质性研究系列 - 与Perri Tutelman一起探索新范式

欢迎收听《言语的力量》播客，通过更好的沟通提升患者护理质量。欢迎来到《言语的力量》播客新一期节目，我是奥利弗·汤普森。在开始前，我想衷心感谢所有通过Patreon支持本节目的听众。你们的支持对我们至关重要，将确保播客保持免费开放、无广告投放，并维持每周或每两周更新的稳定频率。

Welcome to the Words Matter podcast, enhancing patient care through better communication. Welcome to another episode of Words Matter podcast. I'm Oliver Thompson. So before we start, I wanted to say a great big thank you to all of you that have supported the show via Patreon. Your contribution is really appreciated and will help ensure the podcast is free, accessible to all, and ad free, and also that the episodes are regular, something like an episode every week or two.

若您愿意以每期1英镑/美元/欧元的金额支持节目，请访问patreon.com/wordmatterpodcast。这是质性研究系列的首期节目，我和嘉宾将先俯瞰质性研究的全貌，再深入探讨其不同理论、方法论及具体研究方法。除本期外，后续将推出：伯克斯与米尔斯教授的扎根理论、维索夫斯基博士的现象学、克拉克博士的主题分析法、塞切尔博士的批判与后质性研究路径。

So if you'd like to support the show for as little as a pound, a dollar, or a euro per episode, then please visit patreon.com thewordsmatterpodcast. So this is the first episode of the qualitative research series, where my guests and I fly above to get a broad overview of qualitative research, but then also land on areas to get a more detailed sense of the different theories, methodologies, and methods of qualitative research. And in addition to today's episode, the conversations coming up include grounded theory with professors Melanie Berks and Jay Mills phenomenology with Doctor. Purio Vuyskowsky, thematic analysis with Doctor. Victoria Clark, critical and post qualitative approaches with Doctor.

夏洛特·阿尔伯里博士的会话分析，以及戴夫·尼科尔斯教授主持的质性研究答疑特辑。戴夫教授将与我共同讨论并解答关于质性研究各领域的提问，请于6月25日前通过各大社交媒体平台（推特直接/公开@、Instagram或Facebook私信）提交问题。

Jenny Setchall, conversation analysis with Doctor. Charlotte Albury, and there'll be a final special qualitative research ask us anything episode with Professor Dave Nichols. Dave and I will be discussing and answering your questions on any areas of qualitative research, So please send in your questions to me by the June 25, and you can find me on any of the major social media platforms. Either tweet me directly or publicly, or Instagram me, or send me a message over Facebook. So in this first episode of the qualitative research series, I'm speaking with Perry Tuttleman.

本期嘉宾佩里·塔特尔曼是加拿大哈利法克斯达尔豪斯大学临床心理学博士生，其研究聚焦癌症患儿在疾病全程中的疼痛体验。她已发表多项探讨疼痛与重症领域中患者、家属及医护人员生活体验的质性研究，并指导对质性方法感兴趣的研究生，近期还联合客座编辑了《加拿大疼痛杂志》质性研究特刊。节目标注中已附佩里的社论及她与其他特刊作者的网络研讨会视频链接。

Perry is a PhD candidate in clinical psychology at Dalhousie University in Halifax, Canada. Her research is focused on understanding the pain experiences of children with cancer across the disease trajectory. And she's published several qualitative studies that explore the lived experience of patients, families, and health care providers in the areas of pain and serious illness. She actually mentors graduate students interested in qualitative methods, and recently co guest edited a special issue on qualitative research in pain for the Canadian Journal of Pain. And in the show notes, I've linked Perry's editorial and also a series of webinar videos from Perry and also the other contributors to the special issue.

本期我们将探讨：佩里从量化研究背景转向质性研究的历程；质性研究的本质界定（远不止数据类型问题）；作为方法论家族的异质性特征（各具哲学/历史/理论基础）；这种多样性带来的挑战与优势（丰富性/灵活性/实用性）；以及认识论/本体论等基础假设如何支撑研究方法。

So in this episode, we speak about Perry's journey into qualitative research from her background as a psychologist trained in quantitative research methods. We discuss what qualitative research is and what it isn't, and that it is more than just the type of data collected. We talk about qualitative research as a heterogeneous family of methodologies, each with different philosophical, historical, and theoretical backgrounds and underpinnings. And we discuss the challenges that this diversity can bring, but also the richness, flexibility, and utility of qualitative approaches. And we touch on the different foundational assumptions of qualitative research, such as views on knowledge, reality, and truth, and how these support, justify, and inform the research methods.

我们将质性研究置于循证实践框架中探讨其定位与价值，最后聚焦质性研究在疼痛及疼痛管理知识建构中的独特贡献。与佩里的对话堪称系列最佳开场：她从初期挫遇到如今娴熟运用质性方法的经历，与我及许多听众跨越研究范式时的困境产生强烈共鸣。本次交流既系统介绍了质性研究核心要素，也阐明了其对构建全面临床证据体系的重要作用。

And we locate qualitative research in the context of evidence based practice, and what it offers and where it fits. And finally, talk about the role, value, and contribution of qualitative research for generating knowledge about all aspects of pain and pain management. So this was such an enjoyable discussion with Perry, and the perfect opener for the series. Hearing Perry's journey into qualitative research, her early challenges and frustrations, and how she is now using qualitative approaches really resonates with my own experiences, and I'm sure many of you have had to grapple with the initial discomfort of stepping into a different research paradigm. So it's great to share this and introduce some of the key aspects of qualitative research, and also talk through the valuable contribution that qualitative research can make to building a rounded and relevant evidence base to support clinical practice.

现在有请佩里·塔特尔曼。佩里，欢迎来到节目。

So I bring you Perry Tuttleman. Perry, welcome to the podcast.

感谢邀请我参加。

Thank you for having me.

所以这个关于定性研究的系列节目筹备已久，而我想你将成为首位嘉宾。对此我要恭喜你。

So this is a real long time coming, this series of episodes that I'm doing on qualitative research. And I think you're going to be the first. So congratulations to that.

谢谢，这真是莫大的荣幸。看到其他受邀嘉宾名单，能被纳入这个系列让我倍感荣幸。

Thank you. It's really an honor. And looking at the other line up of speakers, I feel really honored to be included in this series.

说实话，我希望所有节目都能做到的是——回想起我开始攻读博士学位时，就像我们私下聊的那样，我们大多来自定量研究背景，却决定做些定性工作。对我而言那是十多年前的事，当时根本没有关于定性研究的播客，YouTube上可能有些模糊的老视频，还有大量书籍虽然有用，但恐怕不如我们即将展开的对话这样引人入胜。

And really, I think what I want all the episodes to do is to I'm thinking about when I was embarking on my PhD and I came as pretty much all of us, as you and I were talking offline, coming from a quantitative background and you decide to do some qualitative work. And this for me, it was ten, twelve years ago for my PhD, but there wasn't there certainly wasn't any podcasts around the qualitative research. And there might have been some old grainy videos on YouTube and just lots and lots of books which were helpful, but perhaps not hopefully as engaging as the conversation we're about to have.

完全同意。这种原生态的基础经验交流和对话非常有益——探讨定性研究的本质、边界以及争议点。这些内容在那些理论性出版物中常常被忽略，而这正是人们入门需要掌握的实用知识。

Absolutely. I think this is helpful in getting kind of that raw ground level experience and conversation about what qualitative research is, what it isn't, what some of the controversies are. And I think those are things that are often missed, in those more theoretical publications. And this is the practical stuff that people need to know in order to kind of get started.

确实。不过首先我们需要介绍你。但在那之前，我还想对临床医生说几句——当他们面对定性研究时，需要理解其价值并做出判断：这属于什么类型的知识？这类证据该如何与我接诊的患者联系起来？

For sure. And I think we need to introduce you first. But before we do, I also want to say that about clinicians, you know, that clinicians that are confronted with a qualitative study and need to make some kind of sense of it and make some kind of judgment about, well, what kind of knowledge is this? What kind of evidence is this? And how am I supposed to relate it to the patients that I see?

希望收听节目的临床医生能更有信心运用这些定性证据，而不是固守那些我们知道无法匹配个体病例的大群体研究数据。

So hopefully clinicians listening will have greater confidence to utilise some of this qualitative evidence rather than just sticking with the stuff, which we know doesn't map to individual cases because they're from large populations.

确实。我一直在思考定性研究如何与循证医学、循证实践相结合。也许我们可以探讨一下这个话题。

Exactly. I've done a bit of thinking on how qualitative research maps on to evidence based medicine, evidence based practice. And so perhaps that's something we can touch on.

太好了。不过在开始之前，不如你先简单介绍一下自己？包括你的学术背景以及如何进入定性研究领域的历程？

Brilliant. Well, before we do, why don't you say a little bit about yourself, your academic background and your journey into qualitative research?

是啊，这段历程确实不简单。我即将在加拿大哈利法克斯的达尔豪斯大学完成临床心理学博士学位，导师是Christine Chambers博士。正如你所说，我的学术训练主要侧重于定量方法。我的研究聚焦于疼痛问题，特别是儿童癌症在整个病程中的疼痛管理。

Yeah, it is quite the journey. So I'm just finishing my PhD in clinical psychology at Dalhousie University, which is in Halifax, Canada, and I'm supervised by Doctor. Christine Chambers. And like you kind of said, you know, my training background has predominantly been in quantitative methods. My research has been focused on pain, mostly in childhood cancer, across the disease trajectory.

