Health Care Services In Settings Research Articles

Discrimination Experienced by Women Living with HIV and AIDS Accessing Reproductive Health Services

Women with disclosed HIV status experience different barriers and are stigmatized and discriminated against in health services. The sexual and reproductive health of women living with HIV is critical when compared to those who are not living with HIV. Discriminatory behaviour in health settings decreases the morale of women and limits the care of their health. Women living with HIV hide their status because of fear of discrimination, which puts the health personnel at high risk of transmission. The goal of this study was to learn more about the reasons for and types of discrimination faced by HIV-positive women seeking reproductive health services in healthcare settings. The researcher found three significant findings. To begin with, pre-existing social attitudes, perceptions, and information regarding women with HIV are at the foundation of stigma and discrimination in healthcare settings. Second, the forms of stigma and prejudice that WLHIV perceived or experienced differed from each other, regardless of which service under reproductive health they sought. Finally, due to such discrimination, WLHIV refuses to disclose their HIV status, delaying or avoiding seeking medical help, experiencing emotional stress, and having low self-esteem.

Expectations of the Ontario Healthcare System following the Implementation of Ontario Health Teams

With the arrival of Ontario Health Teams (OHTs), healthcare providers, clinicians and patients seek to witness the efficacy of an integrated care model. OHTs are built on the concept of healthcare integration, coordinated care, shared fiscal and clinical accountabilities between multiple healthcare service providers, as well as bridging the gaps between the clinical, social and health promotional aspects of care delivery. This meta-narrative review seeks to examine, compare and determine the efficacy of the integrated care model using cross-sectional studies from around the world to see how integrated care effects health related outcomes. The efficacy of the model will be determined by evaluating the abilities of other integrated care models to reduce healthcare expenditures, improve coordination of care between healthcare service providers, bolster patient satisfaction and health outcomes, minimise emergency and life-threatening cases, lower emergency hospital admission rates as well as provide a comprehensive set of healthcare services including biomedical, mental and social supports. For future applications, this study could be used as a guideline to highlight areas of improvement in integrated care models, as well as to evaluate benefits of existing models and determine best approaches forward.

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

A mixed-methods feasibility study of Nyamekela4Care: An intervention to support improved quality of care among service providers in low-resource settings

BackgroundIn South Africa, health and care service providers (SPs) face many interconnected challenges at work, including inadequate training and supervision and high levels of burnout. Nyamekela4Care (N4C) was developed as an integrated intervention for SP teams, to support their ability to provide high-quality care through providing a structure for operating regular team meetings that includes training, empathic skills development, administration, case sharing and self-care. We aimed to determine the feasibility, acceptability, and preliminary effectiveness of the N4C intervention as a support package for SPs in resource-constrained settings. MethodsThis study utilized a mixed-methods, repeated measures design. Purposive sampling was used to recruit 42 SPs from two healthcare service settings in South Africa where teams of primary care clinic staff work together with home-visiting community health workers from community-based organisations. Data were collected across three timepoints. Self-report data were collected directly from participants at all timepoints, alongside qualitative interviews, investigating participants’ wellbeing, work satisfaction, work-related knowledge, and acceptability of N4C. A repeated measures ANOVA was applied to the data to test the preliminary effectiveness of N4C. Qualitative interview data were analysed using a thematic analysis approach to identify pertinent themes in the data. ResultsThe N4C intervention was found to be acceptable, with low uptake of the intervention at one site limiting interpretation of its feasibility. Qualitative data demonstrated that the intervention resulted in improved collaboration between organisations; improved capacity to practice self-care in certain cases; and improved work-related knowledge. Quantitative data identified a significant increase in work-related knowledge, but no significant differences for any other outcomes. The success of implementation may have been impeded by contextual factors such as uncertainty regarding contractual agreements for staff, staff attrition, lack of commitment and skill of some of the operational leadership and the small number of N4C meetings held. ConclusionWhile participants noted improvements in work-related knowledge, self-care and intersectoral collaboration as benefits of the intervention, the implementation of N4C, particularly at one site, limited our ability to assess its feasibility and impact. Further areas for quality of care intervention research are discussed.

