Integrating patient values and preferences in healthcare: a systematic review of qualitative evidence

Objectives: To identify and thematically analyse how healthcare professionals (HCPs) integrate patient values and preferences (‘values integration’) in primary care for adults with non-communicable diseases (NCDs). Design: Systematic review and meta-aggregation methods were used for extraction, synthesis and analysis of qualitative evidence. Data sources: Relevant records were sourced using keywords to search 12 databases (ASSIA, CINAHL, DARE, EMBASE, ERIC, Google Scholar, GreyLit, Ovid-MEDLINE, PsycINFO, PubMed-MEDLINE, Scopus and Web of Science). Eligibility criteria: Records needed to be published between 2000 and 2020 and report qualitative methods and findings in English involving HCP participants regarding primary care for adult patients. Data extraction and synthesis: Relevant data including participant quotations, authors’ observations, interpretations and conclusions were extracted, synthesised and analysed in a phased approach using a modified version of the Joanna Briggs Institute (JBI) Data Extraction Tool, as well as EPPI Reviewer and NVivo software. The JBI Critical Appraisal Checklist for Qualitative Research was used to assess methodological quality of included records. Results: Thirty-one records involving >1032 HCP participants and 1823 HCP-patient encounters were reviewed. Findings included 143 approaches to values integration in clinical care, thematically analysed and synthesised into four themes: (1) approaches of concern; (2) approaches of competence; (3) approaches of communication and (4) approaches of congruence. Confidence in the quality of included records was deemed high. Conclusions: HCPs incorporate patient values and preferences in healthcare through a variety of approaches including showing concern for the patient as a person, demonstrating competence at managing diseases, communicating with patients as partners and tailoring, adjusting and balancing overall care. Themes in this review provide a novel framework for understanding and addressing values integration in clinical care and provide useful insights for policymakers, educators and practitioners. PROSPERO registration number: CRD42020166002

The Use of Traditional Vietnamese Medicine Among Vietnamese Immigrants Attending an Urban Community Health Center in the United States

OBJECTIVES: Little is known about Traditional Vietnamese Medicine (TVM) and its use among Vietnamese immigrants in the United States. This study aimed to characterize TVM and improve understanding of its use among Vietnamese outpatients attending an urban clinic. METHODS: This cross-sectional observation study was performed by mailing bilingual surveys to a stratified random sample of 400 Vietnamese adult patients ( \u3e /=18 years of age) who had visited a community health center in Boston, Massachusetts, at least once in the prior 12 months. The data were analyzed by using descriptive and multivariable regression statistics. The use of TVM and the factors influencing their use were reported. RESULTS: Among the 216 respondents, 68% reported using TVM. Of those users, the median age was 56 years and 68% were female, 51% had lived in the United States for less than 13 years, and 91% spoke English not well or not at all. Among the 89% who reported using TVM of indigenous origin, 62% used wind scraping, 35% used herbal pills/products, and 30% used wind snatching. Sixty-one percent used therapies of foreign origin; of those, 51% used Asian-originated TVM (herbs, 25%; Eastern massage, 23%) and 38% used Western-influenced TVM (diet supplements, 28%; Western massage, 8%). TVM was mostly used for pain conditions (57%), staying well (38%), and cough/colds (27%). Forty-five percent ignored the question on revealing TVM use to providers; of those who answered, 57% said no. Fifty-one percent of TVM users reported using Western medicine for the same problem, while 46% used TVM and Western medicine within 2 days of each other. Self-rated health (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.34-5.06), household size (OR, 2.09; 95% CI, 1.04-4.22), and education (OR, 2.65; 95% CI, 1.03-6.80) were associated with TVM use. CONCLUSION: TVM is an important component of the healthcare of urban Vietnamese and needs to be further investigated. Healthcare providers need to encourage open discussion to better care for this population

Predictors of timely follow-up after abnormal cancer screening among women seeking care at urban community health centers

BACKGROUND: We sought to measure time and identify predictors of timely follow-up among a cohort of racially/ethnically diverse inner city women with breast and cervical cancer screening abnormalities. METHODS: Eligible women had an abnormality detected on a mammogram or Papanicolaou (Pap) test between January 2004 and December 2005 in 1 of 6 community health centers in Boston, Massachusetts. Retrospective chart review allowed us to measure time to diagnostic resolution. We used Cox proportional hazards models to develop predictive models for timely resolution (defined as definitive diagnostic services completed within 180 days from index abnormality). RESULTS: Among 523 women with mammography abnormalities and 474 women with Pap test abnormalities, \u3e90% achieved diagnostic resolution within 12 months. Median time to resolution was longer for Pap test than for mammography abnormalities (85 vs 27 days). Site of care, rather than any sociodemographic characteristic of individuals, including race/ethnicity, was the only significant predictor of timely follow-up for both mammogram and Pap test abnormalities. CONCLUSIONS: Site-specific community-based interventions may be the most effective interventions to reduce cancer health disparities when addressing the needs of underserved populations