202 Chapter 7 METHODS Study design We used Metro Mapping methodology for co-designing care pathways using a person-centered, holistic, iterative approach with interactive involvement of patients and healthcare professionals 13,14. Metro Mapping is a service design method which was created to co-design care pathways to support shared decision making in oncology. The Metro Map provides a clear and structured way of representing a care pathway, and can therefore be used to optimize and redesign current care pathways. The Metro Map consists of five layers: 1) current experience of patients, significant others and healthcare professionals, 2) metro line visualizing the entire care trajectory, 3) information required in every phase, 4) persons involved in the care process and decision-making, and 5) physical context and artefacts 13-15. Settings and participants In the Netherlands, there are six HTCs that provide specialized care for patients with hemophilia and other bleeding disorders 6. Due to the compulsory health insurance in the Netherlands, the treatment cost for patients with bleeding disorders are covered by public insurance, except from a yearly deductible fee of approximately €400. Children under the age of 18 are insured through their parents, and no additional fee is required to receive treatment at one of the six HTCs in the Netherlands 16. Using a mixture of convenience and purposive sampling, one pediatric hematologist and one nurse or nurse practitioner/consultant from each HTC were approached to participate in this study. The healthcare professionals were approached face-to-face and by email between July 1st 2022 and April 30th 2023. If the healthcare professionals wished to participate, an appointment was scheduled to discuss the aim of the study, Metro Mapping method and the mutual expectations regarding participation such as access to documentation about their healthcare process, and the required time investment to create the Metro Map. Healthcare professionals were required to participate in multiple interactive co-design sessions and the entire pediatric HTC team was requested to approve the final version of the Metro Map. This study was reviewed and determined to be exempt from the Medical Research Involving Human Subjects Act (WMO) by the Medical Ethical Research Committee of the Erasmus MC, Rotterdam, the Netherlands (MEC-
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