BackgroundThe aim of this publication is to present a case study of how to locate and appraise qualitative studies for the conduct of a meta-ethnography in the field of complementary and alternative medicine (CAM). CAM is commonly associated with individualized medicine. However, one established scientific approach to the individual, qualitative research, thus far has been explicitly used very rarely. This article demonstrates a case example of how qualitative research in the field of CAM studies was identified and critically appraised.MethodsSeveral search terms and techniques were tested for the identification and appraisal of qualitative CAM research in the conduct of a meta-ethnography. Sixty-seven electronic databases were searched for the identification of qualitative CAM trials, including CAM databases, nursing, nutrition, psychological, social, medical databases, the Cochrane Library and DIMDI.Results9578 citations were screened, 223 articles met the pre-specified inclusion criteria, 63 full text publications were reviewed, 38 articles were appraised qualitatively and 30 articles were included. The search began with PubMed, yielding 87% of the included publications of all databases with few additional relevant findings in the specific databases. CINHAL and DIMDI also revealed a high number of precise hits. Although CAMbase and CAM-QUEST® focus on CAM research only, almost no hits of qualitative trials were found there. Searching with broad text terms was the most effective search strategy in all databases.ConclusionsThis publication presents a case study on how to locate and appraise qualitative studies in the field of CAM. The example shows that the literature search for qualitative studies in the field of CAM is most effective when the search is begun in PubMed followed by CINHAL or DIMDI using broad text terms. Exclusive CAM databases delivered no additional findings to locate qualitative CAM studies.

BackgroundPersonalised (or individualised) medicine in the days of genetic research refers to molecular biologic specifications in individuals and not to a response to individual patient needs in the sense of person-centred medicine. Studies suggest that patients often wish for authentically person-centred care and personal physician-patient interactions, and that they therefore choose Complementary and Alternative medicine (CAM) as a possibility to complement standard care and ensure a patient-centred approach. Therefore, to build on the findings documented in these qualitative studies, we investigated the various concepts of individualised medicine inherent in patients’ reasons for using CAM.MethodsWe used the technique of meta-ethnography, following a three-stage approach: (1) A comprehensive systematic literature search of 67 electronic databases and appraisal of eligible qualitative studies related to patients’ reasons for seeking CAM was carried out. Eligibility for inclusion was determined using defined criteria. (2) A meta-ethnographic study was conducted according to Noblit and Hare's method for translating key themes in patients’ reasons for using CAM. (3) A line-of-argument approach was used to synthesize and interpret key concepts associated with patients’ reasoning regarding individualized medicine.Results(1) Of a total of 9,578 citations screened, 38 studies were appraised with a quality assessment checklist and a total of 30 publications were included in the study. (2) Reasons for CAM use evolved following a reciprocal translation. (3) The line-of-argument interpretations of patients’ concepts of individualised medicine that emerged based on the findings of our multidisciplinary research team were “personal growth”, “holism”, “alliance”, “integrative care”, “self-activation” and “wellbeing”.ConclusionsThe results of this meta-ethnographic study demonstrate that patients’ notions of individualised medicine differ from the current idea of personalised genetic medicine. Our study shows that the “personal” patients’ needs are not identified with a specific high-risk group or with a unique genetic profile in the sense of genome-based “personalised” or “individualised” medicine. Thus, the concept of individualised medicine should include the humanistic approach of individualisation as expressed in concepts such as “personal growth”, “holistic” or “integrative care”, doctor-patient “alliance”, “self-activation” and “wellbeing” needs. This should also be considered in research projects and the allocation of healthcare resources.

In primary care, about half of high-risk patients receive correct assignment of guideline-recommended LDL targets by their physicians. Perception of correct LDL target values varied largely depending on patients' gender and co-morbid conditions. Poor perception of risk resulted in lower rates of objective LDL target achievement.

PurposePersonalized medicine in the days of genetic research is seen as molecular biologic specification in individuals, not as individualized care oriented to patients needs in the sense of person-centered medicine. Yet the question can be raised whether this focus can ameliorate health care needs in view of the invested resources. Studies suggest that patients often miss authentically patientcentred care and individual physician-patient interaction and therefore decide to choose complementary and alternative medicine (CAM). By means of a meta-ethnography this project explored patients' views about individualized medicine and described the patients' perspectives of integrative and person-centred services. MethodsThe procedure included first an electronic databases search for 'qualitative research' AND 'CAM' AND 'patient expectations' subject headings, supplemented with citation searches and hand searching. Second, studies were assessed using an inclusion/exclusion checklist and a quality score according to an adjusted checklist of Behrens and Langer. The third step was meta-ethnography according to Noblit and Hare's method to synthesize and interpret key concepts of individualized medicine using a line of argument synthesis. ResultsA set of 67 electronic databases including CAM, nursing, nutrition, psychological, social, medical databases, the Cochrane Library and DIMDI were searched. Nine thousand five hundred seventy-eight citations were screened, 63 full text publications reviewed, 38 appraised and 30 articles were included. The third-order constructs emerging through the synthesis and interpretation conducted by the multidisciplinary research team were: "Personal development", "holism", "alliance", "room for connecting different models", "self activation", "dimensions of well-being". ConclusionThe perspective of patients choosing alternative and complementary medicine regarding individualized care clearly differs from the current idea of personalized genetic medicine. Individualized medicine has therefore concurrently to bear in mind the humanistic approach of holistic, transformative, integrative and self-activation needs of patients. The allocation of resources should consider patients needs to enhance a high-quality biomedical or scientific health care system.

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