Assuring patient participation and care continuity in intermediate care: Getting the most out of family meetings using the four habits model.

INTRODUCTION: As a transitional care intervention, intermediate care (IC) bridges the pathway for older patients from hospital to home. Within family meetings in IC, the older patient, his or her relatives, the interdisciplinary team and the municipal case manager come together to discuss goals and interventions during the IC stay, including follow-up services after discharge. Although family meetings are a common aspect of teamwork in IC, it is unclear how the voices of older people and their relatives are coming across. The aim of this study is to explore how patient participation is framed and negotiated within family meetings in IC. METHODS: This study is based on qualitative data from the observation of 14 interdisciplinary family meetings in Norwegian IC services. As a theoretical framework, the authors have used the four habits model developed by Frankel and Stein as a lens to understand the interrelated sequence of events that typically takes place during a family meeting and the importance of communication skills to promote patient participation. RESULTS: The thematic analysis resulted in 16 categories and 4 main themes related to the 4 habits model: (i) grounding the family meetings, (ii) what matters to you?, (iii) being empathically present and (iv) the power of a final closure. CONCLUSION: There was considerable variation in the way current family meetings were conducted. It seemed crucial to start the meeting with a proper introduction and explanation of the purpose of the meeting to establish trust and to be able to successfully move to the next stage of eliciting the patients' preferences, views and goals via the 'what matters to you?' QUESTION: There were examples of empathetic communication among meeting participants perceived to facilitate patient participation. Finally, to successfully end the meeting and agree on a shared plan, it seemed crucial for case managers who held the decision-making power to attend the meetings. Framing family meetings in line with the four habits sequential approach may have the potential to assure patient participation and care continuity in IC services. PATIENT OR PUBLIC CONTRIBUTION: This article is part of a larger project based on a James Lind Alliance process that brings patients, relatives, health care professionals and researchers together in priority setting partnerships to identify and prioritize evidence uncertainties that they agree are the most important. Accordingly, the design and content of this article have been initiated and discussed in the project's stakeholder group consisting of one patient representative, one relative representative, two health care professionals from IC settings, two representatives from the Norwegian Health Association and two representatives from the Agency of Health in Norway.

Young peoples' involvement in welfare service development-Is voice enough?-A thematic synthesis of qualitative studies.

BACKGROUND: Young people need to be heard and take an active role in developing welfare services. When they are recognized as having skills and expertize, the advantages young people's involvement brings to both themselves and the organizations, are mobilization and empowering with impact on national decision-making. OBJECTIVE: To synthesize existing literature on how young people's involvement in coproduction can contribute to better welfare services. SEARCH STRATEGY: We performed a systematic literature search in four databases (MEDLINE, EMBASE, PsycINFO and Cinahl). INCLUSION CRITERIA: Publications whose abstracts contained themes as: Young people 12-25 years of age, receiving welfare, youth coproduction/involvement/participation and qualitative studies. DATA EXTRACTION AND SYNTHESIS: Of the 5469 documents retrieved, the full text of 58 studies was read, of which seven studies met the inclusion criteria. A thematic synthesis following Thomas and Harden was used. MAIN RESULTS: Young people being involved in coproduction of developing welfare services experienced to be valued and supported by partnerships, but they also pointed out deficiencies in welfare services. Some of the adolescents expressed not being listened to, lack of trusted relations and not being involved in policy making or prospects. The staff members saw some challenges with partnering with youth; as the need for flexibility, to keep the youth engaged and to purposefully meet the adolescents where they need help, guidance or resources. CONCLUSIONS: More involvement should be stressed. Coproduction is often symbolic more than resulting in real changes in the welfare services. Consequently, what is crucial when young people are involved is that they are encouraged by adults to be clear about the degree of involvement they want. PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement was not explicit in this review.