Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers

Background: Advocates for quality and safety havecalled for healthcare that is patient-centred anddecision-making that involves patients.Objective: The aim of the paper is to explore thebarriers and facilitators to patient-centred care in thehospital discharge process.Methods: A qualitative study using purposive samplingof 192 individual interviews and 26 focus groupinterviews was conducted in five European Unioncountries with patients and/or family members,hospital physicians and nurses, and community generalpractitioners and nurses. A modified Grounded Theoryapproach was used to analyse the data.Results: The barriers and facilitators were classified into15 categories from which four themes emerged:(1) healthcare providers do not sufficiently prioritisedischarge consultations with patients and family membersdue to time restraints and competing care obligations;(2) discharge communication varied from instructingpatients and family members to shared decision-making;(3) patients often feel unprepared for discharge, andpostdischarge care is not tailored to individual patientneeds and preferences; and (4) pressure on availablehospital beds and community resources affect thedischarge process.Conclusions: Our findings suggest that involvement ofpatients and families in the preparations for discharge isdetermined by the extent towhich care providers arewillingand able to accommodate patients’ and families’ capabilities,needs and preferences. Future interventions should bedirected at healthcare providers’ attitudes and theirorganisation’s leadership, with afocus on improvingcommunication among care providers, patients and families,and between hospital and community care providers.