literature review goals

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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

• UConn Library
• Literature Review: The What, Why and How-to Guide
• Introduction

Literature Review: The What, Why and How-to Guide — Introduction

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings

What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
• << Previous: Getting Started
• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
• URL: https://guides.lib.uconn.edu/literaturereview

What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

What is the purpose of literature review , a. habitat loss and species extinction: , b. range shifts and phenological changes: , c. ocean acidification and coral reefs: , d. adaptive strategies and conservation efforts: .

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 

Frequently asked questions 

What is a literature review .

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field.

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example 

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:  

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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How to write a good literature review 

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review 

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:  

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:  

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:  

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:  

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:  

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:  

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

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A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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What is a literature review? [with examples]

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

• the objective of a literature review
• how to write a literature review
• the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

• Studying the references of your research area
• Summarizing the main arguments
• Identifying current gaps, stances, and issues
• Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

• introduction that briefly introduces the main topic
• body that includes the main discussion of the key arguments
• conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

• School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
• Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
• A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

Conducting a Literature Review: Home

What is a literature review.

A literature review is a body of text that aims to review the critical points of current knowledge on a particular topic. Most often associated with science-oriented literature, such as a thesis, the literature review usually proceeds a research proposal, methodology and results section. Its ultimate goals is to bring the reader up to date with current literature on a topic and forms that basis for another goal, such as the justification for future research in the area. (retrieved from http://en.wikipedia.org/wiki/Literature_review )

Print Resources

Many resources on research methodology include a chapter on literature review. Try these titles:

• SAGE Research Methods "SAGE Research Methods (SRM) is a research tool supported by a newly devised taxonomy that links content and methods terms. It provides the most comprehensive picture available today of research methods (quantitative, qualitative and mixed methods)across the social and behavioural sciences."

There are many resources available on the internet and in print to help you conduct a literature review. For graduate students working on a thesis, the most important resource is your graduate committee chair. Also, if you are an ILR student, don't forget to speak with one of Catherwood's reference librarians. They have subject matter expertise and can help you find research materials, as well as show you relevant databases and resources, including Zotero , an online bibliographic management system. Cornell students can also take advantage of the  John S. Knight Institute for Writing in the Disciplines , which offers a walk-in tutoring Service.

Additional Resources for Writing Literature Reviews

• Library Research at Cornell by Michael Engle Last Updated Aug 30, 2024 10050 views this year
• The Literature Review: A Few Tips on Conducting Writing Advice from the University of Toronto Health Sciences Writing Centre.
• Write a Literature Review Research guide from the University Library, UC Santa Cruz
• Learn How to Write a Review of Literature From the Writing Center at University of Wisconsin - Madison.

Searching the Library Catalog

Conducting a guided keyword search from the  Cornell University Library Catalog , using the terms "research methodology" or "qualitative research" will provide additional results, and adding the term "social sciences" to the search will help narrow the results. You can also use this list of the classification numbers for theses by department . We also offer a finding guide to dissertations and theses that you may find useful!

We also recommend you look through other theses - often your graduate chair will have copies.

• Last Updated: Feb 4, 2021 9:22 AM
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Literature Reviews

• What is a Literature Review?
• Steps for Creating a Literature Review
• Providing Evidence / Critical Analysis
• Challenges when writing a Literature Review
• Systematic Literature Reviews

Developing a Literature Review

1. Purpose and Scope

To help you develop a literature review, gather information on existing research, sub-topics, relevant research, and overlaps. Note initial thoughts on the topic - a mind map or list might be helpful - and avoid unfocused reading, collecting irrelevant content.  A literature review serves to place your research within the context of existing knowledge. It demonstrates your understanding of the field and identifies gaps that your research aims to fill. This helps in justifying the relevance and necessity of your study.

To avoid over-reading, set a target word count for each section and limit reading time. Plan backwards from the deadline and move on to other parts of the investigation. Read major texts and explore up-to-date research. Check reference lists and citation indexes for common standard texts. Be guided by research questions and refocus on your topic when needed. Stop reading if you find similar viewpoints or if you're going off topic.

You can use a "Synthesis Matrix" to keep track of your reading notes. This concept map helps you to provide a summary of the literature and its connections is produced as a result of this study. Utilizing referencing software like RefWorks to obtain citations, you can construct the framework for composing your literature evaluation.

2. Source Selection

Focus on searching for academically authoritative texts such as academic books, journals, research reports, and government publications. These sources are critical for ensuring the credibility and reliability of your review. 

• Academic Books: Provide comprehensive coverage of a topic.
• Journal Articles: Offer the most up-to-date research and are essential for a literature review.
• Research Reports: Detailed accounts of specific research projects.
• Government Publications: Official documents that provide reliable data and insights.

3. Thematic Analysis

Instead of merely summarizing sources, identify and discuss key themes that emerge from the literature. This involves interpreting and evaluating how different authors have tackled similar issues and how their findings relate to your research.

4. Critical Evaluation

Adopt a critical attitude towards the sources you review. Scrutinize, question, and dissect the material to ensure that your review is not just descriptive but analytical. This helps in highlighting the significance of various sources and their relevance to your research.

Each work's critical assessment should take into account:

Provenance:  What qualifications does the author have? Are the author's claims backed up by proof, such as first-hand accounts from history, case studies, stories, statistics, and current scientific discoveries? Methodology:  Were the strategies employed to locate, collect, and evaluate the data suitable for tackling the study question? Was the sample size suitable? Were the findings properly reported and interpreted? Objectivity : Is the author's viewpoint impartial or biased? Does the author's thesis get supported by evidence that refutes it, or does it ignore certain important facts? Persuasiveness:  Which of the author's arguments is the strongest or weakest in terms of persuasiveness? Value:  Are the author's claims and deductions believable? Does the study ultimately advance our understanding of the issue in any meaningful way?

5. Categorization

Organize your literature review by grouping sources into categories based on themes, relevance to research questions, theoretical paradigms, or chronology. This helps in presenting your findings in a structured manner.

6. Source Validity

Ensure that the sources you include are valid and reliable. Classic texts may retain their authority over time, but for fields that evolve rapidly, prioritize the most recent research. Always check the credibility of the authors and the impact of their work in the field.

7. Synthesis and Findings

Synthesize the information from various sources to draw conclusions about the current state of knowledge. Identify trends, controversies, and gaps in the literature. Relate your findings to your research questions and suggest future directions for research.

Practical Tips

• Use a variety of sources, including online databases, university libraries, and reference lists from relevant articles. This ensures a comprehensive coverage of the literature.
• Avoid listing sources without analysis. Use tables, bulk citations, and footnotes to manage references efficiently and make your review more readable.
• Writing a literature review is an ongoing process. Start writing early and revise as you read more. This iterative process helps in refining your arguments and identifying additional sources as needed.  

Brown University Library (2024) Organizing and Creating Information. Available at: https://libguides.brown.edu/organize/litreview (Accessed: 30 July 2024).

Pacheco-Vega, R. (2016) Synthesizing different bodies of work in your literature review: The Conceptual Synthesis Excel Dump (CSED) technique . Available at: http://www.raulpacheco.org/2016/06/synthesizing-different-bodies-of-work-in-your-literature-review-the-conceptual-synthesis-excel-dump-technique/ (Accessed: 30 July 2024).

Study Advice at the University of Reading (2024) Literature reviews . Available at: https://libguides.reading.ac.uk/literaturereview/developing (Accessed: 31 July 2024).

Further Reading

Frameworks for creating answerable (re)search questions  How to Guide

Literature Searching How to Guide

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Literature Review - what is a Literature Review, why it is important and how it is done

What are literature reviews, goals of literature reviews, types of literature reviews, about this guide/licence.

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 What is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries. " - Quote from Taylor, D. (n.d) "The literature review: A few tips on conducting it"

Source NC State University Libraries. This video is published under a Creative Commons 3.0 BY-NC-SA US license.

What are the goals of creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

- Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what have been written about your research topic and to point out how your own research will shed a new light into these body of scholarship.

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature reviews look at a topic from a historical perspective to see how the understanding of the topic have change through time.

What kinds of literature reviews are written?

• Narrative Review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : This is a type of review that focus on a small set of research books on a particular topic " to locate these books within current scholarship, critical methodologies, and approaches" in the field. - LARR
• Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L.K. (2013). Research in Communication Sciences and Disorders . San Diego, CA: Plural Publishing.
• Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M.C. & Ilardi, S.S. (2003). Handbook of Research Methods in Clinical Psychology . Malden, MA: Blackwell Pub.
• Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). "Qualitative meta-synthesis: A question of dialoguing with texts," Journal of Advanced Nursing , 53(3), 311-318.

Guide adapted from "Literature Review" , a guide developed by Marisol Ramos used under CC BY 4.0 /modified from original.

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Literature Reviews

• What is a literature review?
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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Librarian Assistance

For help, please contact the librarian for your subject area.  We have a guide to library specialists by subject .

• Last Updated: Aug 26, 2024 5:59 AM
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Literature Review: The What, Why and How-to Guide: Literature Reviews?

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What is a Literature Review?

So, what is a literature review .

"A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available or a set of summaries." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

• Citation: "The Literature Review: A Few Tips on Conducting it"

What kinds of literature reviews are written?

Each field has a particular way to do reviews for academic research literature. In the social sciences and humanities the most common are:

• Narrative Reviews: The purpose of this type of review is to describe the current state of the research on a specific research topic and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weaknesses, and gaps are identified. The review ends with a conclusion section that summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : A type of literature review typical in History and related fields, e.g., Latin American studies. For example, the Latin American Research Review explains that the purpose of this type of review is to “(1) to familiarize readers with the subject, approach, arguments, and conclusions found in a group of books whose common focus is a historical period; a country or region within Latin America; or a practice, development, or issue of interest to specialists and others; (2) to locate these books within current scholarship, critical methodologies, and approaches; and (3) to probe the relation of these new books to previous work on the subject, especially canonical texts. Unlike individual book reviews, the cluster reviews found in LARR seek to address the state of the field or discipline and not solely the works at issue.” - LARR

What are the Goals of Creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 
• Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

Note:  In the humanities, even if they don't use the term "literature review", they may have a dedicated  chapter that reviewed the "critical bibliography" or they incorporated that review in the introduction or first chapter of the dissertation, book, or article.

