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Pitts L, Patrician PA, Landier W, Kazmerski T, Fleming L, Ivankova N, Ladores S. Parental entrustment of healthcare responsibilities to youth with chronic conditions: A concept analysis. J Pediatr Nurs 2024; 76:1-15. [PMID: 38309191 DOI: 10.1016/j.pedn.2024.01.028] [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: 08/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. DESIGN AND METHODS Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. RESULTS Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. CONCLUSION The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. PRACTICE IMPLICATIONS This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition.
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Affiliation(s)
- Leslie Pitts
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Patricia A Patrician
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Wendy Landier
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama Heersink School of Medicine, Division of Pediatric Hematology/Oncology, 1600 7th Avenue South, Lowder 512, Birmingham, AL 35233, United States.
| | - Traci Kazmerski
- The University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University Center, 120 Lytton St.-Suite M060, Pittsburgh, PA 15213, United States.
| | - Louise Fleming
- The University of North Carolina at Chapel Hill, School of Nursing, 105 Carrington Hall, Chapel Hill, NC 37599, United States.
| | - Natalyia Ivankova
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama at Birmingham, School of Health Professions, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Sigrid Ladores
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Fortune J, Ryan JM, Walsh A, Walsh M, Kerr C, Kroll T, Lavelle G, Owens M, Hensey O, Norris M. Transition from child to adult services for young people with cerebral palsy in Ireland: Influencing factors at multiple ecological levels. Dev Med Child Neurol 2024; 66:623-634. [PMID: 37849380 DOI: 10.1111/dmcn.15778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 10/19/2023]
Abstract
AIM To explore the factors that influence the process of transitioning from child to adult services in Ireland among young people with cerebral palsy, their parents, and service providers. METHOD This study followed a qualitative descriptive approach. Semi-structured interviews were conducted with 54 participants, including young people with cerebral palsy aged 16 to 22 years (n = 13), their parents (n = 14), and service providers (n = 27). Data were analysed using the Framework Method. Findings were categorized using an ecological model across four levels: individual, microsystem, mesosystem, and exosystem. RESULTS Limited awareness, preparation, and access to information hindered successful transition. Microsystem factors such as family knowledge, readiness, resilience, and health professional expertise influenced transition experience. Mesosystem factors encompassed provider-family interaction, interprofessional partnerships, and interagency collaboration between child and adult services. Exosystem factors included inadequate availability and distribution of adult services, limited referral options, coordination challenges, absence of transition policies, staffing issues, and funding allocation challenges. INTERPRETATION Transition is influenced by diverse factors at multiple ecological levels, including interactions within families, between health professionals, and larger systemic factors. Given the complexity of transition, a comprehensive multi-level response is required, taking into account the interactions among individuals, services, and systems.
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Affiliation(s)
- Jennifer Fortune
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer M Ryan
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Thilo Kroll
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Grace Lavelle
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mary Owens
- Central Remedial Clinic, Dublin, Ireland
| | | | - Meriel Norris
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
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de Hosson M, De Groote K, Hecke AV, De Wolf D, Vandekerckhove K, Mosquera LM, Panzer J, Logghe K, Mels S, Demulier L, Campens L, Goossens E, De Backer J. Evaluation of a nurse-led multi-component transition program for adolescents with congenital heart disease. PATIENT EDUCATION AND COUNSELING 2024; 118:108028. [PMID: 37879284 DOI: 10.1016/j.pec.2023.108028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the transition program for adolescents with congenital heart disease (CHD) 'Transition With a Heart' (TWAH) on disease-related knowledge, quality of life (QoL), transition experiences, and gaps in follow-up. METHODS A study with pre-posttest and control group (post-test) using consecutive sampling, including adolescents with moderate to severely complex CHD, without intellectual disability, aged≥ 12 y, and parents. After weighting, t-tests were performed. A multivariable regression analysis explored the outcomes' determinants. RESULTS In the intervention group, 28 adolescents and 25 parents were included, and 53 adolescents and 18 parents as controls. Adolescents' knowledge significantly increased after completing TWAH (from 59.8% to 75.7%;p < 0.01). Their knowledge was positively correlated with TWAH (β = +13.3;p < 0.01). Adolescents' transition experiences were also positively related to TWAH (general experience: β = +5.5;p < 0.01; transfer satisfaction: β = +0.8; p < 0.01). Adolescents' QoL was mainly determined by CHD complexity and not by TWAH. No one showed gaps in follow-up. TWAH was not associated with parents' transition experiences. CONCLUSION Implementing TWAH substantially improved adolescents' disease-related knowledge and transition experiences. PRACTICE IMPLICATIONS The results regarding transition experiences need to be confirmed by further research. The TWAH design with the person-tailored educational program, skills training, and the transition coordinator can be used in settings with other chronic diseases.
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Affiliation(s)
- Michèle de Hosson
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium.
