Barriers and facilitators to continuity and co-ordination of healthcare for under 18 years old: a systematic review.

OBJECTIVE: To determine views and experiences of babies, children and young people relating to continuity of their healthcare. DESIGN: Qualitative systematic review. SETTING: Primary research from UK settings where NHS-commissioned or local authority-commissioned healthcare is provided. Systematic reviews from UK and non-UK high-income countries. POPULATION: Babies, children and young people under 18 years old with experience of healthcare. Parental and/or carer perspectives only included if children are under 5 years old or unable to express their own view. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Thematic analysis of the benefits and facilitators to continuity of care for babies, children and young people. RESULTS: 20 047 abstracts were screened; 186 full-text articles were reviewed; 11 papers fulfilled the review criteria. From these, four main themes and 14 subthemes were identified. The theme 'individuals' had four subthemes: 'knowledge of healthcare system', 'support', 'personal lives' and 'results'. The theme 'healthcare professionals' had four subthemes: 'interservice communication', 'collaboration with babies, children and young people', 'communications' and 'relationships with healthcare professionals'. The theme 'practical' had four subthemes: 'colocation', 'appointment times', 'referrals' and 'waiting times'. The theme 'technological' had two subthemes: 'ease of use' and 'complements current healthcare management'. CONCLUSIONS: Continuity of healthcare for babies, children and young people can enhance clinical outcomes but requires active facilitation by healthcare providers and services, especially in circumstances where individuals or their families are less able to advocate for themselves. A range of barriers and facilitators were identified together with recommendations for enhancing continuity of care. PROSPERO REGISTRATION NUMBER: CRD42019145566.

Effective healthcare communication with children and young people: a systematic review of barriers and facilitators.

OBJECTIVE: To identify children and young people's preferences for effective healthcare communication. DESIGN: A systematic review of qualitative studies was conducted to identify evidence from children and young people on effective healthcare communication. Electronic databases and reference lists of relevant articles were searched to July 2020. RESULTS: A total of 13 studies were included. Five major themes were identified: medical information (timing, amount, coordination and futures), person not patient (creating relationships, time, nurse involvement, sensitivity), type of communication (creative and interactive, behavioural, talking and listening, written communication), consultations (first impressions, with and without parents, actively promoting involvement, open and honest, age appropriate) and communication with parents (using parental knowledge, support). CONCLUSIONS: Research in this area remains sparse and consistent implementation is debateable. Children and young people articulate a preference for two-way healthcare communication. General principles for effective communication are identified as well as the need to avoid making assumptions and to tailor approaches to individuals. Establishing and maintaining relationships is essential and requires time and resources. Parents and carers have a positive role in healthcare communication which needs to be balanced with the needs and rights of children. All these factors also apply to children with communication difficulties or from marginalised groups, but additional extra support may be required. PROSPERO REGISTRATION NUMBER: CRD42019145539.