple sections, including the introduction, discussion, and conclusion, saving you valuable time and effort.

Who can write a Research Paper?

Everyone can! Smodin's research paper generator is perfect for students, researchers, and anyone else who needs to produce high-quality research papers quickly and efficiently. Whether you're struggling with writer's block or simply don't have the time to conduct extensive research, Smodin can help you achieve your goals.

Tips for Using Smodin's Research Paper Generator

With our user-friendly interface and advanced AI algorithms, you can trust Smodin's paper writer to deliver accurate and reliable results every time. While Smodin's research paper generator is designed to be easy to use, there are a few tips you can follow to get the most out of Smodinl. First, be sure to input a clear and concise abstract or title to ensure accurate results. Second, review and edit the generated paper to ensure it meets your specific requirements and style. And finally, use the generated paper as a starting point for your research and writing, or to continue generating text.

The Future of Research Paper Writing

As technology continues to advance, the future of research paper writing is likely to become increasingly automated. With tools like Smodin's research paper generator, researchers and students can save time and effort while producing high-quality work. Whether you're looking to streamline your research process or simply need a starting point for your next paper, Smodin's paper generator is a valuable resource for anyone interested in academic writing.

So why wait? Try Smodin's free AI research paper generator and paper writer today and experience the power of cutting-edge technology for yourself. With Smodin, you can produce high-quality research papers in minutes, saving you time and effort while ensuring your work is of the highest caliber.

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AI Research Paper Generator

Transform your research journey with groundbreaking ai technology, effortlessly crafting academic papers that meet professional standards..

Streamlining Your Academic Writing Process Using EssayGPT

EssayGPT's AI research paper generator simplifies the process of crafting well-structured, comprehensive research papers. Here is how to do it in simple steps:

• 1. Get started by entering the central theme of your research in the 'Essay Topic' box.
• 2. Add up to five specific keywords related to your research topic to create relevant and focused content.
• 3. Enter your desired format including APA, MLA, or Harvard for accurate citation and formatting.
• 4. Use the 'Outline Suggestions' and 'Essay Title' boxes to tailor the structure and title to your specific needs.
• 5. Pick your target audience, tone of voice, and language. Then, hit the 'Generate' button to create your paper.

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Create undetectable, plagiarism-free essays with accurate citations

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Choosing EssayGPT's AI Research Paper Generator: A Cut Above the Rest

When it comes to crafting a research paper, the choice of tools can be a game-changer. With cutting-edge features, EssayGPT's AI research paper generator stands out as a superior choice for researchers seeking an efficient, versatile, and high-quality AI research paper writer.

This AI research paper generator from EssayGPT distinguishes itself from other AI writers for numerous compelling reasons such as:

Advanced AI Capabilities: At the heart of EssayGPT's AI research paper generator lies the integration of both GPT-3.5 and GPT-4 technologies. This dual AI power ensures not only advanced capabilities in generating research content but also guarantees versatility and depth in analysis, making it an unparalleled AI paper writer.

Full Customizability: Unlike standard research paper writers, EssayGPT's AI research paper generator provides complete control over the creation process. Whether it's adjusting the style, format, or specific content requirements, EssayGPT's AI research paper generator caters to all your unique academic needs.

Professional Citations and Reference Format: Catering to diverse academic standards, EssayGPT's AI paper generator offers a variety of professional paper reference formats. From APA to MLA or custom formats, the tool ensures your research paper meets the highest academic criteria.

Multi-Language Support: Breaking language barriers, EssayGPT's research paper writer extends its support to over 30 languages. This feature not only broadens the tool's accessibility but also makes it an invaluable asset for international research communities.

Advanced Context-Aware Technology: Understanding the importance of context in academic writing, EssayGPT's AI research paper generator employs advanced context-aware technology. This ensures that each paper generated is not only relevant but also resonates with the intended research topic, making it more than just an ordinary AI paper generator.

How Can You Benefit From EssayGPT's AI Research Paper Generator?

Embrace the future of research with EssayGPT's AI research paper generator. This tool is not just an advanced AI paper writer; it's a revolution in academic writing. Designed to cater to a diverse range of research needs, it offers an unparalleled blend of efficiency, customization, and quality, ensuring your research stands out.

Let's explore how it can significantly benefit users in the academic and professional fields:

Innovative Idea Cultivation: The AI research paper generator serves as a springboard for your research ideas. It helps conceptualize diverse topics, offering unique perspectives and thought-provoking angles, essential for groundbreaking research papers.

Time-Saving and Cost-Effective Solution: Reduce the hours spent on research and writing significantly. This free tool streamlines the writing process, allowing more focus on analysis and less on structuring, making efficient use of your valuable time and resources.

Simplifying the Writing Journey: Experience a transformed writing process with our AI paper writer. From outlining to drafting, the tool organizes and structures your thoughts, turning complex ideas into well-articulated research papers with ease.

Educational Enhancement: Beyond just generating papers, the AI research paper generator is a learning tool. It exposes users to varied writing styles and structures, enhancing their understanding of academic writing norms and encouraging skill development in research methodology.

EssayGPT AI Research Paper Generator’s Innovations in AI Paper Writing

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Research paper summarizer, ai essay writer, essay checker, chatgpt essay writer, essay extender, essay introduction generator, essay paraphraser, essay rewriter, essay outline generator, essay topic generator, dive into a world of inspiration.

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1. How does the EssayGPT AI research paper generator ensure data accuracy in the generated papers?

The EssayGPT AI research paper generator utilizes an advanced AI algorithm to fetch relevant and credible information. It employs sophisticated contextual understanding and keyword analysis to maintain accuracy. However, this tool is designed to augment rather than replace comprehensive manual research.

2. How does the EssayGPT AI research paper generator address plagiarism concerns?

The tool employs machine learning algorithms to synthesize information, ensuring each output is unique and original. Additionally, EssayGPT recommends users utilize its plagiarism checker, for thorough plagiarism verification.

3. Can the EssayGPT AI research paper generator handle complex academic disciplines?

Yes, the AI research paper generator is equipped with algorithms capable of handling a wide range of subjects, including advanced and specialized academic disciplines. It understands the complexity of various subjects and structures the research paper accordingly. Users are always advised to review and edit the generated content for precision.

4. What should I do if I find issues with the paper generated by EssayGPT's tool?

If you encounter any issues with the generated paper, you can always modify your inputs and regenerate them for better results. For specific concerns or improvement suggestions, you can always contact our support .

Get High-quality Paper with AI Research Paper Generator

Elevate your academic journey and let our AI research paper generator from EssayGPT turn your ideas into polished, scholarly works. Begin your transformative writing adventure now.

Research Paper Generator: Free + Intuitive

Writing a research paper is one of the most challenging objectives you’ll encounter during your studies. With the help of our research paper generator, you’ll be able to complete this assignment quickly and easily. Let’s see how it works!

• ✅ How to Use
• 🏆 What Is the Best Generator?
• 🔬 Research Paper Definition
• ️✍️ How to Write
• ️🏅 Winning Tips

🔗 References

✅ free research paper generator: how to use.

• Choose your assignment type.
• Type in your topic.
• Indicate how many body paragraphs you need.
• Press “Generate” and receive your perfect research paper just like that.

🏆 What Is the Best Free Research Paper Generator?

With many other AI research generators online, you might wonder, "Why pick this one?”

Well, that’s because our tool is truly the best! It has every feature of a perfect research paper generator:

All of these benefits are included in our GPT-powered tool. So, why not try it right now?

🔬 What Is a Research Paper?

A research paper is an academic work where you provide an in-depth analysis or interpretation of something. Writing a research paper involves expanding your existing knowledge on the topic and purposefully incorporating the expertise of other people who studied it.

The research itself can be quantitative or qualitative :

• Quantitative studies use data that is countable, measurable, and dependent on numbers.
• Qualitative research is descriptive and rooted in interpretation.

Some research papers use a mixed approach combining qualitative and quantitative methods.

Did you know our generator can create research paper samples using any of the above methods? Try it now, and see for yourself!

✍️ How to Write a Research Paper

So, how can you write an outstanding research paper? Check out our handy step-by-step guide below!

1. Get Ready

Before you start writing, you should choose a topic , conduct preliminary research, and build a roadmap for your paper.

When looking for a good topic, follow these tips:

• Pick something you find interesting.
• Scan how much information is available on the chosen topic.
• Avoid topics that are too obvious or complicated.

After you’ve picked a research topic , it’s time to do some digging. For that, go through scientific literature and recent publications. It’s a good idea to use various types of sources, from scholarly articles to books. Make sure to write down any important information in your notes.

Once you’ve learned enough about your topic, you can create an outline . It will serve as a roadmap for your research paper. In your outline:

• Include the key findings and your thoughts on the subject.
• Group the information logically.
• Discard everything you find redundant or irrelevant.

2. Write a Thesis Statement

Using the collected information, write a concise, well-defined thesis statement . To do it, formulate your topic as a question and answer it. This answer will be the key sentence that will determine your work's overall structure and flow.

💡 Pro Tip: Using a thesis generator will help you ace this task.

3. Do the Research

Now, it’s time to conduct your research. While doing it, note the sources of all important information. We also recommend to avoid relying too much on online encyclopedias. They are more likely to contain misinformation than peer-reviewed articles .

After gathering enough data, do the following:

• Expand your outline with details and examples.
• Conduct additional research if necessary.
• Modify your thesis statement to represent your findings more accurately.

4. Draft Your Paper

Once you're done researching and unraveling your thesis, you can start making the first draft. We recommend writing the main body first. Then, you can revise it, add more specifics, and complete the remaining parts.

5. Write the Final Draft

Now, you’re ready to make the final draft. The following checklist will help you ensure everything is perfect:

• Have you appropriately cited the sources ?
• Does every citation follow the proper format?
• Does each paragraph focus on a single topic?
• Have you achieved the primary goal of your research?
• Did you include all the necessary paragraphs?
• Are your arguments logically connected?

6. Proofread and Edit

Finally, proofread your work for grammar, punctuation, appropriate word choice, seamless transitions, sentence structure, and variety. If possible, give yourself a few days after finishing your final draft before making any edits. Doing so will allow you to notice more things and proofread more thoroughly.

🏅 Winning Tips for Research Paper Writing

Want to take your research to the next level? Check out our helpful tips below:

• Always consider your target audience. Adapt your vocabulary and writing style to your readers' degree of experience and understanding. It's best to refrain from employing technical phrases or jargon your audience might not understand.
• Provide definitions for key terms. This way, your readers will understand your research better.
• Employ an active voice. This will make your essay more readable. For instance, instead of writing "the experiment was conducted by the researchers," state "the researchers conducted the experiment."
• Ask for feedback. Have a mentor, professor, or friend review your writing. They can provide insightful advice and recommendations for enhancing coherence and clarity.

And here’s our final tip: use our free research paper generator to get inspiration for your next project! It can assist you with research on any topic absolutely free of charge.

We also recommend using our abstract creator and transition phrase generator to enhance your writing even further.

• Writing a Research Paper: Purdue OWL
• The Ultimate Guide to Writing a Research Paper: Grammarly
• Writing a Research Paper: UW–Madison
• Research Paper Structure: UCSD Psychology
• What Is a Research Paper?: ThoughtCo

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RAxter is now Enago Read! Enjoy the same licensing and pricing with enhanced capabilities. No action required for existing customers.

Your all in one AI-powered Reading Assistant

A Reading Space to Ideate, Create Knowledge, and Collaborate on Your Research

• Smartly organize your research
• Receive recommendations that cannot be ignored
• Collaborate with your team to read, discuss, and share knowledge

From Surface-Level Exploration to Critical Reading - All in one Place!

Fine-tune your literature search.

Our AI-powered reading assistant saves time spent on the exploration of relevant resources and allows you to focus more on reading.

Select phrases or specific sections and explore more research papers related to the core aspects of your selections. Pin the useful ones for future references.

Our platform brings you the latest research related to your and project work.

Speed up your literature review

Quickly generate a summary of key sections of any paper with our summarizer.

Make informed decisions about which papers are relevant, and where to invest your time in further reading.

Get key insights from the paper, quickly comprehend the paper’s unique approach, and recall the key points.

Bring order to your research projects

Organize your reading lists into different projects and maintain the context of your research.

Quickly sort items into collections and tag or filter them according to keywords and color codes.

Experience the power of sharing by finding all the shared literature at one place.

Decode papers effortlessly for faster comprehension

Highlight what is important so that you can retrieve it faster next time.

Select any text in the paper and ask Copilot to explain it to help you get a deeper understanding.

Ask questions and follow-ups from AI-powered Copilot.

Collaborate to read with your team, professors, or students

Share and discuss literature and drafts with your study group, colleagues, experts, and advisors. Recommend valuable resources and help each other for better understanding.

Work in shared projects efficiently and improve visibility within your study group or lab members.