| | - Katya De Groote
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Ann Van Hecke
- Ghent University - Faculty of Medicine and Health Sciences - Department of Public Health and Primary Care - University Center for Nursing and Midwifery, Ghent, Belgium; Ghent University Hospital, Staff nursing department, Ghent, Belgium
| | - Daniël De Wolf
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | | | | | - Joseph Panzer
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Karen Logghe
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Saskia Mels
- Ghent University Hospital, Department of Pediatric Psychology, Ghent, Belgium
| | - Laurent Demulier
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
| | - Laurence Campens
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
| | - Eva Goossens
- University of Antwerp - Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, Antwerp, Belgium; KU Leuven - Department of Public Health and Primary Care, Leuven, Belgium
| | - Julie De Backer
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
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de Hosson M, De Groote K, Wynendaele H, Mosquera LM, Goossens E, De Backer J. Preferences for disease-related information and transitional skills among adolescents with congenital heart disease in the early transitional stage. Eur J Pediatr 2023; 182:3917-3927. [PMID: 37351648 DOI: 10.1007/s00431-023-05020-1] [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: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE The transition towards adult-focused healthcare comprises a complex process requiring careful, individualized guidance of adolescents with congenital heart disease (CHD). Detailed data on their preferences regarding disease-related information and acquirable transitional skills are mostly lacking. We examined the preferences of CHD adolescents in the early transition stage. METHODS A cross-sectional descriptive study was performed with adolescents recruited from a transition program. Two questionnaires assessing needs for information and transitional skills were used. Only questionnaires completed in the early transition stage were included. RESULTS Forty-nine adolescents participated (mean age 15.9 ± 1.2 years, 43% girls). 59% requested information about their heart and previous and/or future surgeries/interventions, 45% about sports and medication, and a maximum of 27% about psychosocial topics. More girls than boys requested surgical information (76% versus 46%; p = 0.04). Adolescents with severely complex CHD more often requested information about medication than those with moderately complex CHD (63% versus 28%; p = 0.02). Older adolescents were less likely to request surgical information (OR = 0.53; 95%CI [0.26-0.88]; p = 0.03). Up to 83% of the adolescents perceived their skills as insufficient, but less than 14% was interested in acquiring skills. Conclusion: Adolescents were mainly interested in medical topics, followed by lifestyle information. The informational needs tended to decrease with age. Timely gauging individual needs and delivering information, ideally in the early teens, appear important when providing person-tailored transitional care in CHD. Paradoxically, although the transitional skills were low-perceived, there was limited motivation to improve them. This paradox requires further investigation to better tailor transition interventions. Clinical trial registration: Not applicable. WHAT IS KNOWN • Transition towards adult life and care requires careful patient guidance. A person-tailored approach is strongly encouraged. However, details on preferences regarding disease-related information and transitional skills are scarce in adolescents with CHD. WHAT IS NEW • This study showed that adolescents with CHD in early transition mainly need medical-related information. Their informational needs tend to decrease with age necessitating timely gauging for interest and delivering information. Adolescents report a low need to acquire transitional skills despite low self-esteemed skills levels.
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Affiliation(s)
- Michèle de Hosson
- Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Herlinde Wynendaele
- Department of Public Health and Primary Care & Health Economics, Ghent University, Ghent, Belgium
| | - Laura Muiño Mosquera
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Eva Goossens
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Julie De Backer
- Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
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Miller VA, Ibarra Toro A, Friedrich EA, Snyder M, Stevens E, Fremont ER. Adolescent, Parent, and Clinician Perspectives on Increasing Adolescent Involvement in Decision-Making During Clinic Visits. J Pediatr Health Care 2023; 37:528-536. [PMID: 37204373 PMCID: PMC10524528 DOI: 10.1016/j.pedhc.2023.04.012] [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: 04/04/2023] [Revised: 04/05/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION This study aimed to describe adolescent, parent, and clinician ideas for enhancing adolescent decision-making involvement (DMI) during clinic visits for chronic illness. METHOD Adolescents who recently attended a follow-up visit for a chronic illness, their parents, and clinicians were interviewed. Participants completed semistructured interviews; transcripts were coded and analyzed in NVivo. Responses to questions about ideas to increase adolescent DMI were reviewed and sorted into categories and themes. RESULTS There were five themes: (1) adolescents need to understand their condition and regimen, (2) adolescents and parents should prepare before the visit, (3) clinicians and adolescents should have one-on-one time, (4) opportunities for condition-specific peer support would be helpful, and (5) clinicians and parents should engage in specific communication behaviors. DISCUSSION Findings from this study highlight potential clinician-, parent-, and adolescent-focused strategies for enhancing adolescent DMI. Clinicians, parents, and adolescents may need specific guidance on how to enact new behaviors.
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Affiliation(s)
- M Foster
- School of Clinical Sciences, Nursing, Auckland University of Technology, Auckland 0627, New Zealand; Edith Cowan University, School of Nursing and Midwifery, Joondalup, Perth, Western Australia 6027, Australia.
| | - J Blamires
- School of Clinical Sciences, Nursing, Auckland University of Technology, Auckland 0627, New Zealand
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Bailey K, Lee S, de Los Reyes T, Lo L, Cleverley K, Pidduck J, Mahood Q, Gorter JW, Toulany A. Quality Indicators for Youth Transitioning to Adult Care: A Systematic Review. Pediatrics 2022; 150:188245. [PMID: 35665828 DOI: 10.1542/peds.2021-055033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transition from pediatric to adult care is associated with adverse health outcomes for many adolescents with chronic illness. We identified quality indicators for transition to adult care that are broadly applicable across chronic illnesses and health systems. METHODS Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched, covering earliest available date to July 2021. The Gray Matters framework was used to search gray literature. Two independent reviewers screened articles by title and abstract, followed by full-text review. Disagreements were resolved by a third reviewer. Studies were included that identified quality indicators developed via consensus-building methods. Indicators were organized into a framework categorized by illness specificity, level of care, Donabedian model, and Institute of Medicine quality domain. Appraisal of Guidelines for Research and Evaluation tool was used for critical appraisal. RESULTS The search identified 4581 articles, of which 321 underwent full-text review. Eight peer-reviewed studies and 1 clinical guideline were included, identifying 169 quality indicators for transition. Of these, 56% were illness specific, 43% were at the patient level of care, 44% related to transition processes, and 51% were patient centered and 0% equity focused. Common indicator themes included education (12%), continuity of care (8%), satisfaction (8%), and self-management/self-efficacy (7%). The study was limited by quality indicators developed through consensus-building methodology. CONCLUSIONS Although most quality indicators for transition were patient-centered outcomes, few were informed by youth and parents/caregivers, and none focused on equity. Further work is needed to prioritize quality indicators across chronic illness populations while engaging youth and parents/caregivers in the process.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine.,Institute of Health Policy, Management and Evaluation
| | - Stephanie Lee
- Department of Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Monash Children's Hospital, Melbourne, Australia
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Kristin Cleverley
- Temerty Faculty of Medicine.,Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science & Sports.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Alene Toulany
- Temerty Faculty of Medicine.,Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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de Jong-Witjes S, Kars MC, van Vliet M, Huber M, van der Laan SEI, Gelens EN, Berkelbach van der Sprenkel EE, Nijhof SL, de Jonge MV, Rippen H, van de Putte EM. Development of the My Positive Health dialogue tool for children: a qualitative study on children's views of health. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001373. [PMID: 36053589 PMCID: PMC9014061 DOI: 10.1136/bmjpo-2021-001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/20/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Children's views of health were explored in order to develop a health dialogue tool for children. METHODS A qualitative research design was used as part of a codesign process. Based on semi-structured interviews with both healthy children and children with a chronic condition (aged 8-18). Two approaches were applied. The first was an open exploration of children's views on health, which was then thematically analysed. Subsequently, a framework was used, based on the six-dimensional My Positive Health (MPH) dialogue tool for adults, to guide the second part of the interviews, focusing on reviewing the children's view on health within the context of the framework. For the final draft of the dialogue tool, a framework analysis was conducted and then validated by members of the 'children's council' of the Wilhelmina Children's Hospital. RESULTS We interviewed 65 children, 45 of whom had a chronic condition and 20 were healthy. The children described a broad concept of health with the central themes of 'feeling good about yourself' and 'being able to participate'. Based on the subsequent framework analysis, the wording of two of the six dimensions of the MPH dialogue tool was adjusted and the related aspects were adapted for better alignment with the children's concept of health. After these modifications, the tool fully matched the children's concept of health. CONCLUSION The MPH dialogue tool for children was developed for children with and without a chronic condition, to help them open up about what they consider important for their health and well-being, and to improve directorship over decisions and actions that would affect their health. The MPH dialogue tool aims to support healthcare professionals in providing the type of care and treatment that is in line with the needs of their young patients/clients.