• UCSB electronic theses and dissertations In partnership with the Graduate Division, the UC Santa Barbara Library is making available theses and dissertations produced by UCSB students. Currently included in ADRL are theses and dissertations that were originally filed electronically, starting in 2011. In future phases of ADRL, all theses and dissertations created by UCSB students may be digitized and made available.

Where to Find Standalone Literature Reviews

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature review looks at a topic from a historical perspective to see how the understanding of the topic has changed over time. 

• Find e-Journals for Standalone Literature Reviews The best way to get familiar with and to learn how to write literature reviews is by reading them. You can use our Journal Search option to find journals that specialize in publishing literature reviews from major disciplines like anthropology, sociology, etc. Usually these titles are called, "Annual Review of [discipline name] OR [Discipline name] Review. This option works best if you know the title of the publication you are looking for. Below are some examples of these journals! more... less... Journal Search can be found by hovering over the link for Research on the library website.

Social Sciences

• Annual Review of Anthropology
• Annual Review of Political Science
• Annual Review of Sociology
• Ethnic Studies Review

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
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What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Frequently asked questions

What is the purpose of a literature review.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

Frequently asked questions: Academic writing

A rhetorical tautology is the repetition of an idea of concept using different words.

Rhetorical tautologies occur when additional words are used to convey a meaning that has already been expressed or implied. For example, the phrase “armed gunman” is a tautology because a “gunman” is by definition “armed.”

A logical tautology is a statement that is always true because it includes all logical possibilities.

Logical tautologies often take the form of “either/or” statements (e.g., “It will rain, or it will not rain”) or employ circular reasoning (e.g., “she is untrustworthy because she can’t be trusted”).

You may have seen both “appendices” or “appendixes” as pluralizations of “ appendix .” Either spelling can be used, but “appendices” is more common (including in APA Style ). Consistency is key here: make sure you use the same spelling throughout your paper.

The purpose of a lab report is to demonstrate your understanding of the scientific method with a hands-on lab experiment. Course instructors will often provide you with an experimental design and procedure. Your task is to write up how you actually performed the experiment and evaluate the outcome.

In contrast, a research paper requires you to independently develop an original argument. It involves more in-depth research and interpretation of sources and data.

A lab report is usually shorter than a research paper.

The sections of a lab report can vary between scientific fields and course requirements, but it usually contains the following:

• Title: expresses the topic of your study
• Abstract: summarizes your research aims, methods, results, and conclusions
• Introduction: establishes the context needed to understand the topic
• Method: describes the materials and procedures used in the experiment
• Results: reports all descriptive and inferential statistical analyses
• Discussion: interprets and evaluates results and identifies limitations
• Conclusion: sums up the main findings of your experiment
• References: list of all sources cited using a specific style (e.g. APA)
• Appendices: contains lengthy materials, procedures, tables or figures

A lab report conveys the aim, methods, results, and conclusions of a scientific experiment . Lab reports are commonly assigned in science, technology, engineering, and mathematics (STEM) fields.

The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis , dissertation or research paper .

If you’ve gone over the word limit set for your assignment, shorten your sentences and cut repetition and redundancy during the editing process. If you use a lot of long quotes , consider shortening them to just the essentials.

If you need to remove a lot of words, you may have to cut certain passages. Remember that everything in the text should be there to support your argument; look for any information that’s not essential to your point and remove it.

To make this process easier and faster, you can use a paraphrasing tool . With this tool, you can rewrite your text to make it simpler and shorter. If that’s not enough, you can copy-paste your paraphrased text into the summarizer . This tool will distill your text to its core message.

Revising, proofreading, and editing are different stages of the writing process .

• Revising is making structural and logical changes to your text—reformulating arguments and reordering information.
• Editing refers to making more local changes to things like sentence structure and phrasing to make sure your meaning is conveyed clearly and concisely.
• Proofreading involves looking at the text closely, line by line, to spot any typos and issues with consistency and correct them.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

Avoid citing sources in your abstract . There are two reasons for this:

• The abstract should focus on your original research, not on the work of others.
• The abstract should be self-contained and fully understandable without reference to other sources.

There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.

An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:

• To help potential readers determine the relevance of your paper for their own research.
• To communicate your key findings to those who don’t have time to read the whole paper.

Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarizes the contents of your paper.

In a scientific paper, the methodology always comes after the introduction and before the results , discussion and conclusion . The same basic structure also applies to a thesis, dissertation , or research proposal .

Depending on the length and type of document, you might also include a literature review or theoretical framework before the methodology.

Whether you’re publishing a blog, submitting a research paper , or even just writing an important email, there are a few techniques you can use to make sure it’s error-free:

• Take a break : Set your work aside for at least a few hours so that you can look at it with fresh eyes.
• Proofread a printout : Staring at a screen for too long can cause fatigue – sit down with a pen and paper to check the final version.
• Use digital shortcuts : Take note of any recurring mistakes (for example, misspelling a particular word, switching between US and UK English , or inconsistently capitalizing a term), and use Find and Replace to fix it throughout the document.

If you want to be confident that an important text is error-free, it might be worth choosing a professional proofreading service instead.

Editing and proofreading are different steps in the process of revising a text.

Editing comes first, and can involve major changes to content, structure and language. The first stages of editing are often done by authors themselves, while a professional editor makes the final improvements to grammar and style (for example, by improving sentence structure and word choice ).

Proofreading is the final stage of checking a text before it is published or shared. It focuses on correcting minor errors and inconsistencies (for example, in punctuation and capitalization ). Proofreaders often also check for formatting issues, especially in print publishing.

The cost of proofreading depends on the type and length of text, the turnaround time, and the level of services required. Most proofreading companies charge per word or page, while freelancers sometimes charge an hourly rate.

For proofreading alone, which involves only basic corrections of typos and formatting mistakes, you might pay as little as $0.01 per word, but in many cases, your text will also require some level of editing , which costs slightly more.

It’s often possible to purchase combined proofreading and editing services and calculate the price in advance based on your requirements.

There are many different routes to becoming a professional proofreader or editor. The necessary qualifications depend on the field – to be an academic or scientific proofreader, for example, you will need at least a university degree in a relevant subject.

For most proofreading jobs, experience and demonstrated skills are more important than specific qualifications. Often your skills will be tested as part of the application process.

To learn practical proofreading skills, you can choose to take a course with a professional organization such as the Society for Editors and Proofreaders . Alternatively, you can apply to companies that offer specialized on-the-job training programmes, such as the Scribbr Academy .

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• Literature Review Guidelines

Making sense of what has been written on your topic.

Goals of a literature review:.

Before doing work in primary sources, historians must know what has been written on their topic.  They must be familiar with theories and arguments–as well as facts–that appear in secondary sources.

Before you proceed with your research project, you too must be familiar with the literature: you do not want to waste time on theories that others have disproved and you want to take full advantage of what others have argued.  You want to be able to discuss and analyze your topic.

Your literature review will demonstrate your familiarity with your topic’s secondary literature.

GUIDELINES FOR A LITERATURE REVIEW:

1) LENGTH:  8-10 pages of text for Senior Theses (485) (consult with your professor for other classes), with either footnotes or endnotes and with a works-consulted bibliography. [See also the  citation guide  on this site.]

2) NUMBER OF WORKS REVIEWED: Depends on the assignment, but for Senior Theses (485), at least ten is typical.

3) CHOOSING WORKS:

Your literature review must include enough works to provide evidence of both the breadth and the depth of the research on your topic or, at least, one important angle of it.  The number of works necessary to do this will depend on your topic. For most topics, AT LEAST TEN works (mostly books but also significant scholarly articles) are necessary, although you will not necessarily give all of them equal treatment in your paper (e.g., some might appear in notes rather than the essay). 4) ORGANIZING/ARRANGING THE LITERATURE:

As you uncover the literature (i.e., secondary writing) on your topic, you should determine how the various pieces relate to each other.  Your ability to do so will demonstrate your understanding of the evolution of literature.

You might determine that the literature makes sense when divided by time period, by methodology, by sources, by discipline, by thematic focus, by race, ethnicity, and/or gender of author, or by political ideology.  This list is not exhaustive.  You might also decide to subdivide categories based on other criteria.  There is no “rule” on divisions—historians wrote the literature without consulting each other and without regard to the goal of fitting into a neat, obvious organization useful to students.

The key step is to FIGURE OUT the most logical, clarifying angle.  Do not arbitrarily choose a categorization; use the one that the literature seems to fall into.  How do you do that?  For every source, you should note its thesis, date, author background, methodology, and sources.  Does a pattern appear when you consider such information from each of your sources?  If so, you have a possible thesis about the literature.  If not, you might still have a thesis.

Consider: Are there missing elements in the literature?  For example, no works published during a particular (usually fairly lengthy) time period?  Or do studies appear after long neglect of a topic?  Do interpretations change at some point?  Does the major methodology being used change?  Do interpretations vary based on sources used?

Follow these links for more help on analyzing  historiography  and  historical perspective .

5) CONTENTS OF LITERATURE REVIEW:

The literature review is a research paper with three ingredients:

a) A brief discussion of the issue (the person, event, idea). [While this section should be brief, it needs to set up the thesis and literature that follow.] b) Your thesis about the literature c) A clear argument, using the works on topic as evidence, i.e., you discuss the sources in relation to your thesis, not as a separate topic.

These ingredients must be presented in an essay with an introduction, body, and conclusion.

6) ARGUING YOUR THESIS:

The thesis of a literature review should not only describe how the literature has evolved, but also provide a clear evaluation of that literature.  You should assess the literature in terms of the quality of either individual works or categories of works.  For instance, you might argue that a certain approach (e.g. social history, cultural history, or another) is better because it deals with a more complex view of the issue or because they use a wider array of source materials more effectively. You should also ensure that you integrate that evaluation throughout your argument.  Doing so might include negative assessments of some works in order to reinforce your argument regarding the positive qualities of other works and approaches to the topic.

Within each group, you should provide essential information about each work: the author’s thesis, the work’s title and date, the author’s supporting arguments and major evidence.

In most cases, arranging the sources chronologically by publication date within each section makes the most sense because earlier works influenced later ones in one way or another.  Reference to publication date also indicates that you are aware of this significant historiographical element.

As you discuss each work, DO NOT FORGET WHY YOU ARE DISCUSSING IT.  YOU ARE PRESENTING AND SUPPORTING A THESIS ABOUT THE LITERATURE.