Keep track of your team's progress by being constantly connected and engaging in active knowledge transfer by requesting full access to relevant papers and drafts.

Find papers from across the world's largest repositories

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Privacy and security of your research data are integral to our mission..

Everything you add or create on Enago Read is private by default. It is visible if and when you share it with other users.

You can put Creative Commons license on original drafts to protect your IP. For shared files, Enago Read always maintains a copy in case of deletion by collaborators or revoked access.

We use state-of-the-art security protocols and algorithms including MD5 Encryption, SSL, and HTTPS to secure your data.

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“Write your paper 10x faster”

The #1 AI Research Tool for Students, Teachers, Scholars, and those in Academia

Generate study guides, outlines, research topics, key findings, hypotheses, and exam questions in seconds..

Streamline your planning and preparation with the top AI-generated answers for your specific academic field.

How Research Panda Works

1. pick the research template, 2. fill out the form in less than 2 minutes, 3. generate your academic content.

Save Hours and Days of Research Work

What You Get

Topic and idea selection.

Retrieve topics and subtopics, a longside possible ideas to e nforce and expand upon. Simplify and expand any topic or subtopic of reference.

Brainstorm and Outline Build

Have a thought flow built out s o you’re not mentally stuck. C reate a concrete outline and structure f or your research paper.

Research Questions, Gaps, and Hypothesis Generator

Based on a topic and keywords, g et a list of questions, gaps in research, a nd possible hypotheses t o utilize.

Methodology and Techniques Creator

Explain how the qualitative or quantitive approach  can be used to address the topic. Get the top data collection practices.

Research Paper and Article Locator

Literature Review – Based on a given topic and keywords, p roduce articles for reference.

Summary and Analysis Generator

Get the main arguments and key findings  of a given text. Describe the theoretical framework and methodology used.

Personal Study Guide and Plan Build

Create a step-by-step c omprehensive guide and plan b ased on y our timeframe to study.

Exam Preparation Creator

Generate multiple choice questions based on your given research topic

…ranging in various difficulties.

Book Summarizer

Give the title and author. Condense books into concise and comprehensive summaries for effortless learning.

Lesson Plan Generator

Structured lesson plans for any subject, idea, course, or concept. Just plug in the topic and grade level. AI will provide the rest.

Educational Handout Writer

Efficiently create comprehensive handouts encompassing all the essential information about a particular topic, concept, or subject area for both yourself and a student.

Gaps in Understanding Identifier

Provide your own understanding of a given topic, idea, or concept. An analysis will take place pointing out the gaps in knowledge of the said topic.

Bonus #1: The Quick Learner

Pick the topic, keywords, and main points you want to focus on and learn about. Be broad or specific as need be. Use the 80/20 principle to learn faster than ever.

Bonus #2: The Proofreader

Improvise your writing. Proofread, correct, and get tailored feedback to what you need to do to better your writing. This detailed feedback will give you the steps needed to take next.

Bonus #3: The Detailer

Completely understand a topic, idea, or research point. Have a concept broken down to have a strong mental grasp on it, being able to speak and write on it intelligently.

Why Research Panda?

Enhance your planning and preparation process through the power of comprehensive AI. Discover streamlined templates for study guides and receive tailored writing prompts and answers for each section of your paper that cater to your specific academic field. Research Panda was built for the academic .

Pick a Plan

Optimize your research and writing, get all the ai research tools, built for students, teachers, scholars, and academics.

1. Topic Selection and

Idea Generator

2. Brainstorm and Outline Generator

3. Research Questions, Research Gaps,

and Hypothesis Generator

4. Methodology and Technique Generator

5. Research Paper

and Article Locator Generator

6. Summary and Analysis Generator

7. Study Guide and Plan Generator

8. Exam Preparation Generator

Research Panda works for education levels ranging from high school students to doctoral academics. Nevertheless, it is for any academic looking to further their research in any given field.

Research Panda is capable of generating educational guides, study plans, academic content, and much more. If you can think it, Research Panda can create it. This includes materials related to mathematics, English Language Arts (reading, writing, grammar), science (biology, chemistry, physics), social Studies (history, geography, civics, economics), computer science, political science, and any subject you work in.

To use Research Panda, simply click one of the membership options above to “Try for 3 Days Free” to access the sign up page. From there, you can give Research Panda detailed instructions using any of the 8+ premium AI tools. Once you’ve generated your first AI content, go ahead and edit it to your liking, and copy it for your research use.

Yes! All Research Panda users get unlimited usage and access to all AI tools as long as they are a member. This means you can create as many guides, handouts, article reviews, outlines, and academic content as you’d like.

We offer a 3-day free trial with both membership tiers, Monthly and Quarterly. If you are not 100% satisfied, no worries! Just cancel before your free trial ends. Because of the work in the upkeep of Research Panda, we do not offer any refunds.

Feel free to send us a message using the form below! We will get back to you within 48 hours.

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Research Paper Abstract Generator

Writing the abstract for your research paper, dissertation, or book chapter is usually one of the final steps before you submit your work. It’s also the activity that many students and researchers find most difficult. A strong abstract must be clear, succinct and informative, but how do you decide what to include?

Structuring your abstract

Many journals require the abstract to be structured according to

whereas the abstract for your dissertation or chapter may just be a short narrative paragraph. Either way, the abstract should contain key information from the study and be easy to read. Creating an abstract is as much an art as a science.

Happily, Scholarcy can help by identifying exactly the right information to include in your abstract.

Abstract in numbers

4 steps to generate an abstract with scholarcy, upload your article.

Simply upload your article to Scholarcy Library to generate a summary flashcard that outlines your research and contains the information needed to create your abstract.

View Scholarcy Highlights

The Scholarcy Highlights tab contains 5-7 bullet points comprising the background to the study, the key findings, and the conclusion.

View Scholarcy Summary

If your paper contains standard IMRaD sections, then the Scholarcy Summary will automatically be structured to follow these headings and will include any study objectives that you have written.

And the Study subjects and participants tab extracts key information about study participants, interventions, and quantitative results. Perfect for your abstract!

Try Smart Synopsis

Alternatively, for your dissertation or book chapter, you can use our Smart Synopses tool to create a more naturally flowing, narrative abstract.

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Hypothesis Maker Online

Looking for a hypothesis maker? This online tool for students will help you formulate a beautiful hypothesis quickly, efficiently, and for free.

Are you looking for an effective hypothesis maker online? Worry no more; try our online tool for students and formulate your hypothesis within no time.

• 🔎 How to Use the Tool?
• ⚗️ What Is a Hypothesis in Science?

👍 What Does a Good Hypothesis Mean?

• 🧭 Steps to Making a Good Hypothesis

🔗 References

📄 hypothesis maker: how to use it.

Our hypothesis maker is a simple and efficient tool you can access online for free.

If you want to create a research hypothesis quickly, you should fill out the research details in the given fields on the hypothesis generator.

Below are the fields you should complete to generate your hypothesis:

• Who or what is your research based on? For instance, the subject can be research group 1.
• What does the subject (research group 1) do?
• What does the subject affect? - This shows the predicted outcome, which is the object.
• Who or what will be compared with research group 1? (research group 2).

Once you fill the in the fields, you can click the ‘Make a hypothesis’ tab and get your results.

⚗️ What Is a Hypothesis in the Scientific Method?

A hypothesis is a statement describing an expectation or prediction of your research through observation.

It is similar to academic speculation and reasoning that discloses the outcome of your scientific test . An effective hypothesis, therefore, should be crafted carefully and with precision.

A good hypothesis should have dependent and independent variables . These variables are the elements you will test in your research method – it can be a concept, an event, or an object as long as it is observable.

You can observe the dependent variables while the independent variables keep changing during the experiment.

In a nutshell, a hypothesis directs and organizes the research methods you will use, forming a large section of research paper writing.

Hypothesis vs. Theory

A hypothesis is a realistic expectation that researchers make before any investigation. It is formulated and tested to prove whether the statement is true. A theory, on the other hand, is a factual principle supported by evidence. Thus, a theory is more fact-backed compared to a hypothesis.

Another difference is that a hypothesis is presented as a single statement , while a theory can be an assortment of things . Hypotheses are based on future possibilities toward a specific projection, but the results are uncertain. Theories are verified with undisputable results because of proper substantiation.

When it comes to data, a hypothesis relies on limited information , while a theory is established on an extensive data set tested on various conditions.

You should observe the stated assumption to prove its accuracy.

Since hypotheses have observable variables, their outcome is usually based on a specific occurrence. Conversely, theories are grounded on a general principle involving multiple experiments and research tests.

This general principle can apply to many specific cases.

The primary purpose of formulating a hypothesis is to present a tentative prediction for researchers to explore further through tests and observations. Theories, in their turn, aim to explain plausible occurrences in the form of a scientific study.

It would help to rely on several criteria to establish a good hypothesis. Below are the parameters you should use to analyze the quality of your hypothesis.

🧭 6 Steps to Making a Good Hypothesis

Writing a hypothesis becomes way simpler if you follow a tried-and-tested algorithm. Let’s explore how you can formulate a good hypothesis in a few steps:

Step #1: Ask Questions

The first step in hypothesis creation is asking real questions about the surrounding reality.

Why do things happen as they do? What are the causes of some occurrences?

Your curiosity will trigger great questions that you can use to formulate a stellar hypothesis. So, ensure you pick a research topic of interest to scrutinize the world’s phenomena, processes, and events.

Step #2: Do Initial Research

Carry out preliminary research and gather essential background information about your topic of choice.

The extent of the information you collect will depend on what you want to prove.

Your initial research can be complete with a few academic books or a simple Internet search for quick answers with relevant statistics.

Still, keep in mind that in this phase, it is too early to prove or disapprove of your hypothesis.

Step #3: Identify Your Variables

Now that you have a basic understanding of the topic, choose the dependent and independent variables.

Take note that independent variables are the ones you can’t control, so understand the limitations of your test before settling on a final hypothesis.

Step #4: Formulate Your Hypothesis

You can write your hypothesis as an ‘if – then’ expression . Presenting any hypothesis in this format is reliable since it describes the cause-and-effect you want to test.

For instance: If I study every day, then I will get good grades.

Step #5: Gather Relevant Data

Once you have identified your variables and formulated the hypothesis, you can start the experiment. Remember, the conclusion you make will be a proof or rebuttal of your initial assumption.

So, gather relevant information, whether for a simple or statistical hypothesis, because you need to back your statement.

Step #6: Record Your Findings

Finally, write down your conclusions in a research paper .

Outline in detail whether the test has proved or disproved your hypothesis.

Edit and proofread your work, using a plagiarism checker to ensure the authenticity of your text.

We hope that the above tips will be useful for you. Note that if you need to conduct business analysis, you can use the free templates we’ve prepared: SWOT , PESTLE , VRIO , SOAR , and Porter’s 5 Forces .

❓ Hypothesis Formulator FAQ

Updated: Oct 25th, 2023

• How to Write a Hypothesis in 6 Steps - Grammarly
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• The Hypothesis in Science Writing
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Use our hypothesis maker whenever you need to formulate a hypothesis for your study. We offer a very simple tool where you just need to provide basic info about your variables, subjects, and predicted outcomes. The rest is on us. Get a perfect hypothesis in no time!

The best AI tools for research papers and academic research (Literature review, grants, PDFs and more)

As our collective understanding and application of artificial intelligence (AI) continues to evolve, so too does the realm of academic research. Some people are scared by it while others are openly embracing the change. 

Make no mistake, AI is here to stay!

Instead of tirelessly scrolling through hundreds of PDFs, a powerful AI tool comes to your rescue, summarizing key information in your research papers. Instead of manually combing through citations and conducting literature reviews, an AI research assistant proficiently handles these tasks.

These aren’t futuristic dreams, but today’s reality. Welcome to the transformative world of AI-powered research tools!

This blog post will dive deeper into these tools, providing a detailed review of how AI is revolutionizing academic research. We’ll look at the tools that can make your literature review process less tedious, your search for relevant papers more precise, and your overall research process more efficient and fruitful.

I know that I wish these were around during my time in academia. It can be quite confronting when trying to work out what ones you should and shouldn’t use. A new one seems to be coming out every day!

Here is everything you need to know about AI for academic research and the ones I have personally trialed on my YouTube channel.

My Top AI Tools for Researchers and Academics – Tested and Reviewed!

There are many different tools now available on the market but there are only a handful that are specifically designed with researchers and academics as their primary user.

These are my recommendations that’ll cover almost everything that you’ll want to do:

Want to find out all of the tools that you could use?

Here they are, below:

AI literature search and mapping – best AI tools for a literature review – elicit and more

Harnessing AI tools for literature reviews and mapping brings a new level of efficiency and precision to academic research. No longer do you have to spend hours looking in obscure research databases to find what you need!

AI-powered tools like Semantic Scholar and elicit.org use sophisticated search engines to quickly identify relevant papers.