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Affiliation(s)
- Stacey de Jong-Witjes
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Marja van Vliet
- Institute for Positive Health Foundation, Utrecht, The Netherlands
| | - Machteld Huber
- Institute for Positive Health Foundation, Utrecht, The Netherlands
| | - Sabine E I van der Laan
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Eva N Gelens
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | | | - Sanne L Nijhof
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Maretha V de Jonge
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
| | - Hester Rippen
- Stichting Kind En Ziekenhuis, Utrecht, The Netherlands
| | - Elise M van de Putte
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
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Meulendijks P, van Haren NEM, Gielen MA, van Veelen-Vincent MLC. A self-portrait: Design opportunities for a tool that supports children's involvement in brain-related health care. Health Expect 2022; 25:2235-2245. [PMID: 35084076 PMCID: PMC9615056 DOI: 10.1111/hex.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/02/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Paediatric patients with disorders that involve brain functioning are particularly vulnerable with respect to including them in shared decision‐making. Current tools are mostly paper or digital patient information. We lay the groundwork for improving engagement with a concept that we coined ‘the Self‐Portrait’. The main goals were to identify (1) obstacles and (2) design parameters that enable patient participation. Methods A research‐through‐design approach was utilized in nine patients with brain‐related disorders (4–12 years), 15 parents and 15 medical professionals, involving contextual research (interviews and observations) within the paediatric hospital and patients' homes and codesign. Sensitizing materials and early instances of design solutions were deployed as catalysts for communication. Five rounds of enriched interviews and design reviews were thematically analysed to answer the research questions. Results Obstacles to child involvement were related to children's level of understanding, the time and energy necessary for information processing and lack of perceived relevance of the information. Patients' engagement is supported by design features that extend the time frame of interaction beyond the consultation, transfer information interactively and give control and influence during the consultation. Conclusion Obstacles were detected that complicate child engagement, which differ between stakeholders. Promising design features were identified that have the potential to play an important role in enabling active child involvement. These findings show that applying principles of human‐centred design research and codesign can bring together patients, parents and medical professionals around a tool that provides a shared language and focus, which are prerequisites to increase child engagement. Patient or Public Contribution Patients, parents and clinicians contributed as design informants during contextual research and design reviews. Clinicians provided feedback on the initial outcomes of thematic analysis. Two researchers assisted in consensus sessions during the thematic analysis.
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Affiliation(s)
- Paul Meulendijks
- Department of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mathieu A Gielen
- Department of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
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The added value of transition programs in Dutch diabetes care: A controlled evaluation study. J Pediatr Nurs 2022; 62:155-163. [PMID: 34419327 DOI: 10.1016/j.pedn.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The desirability of evaluating transition programs is widely acknowledged. This study aimed to explore the added value of transitional care investments for young adults with type 1 diabetes mellitus. DESIGN AND METHODS Based on qualitative data, two groups of diabetes teams were created through cluster analysis: paying more (HI-ATT) versus less attention (LO-ATT) to transitional care. Retrospective controlled evaluation included chart reviews on healthcare use and clinical outcomes; and a survey on young adults' experiences, satisfaction with care, and self-management skills. RESULTS Data from 320 patients in fifteen diabetes teams were collected; 123 young adults (38.4%) completed a questionnaire. Self-reported outcomes showed that young adults treated by a HI-ATT team felt better prepared for transfer (p < .05). Self-management outcomes did not differ between groups. HI-ATT teams had more scheduled consultations in the year after transfer (p < .05); only 10.6% of all measurements had reached targeted HbA1c scores. CONCLUSIONS Current transitional care investments in Dutch diabetes care did not lead to notable improvements in experiences and outcomes, except for preparation for transfer. The period after transfer, however, is just as important. Attention is required for parent involvement. PRACTICE IMPLICATIONS Transitional care investments should extend beyond the transfer. By educating young adults about the importance of regular clinic attendance and introducing additional person-centered consultations in adult care, nurses may help ensure continuity of care. Nurses could also introduce support programs for parents to prepare for the transition and their change in role, taking into account their continuing partnership.
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Wakimizu R, Sasaki K, Yoshimoto M, Miyazaki A, Saito Y. Multidisciplinary Approach for Adult Patients With Childhood-Onset Chronic Disease Focusing on Promoting Pediatric to Adult Healthcare Transition Interventions: An Updated Systematic Review. Front Pediatr 2022; 10:919865. [PMID: 35774103 PMCID: PMC9237398 DOI: 10.3389/fped.2022.919865] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Owing to improved prognosis, the number of adult patients with childhood-onset chronic disease (APCCD) has increased. In this systematic review, we evaluated a multidisciplinary approach toward APCCD, focusing on promoting pediatric to adult healthcare transition interventions and their effects. METHODS We reviewed literature comparing the effects of pediatric to adult healthcare transition interventions in children and adolescents with childhood-onset chronic disease, using PubMed, MEDLINE, and CINAHL, from 2010 to 2021 (keywords: "transition," "children," "intervention," "healthcare," etc.). The inclusion criteria were as follows: (i) original studies, (ii) studies on pediatric to adult healthcare transition interventions in children with chronic disease, (iii) patients including "adolescents" aged 12 and older receiving intervention, and (iv) studies that included the four elements of the PICO model: Patient/ Problem, Intervention, Comparison and Outcome model. RESULTS After evaluating 678 studies, 16 were selected, comprising topics such as "individual education programs" (n = 6), "group meetings" (n = 6), "active learning using information and communications technology" (n = 2), and "transition clinics" (n = 2). The effects obtained varied, depending on the contents and methods of the intervention. Additionally, there was no evidence of adverse outcomes from these interventions. CONCLUSIONS Pediatric to adult healthcare transition interventions provide systematic support for the transition, patient independence, and social participation; thus, they should be adopted based on their expected effects.
