{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:44:22Z","timestamp":1787330662277,"version":"build-2736575974"},"reference-count":35,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Holistic care aims to address the physical, psychosocial, and spiritual well-being of patients and their families. In the context of China\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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\u2019s case study methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319261480285","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T13:37:51Z","timestamp":1787146671000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and Facilitators to the Implementation of Holistic Care Within an International Medical Center: A Case-Based Qualitative Study"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2853-543X","authenticated-orcid":false,"given":"Haoyang","family":"Ma","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weichun","family":"Ke","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"},{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakun","family":"Chen","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianying","family":"Chen","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"},{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"},{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"},{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Li","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"},{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaru","family":"Chen","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Hainan Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1075.197960"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15210"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-03737-y"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-021-00684-2"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.00085"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534735415617015"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpopen.2022.100066"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1569855"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.12458\/HDPR.202412005"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.2196\/53898"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.12458\/HDPR.202409087"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.13688\/j.cnki.chr.2015.15064"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"issue":"5","key":"e_1_3_6_15_2","first-page":"1189","article-title":"Enhancing the quality and credibility of qualitative analysis","volume":"34","author":"Patton MQ","year":"1999","unstructured":"Patton MQ. 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