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Bonanno M, Desjardins L, Lugasi T, Carrier J, Labonté N, Sultan S, Coltin H, Perrault S, Provost C, Laverdière C, Cloutier N, Saragosti A, Régnier-Trudeau É, Koukoui B. Protocol for evaluation of the feasibility and preliminary efficacy of a targeted transition readiness workshop intervention for pediatric brain tumor survivors. Pilot Feasibility Stud 2024; 10:11. [PMID: 38243344 PMCID: PMC10797753 DOI: 10.1186/s40814-023-01437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Pediatric brain tumor survivors (PBTS) are at risk of physical, cognitive, and psychosocial challenges related to their diagnosis and treatment. Routine follow-up care as adults is therefore essential to their long-term health and quality of life. In order to successfully navigate to adult healthcare, it is recommended that youth develop transition readiness skills. Existing transition readiness interventions often focus on disease management. However, PBTS are also at risk of social competence and cognitive functioning challenges. In this paper, we describe the protocol of this pilot study and the methodology that will be used for the evaluation of the feasibility, acceptability, and preliminary efficacy testing of the first targeted transition intervention workshops specifically designed to meet the needs of PBTS and their caregivers. METHODS This study will use a mixed method to evaluate three 1 ½-h workshops targeted for dyads (N = 40) of PBTS (14 years or older) and their parents. Dyads will be recruited via a community pediatric cancer organization and the long-term follow-up clinic of a large pediatric hospital. Participants will complete an online survey which includes the Transition Readiness Assessment Questionnaire (TRAQ) before and after the workshops. Each workshop will cover a specific topic related to PBTS transition readiness: disease management, social competence, and cognitive functioning. Workshops will follow the same structure: topic presentation, discussion by a post-transfer survivor or parent, teaching two strategies, and workshop evaluation. Workshops will be co-led by healthcare specialists and patient partners. Feasibility and acceptability will be assessed via recruitment, attendance, retention, and Likert scales, and they will be analyzed by describing and comparing rates. Satisfaction will be measured using satisfaction surveys and audio-recorded focus groups. Qualitative data will be described through thematic content analysis. In order to test the preliminary efficacy of this study, we will compare transition readiness skills pre- and post-workshops using paired samples T test and ANCOVA to examine the impact of workshop on TRAQ skills. DISCUSSION Results of the study will inform refinement and future broader implementation of targeted transition readiness workshops for the specific needs of pediatric brain tumor survivors.
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Affiliation(s)
- Marco Bonanno
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
- Sainte-Justine Research Health Center, Montreal, QC, Canada
| | | | - Tziona Lugasi
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Julie Carrier
- Department of Psychology, Université de Montréal, Montreal, Québec, Canada
| | - Nathalie Labonté
- École Des Petits-ExpCrateurs, Marie-Victorin School Board, Montreal, QC, Canada
| | - Serge Sultan
- Sainte-Justine Research Health Center, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, Québec, Canada
| | - Hallie Coltin
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Sébastien Perrault
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Carole Provost
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Caroline Laverdière
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Nancy Cloutier
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Andrea Saragosti
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
| | | | - Benedicte Koukoui
- Hematology-Oncology Unit, Sainte-Justine University Health Center, Montreal, QC, Canada
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Renaud-Charest O, Mok E, Frei J, Brunet ML, Henderson M, Rahme E, Dasgupta K, Nakhla M. Diabetes duration, perceived comfort with self-management and glycaemic control in adolescents with type 1 diabetes: A cross-sectional study. Diabet Med 2024; 41:e15237. [PMID: 37838827 DOI: 10.1111/dme.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
AIMS Evidence is lacking on whether diabetes duration is associated with type 1 diabetes (T1D) self-management during late adolescence before transfer from paediatric to adult care. We examined associations of diabetes duration with dimensions of perceived comfort with diabetes self-management (self-efficacy, transition readiness, diabetes distress) and glycaemic control in late adolescence. METHODS Using a cross-sectional design, we conducted a secondary analysis of baseline data of adolescents (ages 16-17 years) with T1D followed at paediatric diabetes academic hospitals in Montreal and enrolled in the Group Education Trial to Improve Transition (GET-IT-T1D). Participants completed validated questionnaires on self-efficacy (Self-Efficacy for Diabetes Self-Management Measure [SEDM], score 1 to 10), diabetes distress and transition readiness, as well as a haemoglobin (HbA1c) capillary blood test. Our primary outcome was self-efficacy. We examined associations of diabetes duration with self-efficacy, diabetes distress, transition readiness and HbA1c using linear and logistic regression models adjusted for sex, socioeconomic status, insulin pump use, glucose sensor use and psychiatric comorbidity. RESULTS Of 203 adolescents with T1D, mean diabetes duration (SD) was 7.57 (4.44) years. Mean SEDM score was 6.83 (SD 1.62). Diabetes duration was not associated with self-efficacy, diabetes distress or transition readiness. Each additional year of diabetes duration was associated with 0.11% (95% CI, 0.05 to 0.16) higher HbA1c. CONCLUSIONS Although diabetes duration is not associated with dimensions of perceived comfort with diabetes self-management, adolescents with longer diabetes duration are at risk for higher HbA1c and may need additional support to improve glycaemic control before transition to adult care.
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Affiliation(s)
- Olivier Renaud-Charest
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Elise Mok
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Marie-Laurence Brunet
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Mélanie Henderson
- Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montreal, Québec, Canada
- School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Meranda Nakhla
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Endocrinology, Department of Paediatrics, McGill University Health Centre, Montreal, Québec, Canada
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Badour B, Bull A, Gupta AA, Mirza RM, Klinger CA. Parental Involvement in the Transition from Paediatric to Adult Care for Youth with Chronic Illness: A Scoping Review of the North American Literature. Int J Pediatr 2023; 2023:9392040. [PMID: 38045800 PMCID: PMC10691897 DOI: 10.1155/2023/9392040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023] Open
Abstract
With medical advancements and improvements in medical technology, an increasing number of children with chronic conditions survive into adulthood. There is accordant growing interest toward supporting adolescents throughout the transition from paediatric to adult care. However, there is currently a paucity of research focusing on the role that these patients' parents should play during and after the transition to adult care and if maintained parental involvement is beneficial during this transition within a North American context. Accordingly, this scoping review utilized Arksey and O'Malley's five-step framework to consider parental roles during chronically ill children's transition to adult care. APA PsycInfo, CINAHL, EMBASE, MEDLINE, ProQuest, and Scopus were searched alongside advanced Google searches. Thematic content analysis was conducted on 30 articles meeting the following inclusion criteria: (1) published in English between 2010 and 2022, (2) conducted in Canada or the United States, (3) considered adolescents with chronic conditions transitioning to adult care, (4) family being noted in the title or abstract, and (5) patient populations of study not being defined by delays in cognitive development, nor mental illness. Three themes emerged from the literature: the impacts of maintaining parental involvement during transition to adult care for patients, parents experiencing feeling loss of stability and support surrounding the transition of their child's care, and significant nonmedical life events occurring for youths at the time of transition of care. Parents assuming supportive roles which change alongside their maturing child's needs were reported as being beneficial to young peoples' transition processes, while parents who hover over or micromanage their children during this time were found to hinder successful transitions. Ultimately, the majority of reviewed articles emphasized maintained parental involvement as having a net positive impact on adolescents' transitions to adult care. As such, practice and policies should be structured to engage parents throughout the transition process to best support their chronically ill children during this time of change.
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Affiliation(s)
- Bryn Badour
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Amanda Bull
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Abha A. Gupta
- Temerty Faculty of Medicine: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
- Division of Medical Oncology, University Health Network: Princess Margaret Cancer Centre, Toronto, Ontario, Canada M5G 2C1
| | - Raza M. Mirza
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
| | - Christopher A. Klinger
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
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Vaillancourt M, Mok E, Frei J, Dasgupta K, Rahme E, Bell L, Da Costa D, Nakhla M. Qualitative study exploring the perspectives of emerging adults with type 1 diabetes after transfer to adult care from a paediatric diabetes centre in Montreal, Canada. BMJ Open 2023; 13:e076524. [PMID: 37879699 PMCID: PMC10603410 DOI: 10.1136/bmjopen-2023-076524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Among youth living with type 1 diabetes (T1D), the increasing demands to diabetes self-care and medical follow-up during the transition from paediatric to adult care has been associated with greater morbidity and mortality. Inadequate healthcare support for youth during the transition care period could exacerbate psychosocial risks and difficulties that are common during emerging adulthood. The current investigation sought to explore the post-transfer perceptions of emerging adults living with T1D relating to their transition to adult care. RESEARCH DESIGN AND METHODS Thirty-three emerging adults living with T1D were recruited during paediatric care and contacted for a semistructured interview post-transfer to adult care (16.2±4.2 months post-transfer) in Montreal, Canada. We analysed data using thematic analysis. RESULTS We identified four key themes: (1) varied perceptions of the transition process from being quick and abrupt with minimal advice or information from paediatric healthcare providers (HCP) to more positive including a greater motivation for self-management and the transition being concurrent with the developmental period; (2) facilitators to the transition process included informational and tangible social support from HCPs and family or friends, a positive relationship with adult HCP and a greater ease in communicating with the adult care clinic or adult HCP; (3) barriers to adequate transition included lack of advice or information from paediatric HCPs, loss of support from HCPs and friends or family, the separation of healthcare services and greater difficulty in making appointments with adult clinic or HCP and (4) participants recommendations for improving the transition included increasing the length and frequency of appointments in adult care, having access to educational information, and better transition preparation from paediatric HCPs. CONCLUSIONS The experiences and perceptions of emerging adults are invaluable to guide the ongoing development and improvement of transition programmes for childhood-onset chronic illnesses.