General practitioners\u2019 experiences in consultations with foreign language patients after the introduction of a user\u2019s fee for professional interpretation: a qualitative interview study

BackgroundIn 2018, an amendment to the Danish Health Care Act was passed making it a requirement for patients not proficient in Danish to pay for interpretation services in health care settings. Thereafter there has been a drastic decline in the use of professional interpreters, especially in general practice. We aimed to investigate the experiences of general practitioners (GPs) in establishing an understanding with these patients in consultations, without the presence of a professional interpreter.MethodsThe study was qualitative, based on semi-structured interviews with nine purposively selected GPs. Analysis was by interpretative phenomenological analysis.ResultsThe GPs said that after the amendment was passed, the patients chose to almost exclusively use family members or friends as ad hoc interpreters, or they attended consultations with no interpreter present at all. The GPs experienced that the use of family interpreters caused specific problems, due to both their relationship with the patient and their lack of professional interpretation skills. If no mediator was present the GPs perceived the establishment of understanding as extremely challenging. This was particularly the case if patients had chronic conditions, mental or psychosocial problems or if cultural barriers were present. According to the GPs, the challenges were not exclusively restricted to a lack of language translation, but could also involve intertwined cultural barriers or social problems. The impairment in mutual understanding had different consequences, and led to poorer treatment at many levels in health care. The lack of access to a professional interpreter also presented the GP with ethical and legal dilemmas.ConclusionsThe GPs experienced that the changes in interpretation provision for patients in health care had led to professional interpretation being almost absent from general practice settings for patients subject to the fee. This led to several communication challenges, insufficient understanding in consultations, and poorer treatment of these, often very vulnerable, patients. The situation could, however, also involve the risk of epistemic injustice. The GPs experienced the situation as very unsatisfactory; it both comprised their ability to exercise their professionalism and their ethical obligations and restricted their legal rights.

Perceived stigma and healthcare services in healthcare settings among people living with HIV in Egypt: a qualitative study.

The researchers conducted the current study to explore the perspectives of people living with HIV (PLHIV) on HIV-related discrimination and the delivery of healthcare services in healthcare settings. An exploratory study using a qualitative approach was conducted among 46 PLHIV who were seeking HIV counselling and treatment from two HIV centres in the Cairo governorate using a purposive sampling technique. A thematic content analysis was used to examine the responses. Participants had a combination of positive and negative experiences. Some participants reported staff acceptance and friendliness towards HIV-positive patients on antiretroviral treatment. Most interviewees observed that staff took extra precautions when treating or caring for them. The majority stated that counselling about the effects of the treatment was inadequate and that testing was either too far from their homes or at overcrowded centres with long waiting times. All the interviewees recommended ongoing communication and HIV counselling skills for healthcare providers who are in contact with HIV patients. Most of the study participants were not satisfied with HIV services in the participating centres, as well as experiencing stigma. More investment in enhancing the quality of HIV service delivery and reinforcement of health worker competencies, mainly in HIV counselling, may improve satisfaction, bearing in mind HIV-related stigma in the centres involved.

Autoimmune conditions following mRNA (BNT162b2) and inactivated (CoronaVac) COVID-19 vaccination: A descriptive cohort study among 1.1 million vaccinated people in Hong Kong