When discussing a particular work for the first time, you should refer to it by the author’s full name, the work’s title, and year of publication (either in parentheses after the title or worked into the sentence).

For example, “The field of slavery studies has recently been transformed by Ben Johnson’s The New Slave (2001)” and “Joe Doe argues in his 1997 study, Slavery in America, that . . . .”

Your paper should always note secondary sources’ relationship to each other, particularly in terms of your thesis about the literature (e.g., “Unlike Smith’s work, Mary Brown’s analysis reaches the conclusion that . . . .” and “Because of Anderson’s reliance on the president’s personal papers, his interpretation differs from Barry’s”). The various pieces of the literature are “related” to each other, so you need to indicate to the reader some of that relationship.  (It helps the reader follow your thesis, and it convinces the reader that you know what you are talking about.)

7) DOCUMENTATION:

Each source you discuss in your paper must be documented using footnotes/endnotes and a bibliography.  Providing author and title and date in the paper is not sufficient.  Use correct Turabian/Chicago Manual of Style form.  [See  Bibliography  and  Footnotes/Endnotes  pages.]

In addition, further supporting, but less significant, sources should be included in  content foot or endnotes .  (e.g., “For a similar argument to Ben Johnson’s, see John Terry, The Slave Who Was New (New York: W. W. Norton, 1985), 3-45.”)

8 ) CONCLUSION OF LITERATURE REVIEW:

Your conclusion should not only reiterate your argument (thesis), but also discuss questions that remain unanswered by the literature.  What has the literature accomplished?  What has not been studied?  What debates need to be settled?

Additional writing guidelines

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• v.8(3); 2016 Jul

The Literature Review: A Foundation for High-Quality Medical Education Research

a  These are subscription resources. Researchers should check with their librarian to determine their access rights.

Despite a surge in published scholarship in medical education 1 and rapid growth in journals that publish educational research, manuscript acceptance rates continue to fall. 2 Failure to conduct a thorough, accurate, and up-to-date literature review identifying an important problem and placing the study in context is consistently identified as one of the top reasons for rejection. 3 , 4 The purpose of this editorial is to provide a road map and practical recommendations for planning a literature review. By understanding the goals of a literature review and following a few basic processes, authors can enhance both the quality of their educational research and the likelihood of publication in the Journal of Graduate Medical Education ( JGME ) and in other journals.

The Literature Review Defined

In medical education, no organization has articulated a formal definition of a literature review for a research paper; thus, a literature review can take a number of forms. Depending on the type of article, target journal, and specific topic, these forms will vary in methodology, rigor, and depth. Several organizations have published guidelines for conducting an intensive literature search intended for formal systematic reviews, both broadly (eg, PRISMA) 5 and within medical education, 6 and there are excellent commentaries to guide authors of systematic reviews. 7 , 8

• A literature review forms the basis for high-quality medical education research and helps maximize relevance, originality, generalizability, and impact.
• A literature review provides context, informs methodology, maximizes innovation, avoids duplicative research, and ensures that professional standards are met.
• Literature reviews take time, are iterative, and should continue throughout the research process.
• Researchers should maximize the use of human resources (librarians, colleagues), search tools (databases/search engines), and existing literature (related articles).
• Keeping organized is critical.

Such work is outside the scope of this article, which focuses on literature reviews to inform reports of original medical education research. We define such a literature review as a synthetic review and summary of what is known and unknown regarding the topic of a scholarly body of work, including the current work's place within the existing knowledge . While this type of literature review may not require the intensive search processes mandated by systematic reviews, it merits a thoughtful and rigorous approach.

Purpose and Importance of the Literature Review

An understanding of the current literature is critical for all phases of a research study. Lingard 9 recently invoked the “journal-as-conversation” metaphor as a way of understanding how one's research fits into the larger medical education conversation. As she described it: “Imagine yourself joining a conversation at a social event. After you hang about eavesdropping to get the drift of what's being said (the conversational equivalent of the literature review), you join the conversation with a contribution that signals your shared interest in the topic, your knowledge of what's already been said, and your intention.” 9

The literature review helps any researcher “join the conversation” by providing context, informing methodology, identifying innovation, minimizing duplicative research, and ensuring that professional standards are met. Understanding the current literature also promotes scholarship, as proposed by Boyer, 10 by contributing to 5 of the 6 standards by which scholarly work should be evaluated. 11 Specifically, the review helps the researcher (1) articulate clear goals, (2) show evidence of adequate preparation, (3) select appropriate methods, (4) communicate relevant results, and (5) engage in reflective critique.

Failure to conduct a high-quality literature review is associated with several problems identified in the medical education literature, including studies that are repetitive, not grounded in theory, methodologically weak, and fail to expand knowledge beyond a single setting. 12 Indeed, medical education scholars complain that many studies repeat work already published and contribute little new knowledge—a likely cause of which is failure to conduct a proper literature review. 3 , 4

Likewise, studies that lack theoretical grounding or a conceptual framework make study design and interpretation difficult. 13 When theory is used in medical education studies, it is often invoked at a superficial level. As Norman 14 noted, when theory is used appropriately, it helps articulate variables that might be linked together and why, and it allows the researcher to make hypotheses and define a study's context and scope. Ultimately, a proper literature review is a first critical step toward identifying relevant conceptual frameworks.

Another problem is that many medical education studies are methodologically weak. 12 Good research requires trained investigators who can articulate relevant research questions, operationally define variables of interest, and choose the best method for specific research questions. Conducting a proper literature review helps both novice and experienced researchers select rigorous research methodologies.

Finally, many studies in medical education are “one-offs,” that is, single studies undertaken because the opportunity presented itself locally. Such studies frequently are not oriented toward progressive knowledge building and generalization to other settings. A firm grasp of the literature can encourage a programmatic approach to research.

Approaching the Literature Review

Considering these issues, journals have a responsibility to demand from authors a thoughtful synthesis of their study's position within the field, and it is the authors' responsibility to provide such a synthesis, based on a literature review. The aforementioned purposes of the literature review mandate that the review occurs throughout all phases of a study, from conception and design, to implementation and analysis, to manuscript preparation and submission.

Planning the literature review requires understanding of journal requirements, which vary greatly by journal ( table 1 ). Authors are advised to take note of common problems with reporting results of the literature review. Table 2 lists the most common problems that we have encountered as authors, reviewers, and editors.

Sample of Journals' Author Instructions for Literature Reviews Conducted as Part of Original Research Article a

Common Problem Areas for Reporting Literature Reviews in the Context of Scholarly Articles

Locating and Organizing the Literature

Three resources may facilitate identifying relevant literature: human resources, search tools, and related literature. As the process requires time, it is important to begin searching for literature early in the process (ie, the study design phase). Identifying and understanding relevant studies will increase the likelihood of designing a relevant, adaptable, generalizable, and novel study that is based on educational or learning theory and can maximize impact.

Human Resources

A medical librarian can help translate research interests into an effective search strategy, familiarize researchers with available information resources, provide information on organizing information, and introduce strategies for keeping current with emerging research. Often, librarians are also aware of research across their institutions and may be able to connect researchers with similar interests. Reaching out to colleagues for suggestions may help researchers quickly locate resources that would not otherwise be on their radar.

During this process, researchers will likely identify other researchers writing on aspects of their topic. Researchers should consider searching for the publications of these relevant researchers (see table 3 for search strategies). Additionally, institutional websites may include curriculum vitae of such relevant faculty with access to their entire publication record, including difficult to locate publications, such as book chapters, dissertations, and technical reports.

Strategies for Finding Related Researcher Publications in Databases and Search Engines

Search Tools and Related Literature

Researchers will locate the majority of needed information using databases and search engines. Excellent resources are available to guide researchers in the mechanics of literature searches. 15 , 16

Because medical education research draws on a variety of disciplines, researchers should include search tools with coverage beyond medicine (eg, psychology, nursing, education, and anthropology) and that cover several publication types, such as reports, standards, conference abstracts, and book chapters (see the box for several information resources). Many search tools include options for viewing citations of selected articles. Examining cited references provides additional articles for review and a sense of the influence of the selected article on its field.

Box Information Resources

• Web of Science a
• Education Resource Information Center (ERIC)
• Cumulative Index of Nursing & Allied Health (CINAHL) a
• Google Scholar

Once relevant articles are located, it is useful to mine those articles for additional citations. One strategy is to examine references of key articles, especially review articles, for relevant citations.

Getting Organized

As the aforementioned resources will likely provide a tremendous amount of information, organization is crucial. Researchers should determine which details are most important to their study (eg, participants, setting, methods, and outcomes) and generate a strategy for keeping those details organized and accessible. Increasingly, researchers utilize digital tools, such as Evernote, to capture such information, which enables accessibility across digital workspaces and search capabilities. Use of citation managers can also be helpful as they store citations and, in some cases, can generate bibliographies ( table 4 ).

Citation Managers

Knowing When to Say When

Researchers often ask how to know when they have located enough citations. Unfortunately, there is no magic or ideal number of citations to collect. One strategy for checking coverage of the literature is to inspect references of relevant articles. As researchers review references they will start noticing a repetition of the same articles with few new articles appearing. This can indicate that the researcher has covered the literature base on a particular topic.

Putting It All Together

In preparing to write a research paper, it is important to consider which citations to include and how they will inform the introduction and discussion sections. The “Instructions to Authors” for the targeted journal will often provide guidance on structuring the literature review (or introduction) and the number of total citations permitted for each article category. Reviewing articles of similar type published in the targeted journal can also provide guidance regarding structure and average lengths of the introduction and discussion sections.

When selecting references for the introduction consider those that illustrate core background theoretical and methodological concepts, as well as recent relevant studies. The introduction should be brief and present references not as a laundry list or narrative of available literature, but rather as a synthesized summary to provide context for the current study and to identify the gap in the literature that the study intends to fill. For the discussion, citations should be thoughtfully selected to compare and contrast the present study's findings with the current literature and to indicate how the present study moves the field forward.

To facilitate writing a literature review, journals are increasingly providing helpful features to guide authors. For example, the resources available through JGME include several articles on writing. 17 The journal Perspectives on Medical Education recently launched “The Writer's Craft,” which is intended to help medical educators improve their writing. Additionally, many institutions have writing centers that provide web-based materials on writing a literature review, and some even have writing coaches.