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Affiliation(s)
| | - Elise Mok
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Lorraine Bell
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Deborah Da Costa
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Meranda Nakhla
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
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Han A, Gingrich J, Yaskina M, Rankin K, San Martin-Feeney D, Mackie AS. Just TRAC it! Transitioning Responsibly to Adult Care Using Smart Phone Technology. J Adolesc Health 2023; 73:561-566. [PMID: 37306646 DOI: 10.1016/j.jadohealth.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE There is little evidence on whether smartphone technology influences transition readiness among adolescents with heart disease. Just TRAC it! is a method of using existing smartphone features (Notes, Calendar, Contacts, Camera) to manage personal health. We evaluated the impact of Just TRAC it! on self-management skills. METHODS Randomized clinical trial of 16-18 year-olds with heart disease. Participants were randomly allocated 1:1 to either usual care (education session) or intervention (education session including Just TRAC it!). The primary outcome was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes were frequency of use and perceived usefulness of Just TRAC it! Analysis was intention-to-treat. RESULTS We enrolled 68 patients (41% female, mean age 17.3 years), 68% having previous cardiac surgery and 26% had cardiac catheterization. TRANSITION-Q scores were similar at baseline and increased over time in both groups but were not significantly different between groups. Each additional point at the baseline score brought, on average, a 0.7-point increase in TRANSITION-Q score (95% CI 0.5-0.9) at each of 3 and 6 months. The Camera, Calendar and Notes apps were reported as most useful. All intervention participants would recommend Just TRAC it! to others. DISCUSSION A nurse-led transition teaching with versus without Just TRAC it! improved transition readiness, with no significant difference between groups. Higher baseline TRANSITION-Q scores were associated with greater increase in scores over time. Participants had a positive reception to Just TRAC it! and would recommend it to others. Smartphone technology may be useful in transition education.
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Affiliation(s)
- Angela Han
- Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jody Gingrich
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Kathryn Rankin
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Andrew S Mackie
- Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, Edmonton, Alberta, Canada.
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Fishman LN, Ding J. Optimizing the Transition and Transfer of Care in Pediatric Inflammatory Bowel Disease. Gastroenterol Clin North Am 2023; 52:629-644. [PMID: 37543405 DOI: 10.1016/j.gtc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Health care transition from pediatric to adult care has been identified as a priority in the field of medicine, especially for those with chronic illnesses such as inflammatory bowel disease (IBD). Although there is no universally accepted model of preparing the pediatric patient for transfer to adult care, transition care is best accomplished in a structured and consistent manner. The authors highlight concepts for optimizing the transition of care for patients with IBD, which include setting expectations throughout adolescence with the gradual nurturing of self-management skills, preparing and assessing of readiness for transfer, and enacting a successful transfer to adult care.
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Affiliation(s)
- Laurie N Fishman
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Julia Ding
- Division of Gastroenterology and Hepatology, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
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Prasad M, Batthish M, Beattie K, Berard R. A survey of Canadian adult rheumatologists' knowledge, comfort level, and barriers in assessing psychosocial needs of young adults with rheumatic diseases. Rheumatol Int 2023:10.1007/s00296-023-05337-y. [PMID: 37162528 PMCID: PMC10171159 DOI: 10.1007/s00296-023-05337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
To assess adult rheumatologists' comfort level, current practices, and barriers to provision of optimal care in supporting young adults with pediatric-onset rheumatic conditions in Canada. Survey questions were informed by literature review, a needs assessment, and using milestones listed by the Royal College of Physicians and Surgeons of Canada for the entrustable professional activities (EPAs) applicable to care for rheumatology patients transitioning to adult practice. The electronic survey was distributed to adult rheumatology members of the Canadian Rheumatology Association over 4 months. Four hundred and fifty-one rheumatologists received the survey, with a response rate of 15.2%. Most respondents were from Ontario and had been in practice ≥ 10 years. Three quarters reported a lack of training in transition care although the same proportion were interested in learning more about the same. Approximately 40% felt comfortable discussing psychosocial concerns such as gender identity, sexuality, contraception, drug and alcohol use, vaping, and mental health. Despite this, 45-50% reported not discussing vaping or gender identity at all. The most frequently reported barriers to providing transition care were lack of primary care providers, allied health support, and training in caring for this age group. Most adult rheumatologists lack formal training in transition care and view it as a barrier to providing care for this unique patient population. Future educational initiatives for adult rheumatology trainees should include issues pertaining to adolescents and young adults. More research is needed to assess the effectiveness of resources such as transition navigators in ensuring a successful transition process.
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Affiliation(s)
- Madhavi Prasad
- Department of Pediatrics, Western University, London, ON, Canada.
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Karen Beattie
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Roberta Berard
- Division of Rheumatology, Department of Pediatrics, Western University, London, ON, Canada
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Evaluating Transition Readiness: Is Self-Report Valid as the Gold Standard? J Pediatr Gastroenterol Nutr 2023; 76:325-330. [PMID: 36729665 DOI: 10.1097/mpg.0000000000003680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Determination of transitional readiness is an essential component of delivery of transition services to adolescents and young adults with chronic diseases, including those with inflammatory bowel disease (IBD). To date, this has been performed using the transition checklist (TC). However, clinical experience suggests the validity of the checklist may not be ideal. We sought to evaluate the validity of the TC among adolescents and young adults with IBD (AYA IBD). METHODS We evaluated the validity of the TC compared with a skills-based practicum (TKSP) in a cross-sectional study using a real-world clinical cohort of AYA IBD. Extent of concordance between TC and TKSP was assessed using confusion matrices and calculation of Matthews correlation coefficients. RESULTS Concordance between self-reported TC answers and TKSP performance varied based on skill/knowledge base assessed, ranging from 81.3% for mastery of knowing one's medical condition to 39.2% for mastery of knowing one's medication schedule and 29.3% for mastery of knowing how to refill medications. Matthews correlation coefficients were closer to random prediction than perfect correlation for all skills/knowledge tested. CONCLUSIONS Self-reported TC answers lack sufficient concordance with TKSP performance. Our findings suggest that a TKSP should be performed to assess for transition readiness and to identify individual AYA IBD patient needs during the transition process.
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Cassidy M, Doucet S, Luke A, Goudreau A, MacNeill L. Improving the transition from paediatric to adult healthcare: a scoping review on the recommendations of young adults with lived experience. BMJ Open 2022; 12:e051314. [PMID: 36572498 PMCID: PMC9806082 DOI: 10.1136/bmjopen-2021-051314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The goal of this review was to identify recommendations within the literature on how to improve the transition from paediatric to adult healthcare from the perspective of young adults (YAs) living with chronic conditions who have gone through the process. DESIGN This review was conducted in accordance with JBI methodology for scoping reviews. SEARCH STRATEGY We searched MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO) and EMBASE (Elsevier) databases, and conducted a grey literature search for relevant material. The databases were searched in December 2019, and re-searched June 2020 and September 2020, while the grey literature was searched in April 2020. This scoping review focused on the recommendations of YAs with chronic conditions who have transitioned from paediatric to adult healthcare, in any setting (eg, hospital, clinic or community), and across all sectors (eg, health, education and social services). RESULTS Eighteen studies met inclusion criteria for this review. These studies included YAs with 14 different chronic conditions, receiving primary health services in North America (67%) and Europe (33%). YAs' recommendations for improving the transition from paediatric to adult healthcare (n=number of studies reported) included: improving continuity of care (n=12); facilitating patient-centred care (n=9); building strong support networks (n=11) and implementing transition education preparedness training (n=7). CONCLUSION Review findings can benefit service delivery by addressing important barriers to health, education, and social services for youth transitioning to adult healthcare.
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Affiliation(s)
- Monique Cassidy
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alex Goudreau
- UNB Libraries, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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Morisaki-Nakamura M, Suzuki S, Kobayashi A, Kita S, Sato I, Iwasaki M, Hirata Y, Sato A, Oka A, Kamibeppu K. Efficacy of a Transitional Support Program Among Adolescent Patients With Childhood-Onset Chronic Diseases: A Randomized Controlled Trial. Front Pediatr 2022; 10:829602. [PMID: 35433550 PMCID: PMC9010051 DOI: 10.3389/fped.2022.829602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
It is recommended that patients with childhood-onset chronic diseases (CCD) be transferred from pediatric to adult healthcare systems when they reach adulthood. Transitional support helps adolescents with CCD transition smoothly. Transition readiness is one of the key concepts to assess the efficacy of transitional support programs. This study aims to investigate the effect of a transitional support program on transition readiness, self-esteem, and independent consciousness among Japanese adolescents with various CCD using a randomized controlled trial. Adolescents with CCD aged 12-18 years participated in a randomized controlled trial evaluating the efficacy of a transitional support program. The patients in the intervention group visited transitional support outpatient clinics twice. They answered questionnaires regarding their disease and future perspectives to healthcare professionals and independently made a short summary of their disease. All the participants answered the questionnaires four times. Eighty patients participated in this study. Among those in the intervention group, transition readiness within one, three, and 6 months after interventions, and self-esteem within 1 month after interventions were higher than that of the control group. The scores on the "dependence on parents" subscale at 6 months after interventions were lower for the intervention group as compared to the control group. This program is expected to help patients transition smoothly from pediatric to adult healthcare systems.
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Affiliation(s)
- Mayumi Morisaki-Nakamura
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seigo Suzuki
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatric Nursing, Tokyo Medical University, Tokyo, Japan
| | - Asuka Kobayashi
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Iori Sato
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwa Iwasaki
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsushi Sato
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Oka
- Saitama Children’s Medical Center, Saitama, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Dahir K, Dhaliwal R, Simmons J, Imel EA, Gottesman GS, Mahan JD, Prakasam G, Hoch AI, Ramesan P, Díaz-González de Ferris M. Health Care Transition From Pediatric- to Adult-Focused Care in X-linked Hypophosphatemia: Expert Consensus. J Clin Endocrinol Metab 2022; 107:599-613. [PMID: 34741521 PMCID: PMC8852209 DOI: 10.1210/clinem/dgab796] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT X-linked hypophosphatemia (XLH) is an inherited skeletal disorder that can lead to lifelong deleterious musculoskeletal and functional consequences. Although often perceived as a childhood condition, children and adults both experience the negative effects of XLH. Adolescents and young adults (AYAs) benefit from effective health care transition (HCT) preparation to support the transfer from pediatric- to adult-focused care. Whereas transition timelines, milestones, and educational tools exist for some chronic conditions, they do not meet the unique needs of patients with XLH. EVIDENCE ACQUISITION To produce the first expert recommendations on HCT preparation for AYAs with XLH developed by clinical care investigators and transition experts, a formal literature search was conducted and discussed in an advisory board meeting in July 2020. A modified Delphi method was used to refine expert opinion and facilitate a consensus position. EVIDENCE SYNTHESIS We identified the need for psychosocial and access-related resources for disease education, genetic counseling, family planning, and AYA emancipation from caregiver-directed care. Additionally, we recognized that it is necessary to facilitate communication with patients through channels familiar and accessible to AYAs and teach patients to advocate for their health care/access to specialists. CONCLUSION Clear HCT preparation guidelines and treatment-related goals are defined. Individualized timelines and practical strategies for HCT preparation are proposed to optimize health outcomes resulting from continuous clinical care throughout the patient lifecycle. We provide an expert consensus statement describing a tailored HCT preparation program specifically for AYAs with XLH to aid in the effective transfer from pediatric- to adult-focused health care.