迄今为止，我的工作主要围绕癌症相关疼痛的普遍性和特征展开。但当我开始撰写以癌症治疗后疼痛和生存者疼痛为主题的博士论文时，发现这个领域的研究如此匮乏，甚至难以确定该从何种定量研究入手。因此我认为应该先进行定性研究。当时定性研究对我来说完全是个未知的黑匣子，于是我开始阅读探索并寻求相关指导。

And, you know, my work so far has really been about understanding the prevalence and the characteristics of cancer related pain. But when I was starting my dissertation, which was focused specifically on pain after cancer treatment had finished on pain and cancer survivorship, there was such little research in the area that it was hard to even figure out like what kind of quantitative study, you know, would I start in that area? So I thought it was important to start with a qualitative study. And at that point, qualitative research was this black box of, you know, something unknown to me. And so I started reading and exploring and sought mentorship in the area.

我与达尔豪斯大学的Robin Urquhart密切合作学习定性方法。学习过程中我感到相当沮丧，因为疼痛学期刊（我的研究领域）发表的定性研究非常少，而且学界对高质量定性研究的评判标准也存在矛盾——我学到的严谨标准包括丰富详实的描述、小样本量、理论框架等，但审稿人和编辑却常以'样本量不足''未达到饱和抽样''缺乏效度'等理由拒稿。在我的导师支持下，我联系了《加拿大疼痛杂志》主编

I worked really closely with Robin Urquhart here at Dalhousie to learn qualitative methods. And as I was learning, I felt quite discouraged and frustrated because for quite a few reasons, but there's really a lack of qualitative research published in pain journals, which is the area that I'm in. And there's quite a bit of inconsistency, you know, between what I was taught to be rigorous, high quality qualitative research, so rich, thick descriptions, small samples, theoretical lenses, and then what reviewers and editors would come back to say on the papers, you know, it's not valid, the samples are too small, you didn't, you know, recruit until saturation. So I was feeling quite frustrated. So, you know, with the support of my supervisor, I reached out to the editor in chief of the Canadian Journal of Pain, Doctor.

Joel Katz博士，询问是否有兴趣合作编辑一期疼痛定性研究特刊，专门收录那些通常难以在医学期刊发表的高质量创新型论文。他对这个想法非常支持。后来我与西安大略大学的Fiona Webster博士共同客座编辑了这期特刊，从中获益良多，之后的事情就顺理成章了。

Joel Katz, to see if he might be interested in having us co edit a special issue on qualitative research in pain, where we could really highlight these high quality, novel, rich types of papers that don't often, you know, get into medical type journals. And he was really keen on the idea. So Doctor. Fiona Webster, Western University, and I co guest edited that special issue where I learned a tremendous amount. And the rest is kind of history.

我运用解释现象学分析法开展了大量关于疼痛与生存体验的研究，同时也涉猎过定性描述等其他方法论领域。

I've done quite a bit of work using interpretive phenomenological analysis to understand pain and survivorship, but have also dabbled in other areas like qualitative description.

这段经历非常有趣。我想不出比撰写一篇总结该期定性研究论文的社论更能让你沉浸于定性研究或至少了解它的方式了。我就是这样知道你的工作的，大概一年前在Twitter上看到你制作的一系列视频，应该是特刊中的一些作者展示他们的定性研究，你主持并讨论自己正在做的事情。我当时就想，哇，YouTube和Twitter上竟然有关于定性研究的可视化内容，而且你讲解得如此清晰、简洁、连贯，所以我必须邀请你上节目。

That's a super interesting journey. I can't think of a better way to immerse yourself in qualitative research, or at least learn about it, than writing an editorial summarising the qualitative papers that were in that edition. And that's how I came to know your work, was that somewhere on Twitter, must have been a year or so ago now, you did a series of videos from, I'm assuming, some of the speakers that published in the special edition, that they were presenting their qualitative work and you were kind of hosting it and talking about the stuff that you were doing. And I was like, wow, there's kind of visual stuff on YouTube and on Twitter about qualitative work. And you presented it so clearly and simply and coherently that, yeah, hence I had to come and get you on the show.

谢谢。很高兴你看到了并且给予这么积极的评价。我记得特刊中有七位作者发表了实证文章，后来我们举办了一场网络研讨会让他们展示工作。这也是我和Fiona讨论定性研究与疼痛领域的一些争议和误解的机会，希望能引发讨论，提高这类研究在疼痛领域的接受度和影响力。

Thank you. I'm so glad you saw it and that you viewed it so positively. We had, I believe, seven authors publish empirical articles in the special issue. And then we hosted a webinar to have them kind of showcase their work. Also, it was a chance for Fiona and I to talk a bit about some of these controversies and misconceptions qualitative research and pain, and to hopefully, you know, start a discussion about this and increase, you know, the acceptance and kind of the popularity of this work in the pain field.

那个网络研讨会还能找到吗？

Is that webinar still floating around somewhere?

可以找到。

It is.

我一定会在节目说明中附上那些网络研讨会和视频链接，它们真的非常有用。

I'll certainly link those webinars and those videos in the show notes. They were super helpful.

那太棒了。

Oh, that would be awesome.

或许我们可以一起探讨什么是定性研究。我有些自己的看法，但你是嘉宾，我想听听你的观点。要知道，在相对主义、主观主义的视角下，任何定义都是存在问题的——本就没有绝对标准。但当我们谈论定性研究时，哪些特征或属性使其区别于定量研究方法呢？

I think maybe we can both try and grapple with the question of what is qualitative research. And I've certainly got my own thoughts about it, but you're the guest and I want to hear your thoughts about what and I think, you know, recognising that trying to define anything is problematic when taking a relativist, subjectivist view like there aren't any hard definitions. But when we talk about qualitative research, what are some of the features or attributes or characteristics of qual research which perhaps differentiate it from quantitative approaches?

是的，我很高兴你提出这个问题，因为我认为它真正触及了我们今天要讨论内容的核心。正如我所说，当我刚开始接触定性研究时，我只是把定性视为一个黑箱，认为它必定意味着访谈或开放式问题之类的东西。但实际上它要深刻得多。我认为一个很好的描述方式是：定性研究实际上是指一系列专注于理解经验和意义解释的方法论体系，它有着独特的认识论和本体论假设——也就是关于知识和现实的本质及其理解方式的理念。

Yeah, I'm glad you asked this question because it's, I think, really at the core of what sets up the rest of what we're going to talk about today. And as I said, when I was starting my journey into qualitative research, I just saw qualitative as this black box of qualitative, and it must mean interviews or open ended questions or something like that. But it's really a lot deeper. And so I think kind of a nice way to describe it is that qualitative research, you know, really refers to a family of methodologies that focuses on understanding, like, meaning and interpretation of experience. And it has distinct epistemological and ontological assumptions, you know, which is kind of like the idea of what knowledge and reality are and how they can be understood.

从定量研究的视角来看，定量研究建立在这样一个理念基础上：存在一个可以观察或测量的单一客观现实或真理。而定性研究则采取不同的立场，认为不存在绝对真理，而是基于情境的叙事性真相或解释。我认为这种对比很有意义，因为它凸显出我们在这里运用的是两套完全不同的知识表征逻辑体系。这也说明了将定量研究的标准套用到定性研究上（或反之）是多么成问题——它们根本就是完全不同的东西。

So from a quantitative lens, you know, quantitative research is really founded on this idea that there is one single objective reality or truth that can be observed or measured. And qualitative really takes, you know, a different stance on this, you know, that there's no one absolute truth, but that there's this narrative truth or interpretation that's based on context. And so I I think that's a nice way to kind of contrast the two because it highlights that we're working with two completely different sets of logic here in terms of what knowledge represents. And I think it also highlights, you know, how problematic it then is to apply a set of criteria from quantitative research to qualitative research or vice versa. They're just completely different.

没关系。

That's Okay.

你总结得非常好——要理解定性和定量研究中的技术或方法，必须明白这些方法背后的原因。比如随机对照试验中采用盲法、控制各种混杂因素，其抽样方式与定性研究截然不同，这都有其道理。同样，定性研究中使用的方法都受到特定观点、特定立场的指导，就像你说的关于现实和知识的立场。这就是为什么定性研究只采用六名参与者也没问题，不存在逻辑矛盾，因为你本就不追求普适性。你们对因果关系的看法不同，而且未必关注因果关系。

You summed it up really nicely that to understand the techniques or methods in both qualitative and quantitative research, there are reasons why those methods are done. So there's a reason why in a randomized controlled trial that there's blinding and they're controlling for various confounders and the sampling's quite different to qualitative research. Likewise with qualitative research, the methods which are involved in a qual study, they're all informed by a particular view, by a particular position on, as you said, reality and knowledge, which is why it's okay to have six people in a qualitative study. And there's no logical inconsistency that that you're not looking to generalise. You've got different thoughts around causation and you're not necessarily interested in causation.

所以我想，如果我们要为听众提炼第一个学习要点的话，那就是：要理解定性方法及其内涵，关键在于领会驱动这些方法的底层哲学理念。

So I suppose if we were going put learning point one, if you like, for listeners would be to make sense of the qualitative methods and what they're about is to appreciate the underlying philosophy which drives those methods.

完全正确。我认为很多定性研究新手难以把握的正是这一点：定性研究不只是定性研究，它更像是一个涵盖不同范式和方法论的统称，比如扎根理论、现象学或质性描述，它们都有不同的理论视角。每个类别下还有子类型，它们都奠定了理论基础，规定了需要多少参与者、采用何种数据收集方法等等。因此重要的是确保你具备这种理论视角，而不是简单地说你要做定性研究。

Absolutely. And I think that that is something that I think a lot of people who are new to qualitative research struggle to kind of grasp is this idea that, you know, qualitative research isn't just qualitative research. It's more of an umbrella term for different types of paradigms and methodologies, you know, like grounded theory or phenomenology or qualitative description, which all have different theoretical lenses. And there's even subtypes under each one. And, you know, they all kind of lay that theoretical groundwork that stipulates how many participants you'll need, you know, what types of date methods of data collection you're going to And so it's important to kind of make sure that you have that lens and that you're not just saying that you're going to do a qualitative study.