The literature review is a vital part of medical education research and should occur throughout the research process to help researchers design a strong study and effectively communicate study results and importance. To achieve these goals, researchers are advised to plan and execute the literature review carefully. The guidance in this editorial provides considerations and recommendations that may improve the quality of literature reviews.

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Speaker 1: A literature review is a summary of the existing research on a particular topic. It's typically done at the beginning of a research project and I did one for my undergraduate thesis, for my master's thesis and for my PhD thesis. And in this video I'm going to answer all of your literature review related questions. The first thing is how do you start a literature review? Well, to start a literature review, surprisingly or not surprisingly, you need literature. Where do you find that literature? Well, there's a ton of places. The first place I would go to is illicit.com. This is a new AI tool which allows you to ask a research question and get all of the papers related to that question. For example, here I can say how effective are conditional cash transfer programs? It will go away and search more than 125 million academic papers and here are the first four abstracts here. And here are all of the different researched peer-reviewed papers and that means that experts in the field have looked at these papers and said, yes, they are true. They are something that is a valuable contribution to the research field. So that's why you should be reading them. And we can go through and see that we've got a little summary and we just click through all of these and we can go and read them individually. That's one way, semantic searching. The next thing you can do is use Litmaps. Litmaps creates a map of literature for you to search. We can go in and create a map. Here I've created a map from one of my peer-reviewed papers that I wrote during my PhD and you can see I get a nice map of all of the other stuff that I need to read. You can do this with a single seed paper or you can put in a load of different papers in this tab in Discover to find out a load of different papers that you need to read about. Then you can also use something like Google Scholar. This is old school. This is like OG science and research. You'd go in, you just type keywords. For example, charge transport in OPV. So I'll click here and then here are all of the different papers that I should consider reading. Clearly, you don't need to read all of them but we'll get into that in a minute. But this is where you start. You start by searching the literature. You can have a look since 2024, since 2023 and this is the foundational activity for any literature review. Get comfortable searching the literature and you'll become a power user of all of the literature that you're about to write about. Before you start reading any literature, you need to have a literature review outline to work with. So this is the general structure of nearly every literature review for any field. It goes like this. First of all, we start with an introduction at the top. This introduction gives background information about the research field that you are investigating. It's in a reverse pyramid shape because this is the very, very broad step. This is where we're just sort of like looking at the overarching umbrella of our research field. Then optionally, we can talk about background and methods that are used to look for the research that we're going to talk about in the literature review. For example, you may want to say we looked at these databases, we looked at these sort of questions and background is the background of the field that you're specifically interested in. So we're going a little bit deeper, which is why it's the next step down on the inverse pyramid. Then we need all of the main text and this is all of the literature that you found searched by either theme. So you sort of group it together as like, this is a group of research that I can talk about because it's under one theme. Here's another theme or here's another theme and you've put research under that. So in here, you may have one, two, three plus themes under which you will talk about literature or, which is very uncommon I think these days, but you may be lucky that you may be able to sort this based on time, which means initially these people did this and then they did this and then they did this and that's how you structure your literature review. So you say they did this first, here's all the literature in the initial stages of that research, then they did this, here's the next stage of research, the evolution of that research field, here's the next stage. So it may be theme or time, it's completely up to you which one you use, but most people use theme. Once you've outlined all of the main themes and you've talked about the literature under that theme, then you need to have a discussion to bring it all together. This is where you're looking at all of the research themes and you're talking about your specific research question. Why are you doing this research into this literature and how does it help you sort of like answer the research question or the interest you have in a particular research field and why you're looking at the literature in the first place. And then you're looking at conclusions. Based on all of the stuff that you've read, all of the individual themes, all of the chronological studies, all of the papers you've included in this literature review, what conclusions can you make specifically about the current state of the field? And that is the general structure of nearly every literature review ever produced. Now, there's an easier way to do it obviously. What I like to do is go to ChatGPT and I just say, create a literature review outline for a study about and then whatever I'm interested in. Here I've got an example where it says, the effect of climate change on plants. And as you can see, it says introduction, background and here it says I want basic concepts of climate change. Then it says general impacts of climate change. Then we want direct effects of climate change on plants. So you can see we've started broad and we're getting narrower and narrower as the literature review goes on. And then we've got different themes. So we've got indirect effect of climate change on plants. So altered pests and disease dynamics, that's a theme. Changes in land use and habitat, that's a theme. And then we've got other themes underneath. So this is how you can easily structure and get a first kind of draft of the structure of any literature review that you're writing for nearly any subject. It's just amazing. And as you can see down here, the last one is conclusion, summary of key findings and then final thoughts on the importance of further research. So this is how we can use ChatGPT to structure our literature review outline. Nice stuff. Once you've got all of the literature you need to read and you've got a structure under which to put that literature, then you need to just write. You type out all of the stuff in your literature review. Before you do that, you may want to have a look at something like explainpaper.com that allows you to quickly understand peer-reviewed papers. Peer-reviewed papers are notoriously hard to read. They're dense, they're thick in academic language. And here, it's a really nice way to just get the simple summary. And I think this is one of the most powerful ones, explainpaper.com. All you need to do is highlight a certain area and over here, it will say, okay, explain your explanation. As a middle schooler, we can move this up and down and then we just click explain. And underneath, it will tell you the undergrad explanation of what you've just highlighted. A really great way, particularly if you're early on in your academic career, if you're undergraduate, if you're in high school, this is a great way to unlock all of the power that's behind the horrible language found in peer-reviewed academic papers. Once you understand what's actually in all of this, you've collected them into themes, you need to write it. There are a few tools that you can use. So you can use jenny.ai, that's an auto-writer for research papers and literature reviews. You can use yomoo.ai. And that is another sort of like auto-writer for peer-reviewed and papers. But to be honest with you, the best thing you can do is sit there with a Word document, with a Google document, Google, what do you even call that? Google Docs? Google Word? I completely forgot. Anyway, you know what I mean. You sit there with a word processor and you start typing. You put in your structured headlines and then you say under each one, what literature you're going to mention and you start fleshing it out. It takes ages and ages and many, many revisions. Make sure that you get someone you trust or your supervisor to look over it as you're writing it. Maybe each chapter or each theme that you write, you get someone to look over it and then at the end they look over everything all together. It's a really, really long process. It takes such a long time. For my thesis, it probably took a good few weeks to get all of the information into a sensible structure and literature review. So here we are, here's one of the themes. Overview of photocurrent generation in organic photovoltaic devices. So that's just one of many, many themes in this thesis and depending on what stage of study you're at, it could be long, it could be short but let's talk about that next. Okay, how long should a literature review be? Well, there are no hard and fast rules but I like to think about it like this. Is there enough in your literature review to provide enough context to what you're doing and what you're researching? Is there enough context for you to understand the problem that your literature review is looking at and addressing and also, is there enough data in there to talk about the up-to-date research and where the current state of the field is? That's really what we're looking at but here's some rules of thumb. So if you're doing it for an assignment, one thing I recommend that you look at is about 3,000 to 10,000 words. That's normally good enough to get an overview. For example, in my undergraduate thesis, it's only about seven pages. There's not much in there. There's some fancy diagrams, there's lots of references but ultimately, it's about seven pages. So it's not much. So 3,000 to 10,000 words is all you need for a small assignment or an undergraduate thesis whereas for master's and master's theses and PhD dissertations, one thing I recommend is you look at what's normal for your field. In some fields, it's like 10 pages. In other fields, it can be up to 40 pages but ultimately, as long as you have enough information and literature to be able to provide context to your problem and you provide an up-to-date representation of that research field, then you've got enough in there. Like I said, I like to use just the guide of what is normal for my research field before I start writing my thesis so I can say, okay, normally it's about 20 pages and therefore, I need to fill 20 pages worth of stuff and that is a good starting point for almost any literature review. So there we have it. That's the introduction to literature reviews. I'd love to know what you think and also, I have got so many videos on this very channel about literature reviews with AI, how to find literature using AI tools, how to write it in seconds using tools that are available online. I'll put all of the links below in the description so you can sort of build on the knowledge that we've gained in this video but if you really want to go look at a powerful video, go check out this one where I talk about how to write an exceptional literature review using AI. You won't be disappointed. Go check it out.

Literature Reviews (in the Health Sciences)

• Goals of a Literature Review
• Select Citation Management Software
• Select databases to search
• Conduct searches
• Track your searches
• Select articles to include
• Extract information from articles
• Structure your review
• Find "fill-in" information
• Other sources and help

Keeping these goals in mind throughout your project will help you stay organized and focused.

A literature review helps the author:

• Understand the scope, history, and present state of knowledge in a specific topic
• Understand application of research concepts such as statistical tests and methodological choices
• Create a research project that complements the existing research or fills in gaps

A literature review helps the reader:

• Understand how your research project fits into the existing knowledge and research in a field
• Understand that a topic is important/relevant to the world and persuade them to keep reading your project
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4ir applications in the transport industry: systematic review of the state of the art with respect to data collection and processing mechanisms.

1. Introduction

2. methodology, 2.1. search key/string approach, 2.2. source/database selection, 2.3. selection of closely related articles (inclusion and exclusion criteria), 3. related works, 3.1. general literature review, 3.2. specific literature review, 4. identified gaps, 5. discussion of findings, 6. conclusions and recommendation, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Ajayi, O.O.; Kurien, A.M.; Djouani, K.; Dieng, L. 4IR Applications in the Transport Industry: Systematic Review of the State of the Art with Respect to Data Collection and Processing Mechanisms. Sustainability 2024 , 16 , 7514. https://doi.org/10.3390/su16177514

Ajayi OO, Kurien AM, Djouani K, Dieng L. 4IR Applications in the Transport Industry: Systematic Review of the State of the Art with Respect to Data Collection and Processing Mechanisms. Sustainability . 2024; 16(17):7514. https://doi.org/10.3390/su16177514

Ajayi, Olusola O., Anish M. Kurien, Kareem Djouani, and Lamine Dieng. 2024. "4IR Applications in the Transport Industry: Systematic Review of the State of the Art with Respect to Data Collection and Processing Mechanisms" Sustainability 16, no. 17: 7514. https://doi.org/10.3390/su16177514

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• Published: 03 September 2024

Clinical and scientific review of severe and enduring anorexia nervosa in intensive care settings: introducing an innovative treatment paradigm

• Joseph A Wonderlich 1 , 2 ,
• Dorian R Dodd 1 , 2 ,
• Cindy Sondag 2 ,
• Michelle Jorgensen 2 ,
• Candice Blumhardt 2 ,
• Alexandra N Evanson 2 ,
• Casey Bjoralt 2 &
• Stephen A Wonderlich 1  

Journal of Eating Disorders volume  12 , Article number:  131 ( 2024 ) Cite this article

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Anorexia nervosa is a serious and potentially lethal psychiatric disorder. Furthermore, there is significant evidence that some individuals develop a very long-standing form of the illness that requires a variety of different treatment interventions over time.