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Affiliation(s)
- Kathryn Dahir
- Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Ruban Dhaliwal
- SUNY Upstate Medical University, Syracuse, New York 13210, USA
| | - Jill Simmons
- Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Erik A Imel
- Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Gary S Gottesman
- Shriners Hospitals for Children–St Louis, St Louis, Missouri 63110,USA
| | - John D Mahan
- Nationwide Children’s Hospital, Columbus, Ohio 43205, USA
| | | | - Allison I Hoch
- Ultragenyx Pharmaceutical Inc, Novato, California 94949, USA
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12
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Berard R, Batthish M. Addressing Healthcare Quality in Juvenile Idiopathic Arthritis With a Universal Access Program. J Rheumatol 2021; 48:1635-1638. [PMID: 34334363 DOI: 10.3899/jrheum.210658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this issue of The Journal of Rheumatology, Concha, et al 1 describe the effects of the implementation, in 2010, of a national, legally mandated universal access program (Explicit Health Guarantees [GES]) for guaranteed juvenile idiopathic arthritis ( JIA) diagnosis and treatment in Chile. The GES program guarantees that evaluation by a specialist takes place less than 30 days after referral from primary care, and that treatment must start no later than 7 days after confirmation of diagnosis.
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Affiliation(s)
- Roberta Berard
- R. Berard, MD, MSc, Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario; M. Batthish, MD, MSc, Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. The authors have no conflicts of interest relevant to this editorial. Address correspondence to Dr. M. Batthish, Division of Rheumatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Michelle Batthish
- R. Berard, MD, MSc, Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario; M. Batthish, MD, MSc, Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. The authors have no conflicts of interest relevant to this editorial. Address correspondence to Dr. M. Batthish, Division of Rheumatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
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13
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Johnson LE, Lee MJ, Turner-Moore R, Grinsted Tate LR, Brooks AJ, Tattersall RS, Jones GL, Lobo AJ. Systematic Review of Factors Affecting Transition Readiness Skills in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:1049-1059. [PMID: 33252669 DOI: 10.1093/ecco-jcc/jjaa245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease [IBD] diagnosed before adulthood is increasing worldwide. Transition from paediatric to adult health care requires certain skills. The aim of this study was to identify factors affecting these skills. METHODS This review was registered on the PROSPERO database [CRD42019152272]. Inclusion criteria were: 1] studies of factors affecting transition readiness skills in patients with IBD; 2] written in English; 3] published since 1999. MEDLINE, CINAHL, and PsychINFO databases were searched between 1999 and 2019. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. RESULTS Searches identified 822 papers. Sixteen papers were included. Age was positively associated with skills including disease knowledge and performing self-management behaviours [14 studies]. Improvement often occurs at 18; however, skill deficiency may still remain. Increased self-efficacy [confidence] was associated with greater disease knowledge and performing self-management behaviours [three studies]. Self-efficacy was positively correlated with transition duration [two studies] and health-related quality of life [r = 0.57, p <0.001] [one study], negatively correlated with depression [r = -0.57, p <0.001] and anxiety [r = -0.23, p = 0.03] [one study], and was associated with higher education level [two studies] and a family history of IBD [one study]. Females had higher self-management scores [three studies], and greater health care satisfaction was significantly associated with higher knowledge [one study]. Greater transition communication improved knowledge, self-management, and overall transition readiness [two studies]. CONCLUSIONS Potentially modifiable factors have been identified that could be supported in the transitioning IBD population, to improve transition readiness. Identification of those with non-modifiable characteristics associated with poor readiness may aid targeted support.
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Affiliation(s)
| | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rhys Turner-Moore
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Alenka J Brooks
- Academic Department of Gastroenterology, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel S Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children's Hospitals, Sheffield, UK
| | - Georgina L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Alan J Lobo
- Academic Department of Gastroenterology, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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14
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Nadarajah A, Dimitropoulos G, Grant C, Webb C, Couturier J. Impending Transition From Pediatric to Adult Health Services: A Qualitative Study of the Experiences of Adolescents With Eating Disorders and Their Caregivers. Front Psychiatry 2021; 12:624942. [PMID: 34122164 PMCID: PMC8187588 DOI: 10.3389/fpsyt.2021.624942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background: There is a dearth of research that identifies pediatric to adult health care transition practices that yield positive outcomes for young people with eating disorders (EDs). Further, adolescent and caregiver perspectives are poorly understood and underrepresented in the literature. The purpose of this study, focused on the impending transition from pediatric to adult health services, was twofold: (a) to identify adolescent and caregiver perspectives of barriers and facilitators of a successful transition for adolescents with EDs; and (b) to understand adolescent and caregiver suggestions of interventions for a successful transition. Design/Method: We recruited five adolescents with EDs who were about to be transferred out of pediatric care as well as their caregivers. We conducted a qualitative study in accordance with the principles of interpretive description. Through conducting semi-structured, in-depth interviews with adolescents and caregivers, we investigated their knowledge about health system transitions and anticipated experiences. We identified participants' perceptions of barriers and facilitators regarding a successful transition, as well as their recommendations to improve the transfer of care. Results: Participants possessed a limited understanding of transition processes despite the fact that they were about to be transferred to adult care. From our analyses, the following themes were identified as barriers during the transition process: re-explaining information to adult healthcare providers, lack of professional support while waiting for uptake into the adult health system, and late timing of transition of care discussions. Both adolescents and caregivers expressed that involvement of parents and the pediatric healthcare team helped to facilitate a successful transfer of care. In addition, participants expressed that the implementation of a Transition Coordinator and Transition Passport would be helpful in facilitating a seamless transfer between systems of care. Discussion: These findings demonstrate a significant gap in the system and highlight the importance of developing interventions that facilitate a successful transition. The themes that emerged from this study can inform the development of interventions to facilitate a coordinated transition from pediatric to adult health services for adolescents with EDs.
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Affiliation(s)
| | | | - Christina Grant
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jennifer Couturier
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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15
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McColl J, Semalulu T, Beattie KA, Alam A, Thomas S, Herrington J, Gorter JW, Cellucci T, Garner S, Heale L, Matsos M, Batthish M. Transition Readiness in Adolescents With Juvenile Idiopathic Arthritis and Childhood-Onset Systemic Lupus Erythematosus. ACR Open Rheumatol 2021; 3:260-265. [PMID: 33711192 PMCID: PMC8063142 DOI: 10.1002/acr2.11237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The transition from pediatric to adult rheumatology care represents a particularly vulnerable time for patients with juvenile idiopathic arthritis (JIA) and childhood‐onset systemic lupus erythematosus (cSLE). Improving self‐management skills is important in optimizing health care transition. The study’s objectives were to 1) examine variability in transition readiness of adolescents and young adults within and between different ages, sexes, and disease types; 2) determine the association between age and transition readiness; and 3) identify specific challenges to transition readiness for adolescents. Methods Over 1 year, patients 14 to 20 years of age with JIA or cSLE were recruited from pediatric transition and young adult clinics at a single academic institution. Participants completed the 14‐item Transition‐Q at a single time point. Total scores range from 0 to 100; higher scores indicate greater health care self‐management skills as a proxy for transition readiness. Descriptive statistics summarized patient characteristics and Transition‐Q scores for the population. Regression analyses determined the association between age, sex, and disease type and Transition‐Q score. Results Among 70 participants, 61 had JIA and 9 cSLE (mean disease duration 4.6 years). The mean (SD) total Transition‐Q score was 59.8 (14.9). Age was significantly associated with Transition‐Q score (standardized β = 0.372l P = 0.002). The most commonly reported challenges were seeing the physician alone (without parents), making one’s own appointments, picking up prescriptions, and independent transportation for appointments. Conclusion Transition readiness appears to increase with patient age. There is significant variability in Transition‐Q scores between patients of the same age, suggesting that an individualized approach to improving self‐management skills is necessary.
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Affiliation(s)
| | | | | | - Arzoo Alam
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- McMaster University, Hamilton, Ontario, Canada
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16
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Shamambo L, Niemann M, Jonas R, Douglass LM. Mentorship for Youth With Chronic Neurological Conditions in the Digital Era: An Innovative Approach to Supporting Transition. Semin Pediatr Neurol 2020; 36:100857. [PMID: 33308521 DOI: 10.1016/j.spen.2020.100857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article aims to highlight the impact of mentorship on the lives of youth with chronic conditions (YCC). Here, we focus on the concepts of mentoring and technology as a means to support transitioning YCC. This is in response to the urgent need for effective healthcare transition strategies and the increasing importance and prevalence of technology in healthcare and health systems. This article also highlights an e-mentoring program for youth with epilepsy, an intervention that bridges the fields of mentoring, transition, and technology. While there is need for further research in these areas, consideration of these factors are highly relevant to the effort to improve health for this generation of YCC.