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Affiliation(s)
- Rie Wakimizu
- Department of Child Health Care Nursing, Division of Health Innovation and Nursing, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keita Sasaki
- Master Program in Nursing Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Mitsuki Yoshimoto
- Master Program in Nursing Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Akari Miyazaki
- Master Program in Nursing Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yumiko Saito
- Doctoral Program in Nursing Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
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McDonagh JE, Tattersall R, Clinch J, Swan J, Foster HE, McCann L. Developmentally appropriate transitional care during the Covid-19 pandemic for young people with juvenile-onset rheumatic and musculoskeletal diseases: the rationale for a position statement. Pediatr Rheumatol Online J 2021; 19:136. [PMID: 34433477 PMCID: PMC8386148 DOI: 10.1186/s12969-021-00609-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of developmentally appropriate transitional care in young people with juvenile-onset rheumatic and musculoskeletal disease is well recognised. The Paediatric Rheumatology European Society (PReS) / European League Against Rheumatism (EULAR) Taskforce has developed international recommendations and standards for transitional care and a growing evidence base supports the positive benefits of such care. However, there is also evidence that universal implementation has yet to be realised. In 2020, against this background the COVID-19 pandemic arrived with significant impact on all our lives, young and old, patient, public and professional alike. The unfortunate reality of the pandemic with potential for unfavourable outcomes on healthcare provision during transition was acknowledged by the PReS working groups in a position statement to support healthcare professionals, young people and their caregivers. AIM The aim of this review is to present the literature which provides the rationale for the recommendations in the PReS Position Statement. The following areas are specifically addressed: the prime importance of care coordination; the impact of the pandemic on the various aspects of the transition process; the importance of ensuring continuity of medication supply; the pros and cons of telemedicine with young people; ensuring meaningful involvement of young people in service development and the importance of core adolescent health practices such as routine developmental assessment psychosocial screening and appropriate parental involvement during transitional care.
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Affiliation(s)
- Janet E. McDonagh
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Stopford Building, 2nd floor, Oxford Rd, Manchester, M13 9PT UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Rachel Tattersall
- Sheffield Children’s Hospital and Sheffield Teaching Hospitals, Manchester, UK
| | - Jacqui Clinch
- Bristol Royal Hospital for Children and Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Joanne Swan
- Public Health Family Nurse, Family Nurse Partnership, Wallacetown Health Centre, NHS Tayside, Dundee, UK
- Paediatric Rheumatology European Society (PReS) Juvenile Dermatomyositis Working Party, Manchester, UK
| | - Helen E. Foster
- Paediatric Rheumatology, Newcastle University, Newcastle upon Tyne, UK
- Honorary Consultant Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Chair Paediatric Global Musculoskeletal Task Force, Manchester, UK
| | - Liza McCann
- Paediatric Rheumatology European Society (PReS) Juvenile Dermatomyositis Working Party, Manchester, UK
- Consultant Paediatric Rheumatologist, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
- Honorary Clinical Senior Lecturer, University of Liverpool, Liverpool, UK
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13
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Levy BB, Song JZ, Luong D, Perrier L, Bayley MT, Andrew G, Arbour-Nicitopoulos K, Chan B, Curran CJ, Dimitropoulos G, Hartman L, Huang L, Kastner M, Kingsnorth S, McCormick A, Nelson M, Nicholas D, Penner M, Thompson L, Toulany A, Woo A, Zee J, Munce SEP. Transitional Care Interventions for Youth With Disabilities: A Systematic Review. Pediatrics 2020; 146:peds.2020-0187. [PMID: 33046586 DOI: 10.1542/peds.2020-0187] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Transition from the pediatric to the adult health care system is a complex process that should include medical, psychosocial, educational, recreational, and vocational considerations. OBJECTIVE In this systematic review, we aim to synthesize the evidence on transitional care interventions (TCIs) to improve the quality of life (QoL) for adolescents and young adults with childhood-onset disabilities, including neurodevelopmental disorders. DATA SOURCES Four electronic databases (Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature) were searched. STUDY SELECTION In the included studies, researchers examined TCIs for adolescents and young adults (12-24 years of age) with childhood-onset disabilities. Studies were experimental, quasi-experimental, and observational studies published in the last 26 years. DATA EXTRACTION Two reviewers independently completed study screening, data extraction, and risk-of-bias assessment. RESULTS Fifty-two studies were included. Five studies reported on QoL, but statistically significant improvements were noted in only 1 of these studies. Significant improvements were also found in secondary outcomes including disability-related knowledge and transitional readiness. TCIs targeted patients, families and/or caregivers, and health care providers and exhibited great heterogeneity in their characteristics and components. LIMITATIONS Inconsistent reporting on interventions between studies hindered synthesis of the relationships between specific intervention characteristics and outcomes. CONCLUSIONS Although there is limited evidence on the impact of TCIs on the QoL for youth with childhood-onset disabilities, there is indication that they can be effective in improving patient and provider outcomes. The initiation of transition-focused care at an early age may contribute to improved long-term health outcomes in this population.