The primary goal of this paper was to provide a review of treatment strategies for severe and enduring anorexia nervosa (SE-AN) with the particular focus on treatments involving hospital care. Additionally, we wish to highlight a contemporary approach to such care and provide qualitative reactions to this model from both staff and patients.

A selective and strategic review of the treatment literature for SE-AN was conducted for the current paper. Emphasis was placed on clinical or scientific papers related to hospital-based care. Additionally, staff who work on a specific inpatient eating disorder unit with a substantial treatment program for SE-AN, along with a number of SE-AN patients were surveyed regarding their experiences working on, or receiving treatment on the unit. Importantly, the staff of this unit created a specific treatment protocol for individuals receiving hospital care. The results of the highlight both advantages and challenges of a hospital-based protocol oriented toward emphasizing quality of life, medical stability, and a health-promoting meal plan.

While there is general inconsistency with the type of treatment that is best suited to individuals with SE-AN, this is particularly true for higher levels of care that rely on inpatient hospital units or residential treatment settings. This is a highly significant clinical topic in need of further clinical and scientific examination.

Plain English summary

Anorexia nervosa is a serious illness which often persists for decades. Treatments for persistent anorexia nervosa are not well defined and there is considerable debate in the field about appropriate types of treatment strategies for these individuals. Such clinical uncertainty is particularly noteworthy in terms of the most appropriate types of care for these patients when they are hospitalized, which happens relatively frequently. Greater efforts are needed to develop inpatient programs for SE-AN that take into consideration their unique clinical needs.

Anorexia Nervosa (AN) is a serious and potentially lethal psychiatric disorder that is most typically seen in girls and young women, with a lifetime prevalence of 2–4% [ 1 , 2 ]. While AN is rare in some countries (e.g., Africa and Latin America) it is most prevalent in Europe, North America, and Australasia. AN is considered one of the most lethal psychiatric disorders with a crude mortality rate of 5% per decade and a standardized mortality ratio of around 6 [ 2 , 3 ].

Prospective longitudinal studies have consistently identified a subset of AN patients who have long-standing eating disorders, characterized by minimal improvement and significant impairment over decades (e.g. [ 4 , 5 ]). However, there has been significant variability across studies in terms of rates of remission and recovery from AN. Eddy and colleagues [ 5 ], suggested that the longer the duration of follow up in such prospective longitudinal designs, the greater the rates of recovery. Steinhausen [ 6 ] reported that in studies with follow up to four years since index diagnosis, recovery was approximately 33%, while studies with follow-ups ranging from 4 to 10 years average 47% recovered, and studies longer than 10 years in duration revealed recovery rates over 70%. Robinson [ 7 ] examined the same literature and concluded that rates of recovery after 10 years seemed to be declining compared to follow-ups ranging from 4 to 10 years. Eddy et al., [ 5 ] suggest that studies beyond 20 years of follow-up are not only limited, but the findings are even more inconsistent. For example, Theander [ 8 ] reported outcomes over 33 years of follow-up with 76% achieving recovery. However, two other studies [ 9 , 10 ] found that approximately 20 years after an initial hospitalization, around 50% of the sample of AN individuals was recovered. Ratnasuriya [ 11 ] reported that 20 years after hospitalization only 30% of the patients had a good outcome. Similarly, a study with a large sample of individuals treated for AN revealed that the longer the duration of the eating disorder, the lower the chance of recovery [ 12 ]. These findings are further supported by a recent systematic review on the treatment of eating disorders that showed that 40% of AN cases had partial or no remission of symptoms [ 13 ].

However, another important longitudinal study, by Eddy et al., [ 5 ] relied on a well-characterized and regularly assessed sample of both individuals with AN and bulimia nervosa (BN) over 22 years. In this study, the authors found that at the end of the first decade of illness, approximately 31% of the individuals with AN and 68% of the individuals with BN were recovered. Thus, BN appeared to be a much more remitting illness than AN. However, approximately two decades after the initial diagnosis, there was significant proportional change. At this point, approximately 63% of the individuals with AN and 68% of the individuals with BN had recovered. Approximately half of those with AN who had not recovered in the first decade did recover in the second decade. Interestingly, the recovery rate of BN did not change significantly over that decade. Thus, the study by Eddy and colleagues [ 5 ] suggests that recovery from AN may continue for decades after onset, but importantly, well over a third of the AN sample continued to have very significant AN moving into the third decade of the illness.

During the timeframe when many of these longitudinal studies were being conducted, clinicians were actively attempting to outline treatment strategies for long-term, persistent, and minimally remitting AN. Wonderlich and colleagues [ 14 ] summarized these clinical strategies, which were wide ranging and infrequently tested empirically. Overall, the collection of strategies reflected the informed experience of clinicians who had treated numerous patients with long-standing AN and served as a repository of clinical wisdom accrued largely during the 80s and 90s. Numerous recommendations and suggestions from these individuals still inform contemporary treatment strategies for SE-AN, such as establishing clear guidelines, the value of a team-oriented approach, the importance of meaningful treatment collaboration, inclusion of the patient’s family, avoidance of aggressive change-oriented techniques, and the potential value of psychiatric rehabilitation models of intervention. Additionally, Williams and colleagues [ 15 ] described an integrated treatment program which included staff from hospital-based eating disorder program along with a community-based mental health rehabilitation team and demonstrated some degree of efficacy.

An important point in the treatment literature for long-standing AN was the randomized controlled trial conducted by Touyz and colleagues [ 16 ]. This study compared the efficacy of 30 outpatient sessions of an adapted form of cognitive behavioral therapy (CBT) to an adapted form of specialist supportive clinical management (SSCM). Both treatments had a modified primary focus on enhancing quality of life and promoting harm reduction, rather than weight gain and symptom reduction. Both treatments had excellent retention of participants, with attrition rates under 15%. Comparisons between the two treatments revealed minimal differences in outcome. Furthermore, secondary analyses found a series of meaningful predictors of good response and revealed that quality of the therapeutic alliance was associated with positive responses, broadly [ 17 ]. Thus, this study offers support for the treatment of SE-AN and developing treatments that optimize patient engagement.

Several other empirical studies preliminarily have examined the impact of evidence-based, shorter-term treatments on SE-AN. Some of these studies suggested that treatments, such as CBT appear equally effective when delivered to individuals with AN versus individuals with SE-AN [ 18 ]. Similarly, two studies found that duration of illness was not a significant predictor of the outcome in structured treatment such as CBT and MANTRA [ 19 , 20 ]. However, in another study, which relied on practice guideline-based treatments, there was a significant difference in outcome between early stage versus SE-AN patients. Specifically, the SE-AN patients were less likely to improve in areas of work and social adjustment than the early stage patients and the SE-AN patients were more likely to access intensive services following treatment [ 21 ]. There are an increasing number of empirical studies with SE-AN patients which could ultimately impact effective treatment deliveries, however at this point in time, the number of these studies remains relatively limited and frequently constrained by sample size issues. Thus, there is a significant need for additional strategies to be tested with individuals, displaying long-standing and serious forms of AN.

Wonderlich and colleagues [ 22 ] outline a number of innovative treatment strategies which have been tested, at least preliminarily, in individuals with long-standing SE-AN. They highlight that there are new behavioral strategies (e.g., exposure paradigms [ 23 ], habit-oriented interventions [ 24 ], cognitive remediation therapy [ 25 ]), along with novel pharmacologic interventions, (e.g., ketamine [ 26 ], and dronabinol [ 27 ]) which may have potential value in treating longer standing forms of AN. Additionally, there are brain stimulation interventions (e.g., rTMS [ 28 ], DBS [ 29 ]) which continue to be tested in individuals with SE-AN and show either reasonable tolerability or preliminary efficacy. Also, there are system-oriented strategies that are being looked at, such as stepped-care treatment models [ 30 ] and novel “self-admission” approaches [ 31 ] to inpatient care. Again, preliminary data suggests these strategies may have value.

However, despite these newer developments, we agree with the general idea that the lack of understanding of SE-AN and the associated dearth of treatments represent a serious deficit in the eating disorder field. Moreover, we believe that this dearth of empirically supported treatments for SE-AN patients is even more of an urgent situation for higher levels of care in hospital based and residential treatment settings as many of these patients repeatedly utilize a higher level of care. The primary aim of this paper is to highlight that empirically informed treatments for SE-AN patients are particularly limited in higher levels of care, such as inpatient units, partial hospitals, and residential treatment centers. Furthermore, we want to highlight the significance of this dilemma and the impact it has on SE-AN patients, and the clinical teams who attempt to treat them in these environments. In the next section, we will provide an overview of this situation and describe an innovative program, which has recently been developed based on clinical need and expertise, to provide quality care for SE-AN patients and also support the treatment teams who are attempting to provide the intervention.

Higher levels of care and SE-AN

Historically, there has been some debate about the most preferred treatment setting for patients with SE-AN. Some individuals clearly suggest that outpatient treatment is appropriate if medical stability is maintained [ 32 ]. However, Strober [ 33 ] advocates for inpatient hospitalization for SE-AN and suggests that comprehensive coordinated care is best provided in such a setting. Woodside [ 34 ] provides broad strategy for SE-AN patients when hospitalized, which happens relatively frequently. He notes that many SE-AN patients cannot realistically conceive of recovery but are interested in incremental improvements in their eating disorder. Others are interested in pursuing enhanced quality of life or improving their overall condition. He highlights the importance of collaborative goal setting that is realistic and tailored to each individual patient. There are no minimum standards for goals, virtually any change is promoted. Woodside does not provide high levels of detail about the operations of the program over the course of a hospital stay, but does conclude that there is an urgent need for increased dialogue about the issues regarding inpatient care and SE-AN.