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Affiliation(s)
- Luwi Shamambo
- Division of Child Neurology, Boston Medical Center, Boston, MA.
| | - Madeline Niemann
- Division of Child Neurology, Department of Pediatrics, Boston Medical Center, Boston, MA
| | - Rinat Jonas
- Division of Child Neurology, Department of Pediatrics, Boston Medical Center, Boston, MA
| | - Laurie M Douglass
- Division of Child Neurology, Department of Pediatrics, Boston Medical Center, Boston, MA
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17
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Varty M, Speller-Brown B, Phillips L, Kelly KP. Youths' Experiences of Transition from Pediatric to Adult Care: An Updated Qualitative Metasynthesis. J Pediatr Nurs 2020; 55:201-210. [PMID: 32966960 PMCID: PMC7722194 DOI: 10.1016/j.pedn.2020.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
PROBLEM Improvements in chronic disease management has led to increasing numbers of youth transitioning to adult healthcare. Poor transition can lead to high risks of morbidity and mortality. Understanding adolescents and young adults (AYA) perspectives on transition is essential to developing effective transition preparation. The aim of this metasynthesis was to synthesize qualitative studies assessing the experiences and expectations of transition to adult healthcare settings in AYAs with chronic diseases to update work completed in a prior metasynthesis by Fegran, Hall, Uhrenfeldt, Aagaard, and Ludvigsen (2014). ELIGIBILITY CRITERIA A search of PubMed, Medline, PsycINFO, and CINAHL was conducted to gather articles published after February 2011 through June 2019. SAMPLE Of 889 articles screened, a total of 33 articles were included in the final analysis. RESULTS Seven main themes were found: developing transition readiness, conceiving expectations based upon pediatric healthcare, transitioning leads to an evolving parent role, transitioning leads to an evolving youth role, identifying barriers, lacking transition readiness, and recommendations for improvements. CONCLUSIONS Findings of this metasynthesis reaffirmed previous findings. AYAs continue to report deficiencies in meeting the Got Transition® Six Core Elements. The findings highlighted the need to create AYA-centered transition preparation which incorporate support for parents. IMPLICATIONS Improvements in transition preparation interventions need to address deficiencies in meeting the Got Transition® Six Core Elements. More research is needed to identify and address barriers implementing the transition process.
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Affiliation(s)
- Maureen Varty
- UCHealth University of Colorado Hospital, CO, United States of America; University of Missouri-Columbia Sinclair School of Nursing, S235 School of Nursing, University of Missouri, MO, United States of America.
| | - Barbara Speller-Brown
- Children's National Hospital, DC, United States of America; The George Washington University, DC, United States of America.
| | - Leslie Phillips
- Children's National Hospital, DC, United States of America; The George Washington University, DC, United States of America.
| | - Katherine Patterson Kelly
- Children's National Hospital, DC, United States of America; The George Washington University, DC, United States of America.
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Abstract
Because of effective treatment and prolonged survival, thousands of young adult people living with HIV will need to transfer their health care to adult care providers. However, many lack basic essential skills and are not prepared for this transition. Many providers do not assess transition readiness on a regular basis. Validated transition readiness assessment tools can help providers guide interventions based on identified skill and knowledge deficits. Our purpose was to describe the impact of incorporating a validated Transition Readiness Assessment Questionnaire (TRAQ) into clinical practice. A retrospective chart review of 48 patients with HIV, ages 22-24 years, showed that the use of the TRAQ significantly affected provider interventions in the area of medication management (odds ratio: 0.02). Overall, the use of the TRAQ did not increase clinical interventions; however, it enabled providers to identify knowledge or skill deficits not previously addressed and to plan future clinical interventions to meet individual patient needs.
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19
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Smith LA, Critoph DJ, Hatcher HM. How Can Health Care Professionals Communicate Effectively with Adolescent and Young Adults Who Have Completed Cancer Treatment? A Systematic Review. J Adolesc Young Adult Oncol 2020; 9:328-340. [DOI: 10.1089/jayao.2019.0133] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Luke A.M. Smith
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Deborah J. Critoph
- Clinical Communications Skills Department, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Helen M. Hatcher
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Oncology and Addenbrookes Hospital, Cambridge University Hospitals NHS Trust Foundation, Cambridge, United Kingdom
- TYA Cancer Service, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust Foundation, Cambridge, United Kingdom
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20
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Quintero J, Juampérez J, Mercadal-Hally M, Larrarte M, Vidal L, Castells L, Charco R. Transition to Adult Care for Pediatric Liver Transplant Recipients. Transplant Proc 2020; 52:1496-1499. [PMID: 32247593 DOI: 10.1016/j.transproceed.2020.02.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
Abstract
In recent years a growing number of pediatric liver transplant recipients are reaching adulthood and are transferred to an adult team. Because pediatric to adult transition has become a common event with many particularities, specific clinical protocols are needed to guide professionals in this process. Transition must be seen as a complex process of high vulnerability for the patient. The incorrect assumption that the transition process is only a bureaucratic transfer of information leads to inappropriate transition procedures that result in young patients not ready to move to adult units with guaranteed success. To ensure this success, a correct coordination and transmission of the information, accompaniment by the health professional during the whole process, and the empowerment of the patient are required. To have a successful transition, a person within the pediatric team must be in charge of the process (named worker).
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Affiliation(s)
- Jesús Quintero
- Pediatric Hepatology and Liver Transplant Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Javier Juampérez
- Pediatric Hepatology and Liver Transplant Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Mercadal-Hally
- Pediatric Hepatology and Liver Transplant Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mauricio Larrarte
- Pediatric Hepatology and Liver Transplant Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lis Vidal
- Pediatric Hepatology and Liver Transplant Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ramon Charco
- HPB Surgery and Transplants, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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21
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Harnessing the Electronic Health Record to Distribute Transition Services to Adolescents With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2020; 70:200-204. [PMID: 31978017 DOI: 10.1097/mpg.0000000000002516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate feasibility and utility of an electronic health record (EHR) activity to assess transitional readiness, deliver services to meet individual needs, and to track patient progress. METHODS We developed a Transition EHR activity (TEA) to track patients through a standardized process where transition readiness is annually assessed and services distributed based on need. The process assesses transition skills starting at age 12 years and sets goals through shared decision-making, delivers resources according to need, reviews patients' personal medical histories, and documents healthcare transfer to adult gastroenterology. We piloted TEA among patients with inflammatory bowel disease (IBD) ages ≥12 years. Distribution to patients was measured and tolerability assessed via patient self-report evaluations. RESULTS Since launch, TEA has been distributed to all eligible patients (N = 53) with a median age of 16 (14,18) years (median [IQR]), 62% male, 58% white, 26% Hispanic at our weekly dedicated IBD clinic. All have performed the transition skills' self-assessment and practicum, and set transition goals with their healthcare provider. Of these individuals, 41 (77%) participated in survey feedback. On a utility rating scale of 0 (not helpful at all) to 10 (very helpful), patients reported median (IQR) utility scores of 8 (7,10) for the transition readiness assessment, 9 (7,10) for transition resources provided, and 9 (7,10) for the medical history summary. Most (91%) would recommend TEA to other patients. CONCLUSIONS TEA standardized delivery of resources among pediatric IBD patients and was well received and friendly to clinical workflow.
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22
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Suzuki S, Kita S, Morisaki M, Kikuchi R, Sato I, Iwasaki M, Otomo E, Sekiguchi H, Hirata Y, Sato A, Sugiyama M, Kamibeppu K. Nurses' perceptions regarding transitional care for adolescents and young adults with childhood-onset chronic diseases. Jpn J Nurs Sci 2020; 17:e12323. [PMID: 31943766 DOI: 10.1111/jjns.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/11/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
AIM Nurses are expected to have a role in the transition of care from pediatric to adult medical practices for adolescents and young adults with childhood-onset chronic diseases. This study compares the experience, knowledge, and perceptions regarding the ideal care among adult unit and pediatric nurses regarding the transition to adult care for those with childhood-onset chronic diseases. METHODS A cross-sectional study using self-report questionnaires was conducted with nurses in a tertiary hospital in Tokyo. Questions were generated based on a literature review and expert discussion. Data from 1,064 participants were analyzed (adult unit nurses: n = 959, 90.1%; pediatric nurses: n = 105, 9.9%). RESULTS Among 623 adult unit nurses who had care experience for adult patients with a childhood-onset chronic disease, 458 nurses (73.6%) were unaware of the concept of transitional care. As the obstructive factors for transition, pediatric nurses recognized problems in healthcare providers' attitudes and lack of transitional care coordinators, while the adult unit nurses emphasized the patients' wishes to continue to receive pediatric healthcare. Most adult unit nurses expected pediatric nurses to function as transitional care coordinators. CONCLUSION Adult unit and pediatric nurses had different perceptions of the barriers in transitioning children with chronic diseases to adult care. It is important to have educational programs focusing on transitional care for all nurses, both to enable pediatric nurses to improve transition readiness of children with chronic diseases and to offer adult patients with a childhood-onset chronic disease continuing support through adult unit nurses.
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Affiliation(s)
- Seigo Suzuki
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayumi Morisaki
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Kikuchi
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Iori Sato
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwa Iwasaki
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Eiko Otomo
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Sekiguchi
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Sato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sugiyama
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Frawley JE, Hebert RS. Seriously Ill Pediatric Patients Who Transition to Adulthood #346. J Palliat Med 2019; 21:257-258. [PMID: 29393773 DOI: 10.1089/jpm.2017.0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Varty M, Popejoy LL. A Systematic Review of Transition Readiness in Youth with Chronic Disease. West J Nurs Res 2019; 42:554-566. [PMID: 31530231 DOI: 10.1177/0193945919875470] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The transition of chronically ill adolescents and young adults to adult health care is poorly managed, leading to poor outcomes due to insufficient disease knowledge and a lack of requisite skills to self-manage their chronic disease. This review analyzed 33 articles published between 2009 and 2019 to identify factors associated with transition readiness in adolescents and young adults with chronic diseases, which can be used to design effective interventions. Studies were predominantly cross-sectional survey designs that were guided by interdisciplinary research teams, assessed adolescents and young adults ages 12-26 years, and conducted in the outpatient setting. Modifiable factors, including psychosocial and self-management/transition education factors, and non-modifiable factors, including demographic/ecological and disease factors, associated with transition readiness were identified. Further research is necessary to address gaps identified in this review prior to intervention development, and there is a need for additional longitudinal studies designed to provide perspective on how transition readiness changes over time.
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Affiliation(s)
- Maureen Varty
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Lori L Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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25
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Kim G, Choi EK, Kim HS, Kim H, Kim HS. Healthcare Transition Readiness, Family Support, and Self-management Competency in Korean Emerging Adults with Type 1 Diabetes Mellitus. J Pediatr Nurs 2019; 48:e1-e7. [PMID: 30929981 DOI: 10.1016/j.pedn.2019.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/16/2019] [Accepted: 03/16/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The current study investigated factors related to healthcare transition readiness, including family support and self-management competency, in emerging adults with Type 1 diabetes mellitus (T1DM). DESIGN AND METHODS A cross-sectional survey was conducted with 87 individuals, aged 16-24 years. Participants were recruited both from the outpatient clinic of Severance Children's Hospital, and an online self-help group for emerging adults with T1DM in South Korea. Participants reported perceived levels of family support, self-management competency, and healthcare transition readiness through a structured questionnaire. RESULTS Healthcare transition readiness was positively correlated with family support (r = 0.257, p = .016) and self-management competency (r = 0.606, p < .001). Multivariate linear regression analyses revealed that only self-management competency was a significant factor associated with healthcare transition readiness (β = 0.699, p < .001). CONCLUSIONS For emerging adults with T1DM, ongoing family involvement in diabetes care and enhanced self-management competency can strengthen their healthcare transition readiness. Furthermore, primary factors associated with healthcare transition readiness in the present study were identified as self-management competency and participants' age. PRACTICE IMPLICATIONS Healthcare providers should assess and enhance healthcare transition readiness in emerging adults with T1DM. A primary method of addressing transition readiness is helping people strengthen their self-management competency.