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Affiliation(s)
- Ben B Levy
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jessica Z Song
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Mark T Bayley
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and.,Division of Physical Medicine, and
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Brian Chan
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Cynthia J Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | | | - Laura Hartman
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lennox Huang
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, and.,Family and Community Medicine, and.,North York General Hospital, Toronto, Ontario, Canada
| | - Shauna Kingsnorth
- Rehabilitation Sciences Institute, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, and.,Sinai Health System, Toronto, Ontario, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, and.,Departments of Paediatrics.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Alene Toulany
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Woo
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Joanne Zee
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada; .,Institute of Health Policy, Management and Evaluation, and.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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14
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Willis E, McDonagh JE. Shifting the mindset-adolescent and young adult rheumatology in transition. THE LANCET. RHEUMATOLOGY 2020; 2:e236-e244. [PMID: 38268158 DOI: 10.1016/s2665-9913(19)30163-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 01/26/2024]
Abstract
Almost 30 years have passed since publication of the first reports acknowledging the crucial importance of transitional care for adolescents and young adults with chronic disease, but universal implementation has yet to be achieved. Progress has undoubtedly been made, with increasing evidence for best practice in transitional care. However, translation of research and guidance into clinical practice continues to be challenging. Neuroscience advances in understanding the changes occurring in the adolescent brain demand that the third phase of transition (ie, post-transfer to adult services) is given further attention, with recognition that transfer itself is not the end of the transition process. The complex, often unwieldy health systems delivering care must also be considered. Paediatric and adult rheumatology practitioners need to collaborate not only with each other, but also with practitioners in other disciplines, specialties, and agencies, to plan and commission rheumatology services that are responsive to adolescents and young adults. A shift in approach from focusing on health transition towards developmentally appropriate health care has the potential to improve the care provided during this vulnerable life stage, increasing the likelihood of continuing engagement of patients in their own health care into adulthood and thereby improving health outcomes.
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Affiliation(s)
- Emily Willis
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK; Versus Arthritis Centre for Epidemiology, and Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK.
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15
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de Hosson M, De Backer J, De Wolf D, De Groote K, Demulier L, Mels S, Vandekerckhove K, Goossens E. Development of a transition program for adolescents with congenital heart disease. Eur J Pediatr 2020; 179:339-348. [PMID: 31758312 DOI: 10.1007/s00431-019-03515-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022]
Abstract
Thanks to advances in care, most children with congenital heart disease nowadays survive into adulthood. The majority of patients remain at high risk for future complications. Hence, life-long follow-up is mandatory. Care needs of patients evolve, especially when reaching adulthood. A structured transition period to adult care is advocated. Currently, a fully detailed and structured transition program is not available for patients with congenital heart disease. The aim is to describe the development and design of a multicomponent transition program for adolescents with congenital heart disease, called "Transition with a heart." Transition with a heart was developed based on the Dutch program "On your own feet," starting at the age of 12 years and continuing after transfer. The most vital core components include a general and individualized flowchart, adolescent-centered communication, a joined transfer consultation, and an appointed transition coordinator. Adolescents are gradually informed about their condition and potential late consequences in adult life and stimulated to take medical care in their own hands.Conclusion: Transition with a heart is a practical, multicomponent, comprehensive transition program developed to cover the essential aspects of transitional care for adolescents with congenital heart disease (i.e., continuity of care, disease knowledge, and self-management skills). Interventions were selected from the highest sources of scientific evidence currently available.Clinical trial registration: Not applicableWhat is Known:• Transition towards adult life and health care is a complex process, requiring careful patients' guidance. Various task forces have described the need and potential benefits of transition programs in young people with chronic conditions. Details about the practical development and content of such programs in congenital heart disease are, however, currently lacking.What is New:• This method paper presents the development and design of a person-centered multicomponent transition program for adolescents with congenital heart disease comprising interventional components covering the most important aspects of transitional care: promoting autonomy, disease knowledge, and continuity of care.
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Affiliation(s)
- Michèle de Hosson
- Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Julie De Backer
- Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Daniël De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Laurent Demulier
- Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Saskia Mels
- Department of Psychology, Ghent University Hospital, Ghent, Belgium
| | - Kristof Vandekerckhove
- Research Foundation Flanders (FWO), Brussels, Belgium.,Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Eva Goossens
- Research Foundation Flanders (FWO), Brussels, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Antwerp, Belgium
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16
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Sattoe JNT, Peeters MAC, Haitsma J, van Staa A, Wolters VM, Escher JC. Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation. BMJ Open 2020; 10:e033535. [PMID: 31911522 PMCID: PMC6955474 DOI: 10.1136/bmjopen-2019-033535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Developing and evaluating effective transition interventions for young people (16-25 years) with inflammatory bowel disease (IBD) is a high priority. While transition clinics (TCs) have been recommended, little is known about their operating structures and outcomes. This study aimed to gain insight into the value of a TC compared with direct handover care. DESIGN Controlled mixed-methods evaluation of process outcomes, clinical outcomes and patient-reported outcomes. SETTING Two outpatient IBD clinics in the Netherlands. PARTICIPANTS Data collection included: semistructured interviews with professionals (n=8), observations during consultations with young people (5×4 hours), medical chart reviews of patients transferred 2 to 4 years prior to data collection (n=56 in TC group; n=54 in control group) and patient questionnaires (n=14 in TC group; n=19 in control group). OUTCOMES Data were collected on service structures and daily routines of the TC, experienced barriers, facilitators and benefits, healthcare use, clinical outcomes, self-management outcomes and experiences and satisfaction of young people with IBD. RESULTS At the TC, multidisciplinary team meetings and alignment of care between paediatric and adult care providers were standard practice. Non-medical topics received more attention during consultations with young people at the TC. Barriers experienced by professionals were time restrictions, planning difficulties, limited involvement of adult care providers and insufficient financial coverage. Facilitators experienced were high professional motivation and a high case load. Over the year before transfer, young people at the TC had more planned consultations (p=0.015, Cohen's d=0.47). They showed a positive trend in better transfer experiences and more satisfaction. Those in direct handover care more often experienced a relapse before transfer (p=0.003) and had more missed consultations (p=0.034, Cohen's d=-0.43) after transfer. CONCLUSION A TC offer opportunities to improve transitional care, but organisational and financial barriers need to be addressed before guidelines and consensus statements in healthcare policy and daily practice can be effectively implemented.
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Affiliation(s)
- Jane N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Mariëlle A C Peeters
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jannie Haitsma
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Victorien M Wolters
- Department of Pediatric Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
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17
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Hilberink SR, Grootoonk A, Ketelaar M, Vos I, Cornet L, Roebroeck ME. Focus on autonomy: Using 'Skills for Growing Up' in pediatric rehabilitation care. J Pediatr Rehabil Med 2020; 13:161-167. [PMID: 32444575 PMCID: PMC7458530 DOI: 10.3233/prm-190618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Youth with disabilities face challenges regarding achieving autonomy. The 'Skills for Growing Up' tool was adapted for use in Dutch pediatric rehabilitation (SGU-D) to support development of autonomy. This study presents the experiences with the SGU-D tool. METHODS The SGU-D was implemented in 18 settings, of which 4 participated in the evaluation. Rehabilitation professionals were trained in the use of the SGU-D. In a qualitative study, participants were interviewed for their opinions regarding the tool. RESULTS Experience with the SGU-D was evaluated in 11 youth with disabilities, 11 parents and 8 rehabilitation professionals. They perceived the SGU-D as a helpful tool: i) to support development of autonomy, ii) to focus on future perspectives, and iii) to facilitate communication with family and rehabilitation professionals. Additional support from rehabilitation professionals on using the SGU-D was appreciated. CONCLUSION Youth with disabilities, their parents and rehabilitation professionals value the SGU-D as a practical tool for working on autonomy, and to identify important areas of development.