They can mine key information from countless PDFs, drastically reducing research time. You can even search with semantic questions, rather than having to deal with key words etc.

With AI as your research assistant, you can navigate the vast sea of scientific research with ease, uncovering citations and focusing on academic writing. It’s a revolutionary way to take on literature reviews.

• Elicit –  https://elicit.org
• Litmaps –  https://www.litmaps.com
• Research rabbit – https://www.researchrabbit.ai/
• Connected Papers –  https://www.connectedpapers.com/
• Supersymmetry.ai: https://www.supersymmetry.ai
• Semantic Scholar: https://www.semanticscholar.org
• Laser AI –  https://laser.ai/
• Inciteful –  https://inciteful.xyz/
• Scite –  https://scite.ai/
• System –  https://www.system.com

If you like AI tools you may want to check out this article:

• How to get ChatGPT to write an essay [The prompts you need]

AI-powered research tools and AI for academic research

AI research tools, like Concensus, offer immense benefits in scientific research. Here are the general AI-powered tools for academic research. 

These AI-powered tools can efficiently summarize PDFs, extract key information, and perform AI-powered searches, and much more. Some are even working towards adding your own data base of files to ask questions from. 

Tools like scite even analyze citations in depth, while AI models like ChatGPT elicit new perspectives.

The result? The research process, previously a grueling endeavor, becomes significantly streamlined, offering you time for deeper exploration and understanding. Say goodbye to traditional struggles, and hello to your new AI research assistant!

• Consensus –  https://consensus.app/
• Iris AI –  https://iris.ai/
• Research Buddy –  https://researchbuddy.app/
• Mirror Think – https://mirrorthink.ai

AI for reading peer-reviewed papers easily

Using AI tools like Explain paper and Humata can significantly enhance your engagement with peer-reviewed papers. I always used to skip over the details of the papers because I had reached saturation point with the information coming in. 

These AI-powered research tools provide succinct summaries, saving you from sifting through extensive PDFs – no more boring nights trying to figure out which papers are the most important ones for you to read!

They not only facilitate efficient literature reviews by presenting key information, but also find overlooked insights.

With AI, deciphering complex citations and accelerating research has never been easier.

• Aetherbrain – https://aetherbrain.ai
• Explain Paper – https://www.explainpaper.com
• Chat PDF – https://www.chatpdf.com
• Humata – https://www.humata.ai/
• Lateral AI –  https://www.lateral.io/
• Paper Brain –  https://www.paperbrain.study/
• Scholarcy – https://www.scholarcy.com/
• SciSpace Copilot –  https://typeset.io/
• Unriddle – https://www.unriddle.ai/
• Sharly.ai – https://www.sharly.ai/
• Open Read –  https://www.openread.academy

AI for scientific writing and research papers

In the ever-evolving realm of academic research, AI tools are increasingly taking center stage.

Enter Paper Wizard, Jenny.AI, and Wisio – these groundbreaking platforms are set to revolutionize the way we approach scientific writing.

Together, these AI tools are pioneering a new era of efficient, streamlined scientific writing.

• Jenny.AI – https://jenni.ai/ (20% off with code ANDY20)
• Yomu – https://www.yomu.ai
• Wisio – https://www.wisio.app

AI academic editing tools

In the realm of scientific writing and editing, artificial intelligence (AI) tools are making a world of difference, offering precision and efficiency like never before. Consider tools such as Paper Pal, Writefull, and Trinka.

Together, these tools usher in a new era of scientific writing, where AI is your dedicated partner in the quest for impeccable composition.

• PaperPal –  https://paperpal.com/
• Writefull –  https://www.writefull.com/
• Trinka –  https://www.trinka.ai/

AI tools for grant writing

In the challenging realm of science grant writing, two innovative AI tools are making waves: Granted AI and Grantable.

These platforms are game-changers, leveraging the power of artificial intelligence to streamline and enhance the grant application process.

Granted AI, an intelligent tool, uses AI algorithms to simplify the process of finding, applying, and managing grants. Meanwhile, Grantable offers a platform that automates and organizes grant application processes, making it easier than ever to secure funding.

Together, these tools are transforming the way we approach grant writing, using the power of AI to turn a complex, often arduous task into a more manageable, efficient, and successful endeavor.

• Granted AI – https://grantedai.com/
• Grantable – https://grantable.co/

Best free AI research tools

There are many different tools online that are emerging for researchers to be able to streamline their research processes. There’s no need for convience to come at a massive cost and break the bank.

The best free ones at time of writing are:

• Elicit – https://elicit.org
• Connected Papers – https://www.connectedpapers.com/
• Litmaps – https://www.litmaps.com ( 10% off Pro subscription using the code “STAPLETON” )
• Consensus – https://consensus.app/

Wrapping up

The integration of artificial intelligence in the world of academic research is nothing short of revolutionary.

With the array of AI tools we’ve explored today – from research and mapping, literature review, peer-reviewed papers reading, scientific writing, to academic editing and grant writing – the landscape of research is significantly transformed.

The advantages that AI-powered research tools bring to the table – efficiency, precision, time saving, and a more streamlined process – cannot be overstated.

These AI research tools aren’t just about convenience; they are transforming the way we conduct and comprehend research.

They liberate researchers from the clutches of tedium and overwhelm, allowing for more space for deep exploration, innovative thinking, and in-depth comprehension.

Whether you’re an experienced academic researcher or a student just starting out, these tools provide indispensable aid in your research journey.

And with a suite of free AI tools also available, there is no reason to not explore and embrace this AI revolution in academic research.

We are on the precipice of a new era of academic research, one where AI and human ingenuity work in tandem for richer, more profound scientific exploration. The future of research is here, and it is smart, efficient, and AI-powered.

Before we get too excited however, let us remember that AI tools are meant to be our assistants, not our masters. As we engage with these advanced technologies, let’s not lose sight of the human intellect, intuition, and imagination that form the heart of all meaningful research. Happy researching!

Thank you to Ivan Aguilar – Ph.D. Student at SFU (Simon Fraser University), for starting this list for me!

Dr Andrew Stapleton has a Masters and PhD in Chemistry from the UK and Australia. He has many years of research experience and has worked as a Postdoctoral Fellow and Associate at a number of Universities. Although having secured funding for his own research, he left academia to help others with his YouTube channel all about the inner workings of academia and how to make it work for you.

Thank you for visiting Academia Insider.

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Genei is a research tool that automates the process of summarizing background reading and can also generate blogs, articles, and reports. It allows you to

Afforai is an AI research assistant designed to help researchers collect, organize, and analyze academic materials. Afforai allows you to upload papers, automatically extract metadata

Otio is an AI-powered research and writing assistant designed to help students, researchers, analysts and professionals alike. It can easily summarize your documents and web

ChatPDF allows you to talk to your PDF documents as if they were human. It’s perfect for quickly extracting information or answering questions from large

Lumina Chat

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Discover the latest AI research tools to accelerate your studies and academic research. Search through millions of research papers, summarize articles, view citations, and more.

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Free Research Title Generator

Looking for a creative and catchy title for a research proposal, thesis, dissertation, essay, or other project? Try our research title maker! It is free, easy to use, and 100% online.

Welcome to our free online research title generator. You can get your title in 3 simple steps:

• Type your search term and choose one or more subjects from the list,
• Click on the “Search topic” button and choose among the ideas that the title generator has proposed,
• Refresh the list by clicking the button one more time if you need more options.

Please try again with some different keywords or subjects.

• ️✅ Research Title Generator: 4 Benefits
• ️👣 Making a Research Title in 3 Steps
• ️🔗 References

Creating a topic for the research is one of the most significant events in a researcher’s life. Whether it is a thesis, dissertation, research proposal , or term paper, all of these assignments are time-consuming and require a lot of effort.

It is essential to choose a topic that you like and are genuinely interested in because you will spend a lot of time working on it. Our research title generator can help you with this crucial task. By delegating this work to our research title maker, you can find the best title for your research.

✅ Research Title Generator: 4 Benefits

There are many different research title makers online, so what makes our thesis title generator stand out?

👣 How to Make a Research Title: 3 Simple Steps

Research can be the most stressful period in a student’s life. However, creating a title is not as hard as it may seem. You can choose a topic for your paper in three simple steps.

Step 1: Brainstorm

The first step to take before getting into your research is to brainstorm . To choose a good topic, you can do the following:

• Think of all your interests related to your field of study. What is the reason you've chosen this field? Think of the topics of your area that you like reading about in your free time.
• Go through your past papers and choose the ones you enjoyed writing. You can use some lingering issues from your previous work as a starting point for your research.
• Go through current events in your field to get an idea of what is going on. Whether you are writing a literary analysis , gender studies research, or any other kind of paper, you can always find tons of articles related to your field online. You can go through them to see what issue is getting more attention.
• Try to find any gaps in current researches in your field. Use only credible sources while searching. Try to add something new to your field with your research. However, do not choose a completely new issue.
• Discuss what topic is suitable for you with your professors. Professor knows a lot of information about current and previous researches, so try to discuss it with them.
• Discuss lingering issues with your classmates. Try to ask what questions do they have about your field.
• Think of your desired future work . Your research might serve as a starting point for your future career, so think of your desired job.
• Write down 5-10 topics that you might be interested in. Ph.D. or Master’s research should be specific, so write down all the appropriate topics that you came up with.

Step 2: Narrow It Down

As you are done brainstorming, you have a list of possible research topics. Now, it is time to narrow your list down.

Go through your list again and eliminate the topics that have already been well-researched before. Remember that you need to add something new to your field of study, so choose a topic that can contribute to it. However, try not to select a topic not researched at all, as it might be difficult.

Once you get a general idea of what your research will be about, choose a research supervisor. Think of a professor who is an expert in your desired area of research. Talk to them and tell them the reason why you want to work with them and why you chose this area of study.

As you eliminated some irrelevant topics and shortened your list to 1-3 topics, you can discuss them with your supervisor. Since your supervisor has a better insight into your field of study, they can recommend a topic that can be most suitable for you. Make sure to elaborate on each topic and the reason you chose it.

Step 3: Formulate a Research Question

The next step is to create a research question. This is probably the most important part of the process. Later you'll turn your research question into a thesis statement .

Learn as many materials as you can to figure out the type of questions you can ask for your research. Make use of any articles, journals, libraries, etc. Write notes as you learn, and highlight the essential parts.

First, make any questions you can think of. Choose the ones that you have an interest in and try to rewrite them. As you rewrite them, you can get a different perspective on each of the questions. An example of the potential question:

How did the economic situation in the 19th century affect literature?

Think of a question that you can answer and research best. To do it, think of the most convenient research process and available materials that you have access to. Do you need to do lab testing, quantitative analysis, or any kind of experiment? What skills do you have that can be useful?

Discuss the question that you came up with your supervisor. Get their feedback as they might have their own opinion on that topic and give you creative advice.

❓ Research Title Maker FAQ

❓ how to make a research title.

To make a research title:

• Brainstorm your field of study first.
• Think of the topics that you are interested in.
• Research current events in your study area and discuss your possible topics with your professors and classmates.
• Avoid random topics that are not well-researched.

❓ What is a working title for a research paper?

To make a good research paper title, analyze your area of study and all the related current events. Discuss your possible topics with your classmates and professors to get their opinion on them. You can also use our research title maker for free.

❓ What is the title page of a research paper?

The title page of the research paper is the first paper of your work. It includes your name, research type, and other essential information about your research.

❓ How to title a research proposal?

The research proposal title should be clear enough to showcase your research. Think of a statement that best describes your work and try to create a title that reflects it.

Updated: Jun 5th, 2024

🔗 References

• Research Topics | Frontiers
• Organizing Your Social Sciences Research Paper
• Strategies for Selecting a Research Topic - ResearchGate
• The First Steps: Choosing a Topic and a Thesis Supervisor
• How to Pick a Masters Thesis Topic | by Peter Campbell

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Methodology

• What Is a Research Design | Types, Guide & Examples

What Is a Research Design | Types, Guide & Examples

Published on June 7, 2021 by Shona McCombes . Revised on November 20, 2023 by Pritha Bhandari.

A research design is a strategy for answering your   research question  using empirical data. Creating a research design means making decisions about:

• Your overall research objectives and approach
• Whether you’ll rely on primary research or secondary research
• Your sampling methods or criteria for selecting subjects
• Your data collection methods
• The procedures you’ll follow to collect data
• Your data analysis methods

A well-planned research design helps ensure that your methods match your research objectives and that you use the right kind of analysis for your data.

Table of contents

Step 1: consider your aims and approach, step 2: choose a type of research design, step 3: identify your population and sampling method, step 4: choose your data collection methods, step 5: plan your data collection procedures, step 6: decide on your data analysis strategies, other interesting articles, frequently asked questions about research design.

• Introduction

Before you can start designing your research, you should already have a clear idea of the research question you want to investigate.