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Affiliation(s)
- Gayeong Kim
- Yonsei University College of Nursing, Republic of Korea
| | - Eun Kyoung Choi
- Yonsei University College of Nursing, Republic of Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea.
| | - Hee Soon Kim
- Yonsei University College of Nursing, Republic of Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea
| | - Heejung Kim
- Yonsei University College of Nursing, Republic of Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Republic of Korea
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26
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Ödling M, Jonsson M, Janson C, Melén E, Bergström A, Kull I. Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma. J Asthma 2019; 57:1119-1127. [PMID: 31328590 DOI: 10.1080/02770903.2019.1640726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Asthma is a multifaceted disease, and severe asthma is likely to be persistent. Patients with severe asthma have the greatest burden and require more healthcare resources than those with mild-to-moderate asthma. The majority with asthma can be managed in primary care, while some patients with severe asthma warrant referral for expert advice regarding management. In adolescence, this involves a transition from pediatric to adult healthcare. This study aimed to explore how young adults with severe asthma experienced the transition process.Methods: Young adults with severe asthma were recruited from an ongoing Swedish population-based cohort. Qualitative data were obtained through individual interviews (n = 16, mean age 23.4 years), and the transcribed data were analyzed with systematic text condensation.Results: Four categories emerged based on the young adults' experiences: "I have to take responsibility", "A need of being involved", "Feeling left out of the system", and "Lack of engagement". The young adults felt they had to take more responsibility, did not know where to turn, and experienced fewer follow-ups in adult healthcare. Further, they wanted healthcare providers to involve them in self-management during adolescence, and in general, they felt that their asthma received insufficient support from healthcare providers.Conclusions: Based on how the young adults with severe asthma experienced the transition from pediatric to adult healthcare, it is suggested that healthcare providers together with each patient prepare, plan, and communicate in the transition process for continued care in line with transition guidelines.
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Affiliation(s)
- Maria Ödling
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Marina Jonsson
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Anna Bergström
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
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Low JK, Manias E. Use of Technology-Based Tools to Support Adolescents and Young Adults With Chronic Disease: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2019; 7:e12042. [PMID: 31322129 PMCID: PMC6670279 DOI: 10.2196/12042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/30/2019] [Accepted: 06/10/2019] [Indexed: 01/15/2023] Open
Abstract
Background With the large amount of material that is readily available on the internet, there are endless opportunities for electronic health–literate patients to obtain and learn new information. Although novel, a Web- or mobile-based program can be a powerful way to engage adolescents and young adults (AYAs). The ongoing engagement of AYAs with chronic disease is vital not only to empower them but also to ensure a smooth transition from pediatric to adult health care. Objective This study aimed to evaluate the current evidence on Web- or mobile-based interventions designed for AYAs. Methods This review was registered with PROSPERO: CRD42018096487. A systematic search of MEDLINE Complete, EMBASE, and CINAHL Complete was conducted on April 10, 2019, for studies that examined the perspectives of transition-age patients about technology-based interventions, the process involved in intervention development, or the evaluation of intervention efficacy. For each study, the comprehensiveness of reporting was appraised. The Downs and Black checklist was used for intervention efficacy trials, the Standards for Reporting Qualitative Research checklist was used for qualitative work, and a 16-item tool developed by Tong et al was used for questionnaire research. Results The search uncovered 29 relevant studies, which included qualitative studies (n=14), intervention efficacy studies (n=7), questionnaire studies (n=4), mixed qualitative and questionnaire studies (n=2), and a mixed qualitative and pilot randomized controlled trial study (n=1). The reporting comprehensiveness score of questionnaires was rated considerably lower (n=6, 13%-57% [2/16-8/14]) than the scores of intervention efficacy trials (n=8, 48%-85% [13/27-23/27]) and qualitative research (n=17, 40%-93% [8.5/21-19.5/21]). AYAs were receptive to obtaining information via a website or mobile app. An intervention was more likely to be perceived as useful by AYAs when there was a concerted effort to involve AYAs and subject matter experts in the process of intervention design, as opposed to relying solely on the AYAs or the experts alone. The preferred medium of intervention delivery varied greatly for AYAs, ranging from static text to audiovisual materials. However, AYAs considered being concise was the most important aspect. Across different conditions, AYAs were interested in receiving information on diverse topics, such as anxiety and stress management, dealing with insurance, and having social relationships. Patients also requested for disease-specific information, such as weather forecasts and pollen levels for patients with asthma and information related to the pretransplant period for organ transplant recipients. Meta-analyses showed no significant group differences across time on quality of life, self-efficacy, and self-management. Conclusions Owing to the lack of intervention efficacy trials, no conclusion can be drawn if an intervention delivered via a mobile app is better than that delivered via a website. However, through this systematic review, it is confirmed that AYAs were receptive to receiving medical information electronically.
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Affiliation(s)
- Jac Kee Low
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Australia
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28
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Weitzman ER, Magane KM, Wisk LE, Allario J, Harstad E, Levy S. Alcohol Use and Alcohol-Interactive Medications Among Medically Vulnerable Youth. Pediatrics 2018; 142:peds.2017-4026. [PMID: 30228168 PMCID: PMC6317570 DOI: 10.1542/peds.2017-4026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite their medical vulnerability, youth with chronic medical conditions (YCMCs) drink at levels commensurate with healthy youth. However, information about the prevalence of alcohol use among YCMCs who take alcohol-interactive (AI) medications is scant. To address gaps and inform interventions, we quantified simultaneous exposure to alcohol use and AI medications among YCMCs, hypothesizing that AI exposure would be associated with lower alcohol consumption and mediated by perceptions of alcohol-medication interference. METHODS Adolescents with type 1 diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention-deficit/hyperactivity disorder, or inflammatory bowel disease completed an electronic survey. We measured the prevalence of exposure to AI medications and the associations with past-year alcohol use as well as binge drinking and total consumption volume in the past 3 months using multivariate regression to estimate the odds of alcohol use given AI medication exposure and perceptions of interference. RESULTS Of 396 youth, 86.4% were on AI medications, of whom, 35.4% reported past-year alcohol use (46.3% among those who were not on AI medications). AI medication use was associated with 43% lower odds of past-year alcohol use (adjusted odds ratio: 0.57; 95% confidence interval: 0.39-0.85) and lower total consumption (β = -.43; SE = 0.11; P < .001). Perceptions of alcohol-medication interference partially mediated the relationship between AI medication exposure and past-year alcohol use (Sobel test P = .05). CONCLUSIONS Many YCMCs reported using alcohol; however, drinking was less likely among those who were taking AI medications. Perceptions about alcohol-medication interference mediated the association between drinking and AI medication exposure, suggesting the potential salience of interventions that emphasize alcohol-related risks.
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Affiliation(s)
- Elissa R. Weitzman
- Divisions of Adolescent and Young Adult Medicine and,Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts; and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Lauren E. Wisk
- Divisions of Adolescent and Young Adult Medicine and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Elizabeth Harstad
- Developmental Medicine, and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sharon Levy
- Developmental Medicine, and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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29
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Catena G, Rempel GR, Kovacs AH, Rankin KN, Muhll IV, Mackie AS. "Not such a kid thing anymore": Young adults' perspectives on transfer from paediatric to adult cardiology care. Child Care Health Dev 2018; 44:592-598. [PMID: 29574895 DOI: 10.1111/cch.12564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Transfer of adolescents with congenital heart disease from paediatric cardiology providers to specialized adult congenital heart disease (ACHD) care providers is becoming a standard practice. However, some paediatric cardiologists continue to provide care for their patients into adult life. Little is known about the perspectives of young adult patients who have been transferred to ACHD clinics versus those who continue to receive their cardiology care in paediatric settings. METHODS Content and thematic analysis of structured telephone interviews with 21 young adults age 18-25 (13 transferred to ACHD clinic and 8 who had not transferred) was conducted to identify similarities and differences in patient characteristics of those in ACHD versus paediatric settings. RESULTS There were no appreciable differences in gender, age, heart disease type, and independence between those transferred to ACHD care versus those not transferred. Participants in both groups were aware of differences between the paediatric and ACHD care settings and providers, with some favouring the familiarity offered by the paediatric setting and providers. Participants had varying views on parental involvement in their care; most of them had attended clinic appointments on their own. Those who had transferred to ACHD care acknowledged that it would take time to adjust to new relationships. Positive perspectives on actual or anticipated transfer to ACHD care included a growing sense of autonomy and responsibility, as well as access to reproductive information relevant to ACHD patients. CONCLUSIONS The absence of patient characteristics distinguishing those in ACHD care versus those still followed in paediatric care suggests that system, provider, and parent factors, rather than patient factors, may account for patients' perspectives on transfer to ACHD care.