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Affiliation(s)
- Sander R Hilberink
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Anneke Grootoonk
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Ieteke Vos
- Blixembosch Rehabilitation Centre Eindhoven, Libra Group, The Netherlands
| | | | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
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18
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Peeters MAC, Sattoe JNT, van Staa A, Versteeg SE, Heeres I, Rutjes NW, Janssens HM. Controlled evaluation of a transition clinic for Dutch young people with cystic fibrosis. Pediatr Pulmonol 2019; 54:1811-1820. [PMID: 31424181 PMCID: PMC6852263 DOI: 10.1002/ppul.24476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transition clinics (TCs) are advocated as best practice to support young people with cystic fibrosis (CF) during transition to adulthood and adult care. We aimed to research the functioning of a TC for young people with CF compared with direct hand-over care and to evaluate whether those treated at the TC have better transfer experiences and outcomes compared with the control group. METHODS Mixed-methods retrospective controlled design, including interviews with professionals, observations of clinics, chart reviews (at four measurement moments), and patient surveys. Qualitative data analysis focused on organization and daily routines, and barriers and facilitators experienced. Young people's transfer experiences, self-management, health care use, and clinical outcomes were assessed quantitatively. RESULTS The most notable feature distinguishing the TC and direct hand-over care comprised joint consultations between pediatric and adult care professionals in the former. A transition coordinator was considered essential for the success of the TC. The main barriers were lack of time, planning, and reimbursement issues. Young people treated at the TC tended to have better transfer experiences and were more satisfied. They reported significantly more trust in their adult care professionals. Their self-management-related outcomes were less favorable. CONCLUSIONS The TC had several perceived benefits and showed positive trends in transfer experiences and satisfaction, but no differences in health-related outcomes. Structured preparation of young people, joint consultations with pediatric and adult care professionals, and better coordination were perceived as facilitating elements. Further improvement demands solutions for organizational and financial barriers, and better embedding of self-management interventions in CF care.
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Affiliation(s)
- Mariëlle A C Peeters
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jane N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Simone E Versteeg
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Inge Heeres
- Department of Pediatrics, Division Respiratory Medicine and Allergology, Erasmus MC/Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Niels W Rutjes
- Department of Pediatric Pulmonology, Amsterdam UMC/Emma Children's Hospital, Amsterdam, The Netherlands
| | - Hettie M Janssens
- Department of Pediatrics, Division Respiratory Medicine and Allergology, Erasmus MC/Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW Effective transitional care for adolescents and young adults (AYA) with rheumatic musculoskeletal disease (RMD) is fundamental to rheumatology care provision. Here we review the recent evidence from the literature on transition in rheumatology and debate why universal implementation has yet to be recognised. RECENT FINDINGS Evidence of need for transitional care continues to be reported. The triphasic nature of transitional care remains poorly recognised, and the third phase following transfer to adult rheumatology is particularly under-researched in spite of the recognition of the age-related trajectories of transition skill development during young adulthood. Several rheumatology-specific transitional care interventions have now been evaluated but the search for valid measures including outcome continues. Finally, the need to study transition at a health system level is increasingly recognised. Future research in this area should consider the developmental trajectories of AYA as well as the social-ecological model of transition readiness, which focuses on the interactions between AYA, caregivers and providers (and the systems they are part of) as these are the likely targets of any intervention to improve health transitions.
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Affiliation(s)
- Janet E McDonagh
- Versus Arthritis Centre for Epidemiology, Centre for MSK Research, University of Manchester and NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK.
| | - Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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20
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Coyne I, Sheehan A, Heery E, While AE. Healthcare transition for adolescents and young adults with long-term conditions: Qualitative study of patients, parents and healthcare professionals' experiences. J Clin Nurs 2019; 28:4062-4076. [PMID: 31327174 DOI: 10.1111/jocn.15006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/20/2019] [Accepted: 07/09/2019] [Indexed: 01/26/2023]
Abstract
AIM AND OBJECTIVES To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long-term conditions: diabetes, cystic fibrosis and congenital heart disease. BACKGROUND Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet, limited empirical evidence exists regarding transition experiences. DESIGN Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). METHODS Semi-structured interviews with AYAs aged 14-25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed-methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. RESULTS Transfer occurred between the ages of 16-early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following-up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults' prerogative. CONCLUSIONS The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. RELEVANCE TO CLINICAL PRACTICE Nurses in collaboration with the multidisciplinary team can help AYAs develop their self-management skills and guide parents on how to relinquish responsibility gradually prior to transition.
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Affiliation(s)
- Imelda Coyne
- School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Aisling Sheehan
- School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Emily Heery
- School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Alison E While
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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21
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Nightingale R, McHugh G, Kirk S, Swallow V. Supporting children and young people to assume responsibility from their parents for the self-management of their long-term condition: An integrative review. Child Care Health Dev 2019; 45:175-188. [PMID: 30690751 DOI: 10.1111/cch.12645] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children and young people with long-term conditions (LTCs) are usually dependent on, or share management with, their families and are expected to develop self-management skills as they mature. However, during adolescence, young people can find it challenging to follow prescribed treatment regimens resulting in poor clinical outcomes. Though reviews have looked at children's and parents' experiences of self-management, none have explicitly examined the parent-to-child transfer of self-management responsibility. METHODS An integrative review was conducted with the aim of exploring the parent-to-child transfer of LTC self-management responsibility, through addressing two questions: (a) How do children assume responsibility from their parents for self-management of their LTC? (b) What influences the parent-to-child transfer of this responsibility? Eight databases were searched for papers published from 1995 to 2017. Methodological quality was assessed; included papers were synthesized to identify themes. RESULTS Twenty-nine papers were identified. Most papers used qualitative designs and focused on children with diabetes. Participants were predominantly children and/or parents; only two studies included health professionals. Assuming self-management responsibility was viewed as part of normal development but was rarely explored within the context of the child gaining independence in other areas of their life. Children and parents adopted strategies to help the transfer, but there was limited evidence around health professionals' roles and ambivalence around what was helpful. There was a lack of clarity over whether children and parents were aiming for shared management, or self-management, and whether this was a realistic or desired goal for families. Multiple factors such as the child, family, social networks, health professional, and LTC influenced how a child assumed responsibility. CONCLUSIONS Evidence suggests that the parent-to-child transfer of self-management responsibility is a complex, individualized process. Further research across childhood LTCs is needed to explore children's, parents', and professionals' views on this process and what support families require as responsibilities change.