哪种类型？

What kind?

但这确实让它变得相当难以理解，不是吗？被称为定性方法论的研究群体本身就令人困惑。但当你深入细节和认识论层面的细节时，它们可能大相径庭。作为话语分析师与扎根理论家或现象学家相比，你们可能持有完全不同的理论观点，而这些都归属于定性研究的范畴。但实际上，其中存在一些真正对立的观点。

But it does make it quite impenetrable, isn't it? The fact that it's just confusing that you've got this group of research called qualitative methodologies. But when you dive down into the detail and the epistemological detail, they can be quite different. As a discourse analyst versus a grounded theorist versus a phenomenologist, you might have quite different theoretical views, which all fall under the umbrella of qualitative research. But actually, there's some real contrasting views there.

我认为它们共同之处在于方法往往类似，所以数据收集通常涉及社交互动，比如访谈、观察，但有时也包括文本分析。

I think what is consistent with them all is the methods tend to be kind of similar, so they're often the data collection involves a social interaction, if you like, interviews, observation, but sometimes texture analysis, too.

是的，我同意这一点。

Yep, I would agree with that.

所以我想知道你对此的看法，我们私下也讨论过澄清这个误解。我在教授定性方法或定性研究时，发现人们对其本质存在几个误解。一个关键误区是认为它仅关注主观体验——因为主观体验同样可以通过量化方式研究，对吧？因此定义它的关键不在于研究问题的性质，而在于研究方式。

So I wondered what you thought about, again, spoke offline about clearing this misconception up that I suppose in my mind when I'm teaching qualitative methods or qualitative research, are a couple of misconceptions about what it is and what it isn't. One thing that it isn't is one thing that doesn't necessarily define it is that it just looks at subjective experiences because we can look at subjective experiences quantitatively, right? And so it's not just necessarily the nature of the problem that you're looking at, but it's how you're looking at it.

确实，我认为这个观点很重要。回顾我在定性与定量研究领域的经历，其实两者存在许多我们不愿承认的相似性。定量研究追求普适性、无偏见和测量客观体验，但当前定量研究正面临可重复性危机，大量文献记载了情境效应的影响。

Yeah, and I think that's an important point. And as I've been reflecting on my journey through qualitative and quantitative as well, I think there's often more similarities that we don't like necessarily to acknowledge. The fact that quantitative research aims to be generalizable and free of bias and all those things and measuring objective experience. But, you know, we're facing a reproducibility crisis in quantitative research. And there's lots of literature documenting context effects.

现在学界提倡预注册试验和分析方案，但在日常实践中仍存在大量p值操纵和数据钓鱼行为。我认为这很大程度上源于研究者的先入之见和偏见。我们在定性与定量研究之间划出的这条所谓'定量是客观普适的，定性则不是'的隐形界限，其实两者的重叠度远超我们愿意承认的范围。

And there's this push to pre register your trials and your analyses. But in day to day practice, there's a lot p hacking that goes on and and phishing in in data. And I think that's driven a lot by, you know, researcher preconceived notions and biases and and things like that. And I think, you know, we draw this line, this invisible line between qualitative and quantitative being quantitative is objective and generalizable and qualitative isn't. But I think there's more overlap than we like to admit.

那些自诩'我是客观的真正科学家'的定量研究者总会遇到这样的困境：谁来决定采用何种统计检验？这些都是人为决策。谁制定纳入或排除标准？也是人为决定。即便你给出一张满是p值或置信区间的表格，这些数字本身很少能自我解释。

I mean, the thing that always trips up the quantitative researcher, the ones that wear the badge that says I'm objective, real scientists, is that things like who decides to do the statistical tests? These are human decisions. And who decides the inclusion criteria or exclusion criteria. These are decisions made by people. And also, if you just give someone a table of p values or confidence intervals or whatever it might be, they rarely speak for themselves.

他们需要围绕这些内容进行一些解释性评论才能理解。所以我认为，这种客观性或客观研究本身的概念有点谬误。

They require some interpretive commentary around that to make sense to them. So this idea of objectivity or objective research in itself is a bit of a fallacy, I think.

哦，我完全同意。你知道，定性研究中反身性的概念是我非常喜欢和欣赏的。研究过程实际上是研究者与参与者之间的互动，知识是以这种互动方式产生的。这承认了定性研究者会带着基于自身生活经验的观点进入研究或分析，而这些观点无法完全剥离。在量化研究中，这常被视为坏事——你带着先入为主的观念，会污染数据。

Oh, I completely agree. And that's, you know, the idea of reflexivity in qualitative research is something I really like and really appreciate. You know, this idea that the research process is really an interaction between the researcher and the participants and knowledge is kind of produced in this interactive way. And it kind of acknowledges that research, qualitative researchers will come in to a study or to an analysis with these ideas just based on their own lived experience, and that that can't necessarily be parceled away. And I mean, I think in quantitative research, that's often considered a bad thing, you know, that you come in with these preconceived ideas and you're biasing the data.

但在定性研究中，这并非坏事。只要你阐明自己的观点、立场和研究方法，反而能增加数据的丰富性。

But in qualitative, it's not considered a bad thing. As long as you kind of declare your views and your positions and how you're approaching a topic, it adds to the richness of the data.

确实。我刚和扎根理论的明星学者梅兰妮·伯克斯与杰伊·米尔斯交流过。扎根理论中有个'理论敏感性'概念——你的'理论嗅觉'或'分析嗅觉'会变得敏锐，能更好地感知对参与者重要的事物，以及需要收集的数据类型或访谈中该提的问题。这种能力并非凭空出现。

For sure. And I've just spoken with Melanie Berks and Jay Mills, who are like grounded theory superstars. And within grounded theory, there's this notion of theoretical sensitivity, where your theoretical nose, if you like, or your analytical nose becomes heightened and aware and you begin to to have a good sense of what's important to your participants and the sorts of data which you might need to collect or the sorts of questions you need to ask in your interviews. And that comes from somewhere. It hasn't just appeared out of thin air.

正如你所说，它基于你的生活经验、阅读的文献等。某种程度上，这种特质很有价值，许多资深理论家视其为优势。当然也可能走向反面——强行将数据解释套入现有理论、文献或个人观点。

It's based on, as you said, your own life experience, the literature you've read, all those sorts of things. So in a way, can sometimes be quite valuable and many grander theorists or grander theorists see it as an attribute, if you like. But of course, you can go the other way that you begin to force your interpretation of the data into either existing theory or existing literature or your own views.

完全正确。这确实需要平衡。我认为所有研究者——无论定性定量——都需意识到这点。在我看来，最乏味的莫过于完全遵循标准化脚本、毫无偏离、不提追问问题的定性访谈。正是那些计划外的探索才带来深度。

Totally. It's a balance, for sure. And I think that's something that all researchers, qualitative or quantitative, have to be aware of. In in my opinion, you know, there's nothing more boring than a qualitative interview that follows, like, a standardized script and that doesn't deviate, you know, at all and doesn't ask prompts and follow-up questions and explore avenues that you didn't consider. That's where the richness comes from.

当我们试图强加结构或限制时，问题就出现了。从量化角度看，分析过程或数据收集被访谈者/研究者塑造可能被视为问题。但我不这么认为——这正是该方法的特点：不同研究者做同一研究，可能会提出不同问题，发现不同主题。

And when we try and force, you know, a structure or, like, limits around that, I think that becomes problematic. And, you know, I think from a quantitative perspective, you know, this idea that the analysis is really the analysis or the collection of data is really shaped and formed by the review the interviewer, the the researcher, that that can be a problem. And I I don't see it as a problem. I think it's just characteristic of that method that, if a different researcher were to do that same study, they might be asking different questions. They might find different ideas or themes in the interviews.

这仅仅是它的一部分。你知道吗，我曾收到过一份关于IPA手稿的审稿意见，我在这里读一下。意见说：'由于缺乏标准化且数据易受不同解读影响，请将这些列为方法学局限。'这让我非常沮丧，因为这根本不是局限，而是该方法的一个特性。

And that's just part of what it is. You know, I once got a review on a manuscript, on an IPA manuscript, and I'll just read it here. And it says, due to the lack of standardization and vulnerability for different interpretations of data, Please include these as methodological limitations. And, you know, I got so frustrated about that, because it's like, it's not a limitation. It's just a characteristic of the method.

是啊。这就好比说我们的局限是有两条腿而不是三条腿。

Yeah. That's like saying limitation is that we've got two legs and not three legs.

没错，完全正确。

Exactly. Exactly.

不过确实，这是个很好的观点。我想我们或许应该探讨一下为什么在定性研究中可以这样做——比如常见的策略是在访谈间调整问题。你可能在头几次访谈中使用一套问题，然后在第三、四、五次访谈时决定修改。想象一下定量研究者突然在问卷调查中删减或增加问题会怎样。

But yeah, I mean, that's a really good point. I think we should maybe dwell on why it's okay to have, for example, a common strategy in qualitative research is to change interview questions between interviews. So you might ask the first couple of interviews, you might have a set of questions, but then decide to change them interview three, four, five, whatever. And you can imagine as a quantitative researcher suddenly going into your questionnaire survey and just, well, I think I'll take that question out. Well, I'll put in a few more questions.