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Affiliation(s)
- G Catena
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - G R Rempel
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - A H Kovacs
- Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, University of Toronto, Toronto, ON, Canada
| | - K N Rankin
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - I V Muhll
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - A S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Division of Cardiology, Stollery Children's Hospital, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
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30
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Michaud S, Dasgupta K, Bell L, Yale JF, Anjachak N, Wafa S, Nakhla M. Adult care providers' perspectives on the transition to adult care for emerging adults with Type 1 diabetes: a cross-sectional survey. Diabet Med 2018; 35:846-854. [PMID: 29577410 DOI: 10.1111/dme.13627] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/23/2022]
Abstract
AIMS To assess adult diabetes care providers' current transition practices, knowledge about transition care, and perceived barriers to implementation of best practices in transition care for emerging adults with Type 1 diabetes mellitus. METHODS We administered a 38-item web-based survey to adult diabetes care providers identified through the Québec Endocrinologist Medical Association and Diabetes Québec. RESULTS Fifty-three physicians responded (35%). Fewer than half of all respondents (46%) were familiar with the American Diabetes Association's transition care position statement. Approximately one-third of respondents reported a gap of >6 months between paediatric and adult diabetes care. Most (83%) believed communication with the paediatric team was adequate; however, only 56% reported receiving a medical summary and 2% a psychosocial summary from the paediatric provider. Respondents believed that the paediatric team should improve emerging adults' preparation for transition care by developing their self-management skills and improve teaching about the differences between paediatric and adult-oriented care. Only 31% had a system for identifying emerging adults lost to follow-up in adult care. Perceived barriers included difficulty accessing psychosocial services, emerging adults' lack of motivation, and inadequate transition preparation. Most (87%) were interested in having additional resources, including a self-care management tool and a registry to track those lost to follow-up. CONCLUSIONS Our findings highlight the need to better engage adult care providers into transition care practices. Despite adult physicians' interest in transition care, implementation of transition care recommendations and resources in clinical care remains limited. Enhanced efforts are needed to improve access to mental health services within the adult healthcare setting.
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Affiliation(s)
- S Michaud
- Department of Paediatrics, Montreal Children's Hospital, McGill University
| | - K Dasgupta
- Research Institute of the McGill University Health Centre
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - L Bell
- Department of Paediatrics, Montreal Children's Hospital, McGill University
| | - J-F Yale
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - N Anjachak
- Research Institute of the McGill University Health Centre
| | - S Wafa
- Research Institute of the McGill University Health Centre
| | - M Nakhla
- Department of Paediatrics, Montreal Children's Hospital, McGill University
- Research Institute of the McGill University Health Centre
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31
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The Health Care Transition of Youth With Liver Disease Into the Adult Health System: Position Paper From ESPGHAN and EASL. J Pediatr Gastroenterol Nutr 2018; 66:976-990. [PMID: 29570559 DOI: 10.1097/mpg.0000000000001965] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical advances have dramatically improved the long-term prognosis of children and adolescents with once-fatal hepatobiliary diseases. However, there is no generally accepted optimal pathway of care for the transition from paediatric care to the adult health system. AIM The purpose of this position paper is to propose a transition process for young people with paediatric onset hepatobiliary diseases from child-centred to adult-centred healthcare services. METHODS Seventeen ESPGHAN/EASL physicians from 13 countries (Austria, Belgium, France, Germany, Hungary, Italy, the Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and United Kingdom) formulated and answered questions after examining the currently published literature on transition from childhood to adulthood. PubMed and Google Scholar were systematically searched between 1980 and January 2018. Quality of evidence was assessed by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) system. Expert opinions were used to support recommendations whenever the evidence was graded weak. All authors voted on each recommendation, using the nominal voting technique. RESULTS We reviewed the literature regarding the optimal timing for the initiation of the transition process and the transfer of the patient to adult services, principal documents, transition multi-professional team components, main barriers, and goals of the general transition process. A transition plan based on available evidence was agreed focusing on the individual young people's readiness and on coordinated teamwork, with transition monitoring continuing until the first year of adult services.We further agreed on selected features of transitioning processes inherent to the most frequent paediatric-onset hepatobiliary diseases. The discussion highlights specific clinical issues that will probably present to adult gastrointestinal specialists and that should be considered, according to published evidence, in the long-term tracking of patients. CONCLUSIONS Transfer of medical care of individuals with paediatric onset hepatobiliary chronic diseases to adult facilities is a complex task requiring multiple involvements of patients and both paediatric and adult care providers.
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Gumidyala AP, Greenley RN, Plevinsky JM, Poulopoulos N, Cabrera J, Lerner D, Noe JD, Walkiewicz D, Werlin S, Kahn SA. Moving On: Transition Readiness in Adolescents and Young Adults With IBD. Inflamm Bowel Dis 2018; 24:482-489. [PMID: 29462383 DOI: 10.1093/ibd/izx051] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) often begins early in life. Adolescents and young adults (AYA) with IBD have to acquire behaviors that support self-care, effective healthcare decision-making, and self-advocacy to successfully transition from pediatric to adult health care. Despite the importance of this critical time period, limited empirical study of factors associated with transition readiness in AYA exists. This study aimed to describe transition readiness in a sample of AYA with IBD and identify associated modifiable and nonmodifiable factors. METHODS Seventy-five AYA (ages 16-20) and their parents participated. AYA and parents reported on demographics, patient-provider transition-related communication, and transition readiness. AYA self-reported on disease self-efficacy. Disease information was abstracted from the medical record. RESULTS Deficits in AYA responsibility were found in knowledge of insurance coverage, scheduling appointments, and ordering medication refills. Older AYA age, higher AYA disease-management self-efficacy, and increased patient-provider transition communication were each associated with higher overall transition readiness and AYA responsibility scores. Regression analyses revealed that older AYA age and increased patient-provider transition-related communication were the most salient predictors of AYA responsibility for disease management and overall transition readiness across parent and AYA reports. CONCLUSIONS AYA with IBD show deficits in responsibility for their disease management that have the potential to affect their self-management skills. Findings suggest provider communication is particularly important in promoting transition readiness. Additionally, it may be beneficial to wait to transition patients until they are older to allow them more time to master skills necessary to responsibly manage their own healthcare.
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Affiliation(s)
| | - Rachel N Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jill M Plevinsky
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Natasha Poulopoulos
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jose Cabrera
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Diana Lerner
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Joshua D Noe
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Dorota Walkiewicz
- Department of Pediatric Gastroenterology, UW Health, American Family Children's Hospital, Madison, WI
| | - Steven Werlin
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Stacy A Kahn
- Inflammatory Bowel Disease Center, Boston's Children's Hospital, Boston, MA
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Phillips CR, Haase JE, Broome ME, Carpenter JS, Frankel RM. Connecting with healthcare providers at diagnosis: adolescent/young adult cancer survivors' perspectives. Int J Qual Stud Health Well-being 2017; 12:1325699. [PMID: 28617094 PMCID: PMC5510205 DOI: 10.1080/17482631.2017.1325699] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
Adolescents and young adults (AYAs) with cancer are a vulnerable and underserved population. AYAs' cancer survivorship is complicated by physical and psychosocial late effects which requires long-term follow-up. Connectedness with healthcare providers (HCPs) is a protective factor that may improve long-term follow-up behaviours of AYAs. However, little is known about AYAs' experiences connecting with HCPs. The purpose of this study was to describe AYA cancer survivors' experiences connecting with HCPs. This empirical phenomenological study interviewed nine AYA cancer survivors diagnosed during adolescence. Individual interviews were conducted and analysed using an adapted Colaizzi approach. The essential structure reveals that AYAs begin their experience of connectedness with a sense of disconnectedness prior to treatment. The diagnosis is a period of confusion and emotional turmoil that interfere with the AYAs' ability to connect. When AYAs come to accept their illness and gain familiarity with the environment, they then put forth an effort to connect with HCPs. Although it takes time for AYAs to reciprocate efforts to connect, HCPs should be aware that AYAs carefully assess and make judgments about whether or not HCPs can be trusted. Findings raise awareness of the actions and behaviours of HCPs that hinder connectedness, and targeted in future research.
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Affiliation(s)
- Celeste R. Phillips
- Department of Science Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Joan E. Haase
- Department of Science Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Marion E. Broome
- Division of Healthcare of Women and Children, Duke University School of Nursing, Durham, North Carolina, United States
| | - Janet S. Carpenter
- Department of Science Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Richard M. Frankel
- Department of Internal Medicine, Indiana University, School of Medicine Indianapolis, INUnited States
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Goralski JL, Nasr SZ, Uluer A. Overcoming barriers to a successful transition from pediatric to adult care. Pediatr Pulmonol 2017; 52:S52-S60. [PMID: 28950427 DOI: 10.1002/ppul.23778] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/07/2017] [Indexed: 11/09/2022]
Abstract
As life expectancy for people with cystic fibrosis (CF) has increased dramatically, so has the need for a guided, structured transition from pediatric to adult-focused care. A formalized transition program allows for seamless transfer of patients between providers, helping to ensure continuity of care, and avoid potential declines associated with inconsistent medical care. New CF Center guidelines issued by the CFF strongly recommend that each center establish a transition program for age-appropriate transition to an adult CF clinic. In this article, we explore the remaining barriers to establishing a transition program in a CF Center and offer examples of several successful models. We describe CFF-sponsored and other initiatives that exist to support centers in establishing a transition program and discuss the need for ongoing research in this area.
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Affiliation(s)
- Jennifer L Goralski
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samya Z Nasr
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan
| | - Ahmet Uluer
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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35
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Giuliani S, Grano C, Aminoff D, Schwarzer N, Van De Vorle M, Cretolle C, Haanen M, Brisighelli G, Marzheuser S, Connor M. Transition of care in patients with anorectal malformations: Consensus by the ARM-net consortium. J Pediatr Surg 2017; 52:1866-1872. [PMID: 28688794 DOI: 10.1016/j.jpedsurg.2017.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/02/2017] [Accepted: 06/04/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To develop the first consensus to standardize the management of patients with Anorectal Malformations (ARMs) transitioning from childhood to adulthood. METHODS A dedicated task force of experts performed an extensive literature review and multiple meetings to define the most important aspects of transition of care. The findings were discussed with all ARM-net consortium members and a set of practical recommendations agreed upon at the annual meeting in 2016. RESULT We defined seven domains that are essential to provide an effective and practical transition process. Within each domain we have developed a set of key recommendations that are important to be considered for ARM patients entering the age of transition. CONCLUSIONS It is crucial that transition begins at an early age with regular and well-structured follow-up. Cooperation with a selected multidisciplinary team of pediatric and adult practitioners is required to prepare patients and families for effective transition to adult care and to reduce long term morbidity. TYPE OF STUDY Review/Consensus paper. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stefano Giuliani
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH London, United Kingdom.