There are many different ways you could go about answering this question. Your research design choices should be driven by your aims and priorities—start by thinking carefully about what you want to achieve.

The first choice you need to make is whether you’ll take a qualitative or quantitative approach.

Qualitative research designs tend to be more flexible and inductive , allowing you to adjust your approach based on what you find throughout the research process.

Quantitative research designs tend to be more fixed and deductive , with variables and hypotheses clearly defined in advance of data collection.

It’s also possible to use a mixed-methods design that integrates aspects of both approaches. By combining qualitative and quantitative insights, you can gain a more complete picture of the problem you’re studying and strengthen the credibility of your conclusions.

Practical and ethical considerations when designing research

As well as scientific considerations, you need to think practically when designing your research. If your research involves people or animals, you also need to consider research ethics .

• How much time do you have to collect data and write up the research?
• Will you be able to gain access to the data you need (e.g., by travelling to a specific location or contacting specific people)?
• Do you have the necessary research skills (e.g., statistical analysis or interview techniques)?
• Will you need ethical approval ?

At each stage of the research design process, make sure that your choices are practically feasible.

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Within both qualitative and quantitative approaches, there are several types of research design to choose from. Each type provides a framework for the overall shape of your research.

Types of quantitative research designs

Quantitative designs can be split into four main types.

• Experimental and   quasi-experimental designs allow you to test cause-and-effect relationships
• Descriptive and correlational designs allow you to measure variables and describe relationships between them.

With descriptive and correlational designs, you can get a clear picture of characteristics, trends and relationships as they exist in the real world. However, you can’t draw conclusions about cause and effect (because correlation doesn’t imply causation ).

Experiments are the strongest way to test cause-and-effect relationships without the risk of other variables influencing the results. However, their controlled conditions may not always reflect how things work in the real world. They’re often also more difficult and expensive to implement.

Types of qualitative research designs

Qualitative designs are less strictly defined. This approach is about gaining a rich, detailed understanding of a specific context or phenomenon, and you can often be more creative and flexible in designing your research.

The table below shows some common types of qualitative design. They often have similar approaches in terms of data collection, but focus on different aspects when analyzing the data.

Your research design should clearly define who or what your research will focus on, and how you’ll go about choosing your participants or subjects.

In research, a population is the entire group that you want to draw conclusions about, while a sample is the smaller group of individuals you’ll actually collect data from.

Defining the population

A population can be made up of anything you want to study—plants, animals, organizations, texts, countries, etc. In the social sciences, it most often refers to a group of people.

For example, will you focus on people from a specific demographic, region or background? Are you interested in people with a certain job or medical condition, or users of a particular product?

The more precisely you define your population, the easier it will be to gather a representative sample.

• Sampling methods

Even with a narrowly defined population, it’s rarely possible to collect data from every individual. Instead, you’ll collect data from a sample.

To select a sample, there are two main approaches: probability sampling and non-probability sampling . The sampling method you use affects how confidently you can generalize your results to the population as a whole.

Probability sampling is the most statistically valid option, but it’s often difficult to achieve unless you’re dealing with a very small and accessible population.

For practical reasons, many studies use non-probability sampling, but it’s important to be aware of the limitations and carefully consider potential biases. You should always make an effort to gather a sample that’s as representative as possible of the population.

Case selection in qualitative research

In some types of qualitative designs, sampling may not be relevant.

For example, in an ethnography or a case study , your aim is to deeply understand a specific context, not to generalize to a population. Instead of sampling, you may simply aim to collect as much data as possible about the context you are studying.

In these types of design, you still have to carefully consider your choice of case or community. You should have a clear rationale for why this particular case is suitable for answering your research question .

For example, you might choose a case study that reveals an unusual or neglected aspect of your research problem, or you might choose several very similar or very different cases in order to compare them.

Data collection methods are ways of directly measuring variables and gathering information. They allow you to gain first-hand knowledge and original insights into your research problem.

You can choose just one data collection method, or use several methods in the same study.

Survey methods

Surveys allow you to collect data about opinions, behaviors, experiences, and characteristics by asking people directly. There are two main survey methods to choose from: questionnaires and interviews .

Observation methods

Observational studies allow you to collect data unobtrusively, observing characteristics, behaviors or social interactions without relying on self-reporting.

Observations may be conducted in real time, taking notes as you observe, or you might make audiovisual recordings for later analysis. They can be qualitative or quantitative.

Other methods of data collection

There are many other ways you might collect data depending on your field and topic.

If you’re not sure which methods will work best for your research design, try reading some papers in your field to see what kinds of data collection methods they used.

Secondary data

If you don’t have the time or resources to collect data from the population you’re interested in, you can also choose to use secondary data that other researchers already collected—for example, datasets from government surveys or previous studies on your topic.

With this raw data, you can do your own analysis to answer new research questions that weren’t addressed by the original study.

Using secondary data can expand the scope of your research, as you may be able to access much larger and more varied samples than you could collect yourself.

However, it also means you don’t have any control over which variables to measure or how to measure them, so the conclusions you can draw may be limited.

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As well as deciding on your methods, you need to plan exactly how you’ll use these methods to collect data that’s consistent, accurate, and unbiased.

Planning systematic procedures is especially important in quantitative research, where you need to precisely define your variables and ensure your measurements are high in reliability and validity.

Operationalization

Some variables, like height or age, are easily measured. But often you’ll be dealing with more abstract concepts, like satisfaction, anxiety, or competence. Operationalization means turning these fuzzy ideas into measurable indicators.

If you’re using observations , which events or actions will you count?

If you’re using surveys , which questions will you ask and what range of responses will be offered?

You may also choose to use or adapt existing materials designed to measure the concept you’re interested in—for example, questionnaires or inventories whose reliability and validity has already been established.

Reliability and validity

Reliability means your results can be consistently reproduced, while validity means that you’re actually measuring the concept you’re interested in.

For valid and reliable results, your measurement materials should be thoroughly researched and carefully designed. Plan your procedures to make sure you carry out the same steps in the same way for each participant.

If you’re developing a new questionnaire or other instrument to measure a specific concept, running a pilot study allows you to check its validity and reliability in advance.

Sampling procedures

As well as choosing an appropriate sampling method , you need a concrete plan for how you’ll actually contact and recruit your selected sample.

That means making decisions about things like:

• How many participants do you need for an adequate sample size?
• What inclusion and exclusion criteria will you use to identify eligible participants?
• How will you contact your sample—by mail, online, by phone, or in person?

If you’re using a probability sampling method , it’s important that everyone who is randomly selected actually participates in the study. How will you ensure a high response rate?

If you’re using a non-probability method , how will you avoid research bias and ensure a representative sample?

Data management

It’s also important to create a data management plan for organizing and storing your data.

Will you need to transcribe interviews or perform data entry for observations? You should anonymize and safeguard any sensitive data, and make sure it’s backed up regularly.

Keeping your data well-organized will save time when it comes to analyzing it. It can also help other researchers validate and add to your findings (high replicability ).

On its own, raw data can’t answer your research question. The last step of designing your research is planning how you’ll analyze the data.

Quantitative data analysis

In quantitative research, you’ll most likely use some form of statistical analysis . With statistics, you can summarize your sample data, make estimates, and test hypotheses.

Using descriptive statistics , you can summarize your sample data in terms of:

• The distribution of the data (e.g., the frequency of each score on a test)
• The central tendency of the data (e.g., the mean to describe the average score)
• The variability of the data (e.g., the standard deviation to describe how spread out the scores are)

The specific calculations you can do depend on the level of measurement of your variables.

Using inferential statistics , you can:

• Make estimates about the population based on your sample data.
• Test hypotheses about a relationship between variables.

Regression and correlation tests look for associations between two or more variables, while comparison tests (such as t tests and ANOVAs ) look for differences in the outcomes of different groups.

Your choice of statistical test depends on various aspects of your research design, including the types of variables you’re dealing with and the distribution of your data.

Qualitative data analysis

In qualitative research, your data will usually be very dense with information and ideas. Instead of summing it up in numbers, you’ll need to comb through the data in detail, interpret its meanings, identify patterns, and extract the parts that are most relevant to your research question.

Two of the most common approaches to doing this are thematic analysis and discourse analysis .

There are many other ways of analyzing qualitative data depending on the aims of your research. To get a sense of potential approaches, try reading some qualitative research papers in your field.

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A research design is a strategy for answering your   research question . It defines your overall approach and determines how you will collect and analyze data.

A well-planned research design helps ensure that your methods match your research aims, that you collect high-quality data, and that you use the right kind of analysis to answer your questions, utilizing credible sources . This allows you to draw valid , trustworthy conclusions.

Quantitative research designs can be divided into two main categories:

• Correlational and descriptive designs are used to investigate characteristics, averages, trends, and associations between variables.
• Experimental and quasi-experimental designs are used to test causal relationships .

Qualitative research designs tend to be more flexible. Common types of qualitative design include case study , ethnography , and grounded theory designs.

The priorities of a research design can vary depending on the field, but you usually have to specify:

• Your research questions and/or hypotheses
• Your overall approach (e.g., qualitative or quantitative )
• The type of design you’re using (e.g., a survey , experiment , or case study )
• Your data collection methods (e.g., questionnaires , observations)
• Your data collection procedures (e.g., operationalization , timing and data management)
• Your data analysis methods (e.g., statistical tests  or thematic analysis )

A sample is a subset of individuals from a larger population . Sampling means selecting the group that you will actually collect data from in your research. For example, if you are researching the opinions of students in your university, you could survey a sample of 100 students.

In statistics, sampling allows you to test a hypothesis about the characteristics of a population.

Operationalization means turning abstract conceptual ideas into measurable observations.

For example, the concept of social anxiety isn’t directly observable, but it can be operationally defined in terms of self-rating scores, behavioral avoidance of crowded places, or physical anxiety symptoms in social situations.

Before collecting data , it’s important to consider how you will operationalize the variables that you want to measure.

A research project is an academic, scientific, or professional undertaking to answer a research question . Research projects can take many forms, such as qualitative or quantitative , descriptive , longitudinal , experimental , or correlational . What kind of research approach you choose will depend on your topic.

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What is a Case Study

A case study is like a detailed story that looks closely at a particular situation, person, or event, especially in the business world. It's a way to understand how things work in real life and learn valuable lessons. For instance, if a business wanted to figure out how another one became successful, they might study that business as a case study.

Let's say there's a small company that started selling handmade products online and became successful. A case study about this business could explain the challenges they faced, the strategies they used to grow, and the results they achieved. By reading this case study, other businesses could learn useful tips and apply them to their situations to improve and succeed.

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• Pick a Familiar Topic: Choose a client or project that your audience can relate to. This makes it easier for them to see how your solutions might work for their situations.
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• Focus on the Problem: Clearly define the problem or challenge your case study addresses. This helps readers understand the context and sets the foundation for the solution.
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A free case study generator is a tool or system designed to automatically create detailed case studies. It typically uses predefined templates and may incorporate artificial intelligence (AI) to generate comprehensive analyses of specific situations, events, or individuals.

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Welsh Government

Overcoming cancer twice: experiences of taking part in a research study

Taking part in research is crucial for advancing medical knowledge and improving patient care. Every year, countless individuals join health and social care studies through Be Part of Research, a service connecting people to research opportunities. A former lecturer turned furniture maker shared his story of taking part in research after his cancer unexpectedly came back.

Philip Cumpstone,59, from Ystradgynlais, participated in the PEARL study. which investigated whether the use of PET-CT scans improves targeted radiotherapy planning to potentially reduce side effects for mouth and oropharyngeal  cancer patients.

Why take part in the study?

Despite overcoming lymphoma in 2011, a recurrence occurred in 2022 in his lymph node. When Philip was being treated for the second time, he was keen to take up the opportunity and take part in the PEARL study.

"Having faced diagnosis and recovery in 2011, it prepared me for this time. I can navigate the journey more confidently now, drawing from my past experience and understanding the process better."

His decision to participate in the study was also fuelled by an interest in data management within the NHS and a desire to help expand medical knowledge.

From having the PET scan to find out exactly where the cancer was so they can precisely target the tumour to his first radiotherapy appointment, Philip described the experience as very pleasant.

“The research team has not only shown professionalism but also a human side, making the entire experience enjoyable and reassuring.

"They’re delighted to go into detail and explain everything.”

His experience was very positive thanks to being taken care of with open communication, precise treatments and a sense of being valued throughout the process.

“I've felt respected and almost like a family member at every stage."

During his treatment, Philip kept making furniture:

“The kind of furniture that I make is often referred to as ‘primitive’ or ‘Welsh stick furniture'. It's made mainly from hedgerow foraging and from fallen or coppiced native hardwoods.”

Green woodworking was a great focus for Philip. For him this was time to practice what is called ‘mindfulness’ which gave him an opportunity to meaningfully contemplate and reflect on the self-management of his cancer treatment.

“I kept a diary and a sketchbook during the treatment periods to record design ideas and keep those observations flowing. The creativity never stops!”