这会彻底破坏测量工具的信效度。但定性研究允许这样做有充分的哲学依据：你关注的是观点的多元性。同时作为质性研究者，你本身就是参与式的——你是访谈数据建构的一部分，你需要挖掘个体背后的意义和视角，因此必须通过不同的问题来撬动。

It just blows up the reliability and validity of these instruments. But there's a good philosophical reason why that's okay, is that you're interested in the multiplicity of views. But also as a quality researcher, you are it's participatory, right? That you are part of that construction of the data within that interview, and you want to get behind those individual meanings and perspectives. So you're going to have to use different levers in terms of your questions.

完全同意。无论是审稿、自己写作还是指导学生时，我认为能提供最丰富数据的方式就是呈现参与者之间的对比观点——比如'有些参与者这样描述，另一些那样描述'，从而展现经验的复杂性。如果不动态调整问题，比如问'基于你之前的回答，我想知道你对此的看法'，就无法触及这种复杂性。

Absolutely. And I think, you know, when I'm reviewing for a journal or writing my own manuscript or mentoring other students, I think something that provides kind of the richest data is, you know, providing contrasting views between participants and to be able to say, you know, some participants described it this way, others described it this way, you know, and to be able to show that complexity of experience. And, you know, if you don't change your questions throughout and say, you know, I'm wondering what your thoughts are around this based on what you may have learned earlier, you can't tap into that complexity.

或许现在你可以和我们分享一下，你在自己的研究和博士项目中是如何运用质性研究方法的。

And maybe we can at this point, it's good for you to tell us a bit about how you've used qualitative research in your own research and your Ph. D.

是的，我是说，有各种不同的方法。我的一篇主要博士论文中，我对儿童癌症幸存者及其父母在癌症后的疼痛体验进行了诠释现象学分析。在那项研究中，我采访了8至17岁的儿童及其父母，了解癌症后疼痛的感受及其意义——疼痛的含义是否发生了改变？还是维持原状？

Yeah, I mean, are a range of different ways. One of my main PhD papers, I did an interpretive phenomenological analysis of the experience of pain after cancer in children, childhood cancer survivors and their parents. So in that study, I interviewed children ranging in ages from eight to 17 and their parents about what pain was like after cancer, what it meant. Did it have a changed meaning? Did it not?

那真是一项极其丰富的研究，现已发表在《心理肿瘤学》期刊上。那是一项高度诠释性的研究，着眼于疼痛的体验与解读。作为对比，我和同事凯尔·维德参与了国际疼痛研究协会关于疼痛定义修订的论文工作。在那项研究中，协会向全球公众征集了关于疼痛定义的开放式意见。

And that was a really, really rich study. It's now published in psycho oncology. And then, so that was a very interpretive study that looked at the experience, the interpretation of pain. And then just to contrast that, a colleague, Kyle Vader, and I participated in the International Association for the Study of Pain, their revised definition of pain paper. And for that study, IAS, you know, elicited open ended responses from the general public all over the world about what their thoughts were on the definition of pain.

于是凯尔和我对参与者针对更新版疼痛定义的反馈进行了内容分析。我认为，这体现了两种不同的研究思路：一种是IPA（诠释现象学分析）中丰富的理论诠释，另一种则是内容分析中更为直接客观的陈述。

And so Kyle and I did a content analysis of the participant responses to the updated definition of pain. So I think, you know, those were two separate kind of ideas of this really rich theory interpretation in IPA and a more, straight direct account in content analysis.

这个例子很好地展示了质性研究内部的不同哲学取向——有人可能会说内容分析是以后实证主义为基础的，即研究者假定数据中存在可提取的内容，可以通过编码过程抓取，然后分析频率或构建主题类别。但你们使用的仍是质性数据，我猜你们是通过编码达成某种意义共识？

And yeah, that's a really good example of the different philosophies within qualitative research that I suppose some would say that content analysis is underpinned by kind of post positivism, that you're presuming that there's stuff in the data which you can kind of as a researcher, you can kind of reach in and grab it, if you like, and then look at the frequency or kind of develop some sort of theme or category. But yet you're using qualitative data, and I'm assuming you interpreted it was a process of coding and you reached some kind of consensus, if you like, around the meaning of those codes in the data?

没错，确实包含诠释成分。这一点常被忽视——其实所有研究，无论质性还是量化，都包含诠释元素。我们收到了临床医生、家属、患者和研究人员的反馈，必须理解这些陈述的含义以及它们之间的关联性。

Yes, exactly. So it still did have an interpretive component. And I think that's something that's often missed as well is that, you know, all research, whether it's qualitative or quantitative, you know, has an element of interpretation. And so, you know, there were responses from clinicians, from family members, from patients, from researchers, and we had to kind of figure out what people were saying and how those responses either fit together or didn't.

关于这点，我想强调的是：你们本可以将这些自由文本的质性数据转换为统计数值——比如将'强烈反对'计1分、'强烈赞同'计2分、中立计0分，导入SPSS得出p值等。这说明仅拥有文本数据并不等同于质性研究，质性数据同样可以进行量化分析——关键在于研究者对数据的立场取向。

I think just on that point, this is what I meant to say, was that if you could equally have taken that free text qualitative data and you yourself or with your colleague could have looked at it and said, this is a neutral statement, strongly disagree, strongly agree. Strongly disagree gets one point, strongly agree gets two points, and then neutral gets zero. Had a load of converted, if you like, to statistical numerical data, plugged it into SPSS, and it would have whacked out some p values, whatever you're going to use. So in that example there that I suppose I'm just trying to emphasise this misconception that qualitative data alone, so that just having textual data or free text data doesn't equal a qualitative study, that you can also just analyse that data, that qualitative data quantitatively. You can adopt a position towards that data.

而且这类通过Mailchimp或问卷文本框收集的调研数据，研究者无法介入或识别提交者身份，整个过程是疏离的。就像你开头说的，这更接近'现实的客观中立观察者'而非'现实的参与建构者'的立场。

And also just the collection of that survey data in free text is via Mailchimp or, you know, some kind of questionnaire you put in a box, but, you know, the researcher can't get involved, can't see who puts it in. It's all distant. And as you said at the beginning about this objective, neutral observer of reality rather than a participator constructor of reality.

确实如此。所以这绝对是在光谱的另一端，当我们思考不同类型的定性研究时，文献中存在一些争议，比如自由文本调查回复是否算作定性研究？有人认为绝对是，因为这是基于语言的数据并且你会进行编码。也有人说不算，因为你没有那种互动成分。Brown和Clark最近还发表了一篇关于开放式回答作为定性数据的论文。

Exactly. So it's definitely, you know, on the other side of the spectrum, like when we think of different types of qualitative research and, you know, there is some contention, you know, in the literature, like, do free text survey responses count as qualitative research? There are some people who say absolutely yes, because it's language based data and you're going to code it. There are some people that say no, because you don't have that interactive component. Brown and Clark actually recently published a paper on open ended responses as qualitative data.

他们认为，这当然可以算是。我想我们只需要再次明确我们的目标是什么，以及我们希望得到什么样的最终成果。如果我和Kyle必须给回复分配数字，我认为那会失去很多丰富性，也会失去意义。而我们正是在寻找意义。这就是为什么我们选择采取更偏向定性的方法。

They argue that, you know, it can certainly be, you know, I think we just, again, have to be really clear about what our objectives are, and what we're hoping to get, like kind of as an end product. If Kyle and I were have to assign numbers to the responses, I think that would have lost so much richness, and would have lost the meaning. And we were searching for meaning. And so that's why we elected to take more of that qualitative approach.

完全同意。如果你的目标不是寻找意义，而是以更表面的方式寻找关于意义的可推广模式，那么你给它分配数字并获得一些更可推广的统计数据，那也是可以的。正如你非常正确地指出的，这取决于你的目标和提出的问题。我甚至想在这个问题上再添点乱子，我知道扎根理论的方法是一种定性方法论，它使用数字作为数据，即用定量数据进行定性分析。所以这甚至开始模糊了'这只是定性'的界限。

Completely. And if your aim had been to not search for meaning, but look for generalisable kind of patterns around meaning, for example, in a much more superficial way, then you allocating numbers to it and getting some more generalizable statistics, that would be Okay, too. And as you quite rightly said, it's about the aims and the questions that you're asking. I mean, to throw in even a spanner in the works around this, I know that there are methods of grounded theory, is a qualitative methodology, which uses numbers as the data, so quantitative data to analyse qualitatively. And so even that begins to kind of blend the distinctions of this is this is only qualitative.

这只是定量的。这很棘手。所以我认为这可能归结于研究者对数据的看法或立场。数据本身并不表征研究的性质。正如我们都举出了例子，你可以使用定性数据，定量分析它；使用定量数据，但定性分析它，或者对数据采取定性的立场。

This is only quantitative. It's tricky. So I think it probably boils down to the to the view or the position that the researchers take towards the data. So the data in itself doesn't characterise the nature of the research. As we both came up with examples that you can use qualitative data, analyse it quantitatively, use quantitative data, but analyse it qualitatively, or take a position towards that data qualitatively.

所以我想，再次向听众指出，并非所有基于主观文本的东西都构成定性研究。

So I think just, I suppose, just again, signposting to the listener that not all subjective text based stuff constitutes qualitative research.

我明白你的意思。仅仅因为是书面回复并不意味着它就是定性研究，反之亦然。我认为这种二分法有时会让我们陷入困境，因为期刊编辑或审稿人会说，'哦，我看到另一篇论文提供了数据中出现的不同主题的频率。你为什么不能这样做？' 这种假设认为因为你能够将其转化为数字，你就应该这样做。

I know what you mean. Just because it's a written response doesn't mean it's qualitative research and vice versa. I mean, I think that dichotomy is where we sometimes run into trouble because journal editors or journal reviewers will say, Oh, I saw another paper that provided frequencies of the different themes that came out of the data. Why can't you do that? And there's this assumption that because you can turn it into numbers that you should.