| | - Caterina Grano
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
| | - Dalia Aminoff
- AIMAR-Italian Patients' and Parents' Organization for Anorectal Malformation, Via Tripolitania, 211, Rome, Italy
| | - Nicole Schwarzer
- SoMA e.V.-German organization for people with ARM/HD, Korbinianplatz 17, D-80807 Munich, Germany
| | - Mariette Van De Vorle
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Celia Cretolle
- National Reference Centre for Rare Diseases on Anorectal Malformations and Rare Pelvic Anomalies (MAREP), Rare Diseases National Network NeuroSphinx, Necker-Enfants Malades Hospital, APHP, René Descartes University, Paris, France
| | - Michel Haanen
- "Vereniging Anusatresie" Postbus 78, 1270 AB Huizen, The Netherlands
| | - Giulia Brisighelli
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via della Commenda 10, 20122, Milano, Italy
| | - Stefanie Marzheuser
- Department of Pediatric Surgery, Charité Uniklinik Abt., Kinderchirurgie, Augustenburger Platz, 1, Berlin, Germany
| | - Martin Connor
- Department of Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, United Kingdom
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Morsa M, Gagnayre R, Deccache C, Lombrail P. Factors influencing the transition from pediatric to adult care: A scoping review of the literature to conceptualize a relevant education program. PATIENT EDUCATION AND COUNSELING 2017; 100:1796-1806. [PMID: 28528694 DOI: 10.1016/j.pec.2017.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/24/2017] [Accepted: 05/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To give a comprehensive overview of the factors that influence the transition from pediatric services to adult care, and to conceptualize a relevant education program. METHOD An evaluation grid was used to analyze the literature and classify factors depending on whether they were related to the patients, to the health care organization, to health care personnel, to the interaction between medical staff and patient, or to the illness and its treatment. RESULTS We based our analysis on a selection of 20 publications. The following factors were identified and classified in an integrative framework: self-management skills, trust in adult care, the feeling of self-efficacy, social support, the patient's gender and social position, the trust between child carers and adult carers, interdisciplinary cooperation, and the medical staff's consideration of the patient's projects. CONCLUSIONS AND PRACTICE IMPLICATIONS The current analysis makes it possible to formulate educational aims and to design a way of integrating them to a transition plan. However, the collected studies mainly focus on knowledge of the illness, on treatment, and on the health care system. Psychosocial dimensions at play at the time of the transition - such as identity development - are not sufficiently explored in the research.
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Affiliation(s)
- Maxime Morsa
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Rémi Gagnayre
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Carole Deccache
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Pierre Lombrail
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France; Department of Public Health, Paris Seine St-Denis hospital, AP-HP, France.
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Hunt S, Davis T. Preparing for Transition of Youth with Special Health Care Needs. Curr Probl Pediatr Adolesc Health Care 2017; 47:200-207. [PMID: 28803828 DOI: 10.1016/j.cppeds.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Susan Hunt
- Division of General Internal Medicine, Department of Pediatrics, University of Washington Medical Center, Ann Arbor, MI
| | - Thomas Davis
- Division of Internal Medicine, Division of Pediatrics, Geisinger Health System, Danville, PA
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Transition from children's to adult services for young adults with life-limiting conditions: A realist review of the literature. Int J Nurs Stud 2017; 76:1-27. [PMID: 28898740 DOI: 10.1016/j.ijnurstu.2017.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 04/16/2017] [Accepted: 06/21/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, which means they must make the transition from children's to adult services. This has proved a challenging process for both young adults and service providers, with complex transition interventions interacting in unpredictable ways with local contexts. OBJECTIVES To explain how intervention processes interact with contextual factors to help transition from children's to adult services for young adults with life-limiting conditions. DESIGN Systematic realist review of the literature. DATA SOURCES Literature was sourced from four electronic databases: Embase, MEDLINE, Science Direct and Cochrane Library from January 1995 to April 2016. This was supplemented with a search in Google Scholar and articles sourced from reference lists of included papers. REVIEW METHODS Data were extracted using an adapted standardised data extraction tool which included identifying information related to interventions, mechanisms, contextual influences and outcomes. Two reviewers assessed the relevance of papers based on the inclusion criteria. Methodological rigor was assessed using the relevant Critical Appraisal Skills Programme tools. RESULTS 78 articles were included in the review. Six interventions were identified related to an effective transition to adult services. Contextual factors include the need for children's service providers to collaborate with adult service providers to prepare an environment with knowledgeable staff and adequate resources. Mechanisms triggered by the interventions include a sense of empowerment and agency amongst all stakeholders. CONCLUSIONS Early planning, collaboration between children's and adult service providers, and a focus on increasing the young adults' confidence in decision-making and engaging with adult services, are vital to a successful transition. Interventions should be tailored to their context and focused not only on organisational procedures but on equipping young adults, parents/carers and staff to engage with each other effectively.
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Coad J, Toft A, Claridge L, Ferguson J, Hind J, Jones R, McClean P, McKiernan P, Samyn M, Taylor R. Using Mobile Phone Technology to Support Young Liver Transplant Recipients Moving to Adult Services. Prog Transplant 2017; 27:207-218. [PMID: 28617171 DOI: 10.1177/1526924817699958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The process and preparation of moving from child to adult services (transition) is a challenging period of time for young people and represents significant changes in care and support systems. The proliferation of mobile phone applications for health purposes suggests that it is an area for further investigation. OBJECTIVE The review explores the potential to use mobile phone technology to help support young liver transplant recipients moving to adult services. It represents the first review conducted in this specialism and considers a new model of support for young liver patients. METHODS A systematic rapid review of the published peer-reviewed literature. RESULTS Two searches were conducted: Search 1: the use of technology to support transition to adult services (6 studies) and Search 2: how best to support liver transplant recipients during transition (6 studies). DISCUSSION Research shows that to achieve positive transition young people need information about their condition and transition. The process needs to be guided by transition readiness, rather than the young persons' age. Although parents and support networks should be in place and are valued, transition should build upon self-management and independence. Results suggest that there appears to be scope to use mobile phone technology to support transition. This is the first time a review has explored the types of issues or concerns facing liver transplant patients and how these can be addressed through mobile phone technology.
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Affiliation(s)
- Jane Coad
- 1 Children and Families Research (CFR), Centre for Technology Enabled Health Research (CTEHR), Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Alex Toft
- 1 Children and Families Research (CFR), Centre for Technology Enabled Health Research (CTEHR), Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Different Demands, Same Goal: Promoting Transition Readiness in Adolescents and Young Adults With and Without Medical Conditions. J Adolesc Health 2017; 60:727-733. [PMID: 28274737 DOI: 10.1016/j.jadohealth.2017.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to examine differences in transition readiness, self-involvement and parental involvement in completing medical tasks, and general self-efficacy between a sample of older adolescents and young adults (AYAs) with medical conditions and a sample of healthy peers. Relations among these variables were also examined. METHODS The sample included 494 AYAs (mean age = 19.30 years, standard deviation = 1.33) who reported on their levels of transition readiness, self-involvement and parental involvement in completing medical tasks, and general self-efficacy. RESULTS AYAs with medical conditions reported significantly higher levels of transition readiness and self-involvement in completing medical tasks and lower levels of parent involvement in completing medical tasks than healthy peers. Parent involvement in completing medical tasks indirectly related to transition readiness through AYA self-involvement in completing medical tasks for both AYAs with medical conditions and healthy peers. CONCLUSIONS AYAs with medical conditions appear to have greater transition readiness skills and demonstrate more independence in completing medical tasks than healthy peers. For AYAs with medical conditions and healthy peers, transition readiness appears to be enhanced as parents decrease their involvement in completing AYAs' medical tasks and AYAs increase self-involvement in completing these tasks. AYAs with medical conditions, as well as healthy peers, may benefit from programming delivered in primary care, specialty clinic, or educational settings that focuses on increasing AYAs' involvement in and responsibility for managing their health care.
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von Gontard A, Cardozo L, Rantell A, Djurhuus JC. Adolescents with nocturnal enuresis and daytime urinary incontinence-How can pediatric and adult care be improved-ICI-RS 2015? Neurourol Urodyn 2017; 36:843-849. [DOI: 10.1002/nau.22997] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/01/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry; Saarland University Hospital; Homburg Germany
| | - Linda Cardozo
- Department of Urogynaecology; King's College Hospital; London United Kingdom
| | - Angie Rantell
- Department of Urogynaecology; King's College Hospital; London United Kingdom
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Bomba F, Herrmann-Garitz C, Schmidt J, Schmidt S, Thyen U. An assessment of the experiences and needs of adolescents with chronic conditions in transitional care: a qualitative study to develop a patient education programme. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:652-666. [PMID: 28173635 DOI: 10.1111/hsc.12356] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 06/06/2023]
Abstract
The transition of adolescents with chronic conditions is a challenging task. This study aimed to explore the experiences and needs of adolescents with chronic conditions in the transition period and to apply these findings to the design of a generic patient education programme. Data were collected from a sample of 29 adolescents with chronic conditions from Northern Germany and Switzerland including a broad range of views due to variation in disease management and organisation of care both in paediatric and adult populations. Participants were interviewed in group (n = 18) or individual (n = 11) interviews between September 2011 and February 2012, and the data were analysed using qualitative content analysis. The findings revealed that the interviewees expressed high levels of competency in the management of their chronic conditions but identified gaps in healthcare and unmet needs during transition. In particular, they believed that they would benefit from opportunities to exchange ideas and more specific information with peers about vocational and medical issues concerning adolescent health. Identified themes reflecting adolescent needs were used to develop the transition workshop including modules regarding the following: transfer to adult medicine, their new role as a patient, orientation within the healthcare system, vocational issues, detachment from parents, social support, contraception, substance abuse, family planning, stress-management, activation of resources and developing personal goals. The workshop's content was largely generic and included some condition-specific components. The workshop was designed as a compact 2-day patient education programme in a group setting for adolescents prior to their transfer to adult care. The guiding principle was the idea of empowerment by supporting the adolescents through various interactive methods to develop adequate knowledge, skills, understanding and motivation regarding their chronic conditions. We conclude that patient education programmes promoting adolescent self-management and empowerment increase the preparedness for transition.