BackgroundConcerns regarding the autoimmune safety of COVID-19 vaccines may negatively impact vaccine uptake. We aimed to describe the incidence of autoimmune conditions following BNT162b2 and CoronaVac vaccination and compare these with age-standardized incidence rates in non-vaccinated individuals. MethodsThis is a descriptive cohort study conducted in public healthcare service settings. Territory-wide longitudinal electronic medical records of Hong Kong Hospital Authority users (≥16 years) were linked with COVID-19 vaccination records between February 23, 2021 and June 30, 2021. We classified participants into first/second dose BNT162b2 groups, first/second dose CoronaVac groups and non-vaccinated individuals for incidence comparison. The study outcomes include hospitalized autoimmune diseases (16 types of immune-mediated diseases across six body systems) within 28 days after first and second dose of vaccination. Age-standardized incidence rate ratios (IRRs) with exact 95% confidence intervals (CIs) were estimated using Poisson distribution. ResultsThis study included around 3.9 million Hong Kong residents, of which 1,122,793 received at least one dose of vaccine (BNT162b2: 579,998; CoronaVac: 542,795), and 721,588 completed two doses (BNT162b2: 388,881; CoronaVac: 332,707). Within 28 days following vaccination, cumulative incidences for all autoimmune conditions were below 9 per 100,000 persons, for both vaccines and both doses. None of the age-standardized incidence rates were significantly higher than the non-vaccinated individuals, except for an observed increased incidence of hypersomnia following the first dose of BNT162b2 (standardized IRR: 1.47; 95% CI: 1.10–1.94). ConclusionsAutoimmune conditions requiring hospital care are rare following mRNA and inactivated COVID-19 vaccination with similar incidence to non-vaccinated individuals. The association between first dose BNT162b2 vaccination and immune-related sleeping disorders requires further research. Population-based robust safety surveillance is essential to detect rare and unexpected vaccine safety events.

Lung cancer disease detection using service-oriented architectures and multivariate boosting classifier

Big data analytics in healthcare is emerging as a promising field to extract valuable information from large databases and enhance results with fewer costs. Although numerous methods have been proposed for big data analytics in the medical field, an authorized entity is required to access data, inhibiting diagnosis accuracy and efficiency. Particularly, the detection of lung cancer is critical as it is the third most common type of cancer occurring in both males and females in the US and a leading cause of cancer-related deaths worldwide, the detection of lung cancer. Therefore, this study introduces the Multivariate Ruzicka Regressed eXtreme Gradient Boosting Data Classification (MRRXGBDC) technique and service-oriented architecture (SOA) to improve the prediction accuracy and reduce the prediction time of lung cancer in big data analytics. Service-oriented architectures (SOAs) provide a set of healthcare services, where patient data are stored in the database of a physician or other certified entity. After receiving the patient data as input, several multivariate Ruzicka logistic regression trees are constructed by the physician to calculate the relationship between the dependent and independent variables. With this regression analysis, the presence or absence of disease is discovered. The experimental results reveal that the MRRXGBDC technique performs better with 10% improvement in prediction accuracy, 50% reduction of false positives, and 11% faster prediction time for lung cancer detection compared to existing works.

GIS-automated delineation of hospital service areas in Florida: from Dartmouth method to network community detection methods

ABSTRACT Since the Dartmouth Hospital Service Areas (HSAs) were proposed three decades ago, there has been a large body of work using the unit in examining the geographic variation in health care in the U.S. for evaluating health care system performance and informing health policy. However, many studies question the replicability and reliability of the Dartmouth HSAs in meeting the challenges of an ever-changing and a diverse set of health care services. This research develops a reproducible, automated, and efficient GIS tool to implement Dartmouth method for defining HSAs. Moreover, the research adapts two popular network community detection methods to account for spatial constraints for defining HSAs that are scale flexible and optimize an important property such as maximum service flows within HSAs. A case study based on the state inpatient database in Florida from the Healthcare Cost and Utilization Project is used to evaluate the efficiency and effectiveness of the methods. The study represents a major step towards developing HSA delineation methods that are computationally efficient, adaptable for various scales (from a local region to as large as a national market) and automated without a steep learning curve for public health professionals.

Scabies in Spain? A comprehensive epidemiological picture.

IntroductionScabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997–2019 as well as to describe the main environments of transmission using different data sources.MethodsWe carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes.ResultsThe elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored.DiscussionAn increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.

Organizational Context and Healthcare Reforms: What Effect on the Professional Distress of Canadian Social Workers and Social Service Provision?