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Affiliation(s)
- Ruth Nightingale
- Great Ormond Street for Hospital NHS Foundation Trust, London, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Gretl McHugh
- School of Healthcare, University of Leeds, Leeds, UK
| | - Susan Kirk
- School of Health Sciences, University of Manchester, Manchester, UK
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22
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Hilberink SR, van Ool M, van der Stege HA, van Vliet MC, van Heijningen-Tousain HJM, de Louw AJA, van Staa A. Skills for Growing Up-Epilepsy: An exploratory mixed methods study into a communication tool to promote autonomy and empowerment of youth with epilepsy. Epilepsy Behav 2018; 86:116-123. [PMID: 29997037 DOI: 10.1016/j.yebeh.2018.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/15/2018] [Accepted: 05/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The consequences of having epilepsy seriously hamper the development of autonomy for youth with epilepsy (YWE) and limit their social participation. This study was designed to provide insight into the impact of epilepsy on autonomy and empowerment and to evaluate the use of the Skills for Growing Up (SGU-Epilepsy) communication tool in pediatric epileptic care. METHODS A mixed methods design was used to examine the impact of epilepsy on autonomy and empowerment and to evaluate the feasibility and use of the SGU-Epilepsy. Six focus groups with YWE and their parents were organized (N = 27), and the benefits of the SGU-Epilepsy were evaluated (N = 72). RESULTS Youth with epilepsy struggled with social participation. Beliefs of YWE and their parents on managing daily life and taking medication were not always similar. Parents worried about the passive attitude of YWE, but autonomy of YWE seemed to be constrained by parents. The SGU-Epilepsy seemed to be feasible. It facilitated the communication on development and empowerment although it was sometimes confronting for parents. Not all YWE were motivated to use and discuss the tool. In the evaluation, no differences in perceived autonomy and empowerment between YWE who used SGU-Epilepsy and received usual care appeared. CONCLUSION On the short-term, a beneficial effect of using the SGU-Epilepsy on autonomy and empowerment for YWE and their parents was not shown. The SGU-Epilepsy seemed to be a feasible instrument, however, to address nonmedical issues during pediatric consultations.
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Affiliation(s)
- Sander R Hilberink
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands.
| | - Marion van Ool
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+, Heeze, P.O. Box 61, 5590 AB Heeze, The Netherlands
| | - Heleen A van der Stege
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
| | - Michelle C van Vliet
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
| | - Heidi J M van Heijningen-Tousain
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
| | - Anton J A de Louw
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+, Heeze, P.O. Box 61, 5590 AB Heeze, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands
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Bratt EL, Burström Å, Hanseus K, Rydberg A, Berghammer M. Do not forget the parents-Parents' concerns during transition to adult care for adolescents with congenital heart disease. Child Care Health Dev 2018; 44:278-284. [PMID: 28980341 DOI: 10.1111/cch.12529] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/26/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing up with congenital heart disease (CHD) often means transfer to adult care and lifelong medical follow-up. An optimal transition process usually involves a multipart collaboration between the patient, their parents and other family members, and the healthcare providers. Taking an active role while knowing when it is time to step aside can be difficult for all the concerned parties, even the healthcare professionals. The aim of the present study therefore, was to explore parents' expectations and needs during their adolescent's transition to adult care. METHOD Semi-structured interviews were conducted with 18 parents of 16 adolescents (aged 13-18 years) with CHD in 4 pediatric cardiology settings in Sweden. The interviews were analysed with qualitative content analysis. RESULTS The analysis resulted in 2 main themes: (a) Feeling secure-the importance of being prepared and informed. This theme focused on the need to be prepared and informed about transition and future transfer to adult care. (b) Recognizing when to hand over at the right time. This theme addressed the process of handing over the responsibility from the parent to the adolescents and contained handing over from pediatric care to adult care. CONCLUSION Being prepared and informed about the upcoming transition process was essential. The parents underlined the importance of being involved in the transition planning for gradually handing over responsibility to the adolescent. They also considered establishing contact with the adult healthcare team before transfer as important and needed to be assured that CHD-related information of importance for the young person's daily life would be given.
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Affiliation(s)
- E L Bratt
- Institution of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Å Burström
- Institution for Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - K Hanseus
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - A Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - M Berghammer
- University West, Department of Health Science, Trollhättan, Sweden.,Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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24
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Zoni S, Verga ME, Hauschild M, Aquarone-Vaucher MP, Gyuriga T, Ramelet AS, Dwyer AA. Patient Perspectives on Nurse-led Consultations Within a Pilot Structured Transition Program for Young Adults Moving From an Academic Tertiary Setting to Community-based Type 1 Diabetes Care. J Pediatr Nurs 2018; 38:99-105. [PMID: 29357987 DOI: 10.1016/j.pedn.2017.11.015] [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: 06/10/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices. DESIGN AND METHODS A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction - short scale). HbA1c values were compared to guideline recommendations. RESULTS Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5±0.5) while patients reported the lowest adherence to diet recommendations (2.9±0.8). Overall satisfaction with nurse-led consultations was high (4±0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations. CONCLUSIONS Young adults found the nurse-led consultations with therapeutic education to develop T1DM self-care skills are an important complement to medical management during transition. PRACTICE IMPLICATIONS Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management.
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Affiliation(s)
- Sandra Zoni
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland
| | - Marie-Elise Verga
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Haute école de santé Fribourg, Fribourg Switzerland
| | - Michael Hauschild
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Marie-Paule Aquarone-Vaucher
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Teresa Gyuriga
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Department of Maternal and Child Health, Lausanne, Switzerland
| | - Andrew A Dwyer
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Endocrinology, Diabetes and Metabolism Service, Lausanne, Switzerland.