Banford et al. [ 35 ] offer comments about the idea that eating disorder treatment programs, both outpatient and inpatient, often pursue treatment goals that are inconsistent with SE-AN patient motivation. Furthermore, many of these programs are oriented toward more acute cases of AN, often of younger ages than many of the SE-AN patients. Thus, the authors highlight the possible problems for SE-AN patients when they are in traditional eating disorder programs. They emphasize that when SE-AN patients are integrated into recovery focused partial hospital programs with younger, more acute patients, problems may emerge and they recommend that SE-AN patients are best treated in a separate program with individualized goals and interventions. They highlight that there are very few descriptions of SE-AN specific hospital units in the eating disorder literature, but note that such patients are frequently admitted. They highlight that in an ideal SE-AN hospital unit, goals might include harm reduction, improved quality of life, achieving stabilization, reducing medical risk and decreasing crisis hospital dependency. Overall, they highlight an approach that is characterized by clinical flexibility, creativity, and adaptability for higher levels of care for SE-AN.

A recent systematic review of treatment interventions for SE-AN suggests that hospital-based care for SE-AN is not well understood and varies significantly across studies [ 36 ]. The evidence suggests that inpatient treatment for SE-AN may have a beneficial impact on eating disorder symptoms, but the evidence is unclear about whether or not such gains are maintained. Importantly, however, the five trials that are included in this review relied on a heterogenous collection of treatment strategies for these patients. Some programs were clearly oriented around cognitive behavioral therapy (CBT) while others were only partly based on CBT. Some programs included well defined nutrition plans, while others did not. Some programs relied on antidepressants while others did not. The length of the programs varied significantly, ranging from 3 to 5 months, which is a substantial variation. We would suggest that the clinical variability reported across the hospital-based programs in this review is representative of hospital programs broadly that treat individuals with SE-AN. In fact, this review provides support for the fundamental argument in the present paper, that there is a need for increased scientific and clinical attention to treatment protocols for SE-AN at higher levels of care.

Considerations for developing a treatment of SE-AN in higher levels of care

The Sanford Eating Disorders Unit in Fargo, North Dakota, is one of a declining number of hospital-based eating disorder programs with inpatient, partial hospital and intensive outpatient programming in the United States. In this program, we provide care annually to approximately 250 patients ranging in age from early adolescence throughout the life span. Additionally, we are one of a limited number of programs that openly accepts public insurance in the U.S. As such, we regularly provide care to individuals turned away from other treatment centers due to high medical complexity or insurance policies not covered by other programs. Typically, these individuals display SE-AN. Over time, the unit has attempted to develop a humane and effective approach to care for these individuals. In the hospital setting, we were forced to grapple with several ethical questions, such as whether we should provide care focused on full-weight restoration for a given SE-AN patient, when there is evidence to suggest that this approach has not worked well with the patient previously. Alternatively, should SE-AN patients be allowed to be admitted to the hospital without an active weight restoration based treatment plan, given the long-term risks of premature death in SE-AN? Thus, we sought to develop a treatment program that provides medical stabilization, promotes quality of life, and retains the possibility that one could, in fact, recover after years or decades of serious SE-AN [ 5 ].

In developing a standardized treatment approach for individuals with SE-AN, addressing the challenges associated with hospital-based care for individuals who vary significantly in terms of their desire or ability to restore weight was crucial. The heterogeneity of individuals with eating disorders is a significant issue in general but is even more significant in the shared space afforded by hospital treatment units. Thus, the typical hospital program for eating disorders must try to develop clinical programming to accommodate a wide variety of individuals. This may become particularly challenging when we consider that there is marked variability in the age of patients, the number of previous inpatient treatment episodes, and the total length of time they have been treated. In the case of AN, hospital programs must provide treatment programming for first-episode patients who are often adolescents and have significant family involvement, as well as long-standing patients with AN who may be significantly older, without family support.

Furthermore, there may be significant differences among SE-AN patients in terms of the degree to which the primary focus should be on weight-based recovery, or one that prioritizes a goal of maintaining medical stability and promoting quality of life. Importantly, these significant differences may, at times, be complicated for treatment teams in the hospital who are actively promoting weight-based recovery in one patient and maintaining medical stability and quality of life, or palliative or hospice care in another. Clearly, the complexity of patient experiences in a hospital environment with shared treatment programming and physical space limitations between patients is noteworthy, and a significant challenge for clinicians.

Another challenge for hospital-based programs is the impact of such diversity of patient characteristics on the distribution of valuable clinical resources. Hospital staff must repeatedly, and frequently, make decisions about who will be admitted when there is an opening for care. Should the opening be allocated to more acute, recent onset cases of AN in teenagers versus individuals with long-standing AN who have been hospitalized multiple times and not established significant weight restoration?

Furthermore, as we have noted previously, all of this clinical diversity and complexity in the hospital environment is increased because there is no well-defined, structured intervention for individuals with SE-AN in the hospital setting. As a result, there is often confusion about whether treatment goals for such individuals should focus on weight-based recovery versus medical stabilization with enhancement of quality of life. There is also uncertainty about what treatment approaches may be beneficial to SE-AN patients. For example, in the hospital, what type of psychological intervention may be most beneficial for individuals with SE-AN? Should dietary interventions be modified for such individuals? What is the role of pharmacotherapy in the treatment of SE-AN?

Given these challenges, and the lack of any clear guidance in the literature, we created an active treatment program track for hospitalized individuals with SE-AN. Due to the need to capitalize on existing resources, the SE-AN track was developed entirely integrated within our traditional eating disorder inpatient program. This means that all patients, regardless of whether they are on the SE-AN track, take part in group therapy and eat in the dining room together. In an effort to reduce potential conflicts arising in treatment as a result of a mixed milieu, some adjustments to therapeutics and dining room rules were implemented. These are described in more detail below.

When developing the SE-AN track, our primary goal was to help our SE-AN patients improve their quality of life, primarily by reducing the duration and frequency of hospitalizations and creating a more personalized treatment approach. Second, we aimed to provide transparency between patients and clinical staff regarding the rationale and procedures for treating individuals with SE-AN. Third, we sought to establish a highly collaborative agreement early in treatment between a patient and clinical staff regarding structured goals to reduce future long-term hospitalizations. Fourth, we aim to actively engage with the patient regarding discharge planning at the start of treatment. The primary objectives of the program are to maintain gains established during the hospital stay, develop an outpatient treatment plan with explicit targets, and provide a clear understanding of the procedures utilized in the long-term treatment plan (which may include repeated short-term, return hospital visits).

A description of a SE-AN treatment program at a higher level of care

In deciding to change treatment outcomes for SE-AN patients in the hospital, it became crucial to re-examine the treatment approaches generally used on the unit, given that they were designed for traditional treatment targets (e.g., full weight restoration). Changes were made across almost all therapeutic modalities (e.g., psychotherapy, psychiatric interventions, and nutritional rehabilitation). For example, our goal was no longer primarily focusing on three to four pounds of weight restoration a week in the hospital. We wondered what this would mean for dietitians working with SE-AN patients or when determining the length of hospitalization. Furthermore, in a patient’s psychotherapy, if quality of life is the outcome being measured, what should a therapist focus on in a session? Though specific quality of life interventions were not clear in the existing literature, what became clear to our team was the need to reduce the length and frequency of hospitalizations. We did not believe that a high-quality life could be achieved moving from hospital admission to hospital admission. However, SE-AN patients also often require significant time and support from providers at higher levels of care due to their high medical acuity arising from complications of their SE-AN. Thus, any quality of life focused treatment for individuals with SE-AN at higher levels of care must find a way to reduce time spent in the hospital by the patients, while also providing them significant ongoing support. This perspective (i.e., reducing frequency and length of hospitalizations while supporting the patients) became an overarching goal across all aspects of the SE-AN program. Below, we outline the fundamental procedures for the program.

Admission procedures and initiation of SE-AN treatment

As previously stated, one of the primary goals of the SE-AN program is to provide transparency and collaborative goal setting between patients and clinical staff. As such, discussing the SE-AN program goals should be started immediately, but not prescriptively. We believe the best approach for goal-setting is through collaborative formulation process among the treatment team and the patient, as this is one of the best ways to ensure adherence to treatment and improve clinical outcomes. Upon intake, patients are assessed as to whether they meet SE-AN criteria (e.g., duration of illness over seven years and multiple failed empirically supported treatment attempts) and their personal treatment goals are identified. Patients who meet these SE-AN criteria and express goals in line with improved quality of life and medical stability are informed of the SE-AN program. All new SE-AN patients are informed that their initial stay will be considered a brief evaluation stay of 2–4 weeks to achieve medical stability and assess readiness for the SE-AN program. During the first few days of the admission, patients meet with the provider to start an ongoing conversation about their therapeutic goals and receive psychoeducational materials about the SE-AN program. Patients are informed about the program’s guidelines, including working towards specific goals, SE-AN-specific interventions, length of stay, and discharge planning, all of which are presented below. If, at the end of the evaluation stay, the patient and team decide that the SE-AN program is suitable for the patient, the “ongoing admission” process is discussed. The details of the ongoing admission process will be described below. In short, this process ultimately allows the patient to return to the hospital on the SE-AN track for brief goal-oriented stabilization stays if they have adhered to their treatment plan for at least three months.

Treatment contract and goal setting

As noted by Woodside [ 34 ] collaborative goal setting that is realistic and tailored to each individual patient is crucial for treating individuals with SE-AN. While Woodside suggests that no goal is too small, we believe that at higher levels of care, goals must actively move the patient toward improved quality of life. Therefore, all patients with SE-AN in our program must set goals in three domains: quality of life improvement, ongoing medical stability, and maintaining a meal plan tailored to work with the patient’s goals (e.g., weight maintenance or varying degrees of weight restoration). Patients are asked to work with their treatment team in each domain to establish 2–3 measurable objectives that will help them move their lives forward. For example, a quality of life goal might be “going to get coffee once a week with a friend,” while an example of a goal to help a patient meet their meal plan requirements might be “establish appointments with an outpatient dietitian twice a month.” The treatment team retains measurable objectives created collaboratively to measure future progress and decide the suitability of continuing specific SE-AN programming for future admissions.