This study examined the lived experience of Canadian clinical social workers in light of the organizational context in which they work. The literature indicates an alarming rise of occupational psychological distress in social workers, which aligns with the rise of the neoliberal ideology within the Canadian healthcare sector. While we know that organizational constraints and structural reforms affect social worker’s workplace well-being, it remains unclear how these changes are represented by front-line practitioners and how they affect the provision of social services in healthcare settings. To deepen our understanding of this issue, we conducted a thematic analysis of thirty semi-directed interviews with social workers currently practicing in three Canadian cities (Ottawa, Moncton and Winnipeg). Discussions of daily work life, responsibilities, autonomy and subjective understandings of the social worker’s role revealed which organizational constraints were the most significant in everyday practice and how they relate to their professional identity and mandate. Provincial healthcare reforms were generally found to have negative effects on clinical social workers, whose struggles for recognition were impaired by the fundamentally neoliberal ideologies behind the large-scale restructuring of service provision, themselves at odds with the humanistic principles of social work. Our findings further suggest that structural changes under the New Public Management frame could be detrimental to both the quality of services provided by clinical social workers and their well-being. Overall, this investigation highlights the importance of organizational improvements in the workplace through systemic changes that would concurrently target managerial expectations, resources allocation, autonomy, work-life balance and respect for professional values.

Potential drug interactions in adults living in the Brazilian Amazon: A population-based case-control study, 2019

BackgroundDrug interactions are important causes of adverse events. Assessments of pharmacological interactions outside healthcare services settings are scarce. ObjectiveTo assess the frequency and factors associated with these potential interactions in adults living in Manaus, Amazonas, Brazil. MethodsWe conducted a case-control study in 2019 with residents who had taken two or more medicines two weeks before the interview. The cases involved people with potential drug interaction, according to Micromedex™, and adults without drug interactions formed the control group. The factors associated with interaction were identified by multivariate logistic regression. Results752 adults out of 2321 interviewed were using two or more medicines and were included. The prevalence of potential drug interactions was 30.2% (95% CI: 26.9; 33.5%). We identified 457 drug interactions, more frequently one interaction per person (49.7%), of major severity (61.9%), and with fair documentation (61.7%); three individuals were using contraindicated associations. Individuals aged 45–59 years (OR 1.88, 95% CI 1.03–3.42), using 3 or more drugs simultaneously (p-value<0.001), had higher chance of drug interactions. ConclusionDrug interaction was common in among adults living in Manaus, mostly of major severity. The odds of interaction increased with age and number of concomitantly medicines.

Does Timing of Antenatal Care Initiation and the Contents of Care Have Effect on Caesarean Delivery in Ethiopia? Findings from Demographic and Health Survey.

Background Antenatal care (ANC) is an important preventive set of core healthcare services through pregnancy. Caesarean deliveries are significantly increasing in many low-, middle-, and high-income countries. However, overuse of the caesarean section service interferes with the quality and cost of the procedure. Hence, this study aimed to assess the effect of timing of first antenatal care initiation and the contents of care on caesarean delivery. Methods A population level cross-sectional study was conducted with a total of 4757 study participants. The multivariable analysis was computed using the setup of 3 models. Results The rate of caesarean section among women who initiated antenatal care in the first trimester was 1.32% (95% CI = 0.91–4.21). Women initiated antenatal care in the first trimester (AOR = 2.74; 95% CI = 1.49–6.2) and received contents of care (AOR = 1.98; 95% CI = 1.24–3.78])were more likely to have caesarean section delivery as compared to their counterparts. Conclusion Caesarean section among women who initiated ANC in the first trimester is low. The finding suggests ANC initiated early (within 16 weeks) can have a positive impact on caesarean section delivery. In addition, being urban residents, primipara women, initiating antenatal care before 16 weeks, received contents of care, and having antenatal care visits three and more increase the odds of having caesarean section. As a result, different obstetric, medical, and surgical complications are detected and managed as early as possible.