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Affiliation(s)
- Franziska Bomba
- Department of Paediatrics and Adolescent Medicine, University of Luebeck, Luebeck, Germany
| | | | - Julia Schmidt
- Department of Paediatrics and Adolescent Medicine, University of Luebeck, Luebeck, Germany
| | - Silke Schmidt
- Department of Psychology, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Ute Thyen
- Department of Paediatrics and Adolescent Medicine, University of Luebeck, Luebeck, Germany
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Long-Term Outcomes on Antiretroviral Therapy in a Large Scale-Up Program in Nigeria. PLoS One 2016; 11:e0164030. [PMID: 27764094 PMCID: PMC5072640 DOI: 10.1371/journal.pone.0164030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/19/2016] [Indexed: 12/18/2022] Open
Abstract
Background While there has been a rapid global scale-up of antiretroviral therapy programs over the past decade, there are limited data on long-term outcomes from large cohorts in resource-constrained settings. Our objective in this evaluation was to measure multiple outcomes during first-line antiretroviral therapy in a large treatment program in Nigeria. Methods We conducted a retrospective multi-site program evaluation of adult patients (age ≥15 years) initiating antiretroviral therapy between June 2004 and February 2012 in Nigeria. The baseline characteristics of patients were described and longitudinal analyses using primary endpoints of immunologic recovery, virologic rebound, treatment failure and long-term adherence patterns were conducted. Results Of 70,002 patients, 65.2% were female and median age was 35 (IQR: 29–41) years; 54.7% were started on a zidovudine-containing and 40% on a tenofovir-containing first-line regimen. Median CD4+ cell counts for the cohort started at 149 cells/mm3 (IQR: 78–220) and increased over duration of ART. Of the 70,002 patients, 1.8% were reported as having died, 30.1% were lost to follow-up, and 0.1% withdrew from treatment. Overall, of those patients retained and with viral load data, 85.4% achieved viral suppression, with 69.3% achieving suppression by month 6. Of 30,792 patients evaluated for virologic failure, 24.4% met criteria for failure and of 45,130 evaluated for immunologic failure, 34.0% met criteria for immunologic failure, with immunologic criteria poorly predicting virologic failure. In adjusted analyses, older age, ART regimen, lower CD4+ cell count, higher viral load, and inadequate adherence were all predictors of virologic failure. Predictors of immunologic failure differed slightly, with age no longer predictive, but female sex as protective; additionally, higher baseline CD4+ cell count was also predictive of failure. Evaluation of long-term adherence patterns revealed that the majority of patients retained through 84 months maintained ≥95% adherence. Conclusion While improved access to HIV care and treatment remains a challenge in Nigeria, our study shows that a high quality of care was achieved as evidenced by strong long-term clinical, immunologic and virologic outcomes.
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Fredericks EM, Magee JC, Eder SJ, Sevecke JR, Dore-Stites D, Shieck V, Lopez MJ. Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic. J Clin Psychol Med Settings 2016; 22:150-9. [PMID: 26231289 DOI: 10.1007/s10880-015-9427-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The transition from pediatric to adult transplant care is a high risk period for non-adherence and poor health outcomes. This article describes a quality improvement initiative integrated into a pediatric liver transplant program that focused on improving outcomes following the transfer from pediatric to adult liver transplant care. Using improvement science methodology, we evaluated the impact of our center's transition readiness skills (TRS) program by conducting a chart review of 45 pediatric liver transplant recipients who transferred to adult transplant care. Medication adherence, clinic attendance, and health status variables were examined for the year pre-transfer and first year post-transfer. 19 recipients transferred without participating in the TRS program (control group) and 26 recipients participated in the program prior to transferring to the adult clinic (TRS group). The TRS group was significantly older at the time of transfer, more adherent with medications, and more likely to attend their first adult clinic visit compared to the control group. Among the TRS group, better adolescent and parent regimen knowledge were associated with greater adherence to post-transfer clinic appointments. Transition planning should focus on the gradual shift in responsibility for health management tasks, including clinic attendance, from parent to adolescent. There may be support for extending transition support for at least 1 year post-transfer to promote adherence.
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Affiliation(s)
- Emily M Fredericks
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA.
| | - John C Magee
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Sally J Eder
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Jessica R Sevecke
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Dawn Dore-Stites
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Victoria Shieck
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - M James Lopez
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
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Christian BJ. Translational Research - Balancing the Demands of Chronic Illness Caregiving and Self-Management for Children, Adolescents, and their Parents. J Pediatr Nurs 2016; 31:449-52. [PMID: 27321877 DOI: 10.1016/j.pedn.2016.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
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Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services - an integrative review. J Clin Nurs 2016; 25:3113-3130. [PMID: 27145890 PMCID: PMC5096007 DOI: 10.1111/jocn.13326] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES This paper aims to provide an updated comprehensive review of the research-based evidence related to the transitions of care process for adolescents and young adults with chronic illness/disabilities since 2010. BACKGROUND Transitioning adolescent and young adults with chronic disease and/or disabilities to adult care services is a complex process, which requires coordination and continuity of health care. The quality of the transition process not only impacts on special health care needs of the patients, but also their psychosocial development. Inconsistent evidence was found regarding the process of transitioning adolescent and young adults. DESIGN An integrative review was conducted using a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. METHODS A search was carried out using the EBSCOhost, Embase, MEDLINE, PsycINFO, and AustHealth, from 2010 to 31 October 2014. The key search terms were (adolescent or young adult) AND (chronic disease or long-term illness/conditions or disability) AND (transition to adult care or continuity of patient care or transfer or transition). RESULTS A total of 5719 records were initially identified. After applying the inclusion criteria a final 61 studies were included. Six main categories derived from the data synthesis process are Timing of transition; Perceptions of the transition; Preparation for the transition; Patients' outcomes post-transition; Barriers to the transition; and Facilitating factors to the transition. A further 15 subcategories also surfaced. CONCLUSIONS In the last five years, there has been improvement in health outcomes of adolescent and young adults post-transition by applying a structured multidisciplinary transition programme, especially for patients with cystic fibrosis and diabetes. However, overall patients' outcomes after being transited to adult health care services, if recorded, have remained poor both physically and psychosocially. An accurate tracking mechanism needs to be established by stakeholders as a formal channel to monitor patients' outcomes post- transition.
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Affiliation(s)
- Huaqiong Zhou
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia
| | - Pamela Roberts
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia
| | - Satvinder Dhaliwal
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia
| | - Phillip Della
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia.
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Vaks Y, Bensen R, Steidtmann D, Wang TD, Platchek TS, Zulman DM, Malcolm E, Milstein A. Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2016; 4:57-68. [PMID: 27001100 PMCID: PMC4805882 DOI: 10.1016/j.hjdsi.2015.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 01/18/2023]
Abstract
Adolescents and young adults (AYA) with serious chronic illnesses face costly and dangerous gaps in care as they transition from pediatric to adult health systems. New, financially sustainable approaches to transition are needed to close these gaps. We designed a new transition model for adolescents and young adults with a variety of serious chronic conditions. Our explicit goal was to build a model that would improve the value of care for youth 15-25 years of age undergoing this transition. The design process incorporated a review, analysis, and synthesis of relevant clinical and health services research; stakeholder interviews; and observations of high-performing healthcare systems. We identified three major categories of solutions for a safer and lower cost transition to adult care: (1) building and supporting self-management during the critical transition; (2) engaging receiving care; and (3) providing checklist-driven guide services during the transition. We propose that implementation of a program with these interventions would have a positive impact on all three domains of the triple aim - improving health, improving the experience of care, and reducing per capita healthcare cost. The transition model provides a general framework as well as suggestions for specific interventions. Pilot tests to assess the model's ease of implementation, clinical effects, and financial impact are currently underway.
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Affiliation(s)
- Yana Vaks
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Loma Linda University Children's Hospital, United States.
| | - Rachel Bensen
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Dana Steidtmann
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Family Medicine, University of Colorado School of Medicine, United States
| | - Thomas D Wang
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Terry S Platchek
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Donna M Zulman
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Division of General Medical Disciplines, Stanford University School of Medicine, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, United States
| | - Elizabeth Malcolm
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
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Hergenroeder AC, Wiemann CM, Cohen MB. Current Issues in Transitioning from Pediatric to Adult-Based Care for Youth with Chronic Health Care Needs. J Pediatr 2015; 167:1196-201. [PMID: 26340879 DOI: 10.1016/j.jpeds.2015.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
For over 25 years, with medical advances increasing the lifespan of YYASHCN, we have been aware of the need to improve health care transition to adult-based care services. Barriers to health care transition have been identified and in a number of settings, recognition of the problem and preliminary success has been achieved for pilot programs. Evidence-based solutions to improve health care transition for YYASHCN are needed. There are barriers at the patient, family, pediatric, and adult provider, and insurance system levels that must be overcome.
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Affiliation(s)
| | | | - Mitchell B Cohen
- University of Alabama at Birmingham Children's of Alabama, Birmingham, AL
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Health Care Transition Experiences of Young Adults With Cerebral Palsy. J Pediatr Nurs 2015; 30:e157-64. [PMID: 26142160 DOI: 10.1016/j.pedn.2015.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 11/20/2022]
Abstract
Health care transition (HCT) describes the purposeful, planned movement of adolescents from child to adult-orientated care. The purpose of this qualitative study is to uncover the meaning of transition to adult-centered care as experienced by young adults with cerebral palsy (YA-CP) through the research question: What are the lived experiences of young adults with cerebral palsy transitioning from pediatric to adult healthcare? Six females and 3 males, aged 19-25 years of age, who identified as carrying the diagnosis of cerebral palsy without cognitive impairment, were interviewed. Giorgi's (1985) method for analysis of phenomenology was the framework for the study and guided the phenomenological reduction. The meaning of the lived experiences of YA-CPs transition to adult health care is expert novices with evidence and experience-based expectations, negotiating new systems interdependently and accepting less than was expected. More information and support is needed for the YA-CP during transition to ensure a well-organized move to appropriate adult-oriented health care that is considerate of the lifelong impact of the disorder. The nurses' role as advocate, mentor and guide can optimize the individual's response to the transition process.
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Abstract
More than 90% of children born with congenital heart disease survive into adulthood due to successes of cardiac surgery and medical management. Interviews with 16 young adults with congenital heart disease to explore their experiences of transfer from pediatric to adult care were performed. The analysis identified five themes; Feeling secure during the transfer process, Experiencing trust in the care, Expecting to be involved, Assuming responsibility for one's health is a process and Lack of knowledge leads to uncertainty. In conclusion; a structured and gradual transfer process was necessary to enable the informants to shoulder the responsibility for self-care.
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Affiliation(s)
- Ann Asp
- Children's Heart center, Department of Pediatrics, Skåne University Hospital Lasarettsgatan 48, Lund, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Paediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Ann-Cathrine Bramhagen
- Malmö University: Health and Society, Department of Care Science, Malmö, Sweden; Department of Pediatrics, Skåne University Hospital Sweden, Malmö, Sweden.
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