EXECUTIVE SUMMARY
Background: Clinical practice frequently involves the practitioner touching patients' bodies in areas that are highly personal. If inappropriately performed, such intimate touch may result in much anxiety, confusion and misinterpretation. Examination of evidence is necessary to guide practice in this area to mitigate risks and foster optimal clinician-patient relations and care.
Objectives: The objective of this qualitative systematic review was to identify and synthesize findings on the perceptions, experiences and preferences of patients receiving a clinician's touch during intimate care and procedures
Inclusion criteria Types of participants: The current review considered studies that included patients who had received a clinician's touch during intimate care and procedures.
Phenomena of interest: The current review considered qualitative studies that evaluated patients' perceptions, experiences and preferences of a clinician's touch during intimate care and procedures.
Types of studies: The current review considered studies that collected qualitative data and included studies using designs such as phenomenology, grounded theory, ethnography, action research, qualitative description, focus group methodology and feminist research. In the absence of research studies, other text such as opinion papers and reports were considered.
Context: The current review considered studies that included patients' perceptions, experiences and preferences of a clinician's touch during intimate care and procedures. Intimate care is likely to occur in any clinical setting where patients need assistance with personal care, where physical examinations occur, or in settings were gynecologic, genitourinary, lower intestinal, dermatologic, cardiac or other procedures involving highly personal areas of the body are performed.
Search strategy: A three-step search strategy was used to find published and unpublished studies in English from 1970 to 2016, searching various databases which included searches of reference lists of studies selected for appraisal.
Methodological quality: Included studies were assessed for methodological quality independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) prior to inclusion. Of the two studies included in the review, one did not discuss ontological and epistemological assumptions, and the other did not include the personal assumptions and role of the researcher.
Data extraction: Data were extracted using the data extraction tool from the JBI-QARI. The data extracted included details about the phenomenon of interest, populations and study methods.
Data synthesis: Qualitative findings were synthesized using JBI-QARI.
Results: Two studies were included in this review. Seven findings were organized into three categories and one synthesized finding, "clinician respect". The finding suggests that clients prefer engaged and meaningful communication prior to and during an intimate touch encounter, expect autonomy over their bodies and desire shared decision making relative to how and by whom intimate touch is provided.
Conclusion: The synthesized finding from this review suggests that:
* Healthcare educators introduce clinician respect as an approach to care activities that involve intimate touch. (Grade B)
* Clinicians practice with overall respect toward their patients by communicating clearly, honoring patients' concerns and preferences, and engaging patients in decision making to improve patients' comfort with intimate touch. (Grade B)
More research is needed to explore the perceptions and preferences for intimate touch among diverse populations, generations, cultures and contexts. Particular exploration is needed for populations with additional vulnerabilities to misunderstandings, anxiety and abuse, such as pediatric and geriatric patients, and patients with physical, mental and cognitive impairments.