Where would we be without research?  

Philip encourages others to consider taking part in research. To Philip, participation in research provides valuable insights into both individual treatments and broader medical understanding of the disease.

"I believe when patients and doctors work together, it not only helps people get better but also gathers valuable data for making future treatments and research better.”

Discover a range of opportunities to take part in or help with health and social care research in your area by visiting the Be Part of Research website.  

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Potential Tesla buyers are going elsewhere thanks to Elon Musk’s ‘Erratic, Impulsive’ Behavior: Study

The electric vehicle maker's lead is slowly being eaten away by other automakers entering the space.

Tesla is having a heck of a time right now. The rollout of its flagship Cybertruck has been fraught with issues, sales of its entire lineup are stagnating and investors are getting worried that big boss Elon Musk is distracted by his other ventures, such as SpaceX and his takeover of Twitter. However, that might not be the only way Musk is hitting Tesla’s balance sheet, as a new study found that many would-be buyers are being put off by his toxic behavior.

Suggested Reading

Musk’s ties to Tesla and its reputation run much, much deeper than other automakers and their CEOs. For this reason, a new report from the New York Times looked into the impact his actions have had on would-be Tesla buyers in recent years, and it’s not looking good.

Related Content

The Times quizzed more than 7,500 people about their attitudes to Musk and Tesla and many reported being put off by the “erratic, impulsive” actions of the big boss. As the site explains:

His image as an erratic, impulsive manager appears to have rubbed off on the cars, raising doubts in some people’s minds about their quality and helping to explain why Tesla sales have been falling. On Tuesday, the company reported that its global sales in the second quarter fell 4.8 percent from the same period a year earlier, after an 8.5 percent drop in the first three months of the year. “Musk is a true lightning rod,” said Ben Rose, the president of Battle Road Research, which has a generally positive view on Tesla’s stock. “There are people who swear by him and people who swear at him. No question, some of his comments are a real turnoff for some people. For a subset, enough to buy another brand.”

Of the people polled by the Times , the “vast majority” of respondents were critical of Musk’s political views and his erratic behavior . Some even cited his handling of the takeover of Twitter where he fired thousands of employees as a reason they look down on Tesla.

What’s more, his increasingly close ties to convicted fellon Donal Trump have further pushed potential buyers away from the brand, as the Times adds:

“You’re basically driving around a giant red MAGA hat,” said Aaron Shepherd, a product designer at Microsoft in Seattle who said he was planning to buy an electric Volkswagen ID.4 instead of a Tesla.

Potential buyers have also taken offence to the spate of racism scandals that have swirled around Tesla in recent years. In February, the EV maker faced a lawsuit from more than 6,000 Black workers accusing the company of racism at its factories and a further case saw Tesla pay one Black worker more than $3 million over discrimination claims. Stories like these should be enough to put anyone laying their cash down on a Tesla, adds Futurism . As the site explains:

Another reader, IT worker Achidi Ndifang, cited Musk’s seeming anti-Black racism as the main reason for his Tesla disdain. “My mother was seriously debating buying a Tesla,” Ndifang, who lives and works in Baltimore, told the newspaper. “As a Black person, I felt like it would be an insult for my mother to drive a Tesla.”

Despite such scandals, Tesla is still one of the largest automakers in the world and there’s nobody who could argue against its dominance in the EV space in recent years. However, that lead is slowly being eaten away by other automakers entering the space. In fact, in its most recent sales figures Tesla posted yet another drop in deliveries.

Now, there’s no telling how much of this is as a result of negative press surrounding the company or merely more options for buyers. However, accusations of racism, allegiances to far-right politicians and a history of anti-union ideas that beat down regular working class Americans are all sure to put hesitant buyers from putting pen to paper and signing away their hard earned cash, right?

This is far from being the first time that researchers have looked into the impact Musk himself is having on Tesla’s sales. Earlier this year, a consumer research group found that the pool of Tesla buyers was shrinking due to Musk’s extreme views and warnings earlier this year suggested that the Tesla boss was losing focus on the automaker, hitting its ability to innovate.

A version of this article originally appeared on Jalopnik.

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• Open access
• Published: 01 July 2024

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

• Delphine Bourmorck 1 ,
• Benoit Pétré 2 ,
• Marie de Saint-Hubert 1 , 3 &
• Isabelle De Brauwer 1 , 4  

BMC Health Services Research volume  24 , Article number:  773 ( 2024 ) Cite this article

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Metrics details

Nearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED’s role in providing palliative care for this population.

We designed a qualitative study based on 1) interviews – conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers – and 2) focus groups – conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis.

Five older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients’(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED’s role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile.

Conclusions

Currently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier.

Peer Review reports

The benefits of palliative care (PC) are well established. When given, patients present fewer burdensome symptoms [ 1 , 2 ], receive less aggressive end-of-life treatments, and are less frequently admitted to emergency departments and hospitals [ 2 , 3 , 4 ]. Patients also report a better quality of life, and a better understanding of their disease [ 5 ].

However, worldwide, PC is introduced rather late, i.e. only about 19 days before death on average, focuses mainly on patients with cancer and is rarely initiated by first-line workers [ 6 , 7 , 8 ]. People suffering from frailty or chronic non-cancerous illnesses are those who benefit least from palliative anticipation [ 7 , 9 ]. The late introduction of palliative care leads to unnecessary and futile treatments which impact the patient’s quality of life [ 10 , 11 ].

A number of reasons for the poor and late initiation of PC have been put forward. General practitioners (GP) argue that patients should initiate the Advance care planning (ACP) process [ 12 ]. But as patients are unaware of their poor state of health and likelihood of death, they find it difficult to plan their end-of-life care. This is influenced by patients’ trust in their caregiver, their past experiences and their fears or need for control [ 13 ]. Moreover, GPs face difficulties to deal with vague patient requests. They also fear depriving the patient of hope, and face the eternal difficulty of finding the "right moment” [ 12 ].

Although the responsibility for monitoring older people living with advanced chronic illnesses lies with primary care, the ED is still called upon by primary care workers in a complementary capacity, to manage distressing or acute symptoms which require immediate specialist care. The ED is the technical platform that provides rapid access to advanced diagnostic methods and specific interventions (intravenous administration of powerful painkillers, X-rays, etc.), to medical and paramedical expertise, and that facilitates transfer to other departments [ 14 , 15 , 16 ].

Older patients with organ failure, dementia or frailty often suffer from a gradual health deterioration, accompanied by episodes of exacerbated distressing symptoms, which in some cases will lead them to the emergency department (ED) [ 17 ]. Even though an ED consultation may be perceived as an undesirable event, it often marks a turning point in the disease, announcing a significative health degradation [ 18 ]. As a result, ED carers play a pivotal role in assessing patients’ state of health and referring them to the appropriate care and treatment.

EDs admit up to a quarter of older patients aged of 65 years or over, of which 15% are aged of at least 80 years [ 19 , 20 ]. Nearly three out of four older patients will use the emergency department (ED) during their last year of life and half of them during their last month of life [ 21 , 22 , 23 ]. ED admission can be an opportunity to support the initiation of a palliative care approach for older patients with organ failure, dementia or frailty.

A palliative approach focuses on the patient's quality of life. To this end, it balances examinations and treatments, considering the patient's preferences and wishes. However, ED professionals face a major dilemma in the follow-up of older patients with a palliative profile, if ever identified as such. They have to decide whether carrying on life-prolonging treatments or initiating a palliative approach that includes discussion and decision about intensity of care and some treatment limitation [ 24 ]. This is even more difficult for clinicians in the ED who are trained in acute, life-saving medicine. In order to make this type of decision, these clinicians need to be able to identify patients with palliative care needs, which is not an easy task, especially for people with non-cancerous diseases [ 17 , 25 , 26 ]. Nevertheless, a palliative approach is important to ensure appropriate care following patient wishes and goals of care, as well as to avoid poor added value treatments regarding the overall disease trajectory [ 10 , 11 ].

The literature on palliative care in EDs is emerging and the recommendations are modest and very recent (2017–2021) [ 16 , 27 , 28 , 29 ]. Despite the limited number of studies and the lack of uniformity in the palliative interventions carried out in the ED, they are showing initial positive effects for the patient and the health care system, such as: improvement of the quality of life without reducing it [ 30 ], reduction in length of hospital stays [ 28 ], reduction in the number of technical examinations (imaging) and costs [ 31 , 32 ].

However, the ED ‘s precise role in a palliative care approach, which is not reserved for the very-end-life, is unclear as it seems to vary according to the context, the culture of care and the overall health care system in place.

In this study we aim 1) to gain understanding of the actual role of EDs in palliative care for older patients and 2) to explore potential future roles for them. To achieve these research objectives, we analyse the role of ED professionals in palliative care from their point of view, and from that of primary care professionals, patients and informal caregivers.

Study design

This is a qualitative study including (1) interviews of older patients with a palliative profile and/or their informal carers and (2) focus groups of primary and ED caregivers. We seek to account for the multidimensionality and complexity of the dynamics and logics underlying the studied phenomenon, i.e. the palliative approach in ED for patients aged 75 and over, with an unrecognised palliative profile. We used an inductive and constant comparative approach for data collection and analysis following the Grounded theory process [ 33 , 34 ].

We collected qualitative data in the French speaking part of Belgium between July 2021 and July 2022. The COREQ criteria supported the report of this qualitative research [ 35 ].

Participants

We considered several types of stakeholders: patients and their informal caregivers on the one hand, primary and ED caregivers on the other. We could not study the ED’s role in palliative care without considering the point of view of primary caregivers. Because of their crucial role in managing older people’s care in community and nursing homes and maintaining continuity of care – particularly after an ED visit and in the overall palliative approach, we included them in the focus groups. We composed a reasoned and diversified sample based on different criteria such as the type of chronic pathology for patients with a palliative profile, gender, profession, and seniority. The description of the study participants can be found in tables [see Tables S1, S2 and S3].

Data collection

We collected data in two ways: by interviews and by focus groups. The interview and focus group guides used were developed for this study [see Additional files 1 and 2]. We chose to complete face-to-face interviews with patients and informal caregivers due to ethical concerns linked with the sensitivity of the research subject. We chose focus groups for the healthcare professionals’ group. All participants gave informed consent to their participation and authorised the audio recording.

Approach for older palliative patients and informal caregivers

We recruited participants purposively, based on a previous study in which older patients were included during an ED consultation [ 36 ].

For the current study, patients were recruited during the phone-call follow-up of the aforementioned study. After giving their oral agreement, patients were provided with the document describing the study. We took the time to answer their questions about informed consent and the content of the study. We asked for permission to record them. Patients aged 75 years or over with a palliative profile associated with a non-cancerous disease or frailty were eligible. The palliative profile was defined following the SPICT and explained in Bourmorck et al. (2023). Informal carers were recruited either directly from the previous study during the follow-up, or by a snowball strategy after a patients’ interview.

The field researcher (DB) conducted the interviews mostly at the patients’ private home, respecting their preference. After informal presentations, the opening question was: “Could you tell me about your last visit to the emergency department?”. All the interviews were audio recorded. Field notes were taken after each interview, composed by the main idea developed, the researcher feelings, the process particularities, the researcher questioning and reflexions, key quotes from the participants, unexpected comments, and tracks for the next steps.

Approach for primary and ED caregivers

For the focus groups, we recruited nurses and doctors from the primary care settings and emergency departments. For diversity purposes, the recruitment considered local differences in practice and covered the different provinces of French-speaking Belgium, in rural and urban hospitals.

The primary caregivers were recruited by email following a snowball strategy, identified during a patient’s interview or from professional associations. The ED caregivers were recruited within the researchers’ network by emailing the head of ED department of five different hospitals. After a positive response, we used a snowball strategy to recruit participants from the same care network to form the focus groups. This makes possible to highlight the dynamics of a team or network functioning, as well as the organisational and structural work conditions.

Prior to the focus group, exploratory interviews were conducted by field researcher (DB) with each type of professionals, i.e. doctors and nurses from primary care and ED, to specify the focus-group guide and obtain the first descriptive results .

Focus groups were conducted in 2 parts: the first part began with “Could you explain how your unit works around older patients with severe chronical conditions?” and was followed by a second question: “What does palliative care mean in your daily work?” in order to get to the heart of research subject more quickly. During the second part of the focus groups, the researchers used clinical vignettes in order to discuss care around specific conditions of older patients with a palliative profile [see Additional file 3]. All the focus groups were audio recorded. Field notes and observations were taken during each focus group by the second researcher (IDB) and discussed directly afterwards, with a threefold aim: 1) to deepen or clarify certain ideas, concepts or statements made by the participants, 2) to fine-tune the interview guide and 3) to carry out a preliminary phase of the analysis process.

