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The providers were identified based on the patients they cared for and were then informed about the study and requested to participate.

The interview guides for the individual and focus group interviews were developed during several HANDOVER Research Consortium meetings.33 The questions for the individual interviews were pilot-tested and refined in each country and the results were used to create the final guide.

Patients, despite the recently increased focus on patient-centredness, often leave the hospital unprepared for postdischarge demands.21–23 A recent survey of patients with complex care needs in 11 countries reported that one in four did not receive instructions for follow-up nor did they receive clear medication directions.24 Other studies have demonstrated that patients and family members express anxiety and a sense of abandonment after discharge.25–27 Patient unpreparedness, anxiety and a misunderstanding of the full ramifications of their situation at discharge are believed to increase hospital readmissions and adverse events in the posthospital setting.

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Conclusions Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients’ and families’ capabilities, needs and preferences.

Future interventions should be directed at healthcare providers’ attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

The transcribed interviews were analysed using Grounded Theory, a qualitative research method focused on the identification of concepts that emerge from study interviews or observation.35 Two researchers in each country independently coded the transcripts to minimise subjectivity.

software V.6.0 (Scientific Software Development Company, Gmb H, Berlin, Germany) was used to facilitate the coding process.

We conducted a qualitative study of patient handovers at hospital discharge in nine hospitals, and their respective primary and community care settings, as part of the HANDOVER project, which addresses patient handovers at the hospital to primary care interface in five European nations.32 The countries involved in the HANDOVER project (The Netherlands, Spain, Poland, Italy and Sweden) represent a wide variety and types of European healthcare and funding systems.

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