Barriers to Applying Integrative Oncology from the Perspective of the Care Providers in Iran: A Mixed-Methods Study.

OBJECTIVE: The present study aims to explain and determine the use of integrative oncology from the perspective of the care providers in Iran. DATA SOURCES: This mixed-methods study is a convergent type of study with quantitative and qualitative phases that have been performed simultaneously. The quantitative phase was a descriptive study that was conducted through convenience sampling. With the use of a psychometrically evaluated questionnaire with 10 items, 202 nurses and physicians were included in the study to assess their views on the integration of traditional and complementary medicine (TCM) within supportive cancer care. The qualitative part of the study was conducted through semistructured interviews with 11 care providers. The interviews were analyzed through conventional content analysis and the method proposed by Graneheim and Lundman with the use of MaxQDA software. CONCLUSION: After the quantitative and the qualitative data were combined, we identified four main categories as the important dimensions of using TCM: patients' main expectations of TCM services, reasons for using these services, existing challenges and barriers, and recommendations and strategies to improve the interaction between physicians and patients to facilitate the use of integrative oncology . IMPLICATION FOR NURSING PRACTICE: Although cancer patients use TCM due to a wide range of expectations, there are many barriers to integrative oncology in Iran. Therefore, it is necessary to pay attention to the benefits of conventional medical and TCM treatments, conceptualize integrative oncology, and try to meet the existing challenges.

A systematic review of strategies used for controlling consumer moral hazard in health systems.

BACKGROUND: Consumer moral hazard refers to an increase in demand for health services or a decrease in preventive care due to insurance coverage. This phenomenon as one of the most evident forms of moral hazard must be reduced and prevented because of its important role in increasing health costs. This study aimed to determine and analyze the strategies used to control consumer moral hazards in health systems. METHODS: In this systematic review. Web of Sciences, PubMed, Scopus, Embase, ProQuest, Iranian databases(Magiran and SID), and Google Scholar engine were searched using search terms related to moral hazard and healthcare utilization without time limitation. Eligible English and Persian studies on consumer moral hazard in health were included, and papers outside the health and in other languages were excluded. Thematic content analysis was used for data analysis. RESULTS: Content analysis of 68 studies included in the study was presented in the form of two group, six themes, and 11 categories. Two group included "changing behavior at the time of receiving health services" and "changing behavior before needing health services." The first group included four themes: demand-side cost sharing, health savings accounts, drug price regulation, and rationing of health services. The second approach consisted of two themes Development of incentive insurance programs and community empowerment. CONCLUSION: Strategies to control consumer moral hazards focus on changing consumer consumptive and health-related behaviors, which are designed according to the structure of health and financing systems. Since "changing consumptive behavior" strategies are the most commonly used strategies; therefore, it is necessary to strengthen strategies to control health-related behaviors and develop new strategies in future studies. In addition, in the application of existing strategies, the adaptation to the structure of the health and financing system, and the pattern of consumption of health services in society should be considered.

Demand-side Interventions to Control Moral Hazard in Health Systems, Beneficial or Detrimental: A Systematic Review Study.

Background: Moral hazard is one of the main reasons for health market failure where supply-side and demand-side interventions are used for its control and prevention. This study aimed to identify the effects of demand-side interventions on moral hazards in health systems. Methods: For this systematic review, electronic databases, including Scopus, PubMed, Web of Science, Embase, ProQuest, Google Scholar's search engine, and Iranian databases such as SID and Magiran, were investigated. No time limitation was considered in the search process. The narrative synthesis approach was used for data analysis. Results: Out of 7484 retrieved papers, 61 papers were included in the study. The Identified effects were divided into 2 categories: health services consumption effects and financial effects, which were summarized in the form of advantages and disadvantages. The most important advantages included a decrease in the utilization of different services and a reduction in health expenditures. Also, the most important disadvantages included lower quality of care, shifting financing burden to the consumers, and limited access to necessary care. Conclusion: The results showed that the most benefits of interventions, especially in cost-sharing and waiting list interventions, are for insurance organizations, where the disadvantages also affect consumers more. Therefore, it is necessary to pay more attention to these effects and their management because a lack of attention in this regard may impair the performance of insurance financial protection and health provision as one of the major goals of the health system.