Accessibility of primary healthcare in low and middle income countries: a systematic review

Background: Accessibility to healthcare is the capability of a population to obtain a specified set of healthcare services. There is a direct link between the distance patients travel to access health and the reduction of ill health and suffering in a country. This has an important impact on the quality of life of people. Objective: To find the spatial or geographic determinants of accessibility of primary healthcare provision in low and middle income countries during last two decades. Methods: Systematic review was done according to PRISMA guidelines. Data bases used were Google scholar, PubMed and Science direct. We found ten different studies from eight different economic groups of countries. Accessibility of primary healthcare in low and middle Income countries published during the period of last two decades were included using the key words like Spatial Accessibility;Geographical Accessibility; Primary Health Care; Primary Care; Low and middle income countries. The countries included were Afghanistan, Bangladesh, Bhutan, Democratic Republic of Congo, India, Indonesia, Sudan, Mozambique /Rural Africa. Two studies each from India and Mozambique (Rural Africa) were included. The categorization as low and middle income counties was as per World Bank classification. Results: We found that accessibility to primary healthcare was worse in low income countries like Afghanistan, Mozambique and South Sudan where more than two third of the population lived in underserved or difficult to access areas while rest of the countries, which come under category of lower middle income countries, more than half of the population lived in underserved or difficult to access areas.] Conclusion: Health care ease of access is a single most important component for equitable and adequate health system. Guaranteeing a healthcare system which is easily accessible to the people is a basic consideration for public health policy makers, policy implementers and academicians.

Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol

BackgroundHealthcare and human services increasingly rely on teams of individuals to deliver services. Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review will identify and summarize empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings.MethodsWe will conduct a comprehensive search of bibliographic databases (e.g., MEDLINE, PsycINFO, CINAHL, ERIC) for articles published from January 2000 or later. We will include peer-reviewed empirical articles and conference abstracts using quantitative, qualitative, or mixed methods. We will include experimental or observational studies that report on the implementation of an innovation in a healthcare or human service setting and examine associations between team functioning and implementation outcomes. Implementation outcomes of interest are acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Two reviewers will independently screen all titles/abstracts, review full-text articles, and extract data from included articles. We will use the Mixed Methods Appraisal Tool to assess methodological quality/bias and conduct a narrative synthesis without meta-analysis.DiscussionUnderstanding how team functioning influences implementation outcomes will contribute to our understanding of team-level barriers and facilitators of change. The results of this systematic review will inform efforts to implement evidence-based practices in team-based service settings.Systematic review registrationPROSPERO CRD42020220168

Making a business case in healthcare: the value of careful consideration

A well thought-out business case offers an opportunity for clinicians to bring about evidenced-based change in clinical practice. It is a powerful tool that can have a significant impact on healthcare services and patient outcomes, while also offering desirable solutions to the NHS, which is facing growing healthcare demands on increasingly limited resources. The role of a business case is to justify the need for change, argue its value, gain support from leadership and illustrate how it can be sustainably implemented. This article guides clinicians through the process of producing a successful business case using the five-case model, which can be applied to the majority of improvement projects or services in healthcare settings. Clinicians might use this guide to support the development of a case to make a change in their own workplace or to help them take a full part in wider system changes.

The lived experiences of men who have sex with men when accessing HIV care services in Zimbabwe.

BackgroundKey populations such as men who have sex with men are disproportionately affected by human immunodeficiency virus (HIV), yet they are underserved. This vulnerable group also faces stigma and discrimination when utilising the healthcare services. However, to achieve the HIV epidemic control, it is important for them to have access to HIV care services.AimThe aim of this study was to explore and describe the experiences of men who have sex with men (MSM) as they accessed HIV care services in healthcare settings in Bulawayo, Zimbabwe.SettingThe study setting was healthcare facilities (state and private owned) in Bulawayo, Zimbabwe, that offer HIV care services.MethodsThe study used a descriptive phenomenological design targeting self-identified MSM living with HIV. Data were gathered by using in-depth individual interviews that were audio recorded. Data saturation determined sample size. Data were transcribed verbatim and later analysed thematically.ResultsThe study revealed that counselling given to MSM was generalised and not individualised. Some clients faced stigma and discrimination after disclosure. Peer and family support were important in the journey to access HIV care services.ConclusionAn enabling environment was not provided for MSM clients to access HIV care services in the majority of health facilities. This calls for sensitisation and competency clinical training of service providers so that the diverse needs of MSM are met. Peer and family support for MSM needs to be strengthened.

