Experiences of older patients before, during and after hospital admission: Patient Journey Mapping

Experiences of older patients before, during and after hospital admission: Patient Journey Mapping | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Experiences of older patients before, during and after hospital admission: Patient Journey Mapping Britt Wagenaar, Hanneke Merten, Cordula Wagner This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7477102/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Feb, 2026 Read the published version in BMC Geriatrics → Version 1 posted 11 You are reading this latest preprint version Abstract Background: The aging population presents a growing challenge for healthcare systems, with older adults, particularly those aged 70 and older, accounting for a significant proportion of hospital admissions due to chronic conditions and multimorbidity. Older patients often require coordinated care across multiple providers, making their healthcare trajectories complex and critical. Enhancing patient-centered care (PCC) is essential for improving outcomes and aligning healthcare with patients' needs and preferences. Methods This qualitative study employed a patient journey mapping approach to explore patients' experiences, needs, and wishes before, during, and after hospital admission. Semi-structured interviews during hospital admission and follow-up conversations after hospital discharge were conducted with admitted patients aged ≥ 70 across multiple Dutch hospital departments from April to December 2024. During the interviews and follow-up conversations, notes were summarized, compiled, and organized using a patient journey map template. Data were analysed using an inductive thematic content analysis, supported by MAXQDA V9 for open coding, focussing on identifying care phases of the patient journey, involved stakeholders, positive and negative experiences, emotions, and needs. The patient journey maps were iteratively developed in collaboration with the research team. The COREQ guidelines were followed for reporting. Results: A total of 132 patients (48% female, 52% male) participated, with a mean age of 79 years. Participants were recruited from six hospitals, with 68% undergoing an acute non-surgical journey. Follow-up was completed by 59%. Patient journey maps, categorized into four quadrants (acute surgical, acute non-surgical, non-acute surgical, non-acute non-surgical), offered a comprehensive view of patient experiences highlighting a variability of interactions, emotions, and needs. Conclusion: Patient journey mapping captured a diversity of experiences of a large cohort of older adults (≥ 70 years) before, during and after hospitalization, revealing critical areas for improvement. Key opportunities for improvement included expectation management, compassionate care, clear information handover, and coordinated general practitioner follow-up, offering insights to improve patient experiences and support more person-centered care for an aging population. Aging geriatrics care transitions qualitative research patient perspective patient experience patient-centered care quality of care Figures Figure 1 INTRODUCTION A major worldwide challenge is an aging population that will place increasing demands on healthcare systems to address complex needs of older adults. Older adults frequently experience co-morbidity and multimorbidity, which often necessitates complex care coordination among multiple healthcare providers during hospitalization, as well as before admission and after discharge ( 1 , 2 ). As older patients represent disproportionate hospital admissions ( 3 – 5 ) (over 40% of hospital patients are 65 + in the Netherlands ( 6 ) and the USA ( 7 ), accounting for 62% of total bed days ( 8 )), it is essential to ensure that multidisciplinary care aligns with this growing proportion of older patient’s needs to achieve enhanced quality of care ( 9 – 15 ). According to the WHO, one of the key pillars of quality of healthcare is the delivery of patient-centered care (PCC) that aligns with individual preferences, needs, and values ( 16 ). PCC has gained widespread recognition among other researchers, clinicians, patients and organisations. The Institute of Medicine (IOM), for instance, identifies PCC as one of six fundamental aims for improving the healthcare system, defining it as care that explicitly integrates patients’ needs, preferences, and values into clinical decision-making ( 17 , 18 ). Building on this, the Picker Institute has identified eight core dimensions of PCC, which include: ( 1 ) timely access to reliable healthcare advice; ( 2 ) effective treatment delivered by trusted professionals; ( 3 ) continuity of care and smooth transitions; ( 4 ) involvement and support for family members and caregivers; ( 5 ) clear communication, information, and support for self-care; ( 6 ) active involvement in decision-making and respect for patient preferences; ( 7 ) emotional support, empathy, and respect; and ( 8 ) attention to physical comfort and the healthcare environment ( 19 ). More concretely, in the Netherlands, PCC is a fundamental component of the Healthcare Quality, Complaints and Disputes Act, which defines good quality of healthcare as care that is safe, effective, efficient, client-centred, and responsive to the actual needs of the client ( 20 ). To successfully implement and evaluate patient-centered care, it is helpful to gain a comprehensive understanding of patients’ needs, preferences, values, and experiences over time by using patient journey mapping (PJM) ( 21 – 23 ). Patient journey mapping is an emerging human-centered design approach ( 23 – 25 ) that can be used to visualize the sequence of experiences, perspectives and needs that patients encounter throughout their care pathway, from the patient’s point of view ( 25 – 31 ). By incorporating patients’ emotions and experiences (highs and lows) into the PJM, their needs and preferences become more visible, along with gaps between needs and healthcare delivery processes, and potential bottlenecks in care transitions. Hence, using the PJM approach enables the identification of opportunities to enhance healthcare services for a more effective alignment with the needs of patients ( 28 ). While patient journey mapping offers valuable insights into care processes, existing literature has revealed notable inconsistencies in how data are visualized and presented across studies as well as differences in the types of healthcare services studied, data collection methods employed, and sample sizes used ( 32 , 33 ). Most existing PJM studies have typically involved small sample sizes, usually between 10 and 30 patients, and have primarily focused on a single hospital department ( 33 ). Given that older adults often need coordinated, multidisciplinary care for complex health needs ( 1 , 2 ), there is a pressing need for a broader, holistic PJM approach ( 34 ) capturing a diverse patient cohort across the healthcare continuum. The aim of this study is therefore to apply a patient journey mapping approach to a larger and more diverse cohort of patients aged 70 years and older. Our study will explore older patient’s needs, wishes, and experiences not only during hospital admission but also in the periods preceding and following hospitalization. These results will be used to reveal gaps in multidisciplinary care and uncovering opportunities to create more patient-centered and seamless care pathways for older adults. DESIGN AND METHODS Study Design This study used a qualitative design with a patient journey mapping approach to obtain an in-depth exploration of the experiences, needs and wishes during, before and after hospital admission. To gather insight in the patient’s journey (phases), experiences, needs and wishes, semi-structured interviews and follow up conversations were conducted ( 35 ). The results from the interviews and follow-up conversations were analysed by using an inductive thematic content analysis to construct the patient journey map. To facilitate the reporting of results, the consolidated criteria for reporting qualitative studies (COREQ) were used (see Additional file 1). The study was conducted according to the guideline of the Declaration of Helsinki and has been granted approval by the ethics review committee of VU University Medical Center (protocol number 2020.076). This committee is registered with the US Office for Human research Protections (OHRP) as IRB00002991. Research team and reflexivity The first researcher (BW) is a female registered PhD candidate at the Amsterdam UMC hospital who conducted the interviews and follow-up conversations. This researcher has experience with conducting semi-structured interviews, but no prior experience with coding interviews and patient journey mapping. However, the second researcher (HM) is an assistant professor quality and organisation of care who provides supervision. She has experience conducting qualitative research (semi-structured interviews, thematic coding and patient journey mapping). Participants Eligibility criteria participants The study utilized a qualitative approach and focused on hospitalized patients aged 70 years and older. The aim was to include a minimum of 10 and a maximum of 15 patients per hospital department, to map a variety of patient journeys. Patients were excluded if they were younger than 70 years, not cognitively responsive, non-Dutch or non-English-speaking, hospitalized due to a readmission, or in the terminal phase of their illness. Recruitment of the participants Patients eligible for inclusion were approached face-to-face during hospital admission by the care coordinating nurse of the department who assessed whether the patients were interested to participate in the patient journey study. Once participants indicated their interest to take part in the study, they received an informational letter, and the researcher then visited them in person to answer any potential questions. If patients decided to participate in the study, they were required to provide written informed consent, after which a physical semi-structured interview was conducted by the first researcher (BW). Prior to the interview, the first researcher did not have any relationship with the participants and the participants were not familiar with the research(er) in advance. Data collection Preparation To prepare for the semi-structured interviews, an interview guide was designed by the first (BW) and second researcher (HM) (see Additional File 2). The interview guide was structured around the patient’s pathway from one day till eight weeks before hospital admission until two to four weeks after discharge, focusing on the patient’s journey and related experiences and needs. The first three interviews were used as a pilot to test whether the interview guide needed any revision. Semi-structured interview and follow-up conversation The interviews took physically place in six hospitals in the Netherlands, within nine different departments. The study period was between April 1, 2024 to November 30, 2024. The interviews were conducted on weekdays after the morning rounds, within the department, and lasted between 20 and 35 minutes. The duration was influenced by the patient's mental and physical condition, their readiness to engage in conversation about the topic, and their inclination to provide detailed information or discuss personal matters. Two to four weeks after the patient had been discharged from hospital, a follow-up conversation took place, because a longer timespan between hospital discharge and the follow-up conversation (e.g., more than 45 days) could have negatively impacted the memories of the patient ( 36 ). The follow-up conversations were held by telephone, lasted 5 to 15 minutes and were conducted by the first researcher (BW). During the interviews and follow-up conversations, field notes were taken and reviewed. With the field notes, the data was mapped and structured around the journey of the patient. Storing the data All interviews were performed in Dutch and were audio-recorded with a voice recorder. The data were safely stored on a secure server to which only the researchers (BW and HM) had access. These audio files were removed after the summary and sketches of the patient journey maps (fieldnotes) from the interviews were completed. The audio recordings were not transcribed or shared with participants for comment or correction, as they were used solely to complement and ensure the completeness of the fieldnotes where necessary. The follow-up conversations were not recorded. Data analysis An inductive thematic analysis based on direct content analysis of the fieldnotes from interviews and follow-up conversations was conducted, as the focus was not on detailed verbal content but on synthesizing findings into a Patient Journey Map. Initially, researcher BW open-coded the fieldnotes using MAXQDA V9 to analyse segments. The second researcher (HM) reviewed the first ten interview-fieldnotes and validated the open-coding process. After consensus was reached, the first researcher (BW) revised the open-coded process, adjusting and adding codes. When the open-coding process was finished, the coded segments were analysed and sorted into different information types that were used for the PJM: ( 1 ) (sub)phases before, during and after hospital admission (e.g., referral, intake, admission, treatment, discharge); ( 2 ) time interval; ( 3 ) involved actors/stakeholders and its link to (sub)phases; ( 4 ) positive and negative experiences; ( 5 ) needs and wishes and ( 6 ) emotions. Ultimately, PJMs were iteratively developed by the first (BW) and second (HM) researcher. Consequently, experiences were structured according to the eight Picker dimensions in the PJM construction phase and linked across the phases in which they were identified. All steps of the analysis were discussed in the research team and iteratively developed through discussions between the researchers, to improve the PJM. RESULTS Characteristics participants, dropouts and refusals Table 1 shows details about the characteristics of participants, dropouts and refusals. A total of 132 patients (52% female, 48% male) with a mean age of 79 years (SD 6.2) was included. In contrast, thirty patients refused to participate with our study. Participants came from diverse living situations and had different education levels. The majority of participants (82%) were admitted to the hospital acutely, though they were distributed across various departments. The sample was predominantly characterized by a low level of education (82%), and most participants (96%) lived at home prior to hospitalization, either independently or with formal care support. Following hospital admission, a greater number of patients received rehabilitation or nursing care (at least 9%). However, the exact percentage is unknown due to incomplete follow-up data: 54 participants (41%) did not complete the follow-up. Table 1: Characteristics participants, dropouts and refusals Variable Attribute Frequency Percentage Variable Attribute Frequency Percentage Participants Total number of participants 132 100% Education level Classification level low [1] 109 82% Sex Woman 69 52% Classification level secondary[2] 2 2% Man 64 48% Classification level high[3] 13 10% Age 70-75 40 30% Other classification 8 6% 76-80 39 30% Department Hospital 1: Internal Medicine 11 7% 81-85 27 21% Hospital 1: Pulmonology/Cardiology 13 10% 86-90 17 14% Hospital 2: Orthopaedics 15 11% 91-95 4 3% Hospital 2: Internal Medicine 17 13% 95-98 2 2% Hospital 3: Pulmonology, Cardiology, Internal Medicine 14 11% Living Situation prior to admission Living alone at home 55 41% Hospital 4: Cardiology 16 12% Living alone in rehabilitation centre 1 <1% Hospital 5: MDL, abdominal surgery, gynaecology 15 11% Living alone in nursing home 4 3% Hospital 5: Cardiology 16 12% Living with partner at home 71 54% Hospital 6: Geriatrics 15 11% Living with family member at home 1 2% Scenario Acute surgical 18 14% Care prior to admission No formal care support 88 67% Acute non-surgical 91 68% Homecare 39 29% Planned admission surgical 16 12% Nursing care 4 3% Planned admission non-surgical 8 6% Rehabilitation care 1 1% Follow-up/drop-outs Follow-Up 78 59% Care after discharge No formal care support 74 56% No response 24 18% Homecare 5 4% Wrong number 24 18% Nursing care 4 3% Did not want to proceed study 4 3% Rehabilitation care 8 6% Illness bottleneck 2 2% Unknown 40 31% Refusals Number of patients that did not participate after being asked/informed by nurse 30 100% Results Patient Journey Maps The patient journey maps (Figures 1a–1d) are structured into four quadrants: acute non-surgical, acute surgical, non-acute non-surgical, and non-acute surgical, because it cannot be captured in one general patient journey map. They consist of chronological care path phases, time interval, involved actors, positive and negative experiences, emotion curves, and needs and wishes. The four quadrants are organized according to different phases of care, in which surgical specifically refers to patients who have undergone surgery. Positive and negative experiences A wide range of positive and negative experiences was reported across various phases of care (see Figure 1a-1d). Differences and commonalities of the experiences between four patient journey maps are linked to the Picker dimensions and structured around the care phases (see Table 2). Fast access to reliable healthcare advice Waiting time was frequently mentioned, with mixed experiences. Patients appreciated short waiting times. Some patients experienced long waiting times, i.e. delays when scheduling (follow-up) appointments, waiting for the ambulance or in emergency departments, absence of doctor during weekends, or postponed surgeries or treatments. When waiting times were long, patients appreciated being informed about both their duration and the reason for the delay, which was especially important in the emergency department phase where waiting times can increase rapidly. Effective treatment by trusted professionals Many patients were positive about the expertise and adequacy of care providers, their appropriate action, care assessment, and overall quality across many phases. In the pre-hospital phase, patients emphasized the importance of physicians conducting accurate assessments, establishing correct diagnoses, and initiating appropriate referrals to hospital care. Patients also valued the quality of in-hospital care, including accurate prescribing and administration of medication, provision of suitable food in accordance with dietary requirements set by the dietitian and consistent monitoring of their condition with timely and appropriate interventions. However, in some situations, patients experienced inadequate care or a misjudgement of their diagnosis or condition. Effective treatment by trusted professionals and continuity of care and smooth transitions At the time of discharge, most patients were positive of having their prescribed medication readily available and receiving clear instructions on its use. Most patients also valued the arrangement of appropriate aftercare services and the scheduling of follow-up appointments. A key concern among patients was the explicit communication that medical information would be transferred to their general practitioner or another aftercare provider. Some patients, in particular, expressed uncertainty about whether this information transfer had occurred, especially when it was not explicitly mentioned. A few patients reported experiencing confusion or frustration during the discharge phase due to incomplete medical records or poor communication between providers, which further contributed to feelings of insecurity. In addition, most patients assumed that the general practitioner would proactively reach out to them—either through a home visit or a phone call—and interpreted the absence of such contact as an indication that the general practitioner had not been informed. This led to concerns that the continuity of care might be compromised. Patients consistently highlighted the importance of follow-up by their general practitioner, not only to guarantee information was transferred. Patients were dissatisfied if they did not have any follow-up by their general practitioner to address any remaining questions and to ensure that the aftercare process was proceeding appropriately. In addition to general practitioner follow-up, patients appreciated receiving a direct phone number of the hospital department in case further questions arose. However, in some instances, the provided contact information was incorrect or calls were not answered, leaving patients feeling abandoned and unsupported. During the aftercare phase, patients placed high value on home care services that were punctual and provided by consistent care personnel. This continuity fostered a sense of stability and trust in the care process. Not only in the post-hospital phase, but across all phases of the care journey patients emphasized the importance of effective information exchange, collaboration between healthcare providers, and clear handover procedures. In the pre-hospital phase, patients appreciated when their GP proactively informed hospital specialists about their condition, where possible. During hospitalization, the involvement of multiple physicians made it particularly important that all professionals were kept informed of developments and worked collaboratively to ensure appropriate care. Similarly, in the post-hospital phase, patients viewed the coordination and transfer of information between care providers as critical to maintaining continuity and quality of care. Clear information, communication and support for self-care Communication of information and expectations between healthcare providers and patients was another important experience. Many patients experienced clear explanations about their condition, test results, treatment options, expectations and procedural preparations. However, other patients felt dissatisfied with the clarity or completeness of the information provided, except for the consult and ambulance phase. During the discharge phase, patients appreciated having the option to reread information enabled by, brochures, discharge letters or their electronic health records. When patient did not receive written information, patients felt unprepared and anxious about their aftercare and recover phase Involvement in decisions and respect for preferences A majority of the patients appreciated to be involved in decision-making, while some patients did not feel the need to be involved in decisions and preferred to rely on medical expertise instead of being involved in decisions, particularly in acute situations or when feeling really sick. Nevertheless, patients expressed a desire to be asked whether they wanted to be involved in decision-making, being kept informed about decisions made and patients found it important to have the opportunity to ask questions (mainly mentioned in acute situations). Involvement in decisions and respect for preferences and emotional support, empathy and respect Patients consistently emphasized the importance of being listened to and taken seriously by healthcare providers across all phases of care, in a manner that made them feel genuinely heard. However, some patients reported not feeling acknowledged—for instance, they were not referred for additional care despite clearly expressing that they could no longer manage at home, and symptoms such as fever were not adequately addressed. In addition to being listened to, patients expressed satisfaction when they were able to ask questions about their condition, the course of their illness, potential treatment options, and other aspects of their care. Having the opportunity to engage in open dialogue with healthcare providers contributed to a greater sense of involvement, understanding, and control over their health situation. Emotional support, empathy and respect Patients expressed mixed feelings about care providers being helpful, thoughtful, compassionate and reassuring. Many individuals felt well-supported and reassured, appreciating thoughtful behaviour, such as being offered broth when feeling dizzy, thinking along with the patient about an appropriate aftercare location, or earplugs to improve sleep. Others, however, reported a lack of attentiveness, citing issues like not receiving help with opening medication or receiving written information while patients are visually impaired. Other similar experiences include friendliness, a good relationship/interaction, good contact, a sense of humour. Patients appreciated friendly and attentive healthcare providers who also show warmth and use humour appropriately. However, a few patients reported poor interactions with their care providers. For instance, private conversations held in public spaces, some patients felt abruptly dismissed or sensed a lack of attentiveness, doctors were perceived as overly jovial and trying too hard to be popular, and care providers were described as curt during a night shift. Additionally, patients valued taking time and giving attention to the patient. Patients appreciated when staff takes time to listen and show genuine attention allowing patients to express their concerns and ask questions. However, mostly during busy periods, some patients felt that the time and attention they received was insufficient. Attention to physical and environmental needs Practical challenges were observed in multiple care phases and included physical barriers like stairs in general practitioner practices, stretchers that did not fit in elevators, and excessive shaking during ambulance rides. Other inconveniences involved detours due to road closures, plastic bed covers, unavailable supplies such as diapers and medication, beeping machines, insufficient hygiene, broken televisions, missing clocks, early check-ins for procedures, and the inability to perform complex treatments at the current hospital. These practical inconveniences added to the stress and discomfort of the patients. During their hospital stay, patients responded positively when there was a wide variety of food options available, including choices that accommodated their dietary restrictions. Patients also appreciated having sufficient space in shared rooms, although this was not always the case, and valued having roommates with whom they could interact positively. While some patients preferred the social aspect of sharing a room, others favoured the peace and privacy of a private room. However, a private room was not always available. In addition, some patients were dissatisfied with the aftercare’s ambiance if the environment of an aftercare facility did not contribute to their comfort and recovery. In contrast, regarding the department’s ambiance, most patients were positive, where patients and care providers engaged in conversations and shared laughter or calm, where patients can rest. However, some patients, mainly in acute situations, felt limited due to overcrowded rooms and wards and some patients felt restricted by policies that limited the ability of leaving the ward. Patients expressed their need for rest and found the busy environment in rooms and wards, as well as the crowded hallways and rooms in the emergency department, to be overwhelming and stressful. Furthermore, hospital distance was another concern for patients during their hospital stay. The longer ambulance response time and the inconvenience for visitors, such as family and partners who had to travel further, added to their worries. Other experiences Some experience themes did not have a clear link to one of the Picker dimensions. Patients expressed dissatisfaction with the alternation of care providers. Patients found it difficult to build trust or feel secure when they were frequently seen by different general practitioners or specialists within the same department, and some reported confusion about which physician was responsible for their care. Furthermore, patients described the progression of their disease and uncertain future often as a negative experience, mainly across different care phases. Many patients reported that they did not expect to require to be admitted to the hospital or their recovery took longer than they had expected or hoped. In these situations, patients greatly valued clear communication about what to expect, and they especially appreciated helpful, attentive, and compassionate nurses and doctors. Finally, dissatisfaction with having to remain sober (the lack of amenities) particularly during the ED phase, was something patients felt could be addressed. Many patients felt not informed in advance about the need to remain sober, which led to frustration. Clear communication could have avoided this negative experience. Emotions Emotional experiences were identified from participants that were able to express their feelings and showed variation across care journeys and phases. Emotions are visualized in the patient journey maps using curves; thicker lines indicate that more patients felt that emotion. Negative emotions , such as fear, panic, and frustration, were mainly linked to uncertainty about the future, illness severity, or dissatisfaction with care. Positive emotions stemmed from hope, relief, a smooth recovery, or being referred by a specialist. Some patients shared emotional neutrality due to fatigue, illness, or personality. Needs and Wishes Ultimately, patients’ needs and wishes were gathered during interviews and visualized in the journey maps as sort of timelines in the last column. While most of the needs and wishes aligned with positive, negative and emotional experiences, some others did not. For example, distance of a healthcare facility, aftercare reputation, autonomy, feeling free, and own network/environment did not align. For patients who could not express their needs, these were inferred from other journey map elements. [1] Primary education, special needs primary education, prevocational secondary education (in Dutch: VMBO), secondary vocational education level 1 or equivalent (in Dutch: MBO 1) [2] Senior years of senior general secondary education (in Dutch: HAVO) or pre-university secondary education (in Dutch: VWO), secondary vocational education levels 2, 3 or 4 (in Dutch: MBO 2, 3 or 4) [3] Higher vocational education (in Dutch: HBO), university bachelor’s or master’s degree, PhD. DISCUSSION This study used patient journey mapping to examine older adults’ experiences across an acute and non-acute care trajectory, highlighting care paths, timelines, actors, emotions, and needs to determine patient centeredness of care. Patients reported a wide range of emotions, needs and experiences, mostly positive experiences. Key touchpoints, pain points and facilitators could be derived from the patient journey maps, offering insights into the gap between needs, experiences and received care, to improve experiences and foster person-centered care. Most important findings on patient experiences and implications Overall, our study showed substantial overlap in elements that shape patient experiences across different care phases with existing frameworks ( 19 , 37 ), and literature ( 38 – 42 ). These findings implicate that patient experiences are not defined by a single factor, but are instead multifaceted. The most apparent findings of this study regarding the elements that affect patient experiences within all four subgroups were the importance of managing expectations, providing compassionate care, ensuring clear handover information to patients, and arranging general practitioner follow-up. The first key finding is that clear, timely information across all phases of care is essential for managing expectations and fostering positive patient experiences.. Patients consistently emphasized the need for information about diagnoses, treatment and test options, disease progression, waiting times, procedures coming up during the hospital stay, around the time of discharge, and during aftercare. Our findings align with existing evidence highlighting the importance of expectation management, clear two-way patient-doctor communication and being informed ( 38 , 40 , 42 – 46 ). In particular, informing patients about waiting times emerged as a key driver of patient experience and satisfaction. While some patients reported long waiting times and expressed dissatisfaction, others viewed the waiting time positively. This indicates that perceptions, rather than actual waiting durations, play a more critical role for patient experiences ( 47 – 49 ). Accordingly, providing timely information especially about expected waiting times is essential to enhance patient satisfaction ( 41 , 50 – 52 ). So, effectively informing patients and managing their expectations are crucial steps in delivering patient-centered care and fostering positive healthcare experiences. Second, our study revealed that patient-provider interaction and emotional support are essential for positive patient experiences. Patients, across all care phases and all journeys in this study, valued genuine interaction, helpful, thoughtful and pro-active care providers, being listened to, feeling taken seriously, and being treated with kindness, compassion and empathy. These findings are consistent with previous research, that show the importance of care providers who engage in active listening ( 43 , 53 – 56 ), foster a sense of being heard and understood ( 38 , 57 ), empathetic patient-doctor relations ( 40 , 46 ), build human connections with caring, respectful, friendly and attentive care providers ( 39 , 43 , 58 – 60 ) and address and are responsiveness to patient concerns and needs ( 43 , 56 ). These elements closely align with a broader concept of compassionate care ( 61 – 63 ), which is identified by literature as a cornerstone of healthcare ( 63 – 68 ) and patient satisfaction ( 69 , 70 ). Compassionate care is a multitude set of components, which involves dynamic, responsive, and proactive actions ( 71 ), defined as sensitivity to other patients’ suffering, emotional engagement, empathy combined with a willingness to help and improve their well-being ( 72 , 73 ). Thus, integrating elements of compassionate care as a core component of person-centered practice is essential to enhancing the overall patient experience. Third, participants in our study strongly emphasized the importance of follow-up—whether with a specialist or a general practitioner—as well as clear communication regarding the transfer of information to the follow-up care provider. More specific, in-person post-discharge follow-up consultations were preferred. The importance of continuity of care—particularly follow-up—for enhancing patient satisfaction is also well-supported in the existing literature ( 74 – 77 ). Although our findings align with previous research, some studies indicate that telephone follow-up can improve patient satisfaction, whereas most participants in our study expressed a clear preference for in-person consultations ( 78 – 81 ). Hence, implementing follow-up procedures—whether conducted in person or via telephone—is an essential component in enhancing patient experiences. Strengths and limitations A key strength of this study was the use of patient journey mapping (PJM), which enabled a structured analysis and visualization of older adults’ care experiences, supported clear communication of findings to stakeholders, care providers or policy makers, and offered patients an engaging way to reflect on and share their journeys. The visual and narrative elements of PJM enhanced comprehension of the care journey, thereby providing insights for care providers to make more informed decisions and promote active patient participation in the evaluation of care. Another strength of our study was its large and diverse sample, which captured patient experiences across the entire care trajectory. Unlike most PJM studies with fewer than 30 participants ( 33 ), our large cohort spanned multiple departments and care types, enabling a broader exploration of patient experiences across diverse clinical contexts. Bedside interviews further improved representativeness by including patients with limited mobility. While this study offered valuable insights, some limitations should be acknowledged. One challenge of this study was the trade-off between a large sample and depth of findings. Our study aimed to identify broader patterns and for a higher level of abstraction in its analysis. Therefore we chose not to transcribe interviews verbatim. Instead, audio recordings were used only to supplement fieldnotes, which also captured non-verbal cues and contextual observations. While this may have limited the level of detail from individual interviews, it is uncertain whether longer, in-depth interviews would have yielded additional insights. Moreover, we deliberately avoided burdening older patients with lengthy interviews, opting for a reflexive and iterative approach instead. This sound alternative method to transcription, aligned with Yin’s recommendations, allowed for a more flexible, efficient yet meaningful interpretation of the data ( 82 ). Another limitation was the follow-up conversations with participants, as not all participants could be re-contacted, leading to missing data and potential bias. Phone interviews were also difficult for some older adults due to hearing issues, lack of visual cues, or unfamiliarity with conducting an interview by telephone, which may have limited the depth of responses. Furthermore, while almost 10% of all Dutch hospitals was included, the geographic and type of hospital variability was limited. Data were collected from Dutch hospitals, primarily outside major urban areas, with only one academic hospital included. This may have caused a bias, as the type of hospital, geographical differences in healthcare infrastructure (e.g., bed capacity and availability/work pressure care providers) and patient population characteristics could have influenced care experiences. Finally, a limitation concerned the direct identification of patients’ needs, as older adults sometimes found it difficult to articulate their needs during specific phases of care. This might have led to certain needs being overlooked. Future research Future research should focus on implementing the most evident opportunities for improvement identified in our study: managing patient expectations, providing compassionate care, ensuring clear and timely information handovers, and arranging appropriate follow-up with general practitioners. In addition, future research should examine whether these improvements positively impact patient experiences and contribute to more patient-centered care. It is suggested to monitor such an impact by conducting another patient journey study. CONCLUSION This study contributed to the growing body of research on patient-centered care by providing insight into the experiences and perspectives of older adults throughout the entire pre- to post-hospitalization phases using patient journey mapping. By capturing the perspectives of a large and diverse cohort of patients aged 70 and older, it highlighted the complexity and variability of care experiences, emotions, and needs. The patient journey maps revealed multiple touchpoints, pain points, and facilitators, which may support healthcare providers in aligning services more closely with patients' needs and preferences. The most obvious opportunities for improvement were managing expectations, providing compassionate care, ensuring clear information handover to patients, and arranging general practitioner follow-up. These findings can contribute to more person-centered care and better-integrated healthcare systems that are equipped to meet the complex needs of an aging population, ultimately improving their overall experience. Declarations Ethics approval and consent to participate: All participants were required to provide written informed consent. The study was conducted according to the guideline of the Declaration of Helsinki and has been granted approval by the ethics review committee of VU University Medical Center (protocol number 2020.076). This committee is registered with the US Office for Human research Protections (OHRP) as IRB00002991. Consent for publication: Not applicable. Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available to protect the privacy of the participants but are available from the corresponding author on reasonable request. Competing interests : The authors declare that they have no competing interests. Funding : This research article is funded by the Dutch Ministry of Health Welfare and Sport. Clinical trial number: Not applicable. Authors’ contributions: Britt Wagenaar (BW), Data collection, Methodology, Writing, Analysis; Hanneke Merten (HM): Methodology, Reviewing/Editing writing, Supervision, Project administration, Verification and Validation; Cordula Wagner (CW): Reviewing/Editing writing, Supervision, Project administration, Verification and Validation. Acknowledgements : Not applicable. Supplementary data: Supplementary material related to this article can be found in the online version. References Navickas R, Petric V-K, Feigl AB, Seychell M. Multimorbidity: what do we know? What should we do? Journal of comorbidity. 2016;6(1):4-11. Kruizenga H, Beijer S, Huisman-de Waal G, Jonkers-Schuitema C, Klos M, Remijnse-Meester W. Richtlijn ondervoeding herkenning, diagnosestelling en behandeling van ondervoeding bij volwassenen. Stuurgroep ondervoeding. 2019(August):36. Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, et al. Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev. 2011;68(4):387-420. Wyman MF, Shiovitz-Ezra S, Bengel J. Ageism in the Health Care System: Providers, Patients, and Systems. In: Ayalon L, Tesch-Römer C, editors. Contemporary Perspectives on Ageism. Cham: Springer International Publishing; 2018. p. 193-212. Fimognari FL, Lelli D, Landi F, Antonelli Incalzi R. Association of age with emergency department visits and hospital admissions: A nationwide study. Geriatr Gerontol Int. 2022;22(11):917-23. CBS Statistics Netherlands. Nearly 230 thousand fewer hospital admissions in 2020. 2022. Commission MPA. Report to the congress, Medicare payment policy: Medicare Payment Advisory Commission; 2003. The National Audit Office. Discharging older patients from hospital. 2016. Mahishale V. Ageing world: Health care challenges. Journal of the Scientific Society. 2015;42(3):138-43. Wolf PhD C, Jason A. Defining patient experience. Patient experience journal. 2014;1(1):7-19. Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing. 2021;20(1):158. Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229-39. Gluyas H. Patient-centred care: improving healthcare outcomes. Nursing Standard (2014+). 2015;30(4):50. Hansson E, Ekman I, Swedberg K, Wolf A, Dudas K, Ehlers L, et al. Person-centred care for patients with chronic heart failure–a cost–utility analysis. European journal of cardiovascular nursing. 2016;15(4):276-84. Stone S. A retrospective evaluation of the impact of the Planetree patient-centered model of care on inpatient quality outcomes. HERD: Health Environments Research & Design Journal. 2008;1(4):55-69. Organization WH. Quality of care 2025 [Available from: https://www.who.int/health-topics/quality-of-care#tab=tab_1. Accessed 25 August 2025. Fix GM, VanDeusen Lukas C, Bolton RE, Hill JN, Mueller N, LaVela SL, et al. Patient‐centred care is a way of doing things: How healthcare employees conceptualize patient‐centred care. Health Expectations. 2018;21(1):300-7. Institute of Medicine Committee on Quality of Health Care in A. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US) Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001. Picker. The Picker Principles of Person Centred care. What is the definition of person centred care?2025. Ministry Healthcare Welfare and Sport. Wet kwaliteit, klachten en geschillen zorg (Wkkgz). 2025. Elliott MN, Lehrman WG, Goldstein EH, Giordano LA, Beckett MK, Cohea CW, et al. Hospital survey shows improvements in patient experience. Health affairs. 2010;29(11):2061-7. Browne K, Roseman D, Shaller D, Edgman-Levitan S. Measuring patient experience as a strategy for improving primary care. Health affairs. 2010;29(5):921-5. Hagendijk ME, Zipfel N, Oomen FJ, Hoving JL, Van Der Wees PJ, Hulshof CT, et al. Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study. BMC Public Health. 2023;23(1):1-15. Carayon P, Wooldridge A, Hoonakker P, Hundt AS, Kelly MM. SEIPS 3.0: Human-centered design of the patient journey for patient safety. Appl Ergon. 2020;84:103033. Bulto LN, Davies E, Kelly J, Hendriks JM. Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services. Eur J Cardiovasc Nurs. 2024;23(4):429-33. Melles M, Albayrak A, Goossens R. Innovating health care: key characteristics of human-centered design. International Journal for Quality in Health Care. 2021;33(Supplement_1):37-44. Trebble TM, Hansi N, Hydes T, Smith MA, Baker M. Process mapping the patient journey: an introduction. Bmj. 2010;341. Carayon P, Albayrak A, Goossens R, Hoonakker P, Hose B-Z, Kelly MM, et al. Macroergonomics of patient work: engaging patients in improving sociotechnical context of their work. The Patient Factor: CRC Press; 2021. p. 61-81. Jung J, Kim KH, Peters T, Snelders D, Kleinsmann M. Advancing design approaches through data-driven techniques: patient community journey mapping using online stories and machine learning. International Journal of Design. 2023;17(2):19-44. Ben-Tovim DI, Dougherty ML, O'Connell TJ, McGrath KM. Patient journeys: the process of clinical redesign. Med J Aust. 2008;188(S6):S14-7. Simonse L, Albayrak A, Starre S. Patient journey method for integrated service design. Design for Health. 2019;3(1):82-97. Joseph AL, Kushniruk AW, Borycki EM. Patient journey mapping: Current practices, challenges and future opportunities in healthcare. Knowledge Management & E-Learning. 2020;12(4):387-404. Davies EL, Bulto LN, Walsh A, Pollock D, Langton VM, Laing RE, et al. Reporting and conducting patient journey mapping research in healthcare: A scoping review. J Adv Nurs. 2023;79(1):83-100. Berntsen GKR, Dalbakk M, Hurley JS, Bergmo T, Solbakken B, Spansvoll L, et al. Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial. BMC Health Services Research. 2019;19(1):682. Ahmed F, Burt J, Roland M. Measuring Patient Experience: Concepts and Methods. The Patient - Patient-Centered Outcomes Research. 2014;7(3):235-41. Foust JB, Vuckovic N, Henriquez E. Hospital to home health care transition: patient, caregiver, and clinician perspectives. West J Nurs Res. 2012;34(2):194-212. NHS Institute for Innovation Improvement. The Patient Experience Book. A Collection of the NHS Institute for Innovation and Improvement’s Guidance and Support. NHS Coventry, UK; 2013. Havana T, Kuha S, Laukka E, Kanste O. Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies. Scandinavian Journal of Caring Sciences. 2023;37(4):1001-15. Bridges J, Collins P, Flatley M, Hope J, Young A. Older people's experiences in acute care settings: Systematic review and synthesis of qualitative studies. International Journal of Nursing Studies. 2020;102:103469. Hoon LS, Mackey S, Hong-Gu H. Elderly patients' experiences of care received in the emergency department: a systematic review. JBI Libr Syst Rev. 2012;10(23):1363-409. Shankar KN, Bhatia BK, Schuur JD. Toward Patient-Centered Care: A Systematic Review of Older Adults’ Views of Quality Emergency Care. Annals of Emergency Medicine. 2014;63(5):529-50.e1. van Grootel JWM, J. CR, M. vDJ, M. vdL, E. G, R. O, et al. Experiences with hospital-to-home transitions: perspectives from patients, family members and healthcare professionals. A systematic review and meta-synthesis of qualitative studies. Disability and Rehabilitation. 2025;47(7):1644-58. Adams C, Walpola R, Iqbal MP, Schembri A, Harrison R. The three pillars of patient experience: identifying key drivers of patient experience to improve quality in healthcare. Journal of Public Health. 2024. Kuipers SJ, Nieboer AP, Cramm JM. Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting. BMC Fam Pract. 2021;22(1):70. Kaya SD, Ileri YY, Yuceler A, editors. Importance of Hospital Way-Finding System on Patient Satisfaction. Business Challenges in the Changing Economic Landscape - Vol 2; 2016 2016//; Cham: Springer International Publishing. Chen X, Liu C, Yan P, Wang H, Xu J, Yao K. The impact of doctor-patient communication on patient satisfaction in outpatient settings: implications for medical training and practice. BMC Medical Education. 2025;25(1):830. Thompson DA, Yarnold PR, Williams DR, Adams SL. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med. 1996;28(6):657-65. Sun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med. 2000;35(5):426-34. Hedges JR, Trout A, Magnusson AR. Satisfied Patients Exiting the Emergency Department (SPEED) Study. Acad Emerg Med. 2002;9(1):15-21. Graham B, Endacott R, Smith JE, Latour JM. 'They do not care how much you know until they know how much you care': a qualitative meta-synthesis of patient experience in the emergency department. Emerg Med J. 2019;36(6):355-63. Driesen BEJM. Patient flow and safety in the acute care: focusing on older patients. 2022. Schouten B, Driesen B, Merten H, Burger B, Hartjes MG, Nanayakkara PWB, et al. Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping. Eur Geriatr Med. 2022;13(2):339-50. Gérard L, François M, de Chefdebien M, Saint-Lary O, Jami A. The patient, the doctor, and the patient's loyalty: a qualitative study in French general practice. Br J Gen Pract. 2016;66(652):e810-e8. Groeschel AH. The trouble with some physicians is that they won't listen, or talk, to patients. Mod Hosp. 1960;95:78-9. Roos A, Skaug EA, Helgesen AK. The Importance of Being Taken Care of-Patients' Experience with the Quality of Healthcare in a Norwegian Hospital. Nurs Rep. 2023;13(4):1742-50. Onwumere, Odilibe, Elufioye P, Omaghomi T, Akomolafe. PATIENT EXPERIENCE AND SATISFACTION IN HEALTHCARE: A FOCUS ON MANAGERIAL APPROACHES - A REVIEW. International Medical Science Research Journal. 2024;4:194-209. Ingersoll LT, Saeed F, Ladwig S, Norton SA, Anderson W, Alexander SC, et al. Feeling Heard and Understood in the Hospital Environment: Benchmarking Communication Quality Among Patients With Advanced Cancer Before and After Palliative Care Consultation. Journal of Pain and Symptom Management. 2018;56(2):239-44. Gillespie H, Kelly M, Duggan S, Dornan T. How do patients experience caring? Scoping review. Patient Education and Counseling. 2017;100(9):1622-33. McCabe C. Nurse-patient communication: an exploration of patients' experiences. J Clin Nurs. 2004;13(1):41-9. Yoo HJ, Lim OB, Shim JL. Critical care nurses' communication experiences with patients and families in an intensive care unit: A qualitative study. PLoS One. 2020;15(7):e0235694. Curtis K. Compassion is an essential component of good nursing care and can be conveyed through the smallest actions. Evidence-Based Nursing. 2015;18(3):95. Von Dietze E, Orb A. Compassionate care: A moral dimension of nursing. Nursing Inquiry. 2000;7(3):166-74. Schantz ML. Compassion: a concept analysis. Nursing forum. 2007;42(2):48-55. Dewar B, Adamson E, Smith S, Surfleet J, King L. Clarifying misconceptions about compassionate care. Journal of Advanced Nursing. 2014;70(8):1738-47. Dewar B, Nolan M. Caring about caring: Developing a model to implement compassionate relationship centred care in an older people care setting. International Journal of Nursing Studies. 2013;50(9):1247-58. Lown BA. Compassion is a necessity and an individual and collective responsibility: Comment on “why and how is compassion necessary to provide good quality healthcare?”. International Journal of Health Policy and Management. 2015;4(9):613-4. Fotaki M. Why and how is compassion necessary to provide good quality healthcare? International Journal of Health Policy and Management. 2015;4(4):199-201. Pehlivan T, Güner P. Compassionate care: Benefits, barriers and recommendations. J Psy Nurs. 2020;11(2):148-53. Varghese A, Khakha DC. Attributes of compassionate care in clinical nursing practice from the perspectives of patients and nurses-A systematic review. J Educ Health Promot. 2025;14:110. Watts E, Patel H, Kostov A, Kim J, Elkbuli A. The Role of Compassionate Care in Medicine: Toward Improving Patients’ Quality of Care and Satisfaction. Journal of Surgical Research. 2023;289:1-7. Malenfant S, Jaggi P, Hayden KA, Sinclair S. Compassion in healthcare: an updated scoping review of the literature. BMC Palliative Care. 2022;21(1):80. Perez-Bret E, Altisent R, Rocafort J. Definition of compassion in healthcare: a systematic literature review. Int J Palliat Nurs. 2016;22(12):599-606. Blomberg K, Griffiths P, Wengström Y, May C, Bridges J. Interventions for compassionate nursing care: A systematic review. International Journal of Nursing Studies. 2016;62:137-55. Yang SC, Zwar N, Vagholkar S, Dennis S, Redmond H. Factors influencing general practice follow-up attendances of patients with complex medical problems after hospitalization. Family Practice. 2009;27(1):62-8. Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2(5):445-51. O’Malley AS. Current evidence on the impact of continuity of care. Current Opinion in Pediatrics. 2004;16(6):693-9. Guss DA, Leland H, Castillo EM. The Impact of Post-discharge Patient Call Back on Patient Satisfaction in Two Academic Emergency Departments. The Journal of Emergency Medicine. 2013;44(1):236-41. Poncia HD, Ryan J, Carver M. Next day telephone follow up of the elderly: a needs assessment and critical incident monitoring tool for the accident and emergency department. J Accid Emerg Med. 2000;17(5):337-40. Hwang U, Hastings SN, Ramos K. Improving Emergency Department Discharge Care with Telephone Follow-Up. Does It Connect? J Am Geriatr Soc. 2018;66(3):436-8. Cochran VY, Blair B, Wissinger L, Nuss TD. Lessons learned from implementation of postdischarge telephone calls at Baylor Health Care System. J Nurs Adm. 2012;42(1):40-6. Braun E, Baidusi A, Alroy G, Azzam ZS. Telephone follow-up improves patients satisfaction following hospital discharge. European Journal of Internal Medicine. 2009;20(2):221-5. Halcomb EJ, Davidson PM. Is verbatim transcription of interview data always necessary? Applied Nursing Research. 2006;19(1):38-42. Table Table 2 is available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files ADDITIONALFILE1COREQ.docx ADDITIONALFILE2INTERVIEWGUIDE.docx Table2.docx Cite Share Download PDF Status: Published Journal Publication published 27 Feb, 2026 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 12 Nov, 2025 Reviews received at journal 29 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers invited by journal 06 Oct, 2025 Editor assigned by journal 01 Oct, 2025 Editor invited by journal 10 Sep, 2025 Submission checks completed at journal 10 Sep, 2025 First submitted to journal 10 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7477102","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530655915,"identity":"a3c03920-e846-4870-b600-016691fc6578","order_by":0,"name":"Britt Wagenaar","email":"data:image/png;base64,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","orcid":"","institution":"Amsterdam UMC Location VUmc","correspondingAuthor":true,"prefix":"","firstName":"Britt","middleName":"","lastName":"Wagenaar","suffix":""},{"id":530655916,"identity":"18390e1e-6637-4f35-88ce-a9f16e5ac847","order_by":1,"name":"Hanneke Merten","email":"","orcid":"","institution":"Amsterdam UMC Location VUmc","correspondingAuthor":false,"prefix":"","firstName":"Hanneke","middleName":"","lastName":"Merten","suffix":""},{"id":530655917,"identity":"4359fe9d-739a-47fd-af8b-fc796ad7646a","order_by":2,"name":"Cordula Wagner","email":"","orcid":"","institution":"Amsterdam UMC Location VUmc","correspondingAuthor":false,"prefix":"","firstName":"Cordula","middleName":"","lastName":"Wagner","suffix":""}],"badges":[],"createdAt":"2025-08-28 06:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7477102/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7477102/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-026-07208-0","type":"published","date":"2026-02-27T15:59:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93795421,"identity":"d78c4fcc-53d0-4556-b719-b32acb93686c","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1832343,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptPatientJourneyStudieFinalversionBMCGeriatricsRevision3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/9809032c56f7e3d3ca60a46a.docx"},{"id":93797294,"identity":"b8afb24c-0241-4a0e-9a4a-bde384062ff4","added_by":"auto","created_at":"2025-10-17 15:57:15","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6114,"visible":true,"origin":"","legend":"","description":"","filename":"bd8e2646209c4de1bb4a985c6357c31b.json","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/93a65003b2f35c9926073b3b.json"},{"id":93797812,"identity":"47373dae-43f2-463c-94a3-3dc1b886ab53","added_by":"auto","created_at":"2025-10-17 16:05:15","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34437,"visible":true,"origin":"","legend":"","description":"","filename":"ADDITIONALFILE1COREQ.docx","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/d0c3db54ad0f7c3564218e8f.docx"},{"id":93795420,"identity":"cf3a57a6-337d-457d-a68b-ac5c9826df65","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":38434,"visible":true,"origin":"","legend":"","description":"","filename":"ADDITIONALFILE2INTERVIEWGUIDE.docx","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/3b0acde6d8413816e71852dc.docx"},{"id":93797297,"identity":"c3b5d600-82a7-43fa-abb5-3370c787604e","added_by":"auto","created_at":"2025-10-17 15:57:15","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":728134,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1aPatientJourneyMap.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/2a3b800abd047ce5b800360d.pdf"},{"id":93795426,"identity":"d379f951-e9c1-42f7-9053-6a72a8adb90d","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":668366,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1bPatientJourneyMap.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/f61372b973c0df287ac86d70.pdf"},{"id":93795423,"identity":"c91c7ccd-8851-4481-8062-53e1722b41e8","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"pdf","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":522775,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1cPatientJourneyMap.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/271d956b72f658f4e862df8e.pdf"},{"id":93795425,"identity":"a4413b9f-2fe1-49eb-82dc-b508b7adaa03","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"pdf","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":570708,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1dPatientJourneyMap.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/803e5b942bd06a8040b646b7.pdf"},{"id":93797814,"identity":"a44ca580-509f-420e-9a74-a3022ce03275","added_by":"auto","created_at":"2025-10-17 16:05:15","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":195414,"visible":true,"origin":"","legend":"","description":"","filename":"bd8e2646209c4de1bb4a985c6357c31b1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/989dc633f74a350b7b861228.xml"},{"id":93797299,"identity":"5617dea0-955f-424c-92c2-016c6f1caf91","added_by":"auto","created_at":"2025-10-17 15:57:15","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3739,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/a3dc2a50e6fbe8ef64f7f61d.png"},{"id":93795439,"identity":"2af687a8-2f5b-4861-91de-a47a59db28b6","added_by":"auto","created_at":"2025-10-17 15:49:16","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":492058,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/24850f1a34a90a866239972d.png"},{"id":93797298,"identity":"01f0a2c7-42dc-4fa8-81aa-30de2fbf2cca","added_by":"auto","created_at":"2025-10-17 15:57:15","extension":"jpeg","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":878707,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/3338f091446f0ba6901a3b33.jpeg"},{"id":93797816,"identity":"d3e08f8b-8db4-4e49-be6f-528566dd6d5d","added_by":"auto","created_at":"2025-10-17 16:05:16","extension":"jpeg","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":724204,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/39b7c707cda86c3d8c5ce2ae.jpeg"},{"id":93798661,"identity":"01e3dd23-eae7-4e5b-8068-e5b6aceea4fb","added_by":"auto","created_at":"2025-10-17 16:13:15","extension":"jpeg","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":870230,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/26bf4c6cf5ea2c23b2e8bd5a.jpeg"},{"id":93795433,"identity":"f9d95754-b192-422f-bfe5-3192193d727d","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1215,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/dd8caed99b1281eca4bfbf0a.png"},{"id":93797304,"identity":"fa57bd96-82d1-46d9-a16b-b30a1acb33f9","added_by":"auto","created_at":"2025-10-17 15:57:16","extension":"png","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113993,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/2a9a7ccf4be4f2468411dbdc.png"},{"id":93797302,"identity":"de9e6519-2ce1-4987-b059-91cf6a66dcae","added_by":"auto","created_at":"2025-10-17 15:57:15","extension":"png","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":228429,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/5f6497020664eab3f536f5b8.png"},{"id":93797813,"identity":"88e66db0-91db-45a3-9c6d-2186b6a7c6d9","added_by":"auto","created_at":"2025-10-17 16:05:15","extension":"png","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":181090,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/697afe188e18719a5eeb1fa8.png"},{"id":93795437,"identity":"24d8928b-6cec-4f5b-950c-cbdbee457fe1","added_by":"auto","created_at":"2025-10-17 15:49:16","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":218600,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/48442f1443630997a2234c4a.png"},{"id":93797306,"identity":"dba03560-f13e-4514-8f4a-2239ed95d5be","added_by":"auto","created_at":"2025-10-17 15:57:16","extension":"xml","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":191912,"visible":true,"origin":"","legend":"","description":"","filename":"bd8e2646209c4de1bb4a985c6357c31b1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/c41db4eadeba5bdfe379cfa4.xml"},{"id":93795432,"identity":"d8d68308-afbe-44f4-83bf-ce02effe6e66","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":207224,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/7e9617ddbaed978bb16a83cc.html"},{"id":93797295,"identity":"81dd837b-fc99-4f85-9d28-954cbb9a4402","added_by":"auto","created_at":"2025-10-17 15:57:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":795330,"visible":true,"origin":"","legend":"\u003cp\u003ea: Patient Journey Map of Acute/Non-surgical situation (N=91)\u003c/p\u003e\n\u003cp\u003eb: Patient Journey Map of Acute/Surgical situation (N=18)\u003c/p\u003e\n\u003cp\u003ec: Patient Journey Map of Non-Acute/Non-surgical situation (N= 8)\u003c/p\u003e\n\u003cp\u003ed: Patient Journey Map of Non-Acute/Surgical situation (N=16)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/9d910306b96a961b9a881f9f.png"},{"id":103765836,"identity":"90e0119a-ebaf-426a-b4dc-76d5235788c6","added_by":"auto","created_at":"2026-03-02 16:09:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1672070,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/3a6a5cbc-e7d0-4735-bcab-a5752b48ddba.pdf"},{"id":93795414,"identity":"4ae05fde-6ce0-4f66-806b-f240dc698d2f","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34437,"visible":true,"origin":"","legend":"","description":"","filename":"ADDITIONALFILE1COREQ.docx","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/5e047d61758429f0be40ee70.docx"},{"id":93795417,"identity":"1a58c5a8-b0b3-4431-baf2-094424d78eb4","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":38434,"visible":true,"origin":"","legend":"","description":"","filename":"ADDITIONALFILE2INTERVIEWGUIDE.docx","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/1f77588e4502b5061ad7c2d9.docx"},{"id":93795419,"identity":"4c2b7ca8-3a3b-4e41-819f-3e0b1f9adea6","added_by":"auto","created_at":"2025-10-17 15:49:15","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":26057,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7477102/v1/89d603be3024eb210691582b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experiences of older patients before, during and after hospital admission: Patient Journey Mapping","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eA major worldwide challenge is an aging population that will place increasing demands on healthcare systems to address complex needs of older adults. Older adults frequently experience co-morbidity and multimorbidity, which often necessitates complex care coordination among multiple healthcare providers during hospitalization, as well as before admission and after discharge (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). As older patients represent disproportionate hospital admissions (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) (over 40% of hospital patients are 65\u0026thinsp;+\u0026thinsp;in the Netherlands (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and the USA (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), accounting for 62% of total bed days (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)), it is essential to ensure that multidisciplinary care aligns with this growing proportion of older patient\u0026rsquo;s needs to achieve enhanced quality of care (\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the WHO, one of the key pillars of quality of healthcare is the delivery of patient-centered care (PCC) that aligns with individual preferences, needs, and values (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). PCC has gained widespread recognition among other researchers, clinicians, patients and organisations. The Institute of Medicine (IOM), for instance, identifies PCC as one of six fundamental aims for improving the healthcare system, defining it as care that explicitly integrates patients\u0026rsquo; needs, preferences, and values into clinical decision-making (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Building on this, the Picker Institute has identified eight core dimensions of PCC, which include: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) timely access to reliable healthcare advice; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) effective treatment delivered by trusted professionals; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) continuity of care and smooth transitions; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) involvement and support for family members and caregivers; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) clear communication, information, and support for self-care; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) active involvement in decision-making and respect for patient preferences; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) emotional support, empathy, and respect; and (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) attention to physical comfort and the healthcare environment (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). More concretely, in the Netherlands, PCC is a fundamental component of the Healthcare Quality, Complaints and Disputes Act, which defines good quality of healthcare as care that is safe, effective, efficient, client-centred, and responsive to the actual needs of the client (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo successfully implement and evaluate patient-centered care, it is helpful to gain a comprehensive understanding of patients\u0026rsquo; needs, preferences, values, and experiences over time by using patient journey mapping (PJM) (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Patient journey mapping is an emerging human-centered design approach (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) that can be used to visualize the sequence of experiences, perspectives and needs that patients encounter throughout their care pathway, from the patient\u0026rsquo;s point of view (\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29 CR30\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). By incorporating patients\u0026rsquo; emotions and experiences (highs and lows) into the PJM, their needs and preferences become more visible, along with gaps between needs and healthcare delivery processes, and potential bottlenecks in care transitions. Hence, using the PJM approach enables the identification of opportunities to enhance healthcare services for a more effective alignment with the needs of patients (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile patient journey mapping offers valuable insights into care processes, existing literature has revealed notable inconsistencies in how data are visualized and presented across studies as well as differences in the types of healthcare services studied, data collection methods employed, and sample sizes used (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Most existing PJM studies have typically involved small sample sizes, usually between 10 and 30 patients, and have primarily focused on a single hospital department (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Given that older adults often need coordinated, multidisciplinary care for complex health needs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), there is a pressing need for a broader, holistic PJM approach (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) capturing a diverse patient cohort across the healthcare continuum.\u003c/p\u003e\u003cp\u003eThe aim of this study is therefore to apply a patient journey mapping approach to a larger and more diverse cohort of patients aged 70 years and older. Our study will explore older patient\u0026rsquo;s needs, wishes, and experiences not only during hospital admission but also in the periods preceding and following hospitalization. These results will be used to reveal gaps in multidisciplinary care and uncovering opportunities to create more patient-centered and seamless care pathways for older adults.\u003c/p\u003e"},{"header":"DESIGN AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis study used a qualitative design with a patient journey mapping approach to obtain an in-depth exploration of the experiences, needs and wishes during, before and after hospital admission. To gather insight in the patient\u0026rsquo;s journey (phases), experiences, needs and wishes, semi-structured interviews and follow up conversations were conducted (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The results from the interviews and follow-up conversations were analysed by using an inductive thematic content analysis to construct the patient journey map. To facilitate the reporting of results, the consolidated criteria for reporting qualitative studies (COREQ) were used (see Additional file 1).\u003c/p\u003e\u003cp\u003e The study was conducted according to the guideline of the Declaration of Helsinki and has been granted approval by the ethics review committee of VU University Medical Center (protocol number 2020.076). This committee is registered with the US Office for Human research Protections (OHRP) as IRB00002991.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch team and reflexivity\u003c/h3\u003e\n\u003cp\u003eThe first researcher (BW) is a female registered PhD candidate at the Amsterdam UMC hospital who conducted the interviews and follow-up conversations. This researcher has experience with conducting semi-structured interviews, but no prior experience with coding interviews and patient journey mapping. However, the second researcher (HM) is an assistant professor quality and organisation of care who provides supervision. She has experience conducting qualitative research (semi-structured interviews, thematic coding and patient journey mapping).\u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eEligibility criteria participants\u003c/h2\u003e\u003cp\u003eThe study utilized a qualitative approach and focused on hospitalized patients aged 70 years and older. The aim was to include a minimum of 10 and a maximum of 15 patients per hospital department, to map a variety of patient journeys. Patients were excluded if they were younger than 70 years, not cognitively responsive, non-Dutch or non-English-speaking, hospitalized due to a readmission, or in the terminal phase of their illness.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRecruitment of the participants\u003c/h3\u003e\n\u003cp\u003ePatients eligible for inclusion were approached face-to-face during hospital admission by the care coordinating nurse of the department who assessed whether the patients were interested to participate in the patient journey study. Once participants indicated their interest to take part in the study, they received an informational letter, and the researcher then visited them in person to answer any potential questions. If patients decided to participate in the study, they were required to provide written informed consent, after which a physical semi-structured interview was conducted by the first researcher (BW). Prior to the interview, the first researcher did not have any relationship with the participants and the participants were not familiar with the research(er) in advance.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003ePreparation\u003c/h2\u003e\u003cp\u003eTo prepare for the semi-structured interviews, an interview guide was designed by the first (BW) and second researcher (HM) (see Additional File 2). The interview guide was structured around the patient\u0026rsquo;s pathway from one day till eight weeks before hospital admission until two to four weeks after discharge, focusing on the patient\u0026rsquo;s journey and related experiences and needs. The first three interviews were used as a pilot to test whether the interview guide needed any revision.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eSemi-structured interview and follow-up conversation\u003c/h3\u003e\n\u003cp\u003eThe interviews took physically place in six hospitals in the Netherlands, within nine different departments. The study period was between April 1, 2024 to November 30, 2024.\u003c/p\u003e\u003cp\u003eThe interviews were conducted on weekdays after the morning rounds, within the department, and lasted between 20 and 35 minutes. The duration was influenced by the patient's mental and physical condition, their readiness to engage in conversation about the topic, and their inclination to provide detailed information or discuss personal matters. Two to four weeks after the patient had been discharged from hospital, a follow-up conversation took place, because a longer timespan between hospital discharge and the follow-up conversation (e.g., more than 45 days) could have negatively impacted the memories of the patient (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The follow-up conversations were held by telephone, lasted 5 to 15 minutes and were conducted by the first researcher (BW). During the interviews and follow-up conversations, field notes were taken and reviewed. With the field notes, the data was mapped and structured around the journey of the patient.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStoring the data\u003c/h2\u003e\u003cp\u003eAll interviews were performed in Dutch and were audio-recorded with a voice recorder. The data were safely stored on a secure server to which only the researchers (BW and HM) had access. These audio files were removed after the summary and sketches of the patient journey maps (fieldnotes) from the interviews were completed. The audio recordings were not transcribed or shared with participants for comment or correction, as they were used solely to complement and ensure the completeness of the fieldnotes where necessary. The follow-up conversations were not recorded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003e An inductive thematic analysis based on direct content analysis of the fieldnotes from interviews and follow-up conversations was conducted, as the focus was not on detailed verbal content but on synthesizing findings into a Patient Journey Map. Initially, researcher BW open-coded the fieldnotes using MAXQDA V9 to analyse segments. The second researcher (HM) reviewed the first ten interview-fieldnotes and validated the open-coding process. After consensus was reached, the first researcher (BW) revised the open-coded process, adjusting and adding codes.\u003c/p\u003e\u003cp\u003eWhen the open-coding process was finished, the coded segments were analysed and sorted into different information types that were used for the PJM: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) (sub)phases before, during and after hospital admission (e.g., referral, intake, admission, treatment, discharge); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) time interval; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) involved actors/stakeholders and its link to (sub)phases; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) positive and negative experiences; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) needs and wishes and (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) emotions. Ultimately, PJMs were iteratively developed by the first (BW) and second (HM) researcher. Consequently, experiences were structured according to the eight Picker dimensions in the PJM construction phase and linked across the phases in which they were identified.\u003c/p\u003e\u003cp\u003eAll steps of the analysis were discussed in the research team and iteratively developed through discussions between the researchers, to improve the PJM.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics participants, dropouts and refusals \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows details about the characteristics of participants, dropouts and refusals. A total of 132 patients (52% female, 48% male) with a mean age of 79 years (SD 6.2)\u0026nbsp;was included. In contrast, thirty patients refused to participate with our study. Participants came from diverse living situations and had different education levels. The majority of participants (82%) were admitted to the hospital acutely, though they were distributed across various departments. The sample was predominantly characterized by a low level of education (82%), and most participants (96%) lived at home prior to hospitalization, either independently or with formal care support. Following hospital admission, a greater number of patients received rehabilitation or nursing care (at least 9%). However, the exact percentage is unknown due to incomplete follow-up data: 54 participants (41%) did not complete the follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1: Characteristics participants, dropouts and refusals \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttribute\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttribute\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eTotal number of participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eClassification level low [1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e82%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e52%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eClassification level secondary[2]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e48%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eClassification level \u0026nbsp;high[3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e70-75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eOther classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e76-80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"9\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepartment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 1: Internal Medicine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e81-85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 1: Pulmonology/Cardiology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e86-90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 2: Orthopaedics\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e91-95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 2: Internal Medicine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e95-98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 3: Pulmonology, Cardiology, Internal Medicine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving Situation prior to admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLiving alone at home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 4: Cardiology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLiving alone in rehabilitation centre\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 5: MDL, abdominal surgery, gynaecology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLiving alone in nursing home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 5: Cardiology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLiving with partner at home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e54%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eHospital 6: Geriatrics\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLiving with family member at home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScenario\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eAcute surgical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCare prior to admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eNo formal care support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eAcute non-surgical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eHomecare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePlanned admission surgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eNursing care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003ePlanned admission non-surgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eRehabilitation care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up/drop-outs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eFollow-Up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e59%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCare after discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eNo formal care support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eNo response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eHomecare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eWrong number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eNursing care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eDid not want to proceed study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eRehabilitation care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eIllness bottleneck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRefusals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eNumber of patients that did not participate after being asked/informed by nurse\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eResults Patient Journey Maps\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient journey maps (Figures 1a\u0026ndash;1d) are structured into four quadrants: acute non-surgical, acute surgical, non-acute non-surgical, and non-acute surgical, because it cannot be captured in one general patient journey map. They consist of chronological care path phases, time interval, involved actors, positive and negative experiences, emotion curves, and needs and wishes. The four quadrants are organized according to different phases of care, in which surgical specifically refers to patients who have undergone surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePositive and negative experiences\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA wide range of positive and negative experiences was reported across various phases of care (see Figure 1a-1d). Differences and commonalities of the experiences between four patient journey maps are linked to the Picker dimensions and structured around the care phases (see Table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFast access to reliable healthcare advice \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWaiting time was frequently mentioned, with mixed experiences. Patients appreciated short waiting times. Some patients experienced long waiting times, i.e. delays when scheduling (follow-up) appointments, waiting for the ambulance or in emergency departments, absence of doctor during weekends, or postponed surgeries or treatments. When waiting times were long, patients appreciated being informed about both their duration and the reason for the delay, which was especially important in the emergency department phase where waiting times can increase rapidly.\u003c/p\u003e\n\u003cp\u003eEffective treatment by trusted professionals\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMany patients were positive about the expertise and adequacy of care providers, their appropriate action, care assessment, and overall quality across many phases. In the pre-hospital phase, patients emphasized the importance of physicians conducting accurate assessments, establishing correct diagnoses, and initiating appropriate referrals to hospital care. Patients also valued the quality of in-hospital care, including accurate prescribing and administration of medication, provision of suitable food in accordance with dietary requirements set by the dietitian and consistent monitoring of their condition with timely and appropriate interventions. However, in some situations, patients experienced inadequate care or a misjudgement of their diagnosis or condition.\u003c/p\u003e\n\u003cp\u003eEffective treatment by trusted professionals and continuity of care and smooth transitions\u003c/p\u003e\n\u003cp\u003eAt the time of discharge, most patients were positive of having their prescribed medication readily available and receiving clear instructions on its use. Most patients also valued the arrangement of appropriate aftercare services and the scheduling of follow-up appointments. A key concern among patients was the explicit communication that medical information would be transferred to their general practitioner or another aftercare provider.\u003c/p\u003e\n\u003cp\u003eSome patients, in particular, expressed uncertainty about whether this information transfer had occurred, especially when it was not explicitly mentioned. A few patients reported experiencing confusion or frustration during the discharge phase due to incomplete medical records or poor communication between providers, which further contributed to feelings of insecurity. In addition, most patients assumed that the general practitioner would proactively reach out to them\u0026mdash;either through a home visit or a phone call\u0026mdash;and interpreted the absence of such contact as an indication that the general practitioner had not been informed. This led to concerns that the continuity of care might be compromised.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients consistently highlighted the importance of follow-up by their general practitioner, not only to guarantee information was transferred. Patients were dissatisfied if they did not have any follow-up \u0026nbsp;by their general practitioner to address any remaining questions and to ensure that the aftercare process was proceeding appropriately. In addition to general practitioner follow-up, patients appreciated receiving a direct phone number of the hospital department in case further questions arose. However, in some instances, the provided contact information was incorrect or calls were not answered, leaving patients feeling abandoned and unsupported.\u003c/p\u003e\n\u003cp\u003eDuring the aftercare phase, patients placed high value on home care services that were punctual and provided by consistent care personnel. This continuity fostered a sense of stability and trust in the care process.\u003c/p\u003e\n\u003cp\u003eNot only in the post-hospital phase, but across all phases of the care journey patients emphasized the importance of effective information exchange, collaboration between healthcare providers, and clear handover procedures. In the pre-hospital phase, patients appreciated when their GP proactively informed hospital specialists about their condition, where possible. During hospitalization, the involvement of multiple physicians made it particularly important that all professionals were kept informed of developments and worked collaboratively to ensure appropriate care. Similarly, in the post-hospital phase, patients viewed the coordination and transfer of information between care providers as critical to maintaining continuity and quality of care.\u003c/p\u003e\n\u003cp\u003eClear information, communication and support for self-care\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCommunication of information and expectations between healthcare providers and patients was another important experience. Many patients experienced clear explanations about their condition, test results, treatment options, expectations and procedural preparations. However, other patients felt dissatisfied with the clarity or completeness of the information provided, except for the consult and ambulance phase.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring the discharge phase, patients appreciated having the option to reread information enabled by, brochures, discharge letters or their electronic health records. When patient did not receive written information, patients felt unprepared and anxious about their aftercare and recover phase\u003c/p\u003e\n\u003cp\u003eInvolvement in decisions and respect for preferences\u003c/p\u003e\n\u003cp\u003eA majority of the patients appreciated to be involved in decision-making, while some patients did not feel the need to be involved in decisions and preferred to rely on medical expertise instead of being involved in decisions, particularly in acute situations or when feeling really sick. Nevertheless, patients expressed a desire to be asked whether they wanted to be involved in decision-making, being kept informed about decisions made and patients found it important to have the opportunity to ask questions (mainly mentioned in acute situations).\u003c/p\u003e\n\u003cp\u003eInvolvement in decisions and respect for preferences and emotional support, empathy and respect\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients consistently emphasized the importance of being listened to and taken seriously by healthcare providers across all phases of care, in a manner that made them feel genuinely heard. However, some patients reported not feeling acknowledged\u0026mdash;for instance, they were not referred for additional care despite clearly expressing that they could no longer manage at home, and symptoms such as fever were not adequately addressed.\u003c/p\u003e\n\u003cp\u003eIn addition to being listened to, patients expressed satisfaction when they were able to ask questions about their condition, the course of their illness, potential treatment options, and other aspects of their care. Having the opportunity to engage in open dialogue with healthcare providers contributed to a greater sense of involvement, understanding, and control over their health situation.\u003c/p\u003e\n\u003cp\u003eEmotional support, empathy and respect\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients expressed mixed feelings about care providers being helpful, thoughtful, compassionate and reassuring. Many individuals felt well-supported and reassured, appreciating thoughtful behaviour, such as being offered broth when feeling dizzy, thinking along with the patient about an appropriate aftercare location, or earplugs to improve sleep. Others, however, reported a lack of attentiveness, citing issues like not receiving help with opening medication or receiving written information while patients are visually impaired.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOther similar experiences include friendliness, a good relationship/interaction, good contact, a sense of humour. Patients appreciated friendly and attentive healthcare providers who also show warmth and use humour appropriately. However, a few patients reported poor interactions with their care providers. For instance, private conversations held in public spaces, some patients felt abruptly dismissed or sensed a lack of attentiveness, doctors were perceived as overly jovial and trying too hard to be popular, and care providers were described as curt during a night shift.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, patients valued taking time and \u0026nbsp;giving attention to the patient. Patients appreciated when staff takes time to listen and show genuine attention allowing patients to express their concerns and ask questions. However, mostly during busy periods, some patients felt that the time and attention they received was insufficient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAttention to physical and environmental needs\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePractical challenges were observed in multiple care phases and included physical barriers like stairs in general practitioner practices, stretchers that did not fit in elevators, and excessive shaking during ambulance rides. Other inconveniences involved detours due to road closures, plastic bed covers, unavailable supplies such as diapers and medication, beeping machines, insufficient hygiene, broken televisions, missing clocks, early check-ins for procedures, and the inability to perform complex treatments at the current hospital. These practical inconveniences added to the stress and discomfort of the patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring their hospital stay, patients responded positively when there was a wide variety of food options available, including choices that accommodated their dietary restrictions. Patients also appreciated having sufficient space in shared rooms, although this was not always the case, and valued having roommates with whom they could interact positively. While some patients preferred the social aspect of sharing a room, others favoured the peace and privacy of a private room. However, a private room was not always available.\u003c/p\u003e\n\u003cp\u003eIn addition, some patients were dissatisfied with the aftercare\u0026rsquo;s ambiance if \u0026nbsp;the environment of an aftercare facility did not contribute to their comfort and recovery. In contrast, regarding the department\u0026rsquo;s ambiance, most patients were positive, where patients and care providers engaged in conversations and shared laughter or calm, where patients can rest. However, some patients, mainly in acute situations, felt limited due to overcrowded rooms and wards and some patients felt restricted by policies that limited the ability of leaving the ward. Patients expressed their need for rest and found the busy environment in rooms and wards, as well as the crowded hallways and rooms in the emergency department, to be overwhelming and stressful.\u003c/p\u003e\n\u003cp\u003eFurthermore, hospital distance was another concern for patients during their hospital stay. The longer ambulance response time and the inconvenience for visitors, such as family and partners who had to travel further, added to their worries.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOther experiences\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome experience themes did not have a clear link to one of the Picker dimensions. Patients expressed dissatisfaction with the alternation of care providers. Patients found it difficult to build trust or feel secure when they were frequently seen by different general practitioners or specialists within the same department, and some reported confusion about which physician was responsible for their care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, patients described the progression of their disease and uncertain future often as a negative experience, mainly across different care phases. Many patients reported that they did not expect to require to be admitted to the hospital or their recovery took longer than they had expected or hoped. In these situations, patients greatly valued clear communication about what to expect, and they especially appreciated helpful, attentive, and compassionate nurses and doctors.\u003c/p\u003e\n\u003cp\u003eFinally, dissatisfaction with having to remain sober (the lack of amenities) particularly during the ED phase, was something patients felt could be addressed. Many patients felt not informed in advance about the need to remain sober, which led to frustration. Clear communication could have avoided this negative experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003e\u0026lt;Insert Table 2\u0026gt;\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEmotions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEmotional experiences were identified from participants that were able to express their feelings and showed variation across care journeys and phases. Emotions are visualized in the patient journey maps using curves; thicker lines indicate that more patients felt that emotion. \u003cem\u003eNegative emotions\u003c/em\u003e, such as fear, panic, and frustration, were mainly linked to uncertainty about the future, illness severity, or dissatisfaction with care. \u003cem\u003ePositive emotions\u003c/em\u003e stemmed from hope, relief, a smooth recovery, or being referred by a specialist. Some patients shared \u003cem\u003eemotional neutrality\u003c/em\u003e due to fatigue, illness, or personality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNeeds and Wishes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUltimately, patients\u0026rsquo; \u003cem\u003eneeds and wishes\u003c/em\u003e were gathered during interviews and visualized in the journey maps as sort of timelines in the last column. While most of the needs and wishes aligned with \u0026nbsp; positive, negative and emotional experiences, some others did not. For example, distance of a healthcare facility, aftercare reputation, autonomy, feeling free, and own network/environment did not align. For patients who could not express their needs, these were inferred from other journey map elements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[1] Primary education, special needs primary education, prevocational secondary education (in Dutch: VMBO), secondary vocational education level 1 or equivalent (in Dutch: MBO 1)\u003c/p\u003e\n\u003cp\u003e[2] Senior years of senior general secondary education (in Dutch: HAVO) or pre-university secondary education (in Dutch: VWO), secondary vocational education levels 2, 3 or 4 (in Dutch: MBO 2, 3 or 4)\u003c/p\u003e\n\u003cp\u003e[3] Higher vocational education (in Dutch: HBO), university bachelor\u0026rsquo;s or master\u0026rsquo;s degree, PhD.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study used patient journey mapping to examine older adults\u0026rsquo; experiences across an acute and non-acute care trajectory, highlighting care paths, timelines, actors, emotions, and needs to determine patient centeredness of care. Patients reported a wide range of emotions, needs and experiences, mostly positive experiences. Key touchpoints, pain points and facilitators could be derived from the patient journey maps, offering insights into the gap between needs, experiences and received care, to improve experiences and foster person-centered care.\u003c/p\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eMost important findings on patient experiences and implications\u003c/h2\u003e\u003cp\u003eOverall, our study showed substantial overlap in elements that shape patient experiences across different care phases with existing frameworks (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), and literature (\u003cspan additionalcitationids=\"CR39 CR40 CR41\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). These findings implicate that patient experiences are not defined by a single factor, but are instead multifaceted. The most apparent findings of this study regarding the elements that affect patient experiences within all four subgroups were the importance of managing expectations, providing compassionate care, ensuring clear handover information to patients, and arranging general practitioner follow-up.\u003c/p\u003e\u003cp\u003eThe first key finding is that clear, timely information across all phases of care is essential for managing expectations and fostering positive patient experiences.. Patients consistently emphasized the need for information about diagnoses, treatment and test options, disease progression, waiting times, procedures coming up during the hospital stay, around the time of discharge, and during aftercare. Our findings align with existing evidence highlighting the importance of expectation management, clear two-way patient-doctor communication and being informed (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43 CR44 CR45\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In particular, informing patients about waiting times emerged as a key driver of patient experience and satisfaction. While some patients reported long waiting times and expressed dissatisfaction, others viewed the waiting time positively. This indicates that perceptions, rather than actual waiting durations, play a more critical role for patient experiences (\u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Accordingly, providing timely information especially about expected waiting times is essential to enhance patient satisfaction (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). So, effectively informing patients and managing their expectations are crucial steps in delivering patient-centered care and fostering positive healthcare experiences.\u003c/p\u003e\u003cp\u003eSecond, our study revealed that patient-provider interaction and emotional support are essential for positive patient experiences. Patients, across all care phases and all journeys in this study, valued genuine interaction, helpful, thoughtful and pro-active care providers, being listened to, feeling taken seriously, and being treated with kindness, compassion and empathy. These findings are consistent with previous research, that show the importance of care providers who engage in active listening (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR54 CR55\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e), foster a sense of being heard and understood (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), empathetic patient-doctor relations (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), build human connections with caring, respectful, friendly and attentive care providers (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) and address and are responsiveness to patient concerns and needs (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). These elements closely align with a broader concept of compassionate care (\u003cspan additionalcitationids=\"CR62\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e), which is identified by literature as a cornerstone of healthcare (\u003cspan additionalcitationids=\"CR64 CR65 CR66 CR67\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e) and patient satisfaction (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). Compassionate care is a multitude set of components, which involves dynamic, responsive, and proactive actions (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e), defined as sensitivity to other patients\u0026rsquo; suffering, emotional engagement, empathy combined with a willingness to help and improve their well-being (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). Thus, integrating elements of compassionate care as a core component of person-centered practice is essential to enhancing the overall patient experience.\u003c/p\u003e\u003cp\u003eThird, participants in our study strongly emphasized the importance of follow-up\u0026mdash;whether with a specialist or a general practitioner\u0026mdash;as well as clear communication regarding the transfer of information to the follow-up care provider. More specific, in-person post-discharge follow-up consultations were preferred. The importance of continuity of care\u0026mdash;particularly follow-up\u0026mdash;for enhancing patient satisfaction is also well-supported in the existing literature (\u003cspan additionalcitationids=\"CR75 CR76\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). Although our findings align with previous research, some studies indicate that telephone follow-up can improve patient satisfaction, whereas most participants in our study expressed a clear preference for in-person consultations (\u003cspan additionalcitationids=\"CR79 CR80\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). Hence, implementing follow-up procedures\u0026mdash;whether conducted in person or via telephone\u0026mdash;is an essential component in enhancing patient experiences.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eA key strength of this study was the use of patient journey mapping (PJM), which enabled a structured analysis and visualization of older adults\u0026rsquo; care experiences, supported clear communication of findings to stakeholders, care providers or policy makers, and offered patients an engaging way to reflect on and share their journeys. The visual and narrative elements of PJM enhanced comprehension of the care journey, thereby providing insights for care providers to make more informed decisions and promote active patient participation in the evaluation of care.\u003c/p\u003e\u003cp\u003e Another strength of our study was its large and diverse sample, which captured patient experiences across the entire care trajectory. Unlike most PJM studies with fewer than 30 participants (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), our large cohort spanned multiple departments and care types, enabling a broader exploration of patient experiences across diverse clinical contexts. Bedside interviews further improved representativeness by including patients with limited mobility.\u003c/p\u003e\u003cp\u003eWhile this study offered valuable insights, some limitations should be acknowledged. One challenge of this study was the trade-off between a large sample and depth of findings. Our study aimed to identify broader patterns and for a higher level of abstraction in its analysis. Therefore we chose not to transcribe interviews verbatim. Instead, audio recordings were used only to supplement fieldnotes, which also captured non-verbal cues and contextual observations. While this may have limited the level of detail from individual interviews, it is uncertain whether longer, in-depth interviews would have yielded additional insights. Moreover, we deliberately avoided burdening older patients with lengthy interviews, opting for a reflexive and iterative approach instead. This sound alternative method to transcription, aligned with Yin\u0026rsquo;s recommendations, allowed for a more flexible, efficient yet meaningful interpretation of the data (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother limitation was the follow-up conversations with participants, as not all participants could be re-contacted, leading to missing data and potential bias. Phone interviews were also difficult for some older adults due to hearing issues, lack of visual cues, or unfamiliarity with conducting an interview by telephone, which may have limited the depth of responses.\u003c/p\u003e\u003cp\u003eFurthermore, while almost 10% of all Dutch hospitals was included, the geographic and type of hospital variability was limited. Data were collected from Dutch hospitals, primarily outside major urban areas, with only one academic hospital included. This may have caused a bias, as the type of hospital, geographical differences in healthcare infrastructure (e.g., bed capacity and availability/work pressure care providers) and patient population characteristics could have influenced care experiences.\u003c/p\u003e\u003cp\u003eFinally, a limitation concerned the direct identification of patients\u0026rsquo; needs, as older adults sometimes found it difficult to articulate their needs during specific phases of care. This might have led to certain needs being overlooked.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eFuture research\u003c/h2\u003e\u003cp\u003eFuture research should focus on implementing the most evident opportunities for improvement identified in our study: managing patient expectations, providing compassionate care, ensuring clear and timely information handovers, and arranging appropriate follow-up with general practitioners. In addition, future research should examine whether these improvements positively impact patient experiences and contribute to more patient-centered care. It is suggested to monitor such an impact by conducting another patient journey study.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study contributed to the growing body of research on patient-centered care by providing insight into the experiences and perspectives of older adults throughout the entire pre- to post-hospitalization phases using patient journey mapping. By capturing the perspectives of a large and diverse cohort of patients aged 70 and older, it highlighted the complexity and variability of care experiences, emotions, and needs. The patient journey maps revealed multiple touchpoints, pain points, and facilitators, which may support healthcare providers in aligning services more closely with patients' needs and preferences. The most obvious opportunities for improvement were managing expectations, providing compassionate care, ensuring clear information handover to patients, and arranging general practitioner follow-up. These findings can contribute to more person-centered care and better-integrated healthcare systems that are equipped to meet the complex needs of an aging population, ultimately improving their overall experience.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;All participants were required to provide written informed consent. The study was conducted according to the guideline of the Declaration of Helsinki and has been granted approval by the ethics review committee of VU University Medical Center (protocol number 2020.076). This committee is registered with the US Office for Human research Protections (OHRP) as IRB00002991.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available to protect the privacy of the participants but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting\u003c/strong\u003e \u003cstrong\u003einterests\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research article is funded by the Dutch Ministry of Health Welfare and Sport.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBritt Wagenaar\u003c/strong\u003e (BW), Data collection, Methodology, Writing, Analysis; \u003cstrong\u003eHanneke Merten\u003c/strong\u003e (HM): Methodology, Reviewing/Editing writing, Supervision, \u0026nbsp;Project administration, \u0026nbsp;Verification and Validation; \u003cstrong\u003eCordula Wagner\u003c/strong\u003e (CW): Reviewing/Editing writing, Supervision, \u0026nbsp;Project administration, \u0026nbsp;Verification and Validation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary data:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSupplementary material related to this article can be found in the online version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eNavickas R, Petric V-K, Feigl AB, Seychell M. Multimorbidity: what do we know? What should we do? Journal of comorbidity. 2016;6(1):4-11.\u003c/li\u003e\n \u003cli\u003eKruizenga H, Beijer S, Huisman-de Waal G, Jonkers-Schuitema C, Klos M, Remijnse-Meester W. Richtlijn ondervoeding herkenning, diagnosestelling en behandeling van ondervoeding bij volwassenen. Stuurgroep ondervoeding. 2019(August):36.\u003c/li\u003e\n \u003cli\u003eLehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, et al. Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev. 2011;68(4):387-420.\u003c/li\u003e\n \u003cli\u003eWyman MF, Shiovitz-Ezra S, Bengel J. Ageism in the Health Care System: Providers, Patients, and Systems. In: Ayalon L, Tesch-R\u0026ouml;mer C, editors. Contemporary Perspectives on Ageism. Cham: Springer International Publishing; 2018. p. 193-212.\u003c/li\u003e\n \u003cli\u003eFimognari FL, Lelli D, Landi F, Antonelli Incalzi R. Association of age with emergency department visits and hospital admissions: A nationwide study. Geriatr Gerontol Int. 2022;22(11):917-23.\u003c/li\u003e\n \u003cli\u003eCBS Statistics Netherlands. Nearly 230 thousand fewer hospital admissions in 2020. 2022.\u003c/li\u003e\n \u003cli\u003eCommission MPA. Report to the congress, Medicare payment policy: Medicare Payment Advisory Commission; 2003.\u003c/li\u003e\n \u003cli\u003eThe National Audit Office. Discharging older patients from hospital. 2016.\u003c/li\u003e\n \u003cli\u003eMahishale V. Ageing world: Health care challenges. Journal of the Scientific Society. 2015;42(3):138-43.\u003c/li\u003e\n \u003cli\u003eWolf PhD C, Jason A. Defining patient experience. Patient experience journal. 2014;1(1):7-19.\u003c/li\u003e\n \u003cli\u003eKwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing. 2021;20(1):158.\u003c/li\u003e\n \u003cli\u003eBertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229-39.\u003c/li\u003e\n \u003cli\u003eGluyas H. Patient-centred care: improving healthcare outcomes. Nursing Standard (2014+). 2015;30(4):50.\u003c/li\u003e\n \u003cli\u003eHansson E, Ekman I, Swedberg K, Wolf A, Dudas K, Ehlers L, et al. Person-centred care for patients with chronic heart failure\u0026ndash;a cost\u0026ndash;utility analysis. European journal of cardiovascular nursing. 2016;15(4):276-84.\u003c/li\u003e\n \u003cli\u003eStone S. A retrospective evaluation of the impact of the Planetree patient-centered model of care on inpatient quality outcomes. HERD: Health Environments Research \u0026amp; Design Journal. 2008;1(4):55-69.\u003c/li\u003e\n \u003cli\u003eOrganization WH. Quality of care 2025 [Available from: https://www.who.int/health-topics/quality-of-care#tab=tab_1. Accessed 25 August 2025.\u003c/li\u003e\n \u003cli\u003eFix GM, VanDeusen Lukas C, Bolton RE, Hill JN, Mueller N, LaVela SL, et al. Patient‐centred care is a way of doing things: How healthcare employees conceptualize patient‐centred care. Health Expectations. 2018;21(1):300-7.\u003c/li\u003e\n \u003cli\u003eInstitute of Medicine Committee on Quality of Health Care in A. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US) Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001.\u003c/li\u003e\n \u003cli\u003ePicker. The Picker Principles of Person Centred care. What is the definition of person centred care?2025.\u003c/li\u003e\n \u003cli\u003eMinistry Healthcare Welfare and Sport. Wet kwaliteit, klachten en geschillen zorg (Wkkgz). 2025.\u003c/li\u003e\n \u003cli\u003eElliott MN, Lehrman WG, Goldstein EH, Giordano LA, Beckett MK, Cohea CW, et al. Hospital survey shows improvements in patient experience. Health affairs. 2010;29(11):2061-7.\u003c/li\u003e\n \u003cli\u003eBrowne K, Roseman D, Shaller D, Edgman-Levitan S. Measuring patient experience as a strategy for improving primary care. Health affairs. 2010;29(5):921-5.\u003c/li\u003e\n \u003cli\u003eHagendijk ME, Zipfel N, Oomen FJ, Hoving JL, Van Der Wees PJ, Hulshof CT, et al. Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study. BMC Public Health. 2023;23(1):1-15.\u003c/li\u003e\n \u003cli\u003eCarayon P, Wooldridge A, Hoonakker P, Hundt AS, Kelly MM. SEIPS 3.0: Human-centered design of the patient journey for patient safety. Appl Ergon. 2020;84:103033.\u003c/li\u003e\n \u003cli\u003eBulto LN, Davies E, Kelly J, Hendriks JM. Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services. Eur J Cardiovasc Nurs. 2024;23(4):429-33.\u003c/li\u003e\n \u003cli\u003eMelles M, Albayrak A, Goossens R. Innovating health care: key characteristics of human-centered design. International Journal for Quality in Health Care. 2021;33(Supplement_1):37-44.\u003c/li\u003e\n \u003cli\u003eTrebble TM, Hansi N, Hydes T, Smith MA, Baker M. Process mapping the patient journey: an introduction. Bmj. 2010;341.\u003c/li\u003e\n \u003cli\u003eCarayon P, Albayrak A, Goossens R, Hoonakker P, Hose B-Z, Kelly MM, et al. Macroergonomics of patient work: engaging patients in improving sociotechnical context of their work. The Patient Factor: CRC Press; 2021. p. 61-81.\u003c/li\u003e\n \u003cli\u003eJung J, Kim KH, Peters T, Snelders D, Kleinsmann M. Advancing design approaches through data-driven techniques: patient community journey mapping using online stories and machine learning. International Journal of Design. 2023;17(2):19-44.\u003c/li\u003e\n \u003cli\u003eBen-Tovim DI, Dougherty ML, O\u0026apos;Connell TJ, McGrath KM. Patient journeys: the process of clinical redesign. Med J Aust. 2008;188(S6):S14-7.\u003c/li\u003e\n \u003cli\u003eSimonse L, Albayrak A, Starre S. Patient journey method for integrated service design. Design for Health. 2019;3(1):82-97.\u003c/li\u003e\n \u003cli\u003eJoseph AL, Kushniruk AW, Borycki EM. Patient journey mapping: Current practices, challenges and future opportunities in healthcare. Knowledge Management \u0026amp; E-Learning. 2020;12(4):387-404.\u003c/li\u003e\n \u003cli\u003eDavies EL, Bulto LN, Walsh A, Pollock D, Langton VM, Laing RE, et al. Reporting and conducting patient journey mapping research in healthcare: A scoping review. J Adv Nurs. 2023;79(1):83-100.\u003c/li\u003e\n \u003cli\u003eBerntsen GKR, Dalbakk M, Hurley JS, Bergmo T, Solbakken B, Spansvoll L, et al. Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial. BMC Health Services Research. 2019;19(1):682.\u003c/li\u003e\n \u003cli\u003eAhmed F, Burt J, Roland M. Measuring Patient Experience: Concepts and Methods. The Patient - Patient-Centered Outcomes Research. 2014;7(3):235-41.\u003c/li\u003e\n \u003cli\u003eFoust JB, Vuckovic N, Henriquez E. Hospital to home health care transition: patient, caregiver, and clinician perspectives. West J Nurs Res. 2012;34(2):194-212.\u003c/li\u003e\n \u003cli\u003eNHS Institute for Innovation Improvement. The Patient Experience Book. A Collection of the NHS Institute for Innovation and Improvement\u0026rsquo;s Guidance and Support. NHS Coventry, UK; 2013.\u003c/li\u003e\n \u003cli\u003eHavana T, Kuha S, Laukka E, Kanste O. Patients\u0026apos; experiences of patient-centred care in hospital setting: A systematic review of qualitative studies. Scandinavian Journal of Caring Sciences. 2023;37(4):1001-15.\u003c/li\u003e\n \u003cli\u003eBridges J, Collins P, Flatley M, Hope J, Young A. Older people\u0026apos;s experiences in acute care settings: Systematic review and synthesis of qualitative studies. International Journal of Nursing Studies. 2020;102:103469.\u003c/li\u003e\n \u003cli\u003eHoon LS, Mackey S, Hong-Gu H. Elderly patients\u0026apos; experiences of care received in the emergency department: a systematic review. JBI Libr Syst Rev. 2012;10(23):1363-409.\u003c/li\u003e\n \u003cli\u003eShankar KN, Bhatia BK, Schuur JD. Toward Patient-Centered Care: A Systematic Review of Older Adults\u0026rsquo; Views of Quality Emergency Care. Annals of Emergency Medicine. 2014;63(5):529-50.e1.\u003c/li\u003e\n \u003cli\u003evan Grootel JWM, J. CR, M. vDJ, M. vdL, E. G, R. O, et al. Experiences with hospital-to-home transitions: perspectives from patients, family members and healthcare professionals. A systematic review and meta-synthesis of qualitative studies. Disability and Rehabilitation. 2025;47(7):1644-58.\u003c/li\u003e\n \u003cli\u003eAdams C, Walpola R, Iqbal MP, Schembri A, Harrison R. The three pillars of patient experience: identifying key drivers of patient experience to improve quality in healthcare. Journal of Public Health. 2024.\u003c/li\u003e\n \u003cli\u003eKuipers SJ, Nieboer AP, Cramm JM. Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting. BMC Fam Pract. 2021;22(1):70.\u003c/li\u003e\n \u003cli\u003eKaya SD, Ileri YY, Yuceler A, editors. Importance of Hospital Way-Finding System on Patient Satisfaction. Business Challenges in the Changing Economic Landscape - Vol 2; 2016 2016//; Cham: Springer International Publishing.\u003c/li\u003e\n \u003cli\u003eChen X, Liu C, Yan P, Wang H, Xu J, Yao K. The impact of doctor-patient communication on patient satisfaction in outpatient settings: implications for medical training and practice. BMC Medical Education. 2025;25(1):830.\u003c/li\u003e\n \u003cli\u003eThompson DA, Yarnold PR, Williams DR, Adams SL. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med. 1996;28(6):657-65.\u003c/li\u003e\n \u003cli\u003eSun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med. 2000;35(5):426-34.\u003c/li\u003e\n \u003cli\u003eHedges JR, Trout A, Magnusson AR. Satisfied Patients Exiting the Emergency Department (SPEED) Study. Acad Emerg Med. 2002;9(1):15-21.\u003c/li\u003e\n \u003cli\u003eGraham B, Endacott R, Smith JE, Latour JM. \u0026apos;They do not care how much you know until they know how much you care\u0026apos;: a qualitative meta-synthesis of patient experience in the emergency department. Emerg Med J. 2019;36(6):355-63.\u003c/li\u003e\n \u003cli\u003eDriesen BEJM. Patient flow and safety in the acute care: focusing on older patients. 2022.\u003c/li\u003e\n \u003cli\u003eSchouten B, Driesen B, Merten H, Burger B, Hartjes MG, Nanayakkara PWB, et al. Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping. Eur Geriatr Med. 2022;13(2):339-50.\u003c/li\u003e\n \u003cli\u003eG\u0026eacute;rard L, Fran\u0026ccedil;ois M, de Chefdebien M, Saint-Lary O, Jami A. The patient, the doctor, and the patient\u0026apos;s loyalty: a qualitative study in French general practice. Br J Gen Pract. 2016;66(652):e810-e8.\u003c/li\u003e\n \u003cli\u003eGroeschel AH. The trouble with some physicians is that they won\u0026apos;t listen, or talk, to patients. Mod Hosp. 1960;95:78-9.\u003c/li\u003e\n \u003cli\u003eRoos A, Skaug EA, Helgesen AK. The Importance of Being Taken Care of-Patients\u0026apos; Experience with the Quality of Healthcare in a Norwegian Hospital. Nurs Rep. 2023;13(4):1742-50.\u003c/li\u003e\n \u003cli\u003eOnwumere, Odilibe, Elufioye P, Omaghomi T, Akomolafe. PATIENT EXPERIENCE AND SATISFACTION IN HEALTHCARE: A FOCUS ON MANAGERIAL APPROACHES - A REVIEW. International Medical Science Research Journal. 2024;4:194-209.\u003c/li\u003e\n \u003cli\u003eIngersoll LT, Saeed F, Ladwig S, Norton SA, Anderson W, Alexander SC, et al. Feeling Heard and Understood in the Hospital Environment: Benchmarking Communication Quality Among Patients With Advanced Cancer Before and After Palliative Care Consultation. Journal of Pain and Symptom Management. 2018;56(2):239-44.\u003c/li\u003e\n \u003cli\u003eGillespie H, Kelly M, Duggan S, Dornan T. How do patients experience caring? Scoping review. Patient Education and Counseling. 2017;100(9):1622-33.\u003c/li\u003e\n \u003cli\u003eMcCabe C. Nurse-patient communication: an exploration of patients\u0026apos; experiences. J Clin Nurs. 2004;13(1):41-9.\u003c/li\u003e\n \u003cli\u003eYoo HJ, Lim OB, Shim JL. Critical care nurses\u0026apos; communication experiences with patients and families in an intensive care unit: A qualitative study. PLoS One. 2020;15(7):e0235694.\u003c/li\u003e\n \u003cli\u003eCurtis K. Compassion is an essential component of good nursing care and can be conveyed through the smallest actions. Evidence-Based Nursing. 2015;18(3):95.\u003c/li\u003e\n \u003cli\u003eVon Dietze E, Orb A. Compassionate care: A moral dimension of nursing. Nursing Inquiry. 2000;7(3):166-74.\u003c/li\u003e\n \u003cli\u003eSchantz ML. Compassion: a concept analysis. Nursing forum. 2007;42(2):48-55.\u003c/li\u003e\n \u003cli\u003eDewar B, Adamson E, Smith S, Surfleet J, King L. Clarifying misconceptions about compassionate care. Journal of Advanced Nursing. 2014;70(8):1738-47.\u003c/li\u003e\n \u003cli\u003eDewar B, Nolan M. Caring about caring: Developing a model to implement compassionate relationship centred care in an older people care setting. International Journal of Nursing Studies. 2013;50(9):1247-58.\u003c/li\u003e\n \u003cli\u003eLown BA. Compassion is a necessity and an individual and collective responsibility: Comment on \u0026ldquo;why and how is compassion necessary to provide good quality healthcare?\u0026rdquo;. International Journal of Health Policy and Management. 2015;4(9):613-4.\u003c/li\u003e\n \u003cli\u003eFotaki M. Why and how is compassion necessary to provide good quality healthcare? International Journal of Health Policy and Management. 2015;4(4):199-201.\u003c/li\u003e\n \u003cli\u003ePehlivan T, G\u0026uuml;ner P. Compassionate care: Benefits, barriers and recommendations. J Psy Nurs. 2020;11(2):148-53.\u003c/li\u003e\n \u003cli\u003eVarghese A, Khakha DC. Attributes of compassionate care in clinical nursing practice from the perspectives of patients and nurses-A systematic review. J Educ Health Promot. 2025;14:110.\u003c/li\u003e\n \u003cli\u003eWatts E, Patel H, Kostov A, Kim J, Elkbuli A. The Role of Compassionate Care in Medicine: Toward Improving Patients\u0026rsquo; Quality of Care and Satisfaction. Journal of Surgical Research. 2023;289:1-7.\u003c/li\u003e\n \u003cli\u003eMalenfant S, Jaggi P, Hayden KA, Sinclair S. Compassion in healthcare: an updated scoping review of the literature. BMC Palliative Care. 2022;21(1):80.\u003c/li\u003e\n \u003cli\u003ePerez-Bret E, Altisent R, Rocafort J. Definition of compassion in healthcare: a systematic literature review. Int J Palliat Nurs. 2016;22(12):599-606.\u003c/li\u003e\n \u003cli\u003eBlomberg K, Griffiths P, Wengstr\u0026ouml;m Y, May C, Bridges J. Interventions for compassionate nursing care: A systematic review. International Journal of Nursing Studies. 2016;62:137-55.\u003c/li\u003e\n \u003cli\u003eYang SC, Zwar N, Vagholkar S, Dennis S, Redmond H. Factors influencing general practice follow-up attendances of patients with complex medical problems after hospitalization. Family Practice. 2009;27(1):62-8.\u003c/li\u003e\n \u003cli\u003eSaultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2(5):445-51.\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Malley AS. Current evidence on the impact of continuity of care. Current Opinion in Pediatrics. 2004;16(6):693-9.\u003c/li\u003e\n \u003cli\u003eGuss DA, Leland H, Castillo EM. The Impact of Post-discharge Patient Call Back on Patient Satisfaction in Two Academic Emergency Departments. The Journal of Emergency Medicine. 2013;44(1):236-41.\u003c/li\u003e\n \u003cli\u003ePoncia HD, Ryan J, Carver M. Next day telephone follow up of the elderly: a needs assessment and critical incident monitoring tool for the accident and emergency department. J Accid Emerg Med. 2000;17(5):337-40.\u003c/li\u003e\n \u003cli\u003eHwang U, Hastings SN, Ramos K. Improving Emergency Department Discharge Care with Telephone Follow-Up. Does It Connect? J Am Geriatr Soc. 2018;66(3):436-8.\u003c/li\u003e\n \u003cli\u003eCochran VY, Blair B, Wissinger L, Nuss TD. Lessons learned from implementation of postdischarge telephone calls at Baylor Health Care System. J Nurs Adm. 2012;42(1):40-6.\u003c/li\u003e\n \u003cli\u003eBraun E, Baidusi A, Alroy G, Azzam ZS. Telephone follow-up improves patients satisfaction following hospital discharge. European Journal of Internal Medicine. 2009;20(2):221-5.\u003c/li\u003e\n \u003cli\u003eHalcomb EJ, Davidson PM. Is verbatim transcription of interview data always necessary? Applied Nursing Research. 2006;19(1):38-42.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aging, geriatrics, care transitions, qualitative research, patient perspective, patient experience, patient-centered care, quality of care","lastPublishedDoi":"10.21203/rs.3.rs-7477102/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7477102/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe aging population presents a growing challenge for healthcare systems, with older adults, particularly those aged 70 and older, accounting for a significant proportion of hospital admissions due to chronic conditions and multimorbidity. Older patients often require coordinated care across multiple providers, making their healthcare trajectories complex and critical. Enhancing patient-centered care (PCC) is essential for improving outcomes and aligning healthcare with patients' needs and preferences.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis qualitative study employed a patient journey mapping approach to explore patients' experiences, needs, and wishes before, during, and after hospital admission. Semi-structured interviews during hospital admission and follow-up conversations after hospital discharge were conducted with admitted patients aged\u0026thinsp;\u0026ge;\u0026thinsp;70 across multiple Dutch hospital departments from April to December 2024. During the interviews and follow-up conversations, notes were summarized, compiled, and organized using a patient journey map template. Data were analysed using an inductive thematic content analysis, supported by MAXQDA V9 for open coding, focussing on identifying care phases of the patient journey, involved stakeholders, positive and negative experiences, emotions, and needs. The patient journey maps were iteratively developed in collaboration with the research team. The COREQ guidelines were followed for reporting.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 132 patients (48% female, 52% male) participated, with a mean age of 79 years. Participants were recruited from six hospitals, with 68% undergoing an acute non-surgical journey. Follow-up was completed by 59%. Patient journey maps, categorized into four quadrants (acute surgical, acute non-surgical, non-acute surgical, non-acute non-surgical), offered a comprehensive view of patient experiences highlighting a variability of interactions, emotions, and needs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatient journey mapping captured a diversity of experiences of a large cohort of older adults (\u0026ge;\u0026thinsp;70 years) before, during and after hospitalization, revealing critical areas for improvement. Key opportunities for improvement included expectation management, compassionate care, clear information handover, and coordinated general practitioner follow-up, offering insights to improve patient experiences and support more person-centered care for an aging population.\u003c/p\u003e","manuscriptTitle":"Experiences of older patients before, during and after hospital admission: Patient Journey Mapping","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 15:49:10","doi":"10.21203/rs.3.rs-7477102/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-12T13:02:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T17:21:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35451119496132579011089482425101926345","date":"2025-10-15T06:54:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132654223741963194508002681671462314621","date":"2025-10-13T21:17:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T08:27:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37011498037200397260569474080024729329","date":"2025-10-06T12:54:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-06T12:48:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T09:22:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-10T14:08:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T11:05:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-09-10T11:01:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2e9bfb1-7149-4503-b6b6-ff5893186840","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:07:18+00:00","versionOfRecord":{"articleIdentity":"rs-7477102","link":"https://doi.org/10.1186/s12877-026-07208-0","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-02-27 15:59:12","publishedOnDateReadable":"February 27th, 2026"},"versionCreatedAt":"2025-10-17 15:49:10","video":"","vorDoi":"10.1186/s12877-026-07208-0","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07208-0","workflowStages":[]},"version":"v1","identity":"rs-7477102","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7477102","identity":"rs-7477102","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}