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25
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Sattoe JNT, Hilberink SR, van Staa A. How to define successful transition? An exploration of consensus indicators and outcomes in young adults with chronic conditions. Child Care Health Dev 2017; 43:768-773. [PMID: 28074484 DOI: 10.1111/cch.12436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/02/2016] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this short report, we use data from a previous cohort study to explore the relationship between five out of eight consensus indicators for successful transition and patient-reported outcomes in young adulthood. METHODS Data came from a 6-year cohort study that consisted of a survey among 518 young adults with various chronic conditions and a review of their electronic patient records. Associations between five indicators for successful transition and background variables and patient-reported outcomes were explored with Spearman's r. Significant variables were included in stepwise (logistic) regression analyses with transition outcomes as dependent variables. RESULTS The indicators relate to some extent to better healthcare-related transition outcomes, but not to autonomy in participation. The explained variance of the models varied from 9.7% to 26.4%. The change in explained variance after adding indicators varied from 2% to 16%. CONCLUSIONS The challenge of translating the definition of transition into holistic indicators remains. The current consensus indicators are a good start, but there is more to transition than transfer.
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Affiliation(s)
- J N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - S R Hilberink
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - A van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Downing J, Gleeson H, Clayton P, Davis J, Dimitri P, Wales J, Young B, Callery P. Communication with young people in paediatric and adult endocrine consultations: an intervention development and feasibility study. BMC Endocr Disord 2017; 17:33. [PMID: 28619024 PMCID: PMC5472891 DOI: 10.1186/s12902-017-0182-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/31/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Communication is complex in endocrine care, particularly during transition from paediatric to adult services. The aims of this study were to examine the feasibility of interventions to support young people to interact with clinicians. METHODS Development and evaluation of a complex intervention in 2 phases: Pre-intervention observational study; Intervention feasibility study. Purposive sample of recordings of 62 consultations with 58 young people aged 11-25 years with long-term endocrine conditions in two paediatric and two adult endocrine clinics. Proportion of time talked during consultations, number and direction of questions asked; Paediatric Consultation Assessment Tool (PCAT); OPTION shared decision making tool; Medical Information Satisfaction Scale (MISS- 21). Young people were invited to use one or more of: a prompt sheet to help them influence consultation agendas and raise questions; a summary sheet to record key information; and the www.explain.me.uk website. RESULTS Nearly two thirds of young people (63%) chose to use at least one communication intervention. Higher ratings for two PCAT items (95% CI 0.0 to 1.1 and 0.1 to 1.7) suggest interventions can support consultation skills. A higher proportion of accompanying persons (83%) than young people (64%) directed questions to clinicians. The proportion of young people asking questions was higher (84%) in the intervention phase than in the observation phase (71%). CONCLUSIONS Interventions were acceptable and feasible. The Intervention phase was associated with YP asking more questions, which implies that the availability of interventions could promote interactivity.
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Affiliation(s)
- J. Downing
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - H. Gleeson
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - P.E. Clayton
- School of Medical Sciences, University of Manchester, Royal Manchester Children’s Hospital, Central Manchester University Hospital’s Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J.R.E. Davis
- School of Medical Sciences, University of Manchester, Royal Manchester Children’s Hospital, Central Manchester University Hospital’s Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - P. Dimitri
- Sheffield Children’s Hospital, Sheffield, UK
| | - J. Wales
- University of Queensland and Department of Endocrinology & Diabetes, Lady Cilento Children’s Hospital, South Brisbane, Australia
| | - B. Young
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - P. Callery
- School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
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Foster HE, Minden K, Clemente D, Leon L, McDonagh JE, Kamphuis S, Berggren K, van Pelt P, Wouters C, Waite-Jones J, Tattersall R, Wyllie R, Stones SR, Martini A, Constantin T, Schalm S, Fidanci B, Erer B, Demirkaya E, Ozen S, Carmona L. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis 2016; 76:639-646. [PMID: 27802961 DOI: 10.1136/annrheumdis-2016-210112] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 02/06/2023]
Abstract
To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks.
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Affiliation(s)
- Helen E Foster
- Newcastle University, Institute of Cellular Medicine (Rheumatology), Newcastle, UK
| | - Kirsten Minden
- Children's University hospital Charité, Campus Virchow, SPZ, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Clemente
- Paediatric Rheumatology Unit, Hospital Infantil Universitario "Niño Jesús", Madrid, Spain
| | - Leticia Leon
- Hospital Cí-nico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Madrid, Spain.,Health Sciences, Universidad Camilo José Cela, Madrid, Madrid, Spain
| | - Janet E McDonagh
- University of Manchester, Centre for Musculoskeletal Research, Manchester, Manchester, UK
| | - Sylvia Kamphuis
- Immunology and Infectiology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | | | - Philomine van Pelt
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Rachel Tattersall
- University of Sheffield, School of Health and Related Research, Sheffield, Sheffield, UK
| | - Ruth Wyllie
- Paediatric Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | - Alberto Martini
- Pediatria II, Universita degli Studi di Genova Scuola di Scienze Mediche e Farmaceutiche, Genova, Liguria, Italy
| | | | - Susanne Schalm
- Transitionssprechstunde am Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Berna Fidanci
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey, Ankara, Turkey
| | - Burak Erer
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erkan Demirkaya
- Gulhane Military Medical Faculty, Pediatric Rheumatology Unit, FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Etlik, Ankara 06018, Turkey, Ankara, Turkey
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey
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Monaghan M, Baumann K. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care. RESEARCH AND REPORTS IN ENDOCRINE DISORDERS 2016; 6:31-40. [PMID: 27812509 PMCID: PMC5087810 DOI: 10.2147/rred.s56609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Science, Children's National Health System
- George Washington University School of Medicine, Washington, DC, USA
| | - Katherine Baumann
- George Washington University School of Medicine, Washington, DC, USA
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29
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Christian BJ. Translational Research--Addressing the Challenge of Healthcare Transitions for Adolescents With Special Health Care Needs. J Pediatr Nurs 2015; 30:797-801. [PMID: 26293903 DOI: 10.1016/j.pedn.2015.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 07/29/2015] [Indexed: 11/27/2022]
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