The palliative management of fungating malignant wounds - generalising from multiple-case study data using a system of reasoning

The project focused on individual experiences, from 45 participants, of liv ing with a fungating wound and the performance of wound dressings in reduci ng the impact of the wounds on daily living. A case study design was adopte d. This posed a key methodological challenge in the form of the contentious epistemological issue, characterised in the literature as the 'nomothetic- idiographic dilemma. This issue concerns the nature of knowledge generated from an individual case and its generalisability. A system of reasoning was adopted as the analytic strategy, within a theory-driven evaluation, to ab stract general issues from the case study data to construct explanations of symptom control and dressing performance. The latter were generalised beyo nd the individual cases with the use of theory. This paper focuses on the m ethodological issues that are inherent in the use of a case study design an d the nature of the evidence generated. The system of reasoning is describe d and illustrated using data from a single participant with advanced uterin e cancer and a fungating nodule in the groin. (C) 2001 Elsevier Science Ltd . All rights reserved.