Positioning Stakeholder Perspectives in COPD End-of-Life Care Using Critical Theory and Actor-Network Theory: A Methodological Approach

Background Meaningful engagement with stakeholders in the provision of healthcare and services is recommended by the World Health Organisation. Culturally specific evaluation may enable deeper exploration of the critical views of people living with advanced long-term conditions, their support people, and healthcare providers. Aim and design This article describes how critical theory and Actor-Network theory involved all stakeholders including patients with severe chronic obstructive pulmonary disease as expert voices during the evaluation of end-of-life care services. Results We describe how critical theory and Actor-Network theory informed the methodologies for focus groups and how stakeholders spoke as critical experts about and in the system. An analytical sample of the focus group study is presented to demonstrate how the frameworks were applied to identify cohesive themes that were inclusive of all stakeholders. Conclusions This paper highlights how the evaluation of health systems can include a critical methodological approach to include the values and perspectives of all stakeholders. The outcomes may be used by those who design health systems to develop high-quality services.