The vulnerable healthcare consumer: an interpretive synthesis of the patient experience literature

The increased policy emphasis on the ‘patient experience’ places the health consumer in centre stage as the driver for healthcare delivery. This poses challenges for service providers to meet the needs of more vulnerable groups, notably those with disabilities, who are often more likely to be both in greater need of services and, at the same time, less able to access them. This paper reports an interpretive synthesis of qualitative research studies in the UK and US on the experience of vulnerable patient groups using a broad range of health services. An interpretive review method was adopted to capture the complexity of the data. Eighteen papers were identified as meeting the inclusion criteria for the review. Seven key themes were identified: life experience, service design, point of delivery, accessibility, availability, specialist education/training and consumer typology. Although policy makers and providers often refer to the need for greater consumerism in the development of health services, our review suggests that it may be appropriate to consider a model of ‘mediated consumerism’ for some groups of service users. While some concerns are common to both mainstream and vulnerable consumers, others such as accessibility of services, and the resulting experience of health care, are particular to specific vulnerable groups. Accessing the experiences of these more vulnerable groups therefore warrants close attention in the development of both policy and practice in health service delivery.