Data saturation was discussed with IDB and confirmed with two additional focus group, one from primary care sector and one from ED. Data saturation was reached according to these two criteria: 1) The generic explanation was the same (data saturation related to data collection) [ 37 , 38 ] and 2) the examples continued to evolve but they no longer added anything to the categories of analysis (inductive thematic saturation focusing on the analysis) [ 38 ].

All recorded interviews and focus groups were fully transcribed and were iteratively coded and analysed by the field researcher (DB).

The coding used to anonymise participants in the verbatim transcripts was constructed as follows: “FG” if it was from a focus group (if not, nothing), the working area (“ED” or “Primary”, if not, nothing) followed by the associated number, the type of participant followed by his or her number (“P” for patient, “InformalCaregiver”, “Ph” for physicians, or “N” for nurses). Example: FG_ED1_Ph1 means that the verbatim transcript is from the focus group carried out with the ED team number 1, physician 1.

We used Atlas.ti software to support the first steps of coding. The two first interviews were double coded by an expert in geriatric medicine specialising in qualitative research (IDB). They then met on a weekly basis to support the analysis process and critically review the findings. The whole study process was discussed and followed by an expert in qualitative method.

Analysis was based on the grounded theory process in order to follow an inductive and constant comparative approach. We completed the three first steps i.e. coding, categorising and linking. Firstly, we performed a vertical analysis within each interview or focus group, from which themes and statements emerged, describing and summarising what the participants had to say.

For example, based on the verbatim coming from a primary care focus group, we were able to make those statements:

Statement 1: 'The organisation of general practice work influences the implementation of palliative care'.

Statement 2: 'The organisation of general practice work in multidisciplinary collaboration supports the implementation of a palliative approach'.

Statement 3: 'Conversely, it is more difficult when GPs work alone'.

These statements were summarised under the thematic ‘ General Practice organisation ’.

Secondly, in order to look for communalities in specific experiences, we performed horizontal analysis of the materials from participants with similar profile: a) patients and informal carers, b) ED caregivers and c) primary caregivers. These analyses, allowed the emergence of categories that go beyond description and begin to provide an interpretation of the studied situation, e.g. ‘ Know-do gaps’ [ 34 ].

Thirdly, in order to refine and link our initial emerging categories, we performed transversal analysis between the entire material, including field notes and observer notes. This allowed a triangulation that can highlight the convergences and divergences of logics [ 39 ]. During the whole process, the main researcher wrote theoretical memo highlighting the links between important themes or categories making it possible to establish relationships between categories. This is how the core category “ widespread discomfort ” emerged, explaining the underlying dynamics about ED palliative care role for older patients.

Characteristics of study participants

Five older patients with a palliative profile assessed by SPICT, four informal caregivers, 55 primary and ED caregivers participated in this study. The older patients and informal caregivers covered a diversity of life-limiting conditions, i.e. frailty, dementia and neurological diseases, severe heart, lung, kidney or liver diseases [see Tables S1 and S2].

Most of the nine interviews took place at the patients’ or informal carers’ residence, except one for which the patient preferred to meet at the researcher’s office and one that was performed at the informal carer’s working place. Interviews lasted 40 to 90 min [see Table S1].

Out of the nine focus groups organized, five included primary caregivers and four included ED teams. They took place in the participants’ working place, except one which was conducted by videoconference (Microsoft Teams®). The latter included general practitioners from different provinces available for an online session. The focus groups included between 3 and 15 participants, and lasted 68 to 120 min [see Table S3].

The ED and primary caregivers interviewed by focus groups worked in four of the five French-speaking provinces of Belgium [see tables S3 and S4]. Their years of professional experience ranged from 1 to 48 years. Representatives from both the nursing and physician professions participated, with a majority of general practitioners ( n  = 30). Among primary caregivers, different ways of working were represented (ranging from self-employed and working alone to teams in medical centres). ED caregivers were less available and formed smaller focus groups [see Table S4].

Main findings

A priori, with their current perception of reality, participants did not identify any role in palliative care for the Emergency Departments (ED). In fact, there is widespread discomfort (core category) about caring for older patients and providing palliative care (see Fig.  1 ). This reality is explained by different areas of tensions.

Widespread discomfort in palliative care for older people

The palliative care approach is fraught with pitfalls (category 1) composed by widespread knowledge and know-how gaps (two major themes), where palliative care implementation depends on the type of work organisation, as well as the patients’ type of pathology, and caregivers’ values and experiences (three subthemes) [see the coding tree in Additional file 4].

Moreover, there are constant tensions between the ED’s routine work and the palliative care approach for older patients (category 2): 1) performance versus relational care, 2) clockwork versus palliative care requirements, and 3) the need for standardised procedures versus the diversity of palliative care projects (major themes). These tensions lead to a risk of disruption of the work balance in the ED.

Nevertheless, despite this unfavourable context for a palliative approach in the ED with older patients, we highlighted opportunities. ED professionals currently endorse four roles that are part of the palliative approach: the investigator, the objectifier, the palliative care provider and the decision-maker on the intensity of care (major themes). It should be noted that these roles were not all identified by caregivers as part of a palliative approach (palliative care roles unconsciously played by ED, category 3). In addition, participants often mentioned the possibility to contribute to the identification of early palliative profiles as a prospect for the future. These main findings are developed here after.

Current perceived reality

A priori, in the eyes of most ED and primary caregivers, the ED does not have a role in a palliative approach.

FG_ED4_Ph1: “No, it’s not our place to do it. FG_ED4_N1: It is not our role.”

FG_Primary2_Ph3: “and it is not up to them (in the emergency room) to decide on the final destination.”

Most participants said that it is not the ED caregivers’ role to design an entire Advance Care Plan with an unknown patient in an acute condition. They believe the ED is not the place for global discussions about end-of-live care, it is not the most appropriate and qualified team to achieve a proper advance care planning. Their decisions are limited to the direct ED care. At present times, palliative care in ED takes place at the very end of life. If death is not imminent, it is not their work.

ED_Ph1: “Hmmm (pauses to think). It doesn't seem complex to me. What would concern me, in my opinion, whatever diagnosis we got, is that there was no immediate danger to the patient's life. It's unlikely. So, we will initiate a complex discussion with a patient who says, 'I'm ready. I can die’. In this clinical situation, however, it is not a matter for today … it (end-of-life discussions) will be dismissed by an emergency doctor. He will, if possible, talk about it to the colleague to whom he will refer the patient. Whether it's the GP or, yes, the geriatrician or the pulmonologist. He will pass on the info, but he will not take care of it.”

Widespread discomfort

In fact, there is widespread discomfort (core category) about caring for older patients with a palliative profile, whether in the ED or primary care sector. This discomfort is expressed by the majority of the participating caregivers, across the whole corpus.

FG_ED3_Ph1: “I think the GPs are like us, they are as uncomfortable as we are, and they do as badly as we do. So, they send people when sometimes they shouldn't, because they don't have the time, because they don't always ask themselves the right questions.”

Areas of tension

A care approach fraught with pitfalls

The implementation of palliative care for older patients is challenged by knowledge and know-how gaps and depends both on the caregiver’s experience and values and on the patients’ profile. These themes are described hereafter (see Fig.  2 ).

Knowledge gaps

The understanding and practice of palliative care evolve at two-tier.

On the one hand, some primary caregivers and most ED caregivers perceive themselves as akin to reapers when initiating palliative care. This responsibility can be burdened with a sense of condemning the patient and a sense of failure. Both caregivers and patients often see palliative care as opposed to the curative approach, and reserved for the very end of life, when there is nothing else to do but to smoothen death. Talking about dying and palliative care remains a taboo. Some patients do not even know what palliative care is and whether they can benefit from it.

P5: “No. I'd rather not hear about it (palliative care). Well, palliative means... ah, I think it's irreversible. The body is tired, the body no longer works normally, whether it's the head, the arms or the feet! The one who's in a cart because he... (he imitates someone bedridden by tilting his head and mouth). As late as possible! That's my only wish [...] in my mind, anyone who goes into palliative care is at the end of his rope. But I've never seen anyone who was treated and cared for in palliative care. I don't suppose we're going to invent that just to plug a hole.”

On the other hand, some primary caregivers describe palliative care as a personalised approach focused on comfort and quality of life.

FG_Primary1_Ph2: “We've gone from end-of-life care when death is imminent to comfort care. But why wait until the end of life to get comfort care? From the moment we know we're entering the process, palliative care should almost begin when we initiate care.”

Know-how gaps

Three main know-how gaps emerged from the corpus; the (a) identification of potential beneficiaries, the (b) type of medical practice organisation and the (c) formalisation of advance care planning .

Identification of potential beneficiaries

The principal know-how gap concerns the identification of older patients who may benefit from palliative care. This identification is mostly intuitive . The initiation of palliative care depends on the practitioner , on their experience, sensitivity and feelings towards the patient’s situation, on their personal values and beliefabout whatis the “right care” for the patient, and on the Belgian law criteria (financial support available if death is estimated within 3 months). Some ED professionals feel fear towards older patients management, while others are not interested in these “cases” or feel useless in “end-of-life situations” and therefore disengage from care. In contrast, others enjoy caring for older patients, whom they see as “interesting medical cases” or “complex challenges”. Some welcome the opportunity to bring back the essence of care: “humanity, dignity, what matters in life”.

FG_ED1 _N1: “It (initiating palliative care) is going to depend on the person. In my case, I might suggest it to the family, and say 'see the attending physician about it or see upstairs'. I might suggest it to my emergency doctor [...] and since there's no well-defined care project, it is set up by such and such a person at such and such a time ... well, it actually depends on who really wants to do it.”

Most practitioners identify patients for PC based on the assessment of comorbidities and severity of chronical diseases. When available, they ask for other opinions (from the general practitioner, the intensive care physician, or the patient’s disease specialist). They refer to death-related probabilities (e.g. number of failing organs). They don’t use tools to support them in the orientation of care and treatment.

The identification also depends on the older patient’s profile . Some profiles are less likely to benefit from palliative care, such as patients with slow health degradation (chronical organ failure), cognitive issues or frailty . The presence of acute cognitive issues or dementia places ED and primary caregivers in a sensitive position when it comes to deciding on the direction of care. In contrast, caregivers identify patients with a cancer profile more easily as beneficiaries of a palliative care approach.

FG_Primary4_Ph4 : “It's more complicated in the case of neurological diseases, or severe cardiac or respiratory decompensation. Here, the boundaries are much more blurred. [...] When we're still trying this drug for IC (heart failure). Still trying out new drugs for COPD, things like that. Because we think there's still a chance…”

The identification of the palliative profile is also difficult for the informal caregivers and the patients. For some informal caregivers, suffering from slow health degradation and frailty is not linked with palliative needs, because these are not “severe diseases”. Most patients are aware of their illness and their "chronic", “not curable" and sometimes “not operable” quality. However, they do not link those terms with palliative needs. None of the patients who participated in this study identified themselves as having a palliative profile.

P5: “There are illnesses that we know how to cure, there are illnesses that we can cure sometimes, and sometimes not. Cancer, for example. And then there's the chronic illnesses, for which I don't see a solution, and neither do they (caregivers). [...] Nor are they able to say 'I'm going to cure you' .... no, I think the course of this disease is like this (draws a downward sawtooth curve with his finger). Here it's great, but the further along you get, the less capacity you have.”

Type of medical practice organisation

A second know-how gap is related to the organisational practice of care. On the one hand, participants working as self-employed in a solo practice reported that implementing palliative care is difficult, even impossible. The need to be constantly available, 24 h a day, is a major constraint for them. Moreover, the time devoted to psychological support and accompanying relatives takes a lot of spacetime in the care process, yet is not valued. Caregivers in ED and in the primary care sector feel that making all the treatment and care decisions alone is too heavy a burden. On the other hand, participants working in a team feel more confident in making those decisions and in implementing PC.

FG_Primary4_Ph4: “If I was a general practitioner all on my own in the depths of my village, without a team around me, with a second line team 40 km away, I might be more reluctant to start the process. But here, I know I can count on the team. That's a support, I'd say, for us as GPs, that multi-level teamwork.”

Poor formalisation of Advance care planning

A third know-how gap is the limited use of Advance care planning (ACP). GPs fear a misuse of ACP, i.e. without re-assessment during a future episode of care, which leads to poor formalisation of a palliative approach. They are also reluctant to share their personal notes. In addition, GPs mentioned difficulties with the translation of patients' wishes into documented medical acts. There is a gap between patients’ ability of looking to the future, including their own wishes, and the translation into medical procedures. Most caregivers ask for the formalisation of the PC project as it is essential for the continuity of care.

P2: “I don't want overtreatment. If there are spare parts, well one can take them, haha ... she said ‘it's written in your file’.”

FG_ED3_Ph1: “Often it's a bit vague, the context isn't clear, patients arrive at the end of their rope (with advanced dementia) with undefined projects and in situations where we must decide whether or not to take action...”

