Introduction MetroMapping (MM) is a service design method developed to support SDM in oncology (Stiggelbout et al. 2023). It is being used in various care paths across the Netherlands and elsewhere, but little is known about its implementation. Aim was to assess the use of and experiences with MM, perceived barriers, and perceived impact of the MetroMap on patient care.

Methods Twenty-one semi-structured interviews were held with users across the Netherlands: medical specialists, nurses, and other (e.g. quality of care staff). Interviews were recorded, and transcripts of the interviews were thematically analyzed using open, axial, and selective coding.

Results Most care paths were oncology, except for obesity, cardiothoracic surgery, peripheral artery disease, and cardiology. In all cases, the MetroLine was created, often the Information and Companion layers were created, but the Experience and Context layers were least often addressed. Approximately half the respondents indicated that they had not used patient participation -important to the method- during MM. Barriers related to the technicalities, time, and the metaphors used (e.g. journey). Further, the current absence of electronic links to the medical record is a barrier. MM was received as a positive change in care path redesign, as the overview of the trajectory becomes much clearer and specific moments of SDM are indicated. But there were misconceptions about the MM process and the implementation of the MetroMap in daily practice.

Discussion More guidance must be provided, and clear manuals, to ensure that the MM process and the MetroMap implementation are done correctly. The European 4d picture consortium (https://4dpicture.eu/) is investigating the implementation of MM in The Netherlands, Spain and Denmark and assessing its impact on the process and outcomes of decision making.

Conclusion MM is a valuable service design methodology, but its implementation still has shortcomings.