Furthermore, individuals with SE-AN often carry comorbidities that may be treatment-interfering (e.g., substance use, obsessive-compulsive disorder, post-traumatic stress disorder). If the treatment team, or patient, determine a patient’s comorbidities interfere with the SE-AN approach during the initial evaluation stay, additional goals must be set to address these ongoing issues either at the outpatient level of care or in a different treatment facility. For example, if a patient with SE-AN also experiences obsessive-compulsive behaviors, the patient and team must think through achievable goals (e.g., exposure and response prevention therapy or medication management) to reduce the impact on SE-AN treatment. These goals should be established with the treatment team and may range from traditional therapeutic interventions (e.g., exposure therapy or substance use treatment) to potentially more experimental approaches (e.g., repetitive transcranial magnetic stimulation [rTMS] or psychedelic-assisted psychotherapy) when indicated. The primary objectives regarding setting goals around comorbidities is to reduce treatment-interfering symptoms not directly related to the eating disorder outside the hospital and increase the likelihood an individual will be able to adhere to the treatment plan.

Another goal-related issue often pertains to step down and discharge planning. Following an inpatient admission on the SE-AN track, individuals may have the desire to step-down their level of care to a partial hospitalization program (PHP) or intensive outpatient program (IOP) to ensure a higher degree of aftercare compared to stepping down to outpatient therapy. As our primary goal is to improve quality of life outside of the hospital, our program has taken the stance that this is acceptable as long as there are specific, and clear goals that have been identified to work on while in the PHP or IOP. Additionally, we have occasionally utilized both PHP and IOP as the primary level of care for our SE-AN protocol; however, only for individuals who come to the hospital medically stable.

Specific interventions for SE-AN

Medical stability.

One of the immediate priorities of a SE-AN approach at a higher level of care is addressing the patients’ physical health and stabilizing any medical complications resulting from SE-AN. This includes addressing the various physical consequences of prolonged inadequate nutrition. Most crucially, medical experts should address issues such as cardiovascular complications, hypoglycemia, organ damage, electrolyte imbalances, and gastrointestinal distress that interferes with the ability to eat. While medication management of psychiatric comorbidities may also be necessary, the initial goal is to stabilize physical health so that there is a life remaining to improve.

Nutritional rehabilitation

An essential consideration for nutritional rehabilitation for individuals with SE-AN is the role of dietitians in the care team and developing simple, and achievable menu plans. While traditional goals, like improved diet variety, have been linked to sustained recovery following weight restoration treatments [ 37 ], the SE-AN program shifts away from what or how these patients eat, prioritizing only that they eat a sufficient amount. Thus, in collaboration with a dietitian, the SE-AN patient creates a meal plan based on foods they are already eating, described as “simple and doable.” While the dietitian works to ensure the patient meets their macronutrient targets (within what is possible given what the patient is willing and able to eat),, there is initially less concern about various food or meal challenges. Over time, if patients successfully adhere to their meal plan, they may choose to increase variety or do meal exposures during future SE-AN admissions. As has been discussed among our team while developing this program, some of these recommendations may challenge the traditional treatment targets utilized by dietitians in treating eating disorders. However, the concept of helping a patient find a meal plan to stabilize their weight and stop weight loss is a skill dietitians most likely already possess. Thus, this does not require extensive additional training. However, we encourage collaborative, and ongoing, discussions among the medical providers and the dietitians in determining various nutritional rehabilitation interventions, such as determining rate of increase in calories to stop weight loss while not destabilize the patient and potentially changes to the macronutrient breakdown of the diet to address medicals needs like treatment of edema. While many of the skills needed to treat SE-AN are already possessed by dietitians, specialized training for working with severely low-weighted, chronically-ill patients may want to be pursued by dietitians, or any of the team members, when it comes to how to best treat SE-AN patients nutritionally.

Another important consideration is how individuals with SE-AN utilize the dining room. Among providers, it has often been argued that the dining room is the most therapeutic intervention for individuals with eating disorders at a higher level of care. While this remains true for individuals with SE-AN, the dining room often serves a very different purpose. The primary function of the dining room is to support SE-AN patients who are trying a different eating model than what they have tried in previous treatments. For the treatment team, this might require changing the expectations in the dining room. For example, in our program, it is understood that patients with SE-AN may engage in some behaviors in the dining room that are often considered disordered. Rather than providing redirection for any eating disorder behavior (e.g., cutting food into small pieces, overuse of condiments), only behaviors that interfere with the patient’s ability to consume their expected nutritional goals (e.g., delaying the start of their meal until the last 5 min so that they are not able to finish their meal) receive redirection. Discussions between SE-AN patients and staff should be supportive, calming, and reassuring. Calm, kind, and reassuring non-verbal messages are also encouraged. Ideally, SE-AN patients should be able to complete their meal in food, given that the patient and dietitian agreed the meal was simple and doable, and that these patients are given only the amount of nutrition needed for medical stabilization and to support their own weight goals, which often means halting weight loss and stabilizing and maintaining current weight. However if a patient does not finish their meal in food, they are expected to consume the missed nutrition immediately following the meal via a liquid supplement. Repeated refusal of planned foods or supplements suggests that the patient is not able to utilize and benefit from the SE-AN program at this time, and calls into question the utility of future admissions under the SE-AN track. The team and the patient would collaboratively discuss expectations for treatment adherence and how nonadherence may decrease the likelihood of the patient being allowed to continue treatment in the SE-AN track.

As previously noted, one of the challenges of creating a hospital-based treatment for SE-AN is the potential interaction of these patients with other patients pursuing different treatment goals. While this might not be an issue in some settings, the dining room can often create a space of conflict between individuals on a traditional restoration plan and those on the SE-AN program. To reduce interference with patients on weight restoration programs, patients on the SE-AN program eat at a designated table within the dining room. These simple modifications are essential in dealing with the heterogeneity of the eating disorder patient population.

Psychotherapeutic interventions

Psychotherapeutic strategies for patients with eating disorders at higher levels of care, in general, are extremely varied, making decisions about psychotherapy interventions for individuals with SE-AN difficult [ 38 , 39 ]. Given that the goal of our SE-AN program is to promote quality of life and increase time outside of hospital units, we have shifted the programming towards values-oriented therapies [ 40 ] and skills-based distress tolerance interventions [ 41 ]. Acceptance and Commitment Therapy (ACT) techniques, like cognitive defusion and committed action, help patients deal with ruminative thinking, a hallmark of SE-AN, while pursuing valued goals following discharge from the hospital. Meanwhile, Dialectical Behavior Therapy (DBT) distress tolerance skills help SE-AN patients more effectively cope with the distress involved in changing eating disorder behaviors and resisting eating disorder urges, in order to approach valued personal goals, even when distressed. With these simple interventions, we hope to help patients increase their treatment motivation and adherence to the treatment plan. The hope is that this approach reduces the pressure on the patient and leads to greater hope and self-efficacy, as they take steps toward recovery in achievable ways, rather than having patients see recovery as an externally imposed goal that is also an insurmountable obstacle.

Additionally, conventional relapse prevention planning, consistent with Cognitive Behavioral Therapy (CBT), is also promoted to assist patients in adhering to clinical goals regarding relapse in the SE-AN program. An essential structural treatment issue is the need to strongly promote continued collaboration with the patient’s outpatient providers following discharge from the hospital program. Such ongoing collaboration is necessary for protecting gains made during the hospitalization.

Criteria for return visits and staying in the SE-AN program

Following discharge from a SE-AN hospital stay, patients are encouraged to immediately begin working towards the goals they set at intake to improve the quality of their life, adhere to their meal plan, and stay medically stable. If, after three months, the patient has been able to meet all of their goals, the patient should still be medically stable and have maintained their weight. Thus, SE-AN patients can return to treatment for 2–3 weeks to work on potential increases in their meal plan, maintaining their progress, or identify opportunities to enhance medical stability. However, patients who are meeting their goals and feel confident in their ability to continue doing so may choose to wait longer than three months before returning. If medically stable patients wait longer than three months, the expectation is still that they can return to treatment for short term stays if they have remained medically stable and have adhered to their individualized meal plan.

While the program aims to provide a more “doable” treatment option, it is necessary to recognize that there is less of a safety net with a maintenance intervention than a full-weight restoration treatment. The likelihood that there are slips, lapses, or relapses for individuals with SE-AN is still high. However, given the slower pace of treatment, getting back on track requires less effort than when relapse happens on traditional treatment approaches. Thus, the first step for any patient who slips on the SE-AN program is simply returning to their meal plan outlined at discharge. The patient-centered meal plan was created to be doable by the patient using foods they were already eating. Returning to the meal plan, the patient can maintain their current weight and potentially drift back to their discharge weight.

If a patient lapses and cannot maintain their weight, we may request that the patient delay return admission beyond three months and begin working to get back on track with their previous discharge plan to demonstrate that they can maintain their weight and stick to their meal plan outside the hospital. For patients unable to get back on track, we advise they seek treatment for medical stabilization. Once medically stable, if they can get back on track, the patient and treatment team must discuss whether it would be appropriate to return for continuation of the SE-AN program. Just as the creation of this program arose from the ethical considerations regarding continually trying unsuccessful full-weight restoration approaches with individuals with chronic anorexia nervosa, the SE-AN program must fall under the same scrutiny. For patients for whom the SE-AN program did not work, the treatment team and patient must carefully weigh the minimal potential for benefit of continuing in a treatment that has not proven to be effective, relative to the costs of continuing a treatment that is not working, as well as the missed opportunity of pursuing other potential treatments options. The treatment team needs to be willing to discuss all alternative options, including returning to weight restoration approaches or the initiation of palliative, or even hospice, care.

Staff and patient feedback

As reviewed above, there is a dearth of research on effective treatments at higher levels of care for patients with SE-AN. Furthermore, the heterogeneity of the limited existing research impedes the ability to meaningfully synthesize this work and translate it to clinical practice. Meanwhile, patients with SE-AN frequently request admissions for hospital care, and programs must decide, with little evidence to consult, how to best serve these patients. Absent empirical guidance or professional consensus on the best way to serve these patients, we believe that exposing higher levels of care treatment programs to professional scrutiny in order to prompt more in-depth discussion of treatment issues for this population would be beneficial. Additionally, without a generalizable understanding of hospital treatment for patients with SE-AN, program evaluations should be conducted within individual treatment programs to inform strengths and shortcomings of each specific program, from the perspective of the patients and staff. We recently began a quality assessment effort to elicit feedback on our program, in order to further refine and enhance the SE-AN treatment protocol. Below, we provide an overview of staff and patient feedback. Of note, this feedback was given as part of evaluation efforts for our particular program, rather than as part of a methodologically rigorous research protocol, and as such is not intended to create generalized knowledge about hospital treatment of SE-AN.

