1
|
Heera S, Beattie K, Punthakee Z, DiRezze B, Herrington J, Cellucci T, Heale L, Matsos M, Gorter JW, Batthish M. The TRUST Study-TRansition US Together: Evaluating the Impact of a Parent- and Adolescent-Centered Transition Toolkit on Transition Readiness in Patients with Juvenile Idiopathic Arthritis and Childhood-Onset Systemic Lupus Erythematosus. CHILDREN (BