Transcultural mediation programme in a paediatric hospital in France: qualitative and quantitative study of participants’ experience and impact on hospital costs

Abstract

ObjectiveIn France, immigrants with chronic diseases encounter numerous difficulties in gaining access to care and then in its initiation and organisation, difficulties only partly explained by socioeconomic factors. A transcultural mediation consultation programme has been set up in Necker Hospital in Paris to help families and professionals deal with these situations. The objective of this study was to assess the economic impact and the experience of this consultation.DesignQualitative and quantitative descriptive study.SettingThis study of inpatients treated at Necker Hospital included those whose families participated in transcultural mediation in 2014 through 2016.ParticipantsThe first portion of the study applied quantitative methods and compared hospital costs before and after the mediation from the patients' records and accounting data for 15 cases. The qualitative portion analysed 15 semistructured interviews of physicians and families after the mediation, and a focus group of three psychologists.ResultsThe results show a systematic reduction in costs after mediation, associated with fewer emergency hospitalisations and the shift of care toward less specialised facilities, calmer relationships between families and professionals, improved mutual understanding and increased confidence by the professionals in the families' ability to manage the treatment.ConclusionTranscultural mediation can benefit both patients and the healthcare system and may be useful for other hospitals that care for socially and culturally diverse patients.

Family‐centred care interventions for children with chronic conditions: A scoping review

“…We further identified 127 records through grey literature searches, and after deduplication and removal of records published before 2019, we retrieved and assessed 59 full‐text reports for eligibility (Figure 1). A total of 63 reports were included in this review, representing 61 unique interventions 41–103 . Furthermore, we consulted additional publications, which were cited in the eligible reports, for additional details about 23 of the 61 included interventions during our data charting 104–132 …”

“…Communication and information provision 45 [41][42][43][44][45][49][50][51][52][53][54][56][57][58]60,61,63,64,66,67,[73][74][75][76][77][78]80,82,[84][85][86][87][88][89][90][91][92][93][94][96][97][98][99][100][101][102][103] In-person interactions with providers 27 [42][43][44][45][51]…”

“…Respect for child and family 27 42,43,45,46,51,53,57,58,60,64,66,71,76,77,79,80,[84][85][86][87][88]90,[94][95][96][97]99,101 In-person assessments of child and family values, preferences, and needs 17 42,43,45,51,53,57,60,66,71,77,79,80,[85][86][87][88]95,99 Home visit before intake to assess needs Discussion at initial contact about families' worldview and understanding of child's condition Communication tools to promote families' expression of their values and needs 6 46,58,64,6...…”

Perspective changes through transcultural mediation training: A qualitative study of trainees, instructors, and experts

“…At the request of one of the health professionals involved in the patient's care, a transcultural mediator, teamed with a cultural broker from the same ethnocultural background as the patient, sees the patient, his or her family, and the medical team for a single two-hour consultation aimed at improving the team's interactions with the patient and family. The objective of the transcultural mediation consultation is to modify the conditions of the interaction between the medical teams, on the one hand, and between patients and their families on the other (Bouznah, 2020; Lachal et al, 2019). The shared narrative of cultural and medical representations may allow each to find meaning in what goes on in treatment and to understand that the different concepts and discourses about the disease can coexist, that is, that one does not necessarily exclude the other.…”

“…A 2016 evaluation of this service in a children's hospital found that it: i) cut health-care costs, by reducing emergency department visits, ii) improved the patient–physician relationship and helped them to understand one another, and iii) significantly enhanced trust between doctors and patients. The doctors reported, in particular, that this trust was owed in part to their increased confidence in the families’ ability to manage the disease by better adherence to the treatment (Lachal et al, 2019).…”