我认为当我刚开始学习定性研究时，真正让我大开眼界的是这样一个观念：更多并不意味着更好。仅仅因为某个主题被每个参与者都描述过，并不意味着它就比另一个只被少数人描述但非常有力量并为工作增添了意义的主题更好。在定量研究中，我们习惯于认为这是排名第一的回复，这是排名第二的回复。但同样的逻辑不一定适用于定性研究。

And I think something that was really eye opening to me when I first started learning qualitative was this idea that more doesn't mean better. Like, just because a theme was described by every single participant doesn't mean it's better than, you know, another theme that was only described by a few, but that was still very powerful and added meaning to the work. And so in quantitative, we're so used to being like this was the top ranked response. This is the second top ranked response. But the same doesn't necessarily hold true to qualitative.

那么，或许我们可以继续探讨一下定性研究中一些常见的方法。让大家了解一下用于生成定性数据的各种技术。欢迎分享你们工作中的实际案例。

And so maybe we can move on to, I suppose, just touching on some of the common methods of qualitative research. Just give people a sense of the sorts of techniques that are used to to generate qualitative data. Feel free to share some of your examples from your work.

是的，确实有很多不同的方法可以采用。我认为最常见的是半结构化访谈，这可以说是首选方法，能够促成互动对话和共同构建会议内容。但还有许多其他方法正逐渐流行起来，比如基于艺术的方法——让参与者通过绘画或照片来表达他们的经历，然后对这些作品进行分析。

Yeah, I mean, there's quite a few different methods that people can use. I would say the most common are just like the general semi structured interview. I would say that's the go to and offers the opportunity to have that interactive conversation and co production of meeting. But there's a lot of other methods that are really starting to pick up steam, like arts based approaches. So, you know, having participants produce drawings or photographs, you know, of their experience that are then kind of analyzed.

还有一种称为'物品诱发法'的方法，向参与者展示可能对他们有特殊意义的物品，以激发反应或回忆。我们在《加拿大疼痛杂志》特刊上发表过一篇Craig Dale及其同事的论文，他们用这种方法记录ICU患者接受口腔护理的经历——在访谈中展示不同口腔护理用具来唤起他们的体验感受。焦点小组显然是访谈的延伸形式，可以同时采访多人。但关键是要捕捉参与者之间的互动，而不仅仅是与每个人单独对话。

A method called object elicitation, where participants are shown objects, you know, that may have different meanings for them and to kind of help bring up reactions or memories. We had a paper published in the special issue, the Canadian Journal of Pain Special Issue by Craig Dale and colleagues that used object elicitation to capture the experiences of individuals who were in the ICU and had received oral care. So they were shown different oral care objects in the interview to kind of bring up what that experience was like. You know, focus groups are obviously an extension of interviews where you're able to kind of interview multiple people at the same time. I think what's key about focus groups that's often missed is capturing that interaction between participants, not just having like a one on one with each person that's there.

观察法也可以用于收集定性数据。文本分析同样适用，无论是政策文件、表格还是社交媒体帖子——这个领域正成为热门话题。还有较新的'故事补全法'，用于捕捉参与者的经历和自我认知。

Observation can be done to capture qualitative data. Text can be analyzed. So whether those are policy documents, forms, social media posts, that's, you know, starting to become a hot topic area. And then also kind of this newer method known as story completion to kind of capture, you know, experience and how participants view themselves and and that kind of thing.

这些都是很好的例子。我觉得物品诱发法特别有趣。更传统的方式可能是使用情景案例，特别是像我研究的临床推理领域——让临床医生回忆他们如何为患者做决策，或解读临床案例。定性方法的优势就在于能灵活运用各种策略来引发深入讨论，这才是核心目的，对吧？

They're really good examples. I think the object elicitation is really interesting. And, you know, I suppose a more traditional way of eliciting people's thoughts and feelings and discussion is using things like vignettes, particularly if you're interested in the work that I've done around clinical reasoning, getting clinicians to recall how they're making decisions with patients or about patients and getting them to interpret clinical cases. You can use the flexibility of qualitative methods is that you can bring in various different strategies to try and generate interesting, rich discussions. I mean, that's really the purpose, isn't it?

无论是提示词、情景案例还是物品诱发，所有这些技巧都是为了帮助人们表达内心或周边的想法。只要能促成细节丰富的讨论，就是极有价值的方法。

You're using all sorts of techniques, whether it's prompts, vignettes, object elicitation to get people to get some kind of way of people communicating stuff which is inside them or inside their head, around them. And anything that you can do to generate that rich discussion with detail, that's going to be super helpful.

完全同意。在我的儿童研究中，很多八九岁的孩子其实能很好地应对常规访谈。但像艺术表达法、物品诱发法这些新方法，让他们能用更符合年龄特点的方式描述自己，效果往往出奇地好。现在这类方法正越来越多地被采用，这很棒。

Absolutely. And I mean, in my work, which is mostly children, you know, like the younger kids, eight, nine years old, lots of them do really well with, you know, just typical interview questions. But I think some of these newer approaches like the arts based methods and object elicitation, things like that, where they can really describe themselves in different ways that are maybe more developmentally appropriate, I think can be really powerful. And we're starting to see more of that now, which I think is great.

我认为现在还有一点值得提及，因为我在即将播出的扎根理论专题中没有过多强调这一点。这是质性研究的一个特征，在某种程度上也是扎根理论的特点，即数据收集与分析是同步进行的。这与量化研究形成鲜明对比——在量化研究中，你收集完所有数据后统一输入电脑生成数字结果。这种做法固然是标准流程，但在质性研究（并非所有质性研究）中，最佳实践是收集部分数据后就进行分析。通常你的分析结果会指导后续数据收集方向，比如调整访谈问题框架，因为前期访谈中浮现了某些观点/概念/主题；或者决定访谈不同人群——可能某类群体能提供更具价值的信息数据。

I think another thing which might be worth mentioning now, because I didn't mention it too much in the grounded theory episode, which will be coming up, again, it's a feature of qualitative research and to some extent, a feature of grounded theory where there's a concurrent data collection, data analysis, which again contrasts with generally with quantitative research in which you collect all your data, get it all, stick it in a computer, and then you chuck out your numbers, and that's fine. That's kind of standard practice, but in qualitative research, not all qualitative research, but it'd be good practice to collect some data, do some analysis. Often your analysis then informs your future data collections. You might say, I'm going to change some interview questions around actually because these ideas or concepts or themes have cropped up in previous interviews, or I'm going to actually going to speak to some different people. You know, it turns out that this group of people might give me some more interesting or helpful information, some data.

这种数据收集与分析并行的模式确实是质性研究的鲜明特征。你可以想象量化研究者此刻正在隐喻的床铺或坟墓里辗转反侧（但愿不是坟墓）。他们无法理解：研究中途怎能调整方案？这简直不可理喻。

So that concurrent data collection, data analysis is a real feature of qualitative research. And you can imagine the quantitative research is just kind of turning over in their metaphorical beds or graves. Hopefully they're not in their graves, but you know what mean? How can you change this in the middle of the study? This is just you just can't do it.

这会彻底破坏研究的效度。但质性研究者们正带着会意的微笑，认为这种动态调整恰恰符合逻辑自洽，反而能产出更可信、更有意义的研究成果——这些成果真实反映了参与者眼中生命里那些重要且困扰的问题。

It just wrecks the validity of it. But the qualitative researchers are kind of sitting back with a smirk thinking this is all logically consistent and actually contributes to more credible, meaningful research, which relates the participants and what they see as being significant and problematic in their lives.

完全同意。正如你所说，在量化研究中提前查看数据是严重禁忌，必须严格遵循预设分析方案不得变更。而质性研究则不同，我认为这本质上是研究过程的自然属性——研究者本身就是数据收集与解读的积极参与者。当我进行访谈时，大脑已经在实时关联信息：这个观点与那个相关，那位受访者的说法...我该如何换个角度追问？

Absolutely. And, you know, as you said in quantitative, peeking at the data, kind of like before the end is really frowned upon. And, you know, you have to have your analysis plan and follow the plan and don't look at it beforehand and don't change your plan and, you know, that kind of thing. Whereas in qualitative, and I think this is also just, you know, somewhat of an artifact of the process where it's, you know, the researcher being very much an active participant in the data collection, in the interpretation. I know when I'm conducting interviews and things like that, I'm already starting to like think in my head like, this fits with this, this fits with that, what that person said, like, how can I ask this in a different way?

因此整个过程具有高度互动性。正是这种特性决定了早期收集的数据会自然塑造后续的数据采集方向。

And so it's very interactive. And I think just by nature of that, your early data collection is informing your next data collection.

这种研究者与参与者的关系，归根结底取决于你对研究领域或现实本质的认知——就像我们对话开头提到的。如果你将现实视为稳定客观的存在，为避免干扰其本真性，那么任何提前查看数据、影响参与者、或监督问卷填写的行为都会导致研究者自身的偏见、判断和价值观污染研究场域，破坏客观性。但在质性研究中，这种互动恰恰被视为获取丰富内涵数据的优势所在。

And that researcher participant relationship is contingent on how you view the research field or reality, as we come back to the beginning of the chat. Whereas if you see reality as this stable, objective thing and you don't want to interfere with it because you want to extract the essence or the truth from that reality, the minute you start peeking at your data or influencing your participant or standing over the participant's shoulder as they're filling in the questionnaire or whatever it might be, then you're going to kind of taint your own bias and judgments and values are going to kind of bleed into the research field and just ruin the objectivity of it. But in qualitative research, that's to be part of the data collection is seen, as like I said, as an attribute to get rich and meaningful data.

千真万确。

Absolutely.