Healthcare beliefs, health information seeking, and healthcare setting preferences among women who inject drugs by community supervision status

ObjectiveWomen on community supervision who inject drugs have significant unmet healthcare needs. However, it remains unclear how the intersection of community supervision and injection drug use influences healthcare experiences and service setting preferences. The present study examines whether the intersection of community supervision and injection drug use is associated with differences in women’s healthcare beliefs, healthcare experiences, and service setting preferences.MethodsA secondary analysis was conducted on a previously collected sample of women who inject drugs recruited from a syringe exchange and social service organization for a cross-sectional survey. Participants (N = 64) were mostly White (75%), and more than a quarter were currently on probation or parole (26%).ResultsIndependent samples t-tests and chi-square tests revealed no significant differences on sociodemographic variables by community supervision status. There were no significant differences by community supervision status across seven indicators of healthcare confidence (ps > .05). However, results revealed significant differences in past experiences and beliefs about healthcare, health information seeking, and healthcare setting preferences by community supervision status (ps < .05), where women on community supervision less frequently sought health information and medical care outside of emergency departments.ConclusionsFindings provide preliminary evidence about differences in the healthcare experiences and setting preferences of women who inject drugs on community supervision.

Lower Health Literacy of Mania Than Depression Among Older People: A Random Survey of a Community Healthcare Service Center.

Purpose: This study examines health literacy among older outpatients in two Community Healthcare Service Centers in Shanghai, China to facilitate the design of public education programs for the aged population on mood disorders (both depression and mania).Patients and Methods: A total of 173 outpatients aged 60 years or more with a chronic physical illness were randomly sampled. A health literacy questionnaire was used to assess participants' awareness of depression and mania. Participants were then asked to label two vignettes depicting depression and mania and to give their recommendations for how to seek help for those in the vignettes and how mood disorders should be managed.Results: In all, 86.1 and 36.4% of participants had heard of depression and mania, respectively, with the most common source of information being relatives and friends. Over half of the participants attributed the possible causes of mood disorders to psychological trauma, pressure or stress in daily life, taking things too hard, and personality problems. Almost two-thirds of participants correctly labeled the depression vignette, but only 26.6% correctly labeled the mania vignette. The most common methods recommended by the participants as being helpful for the individuals portrayed in the vignettes were “traveling” and help-seeking from a psychological therapist/counselor, a psychiatrist, or a close family member or friend.Conclusion: The older individuals attending community healthcare service settings in Shanghai have good depression literacy but relatively poor mania literacy. However, most participants had a positive attitude toward psychiatric treatment for mood disorders.

Addressing Symptom Clusters with Complementary and Integrative Health Therapies in Palliative Care Populations: A Narrative Review

Both palliative care (PC) and integrative medicine (IM) focus on the whole person to optimize wellbeing. Integrative palliative care combines the best of both approaches in relieving the distressing symptoms of serious illness and its treatment by combining evidence informed, pharmacological and nonpharmacological modalities that are aligned with the person’s goals, values and preferences. Healing is valued, as well as symptom relief, shared decisionmaking, person empowerment, compassionate care, and nurturing of hope. Increasingly, symptom clusters in serious illness are being recognized and addressed in both PC and IM. Symptom clusters arise from the complexity of the physical, psychological, social and spiritual aspects of a person interacting with serious illness. Many complementary and integrative health (CIH) modalities address symptom clusters effectively, and may allow for reduced doses of medication and their resulting side effects, or help alleviate the need for medication altogether, and increase health, healing and well being. Research reveals that the public desires more access to CIH including palliative care settings although actual delivery of these services in health care settings remains limited. This review explores the evidence for a combined palliative care and integrative medicine approach to symptom clusters experienced by people with serious illness through increased access and funding of these services in the community and health care settings with quality practitioners.