Constant tensions between ED routine work and the palliative care approach

Caregivers, patients and informal caregivers expressed constant tensions between ED routine work and the palliative care approach for older patients, i.e. 1) performance versus relational care, 2) clockwork versus palliative care requirements, and 3) the need for standardised procedures versus the diversity of palliative care projects . These tensions are described here under.

Performance versus relational care

In the ED, caregivers and older patients have different concerns regarding care. Caregivers mostly focus on diagnosis and treatment (see clockwork and standardised procedures verbatim in the next sections). By contrast, patients and their informal caregivers explained that what is key for them is the care relationship and benevolence. They come to the ED to release the patient from burdensome symptoms linked with their chronic disease (breathlessness, pain, exhaustion, etc.), to manage an acute illness (infection, etc.), or to manage a global health degradation related to frailty, sometimes in a context of mental health issue (depression, emotional difficulties, anxiety). They come hoping for a quick diagnosis , access to specific exams or specialist , an adapted treatment and potentially hospitalisation. But the way they are treated and cared for is as important as the medical expertise .

All patients expressed a need for kindness , seen as the basis of an optimal care relationship. Kindness means for the patients to feel welcome in the unit (which is one of the first role of ED under Belgian law), to be informed through plain-language communication, and to have their basics needs satisfied. They mentioned the importance to adapt the rhythm of the ED with the older patient’s rhythm. These needs for kindness and benevolence are most often expressed in relation to an experience of ageism in care.

InformalCaregiver2: “Kindness begins with addressing patients directly. Because in some consultations, they don't ask Mum anymore, they ask me directly. And it's true that this is demeaning for the elderly person ... yes, she may answer less quickly. She'll be less precise. But you can ask the patient first, and then ask the accompanying person afterwards.”

Patients and informal caregivers appreciate a medical approach that includes patients in decision-making through accessible communication and explanations.

P2: “And I can ask any question, and get an answer. Whereas before, the doctor would tell you: it's this, it's that, goodbye...”

The time frame in decision-making and the presence of an informal caregiver are important to guarantee the patients' autonomy and to respect their preferences for care.

P2: “Yes, and I was the one who decided (not to have shoulder surgery). That was last year, in the spring. He made an appointment for November. He said 'think about it'. I said, 'No, no. When you're 85, I find that... '. And yet, if someone had told me when I fell that they were putting in a prosthesis, they would have put in a prosthesis. If they thought that was the solution... to operate, they would have operated.”

In this study there was no ACP or related documents. All patients explained that they let themselves be taken care of when admitted to the ED. ED physicians were in charge to make all decisions on the treatment and the direction of care.

P3: “In there (in the ED), I let them do whatever.”

Clockwork versus palliative care requirements

The ED functions as a ‘Clockwork’ , an industrial-type organisation where every single task is defined in time and space. As explained by ED caregivers, this machinery is designed to fulfil two pivotal roles: 1) maintain, stabilise or restore the patient, and: 2) provide diagnosis and therapeutic guidance. ED physicians endorse a detective role to find all the information needed to solve the patients’ health issue. This works in a context of fluctuating patient flow, which influences patient care. When the flow is high, ED caregivers explained that they focus on the two pivotal roles.

FG_ED1_Ph1: “... Fine-tuned care (implied: linked to a palliative approach and continuity of care) will unfortunately be modulated by the overload we may experience at certain times if I'm overwhelmed, I'll rely on the general information that the nurse gives me, that I have in the file, that I have obtained from the patient. But I won't have the time to phone the family, consult the GP or phone the nursing home. And I won't.”

For most caregivers (ED and primary), discussions about a global palliative care approach are time consuming and are not adequate in the ED due to the acute situation and clockwork. Moreover, multidisciplinary concertation is not easy to organise within the ED. However, some caregivers mentioned that discussions are absolutely necessary and that an ACP can’t replace a discussion in the present moment. The ED routine and exams are not difficult, but to “know how far we go?” in a palliative care approach is more challenging.

FG_ED1_N2: “Our difficulty is that we're on the front line. We have to work with a panel of people around us, and we have to get them to agree. As we were saying, there's the family, there's the specialists, there's the patient … so, it's an uncomfortable position that we are in. In this kind of situation,it’s 'what do we do? where do we start? with whom?' I think that's a real difficulty, because medical management... well, managing examinations, that's easy. It's the same for all patients. But it's more, how far do we go to give the right guidance? Do we hospitalise the patient? Do we keep them at home? Do we…”

When initiated in the ED, the continuity of palliative care at home is a challenge for ED clinicians because it is time consuming . It is precious to get an outpatient team ready to support the ED. The role of homecare nurses to support ED professional and GP with palliative care organisation is questioned because they are with the patient daily.

For the patients and their informal carers, the continuity of care after an ED admission or hospitalisation is really important. They feel a major rupture when they return home. They mentioned the need for a close follow-up during the first few weeks to ensure the continuity of care.

InformalCaregiver3: “If we could provide people with more precise follow-ups to go by after the patient has left the clinic ... I'd say that from the moment we get to the emergency room, we should determine whether there is a need for follow-up or not [...] I wonder if there is... something that would reassure the families. That we haven't 'just been there' (in the ED).”

Need for standardised procedures versus diversity of PC projects

The diversity of what a palliative care project can be , the misinformation about the existence of advance care planning (ACP), and the different professional attitudes in palliative care, put ED caregivers in an uncomfortable situation when they have to manage the patient care during ED admission. ED caregivers mention the need for palliative care procedures and alternative of treatments. At the time of the focus group, no palliative procedure existed for ED. Some practitioners mentioned a certain fear and discomfort about dying patient in the ED, especially in relation to the choice of medication and dosage.

FG_ED4_N1: “We're lost when it comes to this whole palliative panel. In the emergency room, we always use the same therapeutic artillery. We're not used to using scopolamine, for example.”

FG_ED1_N2: “We're sitting on the fence. Because in the ED, we're there to perform procedures, and that's sometimes complicated. For the medico-nursing team, saying 'Another doctor has decided it's over', even though it's stipulated, is a complicated thing for some. So what do we do? At what point do we stop the [care]. At what point do you cross the line? Is it applying an antibiotic? Is it suctioning a patient? Is it taking blood? That's... there's really no framework for that. So it really depends on the team you're in.”

These tensions lead to the disruption of the routine work balance in ED.

FG_ED3_Ph1: “Doctors have their own autonomy, but sometimes they tend too much to throw in their assessments and then question themselves, when sometimes it should be the reverse.”

ED_Ph1: “And that's where it gets tricky, it's well "OK, but am I doing what I usually do in front of this patient? ' No! 'All right, I'm not doing what I usually do, but to what extent? ' And to define it? Sometimes, you can't do it because you don't know how to contact people anymore, colleagues ... the patient has a bit of trouble. The patient we have on the ward says, 'Oh well, do what's right. ' Do what's right!? 'but what did your GP say? ' 'to come and see and do what's right.'... Ah ok...”

Highlighted opportunities

A priori, the participants perceived the ED to have no role in a palliative care approach. Nonetheless, we highlighted opportunities concerning some roles that emergency caregivers perform in the ED and that are part of the palliative approach. They emerged from the focus group during the discussions based on case scenarios (clinical vignettes). The four roles are: 1) the Investigator, 2) the Objectifier, 3) the Decision-maker about the intensity of care, and 4) the Provider of palliative and end-of-life care . These are roles that they take on but most of these were not initially perceived by ED caregivers as being part of a palliative care approach.

The investigator

The ED physician positions himself as an investigator in charge of finding the reasons why the patient arrives with his complaints. He deploys several actions in order to establish his diagnosis and treatment, i.e. anamnesis with the patient and his informal caregiver, auscultation, rapid technical examinations (X-ray, blood test, ECG,…), checking the medical history written in the patient's file and, if necessary, calling the general practitioner or the nursing home.

FG_ED2_Ph1: “If we see the problem, like a fall or delirium or things like that, that's the tip of the iceberg. There's a whole investigation that goes on to find out the underlying cause ... so there's a whole investigation that starts with it.”

This investigator role is hampered by the lack of information available in the patient’s file from the outpatient department, whether it concerns the reasons for admission, the patient's history, the availability of information concerning pre-existing care plans, but also by the difficulties of contacting the professionals who usually care for the patient in an emergency situation.

FG_ED4_N2: “The lack of information leads emergency physicians to take life-sustaining measures, and sometimes there are difficulties when the information arrives, as it is also difficult for team members who suddenly 'pull the plug'.”

The objectifier

The objectifier is the one who objectifies. There is a need for a neutral assessment of the patient’s needs. The ED caregivers add value by carrying out a full screening of the patient, from a neutral and external point of view. They assess the patient’s health status and trajectory, with the aim of objectively identifying the causes and the extent of the health problem. They support the general practitioner.

FG_Primary1_Ph1: “We work on the front line with a very high degree of uncertainty. We always treat a little blind. We don't have the X-ray to see if there's a pleural effusion, we don't have the troponin dosage, so we're sailing blindly and sometimes, by dint of sailing blindly, we don't really know where we are anymore. So sometimes hospitalisation (and use of the emergency room) enables us to take stock, to see if what we've done so far is good enough. It's still useful.”

The provider of palliative and end-of-life care

A priori, ED caregivers have no role in an “early” palliative care approach (early in opposition to their usual last days/hours of care). Still, they mentioned several situations where they perform legitimate palliative care acts, i.e. releasing burdensome symptoms with treatment adaptation (and sometimes treatment limitation), and accompanying the patient towards death

FG_ED3_Ph1: “But I think there's more to it than that. There's pain, there's weakness, so there's clearly a context of acute suffering, which we can do something about. And then there's the request to stop care or at least, well, yes, rather to limit treatment. Which we can listen to and, based on which, as a result, we can direct our care by saying, well, we're not necessarily going to hospitalise him if we can manage it at the nursing home.”

ED caregivers assessed all the domain that compose palliative profile identification (global health degradation and severity of life limiting conditions). But most of them do not identify them as older patients with palliative profile as defined by the SPICT and Belgian law. Sometimes they perform care and treatment following the philosophy of a palliative care approach without naming it palliative care.

FG_ED1_Ph1: “And so, when I'm confronted with a profile that, medically, has no place in aggressive care, intensive care, hemofiltration, intubation, or resuscitation, quite simply, well, I guide the patient, I hear that he wants to fight, that he would like maximalist care. But he'll have his maximalist care adapted to his profile. And I reassure him because, humanely speaking, you always have to give them a little hope, even if the prognosis is bleak: 'It's going to be complicated, but we'll be able to give you antibiotics, we'll do your maximalist treatment upstairs. But if we have to intubate you, that, that's not going to do you much good, it's going to make you even worse."

The decision-maker about the intensity of care

In the ED, the palliative approach takes place under therapeutic limitations translated in predefined levels of care. ED caregivers do not perceive it as a proper, complete palliative care approach.

FG_ED4_N3: “The palliative approach begins in the emergency room, because the patient will not be referred to an ICU (intensive care unit) but rather to the geriatric unit, which will begin the process with a life project. And if these people come back, then we'll have a project to follow.”

Perspective: Identification of early palliative profile

The main possible role for the emergency department in a palliative approach, which was expressed by most caregivers, is to trigger an alarm signal, after identifying the patient.

FG_Primary1_Ph3: “This kind of acute event (recourse to ED) must be the gateway to therapeutic projects. And [we must] ask ourselves, 'if it happens again, what do we do?'”

ED_Ph1: “But we could set up alerts. So that we can alert the colleague to whom we're passing the patient. Saying 'there's no choice, you've got to decide, you've got to discuss it' (with emphasis) ... I'd say be aware, palliative care needs to be put in place, and by the time the patient is discharged, it must have been done.”

FG_ED1_N1: “Maybe it's an opportunity, I'd like to say. It's neither the right place nor the right people, but it's the right time (to initiate a palliative approach).”

Little is known about the role of the ED in palliative care. The findings of this empirical study conducted in the French-speaking part of Belgium give insights to 1) gain understanding of the actual role of EDs in palliative care for older patients and 2) explore potential future roles for them. To our knowledge, this is the first study on ED’s palliative care roles in Belgium.

Our findings highlight key elements that are essential to understanding the widespread discomfort about palliative care for older patients with life limiting conditions who are admitted in an ED. A priori, the participants perceived that EDs have no role to play in a palliative care approach. This approach of care remains little known ( knowledge gaps ) and poorly applied ( know-how gaps ) by most ED caregivers but also by some primary caregivers. These difficulties of palliative care understanding by ED caregivers were also reported in the UK [ 40 ]. From this study, we see that from the patient’s and their GP’s side there is a lack of anticipation of future scenarios, an absence of a clearly established therapeutic project that translate their wishes into documented medical acts. Anticipation is essential, however, to guaranteeing patients' autonomy and respecting their preferences regarding care, particularly when they are admitted to EDs.