传统上，医疗保健和疼痛的临床管理——或者说疼痛领域，依赖于定量研究，无论是基于实验的研究还是随机对照试验，以考察不同干预措施的效果，或是通过横断面研究来寻找普遍适用的心理模式或特征。考虑到疼痛本质上是这种涌现的、主观的个人体验，这种做法颇为耐人寻味。我们依赖的研究却采取了相反视角，强调客观性、可靠性和有效性。那么根据你的经验，为何定性研究会在疼痛心理学领域及更广泛的医疗环境中兴起？或者你对其扩散有何观察？

So traditionally, health care and the clinical management of pain or the pain field, if you like, have relied upon quantitative research and whether these are experimental based studies or randomised controlled trials to look at the effects of different interventions or kind of cross sectional work to look at generalizable psychological patterns or profiles, that kind of stuff, which is curious given that the nature of pain is this emergent, subjective individual experience. We've relied upon research which takes an opposite view that that's interesting objectivity and reliability and validity. So why is it the case in your experience that qualitative research and not necessarily why, but just any observations that you made about the proliferation of qualitative research in your field in pain psychology and the broader health care setting?

是的，我认为定性研究正处于起步阶段。目前《英国医学杂志》尚未将定性论文视为优秀的新投稿类型。几年前他们甚至一度打算停止评审所有定性论文。所以我觉得...

Yeah, and I will say I think it's in the process of taking off. You know, I think, you know, we're not at the point yet where the BMJ is, you know, seeing a qualitative paper as this, you know, excellent new submission. There was that time a few years ago where they were seeking to stop reviewing qualitative papers altogether. So I think

让我们标记一下这个事件。你说得对，《英国医学杂志》当时的推特标签是#BMJNoQual，他们本打算停止发表定性研究。后来特里西娅·格林哈尔——这位定性研究与人本循证实践的倡导者——联合众多合著者撰写公开信，列举了定性研究对医疗保健的贡献，成功劝阻了这个决定。我要特别推荐这篇论文，稍后会把链接放在节目说明里。

Let's just signpost that. So the BMJ, you're right, the hashtag was BMJNoQual, I think was the Twitter hashtag, at which they were going to stop publishing qualitative work. And then Tricia Greenhall, who's just a champion of pretty much everything qualitative research, but person centered and evidence based practice, got herself and a huge number of co authors to write this letter arguing that BMJ don't make that decision. And that's some really good arguments as to why qualitative research contributes to health care. So I do want to flag that paper and I'll link it in the show notes.

抱歉佩里，请继续。

Sorry, Peri, go on.

没错，这个事件至关重要。那是个定性研究被重新定义为有价值、而非只是找六个朋友聊体验的关键时期。你说疼痛是内在的、个人的、主观的多维体验——有趣的是，这些表述恰恰与国际疼痛研究协会的定义不谋而合。

Yeah, no, no. I think that is so important. And that was a formative time, I think, in making qualitative research seen as valuable and important and not just, you know, talking to six of your friends about their experience. And, you know, it's interesting, you know, you say that pain is this inherent personal, subjective, multidimensional experience. And ironically, these are actually words that are reflected in the IASB definition of pain.

疼痛被描述为情感性、个人化的主观体验。从临床角度看，评估和治疗疼痛本就依赖患者的主观叙述，自我报告至今仍是疼痛评估的金标准。虽然现在有整个研究领域试图通过人工智能和脑成像等技术寻找'客观'测量方法，但由于疼痛的主观特性，这些尝试尚未取得显著成功。因此人们开始意识到，定性研究特别适合提供这类丰富的个人数据，让个体体验重回焦点。

Like it's described as, you know, an emotional, personal, subjective experience. And we know from a clinical perspective that assessing and treating pain relies on people's accounts of their own experience. Like, self report is considered to be the gold standard of pain assessment. I mean, as an aside, there's, you know, a whole field of research now that's trying to find objective, quote unquote, ways of measuring pain through artificial intelligence and brain imaging and things like that so far have not been overly successful, I think, because of this subjectivity and personalized experience of it. And so I think, you know, people are starting to realize that qualitative research is really well suited to provide this kind of rich personal data and brings this individual experience back to the forefront.

这是原因之一。另一点来自我在癌症幸存者研究中的观察：许多大型随机对照试验针对看似重要的主题展开。比如幸存者护理计划——这份指导患者完成癌症治疗后随访治疗的文件，随机对照试验显示患者认为其有帮助，但所有试验结果都是无效的。现在罗宾·厄克特等学者正从定性角度研究：对患者真正重要的疗效指标是什么？

So I think that's kind of like one side of it. I think the other side that we've seen, and this is from my experience in cancer survivorship research, that a lot of large randomized controlled trials have been done on topics that are seen to be, you know, important. So for instance, survivorship care plans are this document that are, you know, is given to patients after they complete cancer treatment that is meant to guide their follow-up treatment. And randomized controlled trials have been done kind of looking at the impact of those survivorship care plans, patients say that they're helpful, but all the RCTs that have been done have come out null. And so, you know, work that Robin Urquhart and others are doing are really kind of looking at from a qualitative perspective, well, what are the outcomes that are important to patients?

我们是否真的在随机对照试验中测量这些结果？因此，我认为定性研究可以很好地补充定量研究。要知道，我们已经在这些得出无效结果的RCT上投入了数百万美元。为什么？因为我们没有测量对患者真正重要的指标。

And are we actually measuring those outcomes in randomized controlled trials? And so I think qualitative research can really complement quantitative research in that way. You know, we've poured millions of dollars into these RCTs that come up with null results. Why? Because we're not measuring things that are important to patients.

所以我认为定性研究确实为我们打开了了解人们重视什么、如何捕捉这些信息的大门。

And so I think qualitative research really gives us that opening into what is important to people, how do we capture that.

这个观点非常到位。它也很好地引出了定性研究与定量研究如何协同工作的话题。我们并非在倡导非此即彼的争论——不是说哪种方法更优越，或者主张废除定量研究让定性研究主导循证医疗。而是说，定性研究既可以用于指导随机对照试验的设计（比如确定对参与者群体重要的结果指标），也可以像我在课程健康系列前几期提到的，用于对RCT结果进行情境化解读。

And that's a really good point. And it's a good segue into how qualitative research and quantitative research can work together. And this eitheror argument that one's better than the other or we're certainly advocating to scrap quantitative research and let qualitative research dominate evidence based care. But certainly using qualitative research to either inform randomized controlled trials might be one way of trying to establish what are the outcomes which are important to my participant group. But also, as I've said in previous episodes of the course health series about using qualitative work to contextualize the findings of randomized controlled trials.

比如将定性研究嵌套在试验内部，这样你就能获得一种三维立体的研究图景——对整个研究现象更全面的理解，而不仅仅是单一的量化视角。

So either nesting them in within the trial themselves. So you get a kind of three-dimensional picture, I suppose, or understanding of the entire research phenomenon, not just a single quantitative perspective.

确实。而且据患者和参与者反馈，他们非常喜欢参与定性研究。部分原因在于，他们感觉自己不只是RCT里的一个编号数字，他们的焦虑程度或疼痛评分也不仅仅被简化为0到10的量表。许多疼痛患者，特别是慢性疼痛患者，都表示很难用0到10分来描述自己的疼痛——这种量表本是为急性疼痛设计的，后来被套用到慢性疼痛场景。

Exactly. And, you know, I've heard from patients and participants that they really enjoy participating in qualitative research. Part of that being because, you know, because they don't feel like they're just a number in an RCT, for example, and that their, you know, ratings of anxiety or their ratings of pain aren't just captured on a zero to 10 scale. And, you know, a lot of patients with pain, especially chronic pain, describe that it's hard to describe their pain on a zero to 10 scale. It's not zero to 10.

当参与研究被问及'过去七天平均疼痛程度（0-10分）'时，他们更想描述疼痛的具体感受和波动变化。单纯用数字来概括实在太困难了。

And that scale was developed, you know, to measure acute pain and has now been kind of transferred to the chronic pain setting. And if they're participating in a research study and it asks, you know, in the past seven days on average, you know, how bad has your pain been zero to 10? It's like, they want to talk about what it's been like and what it's felt like. And there's been ups and downs and whatever. And it's hard to just assign a number to that.

因此定性研究能帮助构建这种情境，让患者获得对自己经历的认同感。

And so it can help kind of build that context and help patients kind of validate their experience.

我认为这再次很好地指出了定性研究与定量研究各自所持的不同预设。以疼痛为例——这是个显而易见的例子，但即便是像残疾这样未必与疼痛直接相关的情况——当你使用问卷或某种测量工具，其中包含一系列关于疼痛如何影响日常生活的陈述性问题时，这些问卷问题本身就隐含了预设意义。比如当问卷问'你觉得爬楼梯困难吗？'时，它已经预设了人们对'困难'的理解，无论采用李克特量表还是其他形式，受访者都没有空间去解释'其实不算困难'。

And I think that's, again, it's a good point to pick up on about the presumptions, the different presumptions that the qualitative and quantitative research will take. So if we imagine we're looking at, I mean, pain's in, I suppose, an obvious example, but even if it's something like disability, which is not necessarily pain, and you've got a questionnaire or some kind of instrument which has a series of items which look to make statements around how pain is affecting someone's daily life. Within those questions on the questionnaire, there is assumed meaning. When it says, do you find it hard to walk up the stairs? It assumes that, you know, people when they read hard, strongly agree or disagree, whatever the Likert scale is, the word hard is there, there's no room for the participant to say, well, it's not really hard.

选项非此即彼——要么困难要么不困难。受访者无法表达'对我来说不算困难'，也无法追问'你说的困难具体指什么？'这种定量研究方法没有容纳多元解释的空间，它假定存在单一标准答案。

It's this or it's that. And this is how it's hard. They've got no room or to say, well, for me, it's not hard. Actually, what do you mean by hard? There's no capacity within that methodology or within quantitative research to assume those multiplicity of meanings that there's a single meaning.

