Barriers and Facilitators to the Implementation of Holistic Care Within an International Medical Center: A Case-Based Qualitative Study.

ObjectivesHolistic care aims to address the physical, psychosocial, and spiritual well-being of patients and their families. In the context of China's ongoing healthcare reforms, the establishment of international medical centers within tertiary public hospitals reflects efforts to promote high-quality and sustainable healthcare. However, the implementation of holistic care in these settings remains complex and insufficiently understood.MethodsThis study explored the barriers and facilitators to implementing holistic care in an international medical center in China. A qualitative multiple-case study design was employed using three clinical vignettes. Data were analyzed according to the Consolidated Framework for Implementation Research (CFIR), and cross-case synthesis followed Yin's case study methodology.ResultsThree clinical vignettes illustrated key domains of holistic care: a patient with chronic kidney disease and multiple complications, exemplifying patient-centered care; a patient with hepatocellular carcinoma and possible metastasis, highlighting multidisciplinary teamwork; and a patient with advanced metastatic cancer, demonstrating end-of-life care. Barriers and facilitators emerged at the system, institutional, and professional levels, encompassing patient and family expectations, shared decision-making and cultural safety, psychosocial and emotional well-being, cultural and spiritual support, multidisciplinary care, and resource and system constraints.ConclusionThis study revealed critical enablers and constraints in implementing holistic care within an international medical center. Strengthening interdisciplinary collaboration, improving culturally appropriate communication and staff training, and establishing patient-centered policies are essential for delivering holistic care. Future larger mixed-methods studies involving multiple stakeholders are warranted.