The implementation of a palliative approach is also influenced by individual factors such as the type of patient's pathology, the experience and values of professionals. Karam et al. (2017) and Leysen et al. (2020) already described the poor use of Advance care planning by Belgian GPs, their difficulties for an early identification of palliative profile -especially for patient with non-cancerous disease, and the need of ED caregivers to have access to palliative care plans, which are confirmed by our study [ 41 , 42 ].

This study revealed constant tensions between the ED’s routine and the palliative care requirements; i.e. 1) performance versus relational care, 2) clockwork versus multidisciplinarity and time requirements, and 3) the needs for standardised procedures versus the diversity of palliative projects. The ED’s primary aim is to ensure rapid assessment and acute clinical care to the detriment of a variable implementation of relational care and palliative care, also described in other studies [ 27 ]. The time constraints and management of patients flow, which are part of the clockwork, are one of the four improvement priorities for ED palliative care approach in the UK [ 40 ]. We highlighted that these tensions between care logics lead to a disruption in the work balance in ED .

However, the provision of palliative care in EDs is necessary. The lack of recognition of ED’s palliative care role, the knowledge and know-how gaps, the lack of skill development and the lack of environmental adaptation can maintain the poor implementation of palliative care in ED [ 27 ].

ED’s roles and perspectives

Despite these contextual, structural and individual elements that slow down the implementation of a palliative care approach in EDs, several roles of ED caregivers were highlighted through the use of clinical vignettes during the focus group discussions: 1) Investigator, 2) Objectifier, 3) Decision-maker about the intensity of care, and 4) Provider of palliative and end-of-life care.

Like in other studies, ED caregivers endorse the investigator role to achieve the management of acute illnesses and distressing palliative symptoms like dyspnea or pain for older patients with a palliative profile, but ED caregivers expressed the need for therapeutic alternatives to their usual medication [ 27 , 43 ]. Nonetheless, their role in realising an entire advance care planning does not seems to meet the ED caregivers skills, nor the right timing, nor the best environment, as also explained by other studies [ 27 , 44 ]. The discussions that take place and decisions that are made in EDs are limited to the intensity of care, targeting access to intensive care, intubation and cardiopulmonary resuscitation. The brevity of the therapeutic relationship and the lack of accessible information about pre-established care plans are additional factors that hamper discussions about goals of care [ 40 , 45 ]. Nonetheless, ED caregivers' external and neutral point of view of, as well as the availability of certain exams and material are requested by general practitioners in order to take a step back from the patient's situation. The EDs support primary caregivers by making objective assessments of the patient’s needs (global health assessment), providing palliative care, and being available 24/7. This is in line with another study, in which GPs turned to ED caregivers for advice [ 41 ]. In French-speaking Belgium, ED is still often used has first-resort instead of community–based generalist and specialist palliative care [ 46 ].

In a context in which older patients’ profiles are unknown, one key potential future role for ED caregivers is as identifiers of patients with a palliative profile. This would support the first step in ACP, which is currently not being taken despite the responsibility on the part of every professional to begin a discussion about the end-of-life care. This ED palliative identification can be a wake-up call for other practitioners to start this discussion.

However, continuity of care, particularly when returning home, is seen as an important element of care for older patients and their informal caregivers. But it is not recognised as part of EDs’ role by ED caregivers, who focus primarily on rapid assessment and acute clinical care. The continuity of care as a part of a palliative approach within EDs is also one of the four areas for improvement in the UK [ 40 ].

Implications for clinical practice and research

Our findings show that there is widespread discomfort about caring for older patients , and thus highlight the importance of making ED and primary caregivers competent and confident in palliative care for patients aged 75 and above . This could be achieved by implementing complex interventions that promote behaviour change through education and interprofessional and organisational collaboration [ 47 ]. Below, we outline four components that are essential to achieving this: 1) specific training programmes to improve knowledge and know-how in primary palliative care (education), 2) the recognition of the role of EDs in the palliative care approach (collaboration), 3) the improvement of shared communication about advance care planning (interprofessional and organisational collaboration) and 4) the implementation of a palliative care model in EDs with a focus on continuity of care (with the long-term aim of behavioural change) [ 40 , 43 , 48 ].

Training in palliative care needs to be emphasised in initial training curricula, as well as in continuous education courses that are tailored for professionals and their working environment, in order to improve knowledge and skills in palliative care [ 15 , 49 ]. Continuous education should include senior caregivers to encourage a change of culture through their leadership [ 27 , 50 ] .

To achieve recognition of the role of EDs in the palliative care approach, it is necessary to clarify each professional role involved in the palliative approach. Clarifying roles will enable better interprofessional collaboration [ 41 ]. A previous study focused on the role of GPs in palliative care, highlighting five of them: care planner (anticipating future scenarios), initiator of decisions in acute situations, provider of end-of-life care, provider of support, and decision maker [ 51 ]. Further research is needed to clarify the respective, differentiated, and shared roles of EDs and primary caregivers to ensure better quality and continuity of care for the older palliative patients who are admitted to EDs.

Primary caregivers, especially GPs, need to be aware of the impact (a) of relinquishing responsibility for advance care planning, (b) of discussions about palliative care and end-of-life wishes and (c) of the unavailability of this information within the patient's clinical record. This information should be available to ED caregivers [ 27 ]. Individual factors such as the fear of ACP misuse could be improved by increasing mutual knowledge and trust [ 41 ].

At present, models for palliative care in the ED exist, but they are poorly implemented [ 27 ]. The only likely perspective for EDs in French-speaking Belgium, under current conditions, is to consciously take on the role of identifying palliative profiles in older patients who are admitted. The model for action -after the identification- should be further investigated to avoid misuse of palliative care expertise and inappropriate demands on primary caregivers [ 52 ]. Palliative care champions in emergency departments is a promising model of care in this context [ 14 , 15 , 27 , 49 , 52 ]. Palliative care champions are ED caregivers who have acquired expertise in palliative care that includes the four roles we defined. They can act as expert referents within the department, in addition to their initial role as emergency caregivers [ 15 , 49 ]. Furthermore, care must be taken to implement a model of care that combines geriatric and palliative care to avoid compartmentalised programmes, given the significant overlap between these two models [ 53 ]. Particular attention must be paid to elements that can ensure the continuity of care within the model implemented and adapted to the local context of care. These elements include collaborative processes, communication between caregivers from different sectors, and predefined pathways [ 43 , 48 ].

Currently, more research is needed to define the care pathway for older palliative patients without cancer and to decide at which stages of the process to integrate the emergency room as a necessary, but not principal, contributor to the palliative approach.

Moreover, our findings also raise questions about the changing role expected of EDs. Initially developed as a response to acute problems, EDs are now the gateway to care for complex problems (chronic illnesses, end of life, etc.). So, is our emergency model still adapted to patient profiles? Does it provide a satisfactory response to society's needs, or does it need to be reorganised as a part of the front-line approach?

Strengths and limitations

Study participants.

The participants took part in this study on a voluntary basis. There were no clinician-patient relationships and no direct professional relationships between research team and clinicians. The participants were informed of the general aims of the research with the specification that their opinions and experiences are important and that there were no wrong answers. Particular attention was paid to patients and family carers when talking about palliative care, since they did not receive it and were not recognised as having a palliative profile by professionals. DB monitored patients' knowledge and awareness of their health and care during the first part of the interview, which focused on the use of the emergency department. Once the patient's situation was known, the researcher could move on to the second research topic, which concerned their representation of palliative care.

In total, 55 caregivers and five patients and four informal caregivers participated in this study.

The ED focus groups were smaller due to a lack of available staff and included more department heads than front-line nurses. For these groups, there is a potential selection bias: those who are more aware of the topic are more inclined to take part in the research.

The GP focus group ( n  = 15) turned out to be a precious negative case. Researchers were invited at a GP peer reviewed practice group meeting, but GPs were not previously informed of the specific subject of our research. The recruitment was thus unbiased by “interest for the topic” since the participants discovered it at the beginning of the meeting. They all agreed for participation.

Research team and reflexivity

Delphine Bourmorck (DB) is a PhD student in Public Health sciences, trained as a nurse specialised in emergency and intensive care. She is a full time research assistant and previously conducted interviews and observations during focus groups in other research projects (COFI, For-Care) [ 54 , 55 ]. To ensure the quality of this qualitative study, DB was supported by Isabelle De Brauwer (IDB) and Olivier Schmitz (OS) during the whole research for guidance and advice.

The main risks in qualitative research on palliative care and end-of-life include superficiality, counter-transference and the researcher's eviction mechanism in relation to his own experience [ 56 , 57 ]. To minimise these potential biases we set up an approach based on the principle of reflexivity [ 35 ]. The principal researcher (DB) carried out ongoing self-criticism in view of improving the interviews and focus groups (e.g. by notifying impressions, feelings, uncomfortable events), and reflected on fundamental questions such as “ How am I affected by my research subject ?”.

She used an inductive approach, following grounded theory principles. She took a constructivist posture: we can only see part of the truth; what participants expressed is a fraction of a bigger picture and the situation is constantly moving. Her personal characteristics and research posture may have influenced the research.

We used grounded theory as a method, in which we stopped at the linking phase, due to time and funding constraints. Nevertheless, this level of analysis allowed to answer our research questions. The theoretical sampling was only partial, i.e. we decided what data to collect next (adaptation of the interview or focus group guide) but we did not adapt the inclusion of participants nor the method to collect the data. Further research is needed to achieve a theory about the palliative care role of ED for older patients with life-limiting conditions.

Palliative care for older patients is causing widespread discomfort among healthcare professionals, patients and their informal caregivers. There are still many barriers to the implementation of palliative care in emergency departments, with tensions exacerbated by the context of acute lifesaving practice. However, even though the ED’s role in palliative care is not recognised at first sight, ED caregivers are effectively playing palliative care roles such as provider of palliative care, decision-maker about the intensity of care and objectifier of the patient’s health situation. In the future, French-speaking Belgian ED caregivers might also perform the role of early identifier and support the formalisation of palliative care by a warning signal. Further research is needed to clarify the palliative care roles of primary and EDs’ caregivers in order to guarantee the quality of care, the continuity of care and the complementarity between emergency expertise and primary care expertise. Research on the implementation of a combined geriatric and palliative care model is also required.

Availability of data and materials

Data are available on reasonable request to the corresponding author.

Abbreviations

Advance care planning

Body Mass Index

Chronic Obstructive Pulmonary Disease

Do Not Resuscitate

• Emergency department

General Practitioner

Older Patient

Palliative Care

Supportive and Palliative Indicators tool

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Acknowledgements

The authors wish to thank Olivier Schmitz for his methodological support during data collection and analysis, and Emilie Weynants who reviewed the quality of the scientific writing (not funded). We also wish to thank the patients, informal caregivers, primary and ED caregivers for their participation and trust. The authors thank the COPE study group for the support in designing the study.

This research was supported by Maurice Maret Fund, King Baudoin Foundation, Belgium. Sponsor played no role in the design, data analysis and redaction of the present article.

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DB and IDB designed the study. DB and IDB were involved in recruitment and data collection, they performed the data analysis. DB wrote the main manuscript. IDB and MdSH helped to draft the paper. MdSH, BP and IDB helped in critical revision of the paper. All authors of the manuscript have read and agreed to its content and are accountable for all aspects of the accuracy and integrity of the manuscript.

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Bourmorck, D., Pétré, B., de Saint-Hubert, M. et al. Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission. BMC Health Serv Res 24 , 773 (2024). https://doi.org/10.1186/s12913-024-11242-2

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Integrating story-based STEM design challenges in early childhood curricula: an activity theory perspective

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The Maker Movement has emerged as a significant cultural phenomenon in the twenty-first century. Stemming from the Maker Movement, the STEM design challenge aims to foster children’s utilization of interdisciplinary knowledge and creative skills to address real-world problems. This study devised the Story-based STEM Design Challenge (SSDC) by integrating storytelling with the STEM Design Challenge. A total of six classrooms, including 12 teachers and 164 children, voluntarily participated in this study. Through the teacher training workshop and the implementation of the SSDC, data related to teachers and children were obtained from the sources of teacher interviews, group discussion, pedagogical documents, and videotaped classroom observations. Results revealed that there were both facilitators (i.e., support from existing kindergarten curricula, stakeholders’ recognition, and assistance of pedagogical tools) and barriers (i.e., constraints within the participating kindergarten, insufficient experience of teachers in STEM fields, limitations of young children’s current abilities and knowledge) when introducing the SSDC in early education settings in China. This research offers valuable insights for implementing STEM design challenges and provides practical guidance and suggestions for educators interested in this field.

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We would like to appreciate the Chinese kindergarten principals, teachers and children who voluntarily took part in the study.

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Zhou, W., Yang, W. Integrating story-based STEM design challenges in early childhood curricula: an activity theory perspective. Int J Technol Des Educ (2024). https://doi.org/10.1007/s10798-024-09917-2

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