这种方法预设了客观意义的存在。这本身没有问题——如果你只需要对'爬楼梯困难'这个概念进行表层理解，比如'因背痛导致爬楼梯困难'。但回到定性研究中的访谈场景，当受访者说'我觉得爬楼梯特别困难'时，

It presumes that there's an objective meaning. And that's fine. You were looking for somewhat superficial understanding of this notion of walking up the stairs. It's hard to walk up the stairs with whatever back pain. Whereas in a qualitative study, coming back to the interview and someone says, Oh, I find it really hard to walk up the stairs.

作为研究者你可以追问：'这个说法很有意思，你说的困难具体指什么？能举例说明吗？你选用困难这个词很有趣，能多谈谈吗？'

As a researcher, you can say, that's really interesting. What did you mean by hard? Can you give me some examples? It's interesting you use the word hard there. Tell me a bit more about that.

这时受访者可能会解释：'其实我不觉得困难'或'我说的困难是指...'这样你就能获得对'困难'现象完全不同的理解视角。这种高度个体化的解读对临床工作者非常有价值。

And they might then say, well, actually, I didn't mean hard or what I mean by hard is whatever. So you get a completely different perspective on that phenomenon of hard. It's a very individual interpretation of it, which can be really helpful for clinicians.

完全同意。实际上这类案例就出现在我的定性研究中——那是我博士研究的一部分。劳伦·希思科特、克里斯·埃克尔斯顿及其团队提出了癌症后疼痛的新理论模型，认为疼痛可能被解读为疾病复发的征兆，因此会引起患者的高度关注。为此我在访谈提纲中专门设置了问题：

Absolutely. And, you know, I think that type of example actually came up in one of my qualitative studies, the one that was part of my doctoral research. Lauren Heathcote and Chris Eccleston and colleagues had come out with this new theoretical model of pain after cancer, suggesting that pain might be interpreted as a sign of disease recurrence. And that's why it might be troubling or, you know, attention grabbing, you know, for people. And so I, you know, incorporated some questions into my interview guide about, you know, what does pain mean?

比如'当你感到疼痛时，首先想到什么？'有趣的是，很多受访青少年表示'确实会担心，但主要不是担心癌症复发，而是担心可能是治疗带来的远期副作用'。

Like, when you have pain, you know, what comes to mind? And it's interesting because for a lot of kids that I interviewed, they said, yeah. Like, I worry when I have pain, but it's not quite about, you know, that the cancer had come back. It's it's slightly different than that. It's that, you know, maybe it's that I'm developing a late effect of my treatment.

或者，你知道，很多孩子会说，我不认为我的癌症复发了，因为医生告诉我复发的几率非常低，但我有很高的二次患癌风险。所以，我想可能是这个原因。这样你就能获得那些通常无法察觉的细微差别。

Or, you know, a lot of kids would say, I don't think it's that my cancer had come back because my doctor told me that there's a really low chance that my my cancer would come back, but I'm at high risk for a secondary cancer. So, you know, I think that it might be that. And so getting that nuance that you wouldn't necessarily get otherwise.

是的。你不仅能理解个体对所研究现象赋予的意义，还能了解这种意义是如何产生的。它从何而来？正如你所说，这背后会有大量基于情境的故事性内容，而问卷无论设计得多好，都无法捕捉这种个人现实——如果愿意这么说的话——参与者所拥有的主观现实。

Yeah. So not only do you get that individual the individual meaning that that person holds for whatever the phenomena you're looking at. But you get a sense of how that meaning arises. Where does it come from? And, you know, as you said, there'll be some whole lot of contextual story based stuff around that, which a questionnaire, no matter how well developed, is unable to capture that individual reality, if you like, that subjective reality that the participant has.

作为定性研究者，你完全理解并参与了这种现实的构建过程。

And as a qualitative researcher, you fully appreciate and a part of that construction of that reality.

确实如此。

Exactly.

我想关联的一点是——再次回到这系列与因果关系哲学家关于定性研究在循证医疗中作用的播客——正如我们与Tricia Greenhall提到的，关于定性研究在循证医学/医疗/实践中角色的讨论持续进行。简单概述下，有个证据或知识的金字塔体系，将随机对照试验或荟萃分析形式的定量研究置于顶端，而专家意见和定性研究基本处于底层——特别是在讨论干预措施证据时。或许你可以谈谈如何看待定性研究与循证实践的关系？

I suppose on a related point is and again, off the back of this series of podcasts with philosophers of causation around the role of qualitative research in evidence based health care, that there's a big and as we mentioned with Tricia Greenhall, there's an ongoing conversation about the role of qualitative research in evidence based medicine or health care or practise. And just to give a quick whistle stop tool, there's a pyramid or hierarchy of evidence or knowledge which puts quantitative research using the form of randomized controlled trials or meta analyses at the top and expert opinion and qualitative research essentially in the bottom, particularly around if we're talking about evidence for interventions, if you like. Perhaps you could say something about how you see the role of qualitative research in relation to evidence based practise.

我得承认，在循证医学领域我并非研究方法专家。我本科在麦克马斯特大学受训，那里是Gordon Guyatt等人发展循证医学的地方。嗯，我认为这是个非常重要的问题，我不确定自己是否有完整答案。我只分享些一直在思考的想法。

I will admit, you know, I'm not a research methodologist when it comes to evidence based medicine. I did train at McMaster University for my undergraduate degree, and that's kind of where Gordon Guyatt and folks kind of developed evidence based medicine. Yeah, I mean, I think this is a really important question, and I don't know if I fully have the answer. I'll just share some thoughts, you know, that I've been kind of mulling on.

我已经做了15期节目，没人有标准答案。别担心，这只是众多观点之一。当然，健康领域人士自有其答案，而你的观点正丰富了答案的多样性。

I've done 15 episodes, and no one had the answer. So don't worry. This is just another answer. Well, course health people do have their answer, but you're contributing to the range of different answers.

好的，非常好。你提到了证据等级体系，系统综述和随机对照试验位于顶端，而专家意见、病例系列和经验类证据则处于底层。但我觉得有趣的是，在流行病学教科书中的传统等级体系里，定性研究甚至根本不会出现在金字塔上。当我们思考循证医学的真正含义时，它其实是关于将最佳证据与临床专业知识和患者价值观相结合。因此，我认为这正是定性研究可以发挥作用的地方。

Okay, very good. You mentioned the hierarchy of evidence with kind of systematic reviews and randomized controlled trials at the top and expert opinion, case series and experience kind of being at the bottom. But I think what's interesting is that in, you know, the traditional hierarchies that appear in epidemiology textbooks, qualitative research actually wouldn't even be on the pyramid at all. And when we think about what evidence based medicine really is about, it's about this integration of what the best evidence is with clinical expertise and patient values. And so, you know, I think that's exactly where qualitative research can fit in.

这其实是在构建关于什么对患者重要、如何将其融入临床决策的理念。正如我们所说，定性与定量研究可以相互补充，我认为在循证实践中同样如此——我们使用随机对照试验等方法来了解药物X或干预措施X的效果，但患者的实际体验是怎样的？这又如何融入其中？

It's, you know, kind of building that, you know, idea of what what is important to patients, how do I incorporate that into the clinical decision making? And so I think, as we were saying that qualitative and quantitative research can complement each other, I think that's exactly true in evidence based practice as well, that we're using some of the randomised controlled trials and things like that to inform the effects of drug X or intervention X. But then what's the patient experience of that? And how does that fit in?

因为这能帮助你判断如何运用那些定量研究。如果有优质的定性数据——比如我们说的患者关注什么、他们如何理解自己的问题或应对方式，不仅仅是‘他们在应对’或‘没在应对’这种程度，而是关于患者生活的真实丰富情境故事，并通过分析形成更抽象的定性叙述——作为临床医生，你将能更好地运用那些随机对照试验和定量研究方法。

Because that will help you make judgments about how you use that quantitative research. So if you've got a there's good qualitative data about how, as we said, what's important to patients or how they're conceptualizing their problem or how they're coping, not just they are coping or they're not coping or they're coping to this extent, but actually some real rich contextual stories about patients' lives, which is then analysed in a way to create more abstract qualitative narratives. As a clinician, you're going to be in a much better place to to utilize those randomized controlled trials and quantitative methods or quantitative studies.

确实。我认为有太多可以结合的途径。比如个人叙事和故事就有助于建立同理心、情境理解和验证，让医生更能体会患者的处境。它可能给医生提供新的提问思路，告诉他们需要向患者解释可能出现的症状并使其正常化。有时医生会害怕触及某些敏感话题。

Exactly. And I mean, I think there's so many ways that it could fit in. Like, you know, for example, I think having that that personal narrative, that story is helpful for, I think, even just building empathy and context and validation in, you know, the clinician for what patients might be going through. I think it might give clinicians ideas, you know, on questions to ask that they might not have otherwise thought to ask, things, you know, that they might want to tell patients about in terms of what symptoms they might experience and kind of normalizing that. I think sometimes clinicians can be nervous or afraid to like bring certain difficult topics up.

而定性研究反复证明——无论是在残疾领域、癌症领域还是疼痛领域——患者常说‘我希望医生问我这类问题’。所以我认为这相当于为处理那些棘手问题提供了许可。

And I think in qualitative research, time and time again, whether it's, you know, in the disability field, or in the cancer field, or in the pain field, you know, patients say like, I want to know, like, you know, ask me that kind of thing. And so I think, you know, it just provides permission to do some of that harder stuff.

当你进行定性访谈或作为定性研究一部分的访谈时，许多策略都是为了充分挖掘参与者的信息——这么说可能不太准确，但确实是为了获取丰富数据，探寻那些潜在意义、深层信念和社会背景层面的内容。临床实践中你也在追求同样的理解，虽然不完全相同，但至少要对那个人有充分认识。这意味着要认识到这是个具有独特视角的个体，并努力理解这种视角。

And many of the strategies that when you're doing a qualitative interview or an interview as part of a qualitative study, when you're interested in really getting the most out of the participant. It sounds not right, but trying to get rich data and trying to find those underlying meanings, underlying beliefs, contextual kind of social aspects. In clinical practice, you're trying to get the same understanding. I mean, it's the same, but not the same, but at least a good understanding of that person. And so being able to take a position where this is an individual with a particular perspective, and I recognise that individual perspective and want to try and understand it.

这些立场在临床实践和定性访谈研究中是相似的。

These are similar positions, both in clinical practise and as a qualitative interviewer or researcher.

完全同意。我认为这很有趣，因为从临床心理学背景来看，参与者访谈可能非常类似于与客户的咨询会话，旨在了解他们的历史、信念来源，以及他们如何理解某些情境。因此，一方面，作为临床医生，尤其是心理学家，我们确实处于有利位置，能够从参与者那里获取丰富的数据。另一方面，我认为重要的是我们要谨慎保持患者与参与者之间的界限。这条界限可能会变得非常模糊，尤其是在谈论困难话题时，你既想提供同理心又想给予认可。

Completely agree. And I think it's interesting because coming from a clinical psychology background, the participant interview could look very similar to a session that you would have with a client where it's trying to understand their history, where their beliefs come from, you know, how they make sense of certain situations. So I think on one hand, you know, as clinicians, especially psychologists, you know, we're really well positioned to be able to elicit this rich data from participants. On the other side, you know, of the coin, I think it's important that we're also careful to to keep that boundary of patient versus participant. And I think, you know, that line can become very, very thin, especially when you're talking about difficult things, and you want to provide empathy and validation.

诸如此类的情况。我认为这对从事定性研究的临床医生来说是一个独特的挑战，而且这个话题可能讨论得还不够充分。

And, you know, that kind of thing. And I think that's, you know, a challenge that's unique to clinicians who are conducting qualitative research and something that's perhaps not talked about enough.

我想我们可以开始总结一下，如果有一系列针对临床医生或研究者的建议，我们可以一起探讨——无论是那些因为定性研究过于神秘、哲学化且与定量研究差异太大而不敢涉足的临床医生，还是那些只熟悉定量方法但对定性工作稍感兴趣的学者。根据你的经验，你会给出哪些建议？

I suppose we could begin to bring this together, and if there were a series of tips or advice for clinicians or researchers, either we can tackle them all together, either clinicians who are too afraid to look at qualitative studies because it's too mysterious and philosophical and too different from the quantitative research or and or researchers which are only familiar with quantitative methods, but are kind of slightly interested in doing some qualitative work. What bits of advice might you give based on your own experience?

哦，有很多建议。我试着分点说明。首先，我认为对双方而言，关键是保持开放的心态。从定量角度看，我们习惯于以特定方式看待真理和现实，定性研究亦然。有时双方会陷入关于哪种方法更好的争论，但实际上并无优劣之分。

Oh, there's a lot of advice. I'll try and break it down. I mean, I think number one is, you know, kind of on both sides of the coin is just to really keep an open mind. You know, I think from a quantitative perspective, we're so used to viewing truth and reality in a certain way and vice versa on the qualitative side. And sometimes there can become like turf wars about, you know, which side is better, and there is no better side.

我们需要共同努力解决当前面临的重大问题，这些问题需要两种方法的结合。对于刚接触定性研究的人，我认为最重要的是理解你进行研究时所采用的理论视角——无论是现象学视角（具体哪种）、女性主义视角，还是民族志视角。明确这一点有助于建立研究的可信度和严谨性。就我个人背景而言，我最初更偏向定量研究。刚开始学习定性研究时，最让我困惑的——我想很多人也有同感——是方法论与方法之间的区别。

I think we need to work together to really tackle some of these big problems that we're facing that need both methods to come together. I think, you know, something that is so important for people starting off in qualitative research is really to understand the theoretical lens that you're coming at the work from, whether it's a phenomenological lens, and if so, what kind, whether it's a feminist lens, whether it's, you know, an ethnography, like, what lens are you coming at the work from? To really understand that that I think, you know, helps build credibility, rigor in the work. When I kind of talk about my background, like I come from a more quantitative background. And when I was starting to learn about qualitative research, I think something that was really confusing to me, and that I think is to a lot of people, is that there's a difference between the methodology and the method.

你必须有一个理论视角指导你的工作。仅仅在方法部分写‘我们进行了定性研究’是不够的。我认为这正是定性研究在某些领域名声不佳的原因。

And it's like you have to have a theoretical lens guiding your work. It's not enough to say in the methods section, we did a qualitative study, you know, and I think that's what gives qualitative research a bad name in a lot of areas.

没错。或者在方法部分写‘我对数据进行了编码’——这没问题，但关键是通过什么视角编码？你编码的目的是什么？

Exactly. Yeah. And like or in the methods saying I did some coding, coding was performed on the data, which is fine, but like coding through what lens? What were you coding for?

完全正确，完全正确。不要担心样本量小的问题。你知道，我觉得这是很多人担忧的事情，比如'我只采访了六个人，期刊会愿意发表吗？'我认为只要你忠于自己的理论视角，并用它来指导样本量选择，那就完全没问题。而且我认为整个领域需要开始更多地接纳定性研究，让更多熟悉定性方法的期刊编辑和审稿人能够公平准确地评审基金申请、论文等材料，因为我认为这是阻碍定性研究发表和该领域从业者职业发展的主要障碍。

Totally, totally. Don't be afraid about small sample sizes. You know, I think that's something that a lot of people feel worried about, like, oh, I'm only interviewing six people, you know, is a journal going to want to publish this? I think if you're true to your theoretical lens, and that you're using that to help guide your sample size, then then that's absolutely fine. And then I think from, you know, the field as a whole, I think we need to start embracing qualitative research a little bit more, having more journal editors, reviewers, you know, who are competent in qualitative methods to be able to, you know, fairly and accurately review whether it's grants or papers or things like that, because I think that is a really big barrier to qualitative publication, but also career advancement for people in this area.

这些建议很棒。关于这一点，我想对临床医生特别说的是，要反思他们如何看待自己的临床角色。作为临床医生，你以人为中心，关注个体，认识到患者持有的各种不同信念和观点，并重视这些差异。我想很少有临床医生会把自己看作执行相同干预措施的客观科学机器人。我相信大多数临床医生都认为自己在调整方法以适应个体的独特需求。

They're great tips. I think on that point, I suppose for me, I would say for clinicians especially to reflect on how they see themselves as clinicians. So it doesn't seem to make too much sense that when you're a clinician, you're person centred, you're interested in the individual, you recognise the range of different beliefs and perspectives that your patients hold, you value that. And I doubt there'd be many clinicians that would see themselves as kind of objective scientific robots performing the same interventions on patients. I'm sure most clinicians would see themselves as adapting and changing their approach to suit the individual needs of the person.

但当涉及研究时，许多临床医生所重视的研究类型却与他们的临床立场相反——这些研究追求客观性，要求每个人都接受相同治疗或回答相同问题，显得疏离而冷漠。因此我认为临床医生需要反思：如果你将临床实践视为复杂的、以人为中心的、充满模糊性的概念，那么我们就需要能够灵活捕捉不同视角、现实情况、复杂性及细微差异的研究方法。

But then when it comes to research, the sorts of research that many clinicians value is the opposite to their clinical position, which is objective, everyone gets the same treatment or asks the same questions, it's distant, it's dispassionate. And so I think just reflecting on how clinicians see practice, if you see practice as complex, person centred, ambiguous kind of conception, then we need research which is flexible and able to access those different perspectives and realities and those complexities and nuances and all that kind of stuff.

完全同意。作为最后一点我想补充的是，我们还需要从政策角度思考这个问题，因为政策倾向于什么？它青睐显示积极效果的随机对照试验。如果你在诊所工作并想实施某种治疗，而诊所采用循证医学模式，他们就会要求证明你所采用的治疗会有效。不是说我们应该否定这点，但我认为需要同时引入以患者为中心的维度，重新关注生活体验，将人文关怀带回我们的工作中。

Absolutely. And just to dovetail off of that as kind of a final point, as I think we need to think about that from a policy perspective as well, because what does policy favor? Well, it favors randomized controlled trials that show positive effects. And, you know, if you're in a clinic and you're wanting to implement, you know, a certain treatment and your clinic operates on an evidence based medicine model, you know, they're going to want proof that, you know, the treatment that you're doing is going to work. And not to say that we should discount that, but I think we need to bring in the patient centered aspect as well, bring back the lived experience, bring this kind of humanity kind of aspect back to the work that we're doing.

是的。我想接着你的话说，这让我想到Tricia Greenhall及其同事关于'真实循证医学'的研究。她实质上提出了一种范式转变，或者说回归到循证医学最初的目的——服务患者而非从业者或其他利益相关者。佩里，这太棒了。非常感谢。

Yeah. And I think just to dovetail off your dovetail, I think it would be a signpost read as to Tricia Greenhall and her colleagues work on real evidence based medicine. So where she brings in essentially this paradigm shift, if you like, or at least returning to how evidence based medicine was originally intended, which is to serve patients, not to serve practitioners, if you like, or other kind of stakeholders. Peri, that's awesome. Thank you so much.

不客气。谢谢邀请我。

No problem. Thank you for having me.

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