Staff feedback

Overall, staff feedback about the SE-AN treatment model has been quite positive. Staff responses consistently indicated that the SE-AN model seemed to give a sense of hopefulness for many patients, and provided a good opportunity for us to “meet patients where they’re at.” Staff acknowledged that this can be a last resort for patients without other options, who are deemed “too sick” or noncompliant and are thus turned away from many other programs. Staff also noted that the greater autonomy given to patients in SE-AN protocol is helpful for their treatment process and progress, and appears to contribute to an increase in effective collaboration between the patient and providers. Staff believe that patients find this approach to be more tolerable, which decreases patient resistance and defensiveness. Finally, staff appreciated being able to individualize treatment around identifying realistic goals for patients to achieve incremental change outside of the hospital, and felt that in this way they were helping to set the patients up for success rather than contributing to a treatment/relapse cycle.

Staff also noted challenging aspects of the SE-AN treatment model, and areas for improvement. Specifically, several staff noted that explaining this model can be difficult as some patients initially worry that providers are “giving up on them.” And although individualization of treatment is generally seen as a strength of the model (by staff and patients alike), staff note that this can also cause issues with consistency and clarity, and for some patients not in the SE-AN program, it can cause an increase in comparisons with others (e.g., patients questioning why other patients are allowed certain accommodations, but they are not). A third challenge noted was that some patients do not use the treatment model effectively. For example, doing it to placate family or outside providers by “doing treatment,” but without genuine collaborative intent, is inconsistent with the model. Finally, this model can lead to significant challenges when patients (and/or their families and outside providers) do not have a realistic understanding of the severity of and impairment from their disorder, which can cause disagreement between the patient and their team regarding what goals are realistic. For example, a patient who states they want to gain significant weight but is unable to adhere to even a maintenance meal plan while in the hospital, would be required to set a more realistic goal. Treatment staff indicated that patients can at times get fixated on the parameters of the SE-AN model, and consistently challenge the SE-AN model limits (e.g., on length of stay, being asked to set more realistic goals); working through this reactivity and conflict detracts from providers being able to more meaningfully work on the eating disorder itself and provide patients with the full benefit of this model.

Patient feedback

Overall, patient feedback has been positive, though somewhat more mixed than staff feedback. Generally, patient and staff feedback show good correspondence, with both groups noting similar strengths and weaknesses of the treatment model. On the positive side, patients voiced appreciation for the autonomy and individuality that this approach provided with regards to being able to tailor their goals to what is specific for them. Patients stated that they “felt heard” and that their team collaborated well with them. As one patient stated “I don’t need to have a 4-hour panic attack over…lasagna which I’m never going to eat outside treatment. It just made sense to me working on what I wanted to work on.” Patients described the program as “realistic” and “autonomy supporting” and “humane” because it is “not forcing something that’s not worked in the past. And it’s not forcing, like, the cookie cutter model on a person, because every person is unique.” One patient with a trauma history stated that being given autonomy over her own choices while being kept safe from her ED was like “nothing I’ve experienced before and I think so incredibly healing.” Another patient highlighted that “people with AN often desire a high need for control. This program helps give us some level of control while working on difficult recovery goals…. This is the first time where I feel like I am in control of my recovery. I’m no longer scared I am going to die. I am no longer going to the ER 1–2 times a week…. It really seems to be working.”

Some patients were conflicted on the theoretical approach to treatment. For example, one patient expressed appreciation that “skills are repeatedly used to help facilitate success on the outside” [outside the hospital], while another patient stated that “more of the process work could be utilized rather than skills over and over” because “if you’re on the SE-AN track you probably have learned that before and probably done those groups a million times.”

Patients struggled with the structure of the treatment model. Some stated that they “wish it was faster” though they know “this is the speed it has to be for me.” Patients also expressed a desire for even more individualization, though also acknowledged that it can be difficult to balance individualization and consistency. One patient stated that she has seen other patients “just messing around” and “not actually working…just doing your disorder in treatment.” So, while patients understand the need for structure and limitations, they tend to think those limits make sense in general and for other patients on the SE-AN model, but should be less rigid for themselves. Patients discussed feeling worried that they may not be allowed to return if they struggle and are unable to meet their goals in between hospital stays, which highlights the difficult balance between requiring patients to demonstrate that they are being helped by the treatment model (to ensure we are not enabling stagnation and continued disorder) while also making allowances for nonlinear recovery processes. Patients also expressed that the SE-AN model can feel limiting. One patient stated that as a result of the SE-AN treatment model she had “lower expectations for myself” and felt the “agenda for this stay was tainted by previous stays” and that “once labeled, no matter your willingness to move forward, regardless of want to go further, it’s shut down.” Several patients similarly commented that being “labeled” as SE-AN and being recommended to the SE-AN treatment model was originally hard as it made them feel hopeless and given up on, but that once the goals of this approach were more clearly communicated, they understood its value better. Finally, patients noted some concern about lack of community resources and understanding of this approach, with one patient stating “I am scared that other treatment programs won’t take an approach like this. It can also be hard to get my outpatient providers to understand the program.”

Staff and patient feedback takeaways

Overall, staff and patient feedback suggest that the SE-AN treatment protocol is beneficial in many ways, especially in providing a treatment option—one that has the potential to extend life and willingness to engage with treatment—for those who are “too sick” for other treatment or who feel they cannot tolerate or do not want full/traditional recovery. Areas for potential improvement have been highlighted. Specifically, further consideration should be given to balancing individualization with consistency and having clearer guidelines for when, and with whom, to hold rigid expectations and under what circumstances greater flexibility can be extended. It will be important to continue to develop better strategies to communicate clearly and collaboratively with patients around what being classified as SE-AN means and the potential benefits of the SE-AN model in a way that can instill hope rather than hopelessness. Also, greater attention should be paid to addressing patient dissatisfaction when they feel limited by the SE-AN model but may not be able or willing to do traditional treatment with full weight restoration. Finally, thorough integration of the SE-AN program with outpatient providers is critical, but it can be challenging to find outpatient providers who will accept patients with SE-AN and who will agree to work on the patient’s SE-AN goals rather than traditional recovery goals and weight restoration.

In summary, we have provided a brief overview of SE-AN both scientifically and clinically. We have also attempted to highlight the limited empirically supported treatment options for SE-AN, but wish to underscore that this dearth of treatment options is significantly pronounced at higher levels of care. Given the severity of SE-AN, it is a simple fact that these patients will often use hospital-based services, and thus, greater attention to this deficit is encouraged.

Our program developed a structured treatment program for SE-AN which highlights flexible goalsetting, high levels of collaboration between patient and clinical staff, and an emphasis on enhancing quality of life, medical stability, and adequate nutritional rehabilitation. Furthermore, the approach highlights the importance of tailoring treatment planning to a given patient and their collaboratively established goals. Explicit treatment contracts are developed with patients and include a shared understanding of targeted objectives. Additionally, there is a significant effort to develop a detailed plan for maintaining health and returning to treatment after discharge from the hospital. This may include future “booster” admissions for limited periods of time to assist patients in continuing to maintain, or incrementally advance, health related goal achievement. Presently, our survey of patients, and staff suggest that the program offers significant advantages for both the treatment team and the patient, but also the continued challenges that a program for SE-AN in a hospital environment must face. We would strongly recommend that clinicians and scientists work to establish empirically supported approaches to treating patients with SE-AN in a hospital environment. Given this is a necessary type of care for such patients and the very serious nature of this illness, it is worthy of such an investment.

Data availability

No datasets were generated or analysed during the current study.

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Analyzing environmental concerns of sustainable development goals in SAARC region: how carbon emissions policy influence environmental sustainability?

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• Published: 02 September 2024

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• H. Akram 1 ,
• J. Li 1 , 2 ,
• M. Irfan   ORCID: orcid.org/0000-0003-1446-583X 3 , 4 , 5 , 6 , 7 , 8 &
• W. A. Watto 9  

Carbon emission policies have gained significant attention internationally as natural disasters are occurring rapidly and the environment worsens. This research aims to determine the causal relationship between various factors, such as the carbon emission of the South Asian Association for Regional Cooperation countries from 1990 to 2018. To achieve this, the study employs non-linear auto-regressive distributed lag models to analyze Load capacity factor, Fossil fuel consumption, Economic Complexity, Foreign direct investment, Renewable electricity consumption, and Economic Growth on carbon emission. Using this method also aids in capturing the non-linear interaction and temporal dependencies of the data. More specifically, the findings indicate a positive and direct relationship between economic complexity, renewable electricity consumption, and foreign direct investment in achieving sustainable development targets. In contrast, the direct influence of fossil fuel consumption and economic growth has been negative. These findings help understand the extent of progress toward carbon emissions and help the policymakers and stakeholders to design and implement sound and effective strategies for sustainable development that are appropriate to the economic and environmental realities of the countries.

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School of Economics and Management, North China Electric Power University, Changping, Beijing, 102206, China

H. Akram & J. Li

Beijing Key Laboratory of New Energy and Low-Carbon Development, North China Electric Power University, Changping, Beijing, 102206, China

Business School, Shandong Management University, Jinan, 250357, China

European Center of Economics, Azerbaijan State University of Economics (UNEC), Istiqlaliyyat Str. 6, Baku, Azerbaijan

University Centre for Research and Development, Chandigarh University, Mohali, Punjab, 140413, India

Department of Economics and Business, Western Caspian University, AZ, 1001, Baku, Azerbaijan

Advanced Research Centre, European University of Lefke, TR-10, Lefke, Mersin, Northern Cyprus, Turkey

School of Business Administration, ILMA University, Karachi, 75190, Pakistan

Department of Accountancy, Superior University Lahore, Lahore, Pakistan

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Hamza Akram: conceptualization, writing—original draft, formal analysis, data handling, variable construction, and methodology. Jinchao Li: Supervision and funding acquisition. Muhammad Irfan: writing, reviewing, and editing. Waqas Ahmad Watto: writing, reviewing, and editing.

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Akram, H., Li, J., Irfan, M. et al. Analyzing environmental concerns of sustainable development goals in SAARC region: how carbon emissions policy influence environmental sustainability?. Int. J. Environ. Sci. Technol. (2024). https://doi.org/10.1007/s13762-024-06007-7

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DOI : https://doi.org/10.1007/s13762-024-06007-7

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