The Terminal Diner: Serving up a Novel Knowledge Exchange Methodology via Participatory Design Installation

Arts-based knowledge mobilisation (ABKM) is a powerful means of interpreting and communicating health services research, centreing experiential, iterative, and reflective knowledge rooted in co-creation. We developed a research-to-public-to-research feedback loop methodology extending beyond existing ABKM practices and our previous research-to-public methodology, creating a novel bidirectional epistemic process wherein meaning making occurs from research to public and from public to research. This approach produces knowledge that is rich, contextually grounded, and otherwise potentially inaccessible through conventional research.

We present a case study documenting the first application of the feedback loop, with the aim of advancing and refining the methodological framework by: sharing quantitative findings with the public and eliciting public engagement via a design installation, and levering engagement to inform subsequent qualitative research.

Using the design-driven research-to-public-to-research feedback loop, we developed a participatory design installation focused on end-of-life care. Within an overarching mixed-methods sequential study, we leveraged design and health services methods to: develop design principles; select installation aims and concept; prototype, refine, and iterate the design; and conduct descriptive analysis of installation outputs.

Borrowing characteristics of a classic diner, the installation entitled The Terminal Diner, invited individuals to complete orders for their desired end-of-life healthcare experience or leave reviews drawn from lived experience with a deceased loved one's end-of-life journey. The installation disseminated quantitative findings and engaged the general public in contemplating and co-creating around the subject of death-outputs of which were used to inform subsequent qualitative research, while recruiting an interested audience as research participants.

This study presents an innovative extension of our previous research-to-public methodology, representing a paradigmatic shift towards creative knowledge exchange and bidirectional meaning making within health services research.

The public's role as co-creators is foundational to the research-to-public-to-research feedback loop methodology. Those with lived experience-bereaved caregivers and patient partners-were also embedded throughout both the research and design processes, ensuring accessibility, relevance, and emotional resonance. Blending personal knowledge and public perspective, The Terminal Diner foregrounded the essential role of patient and public contributions in co-creating meaningful, responsive, and inclusive health services research.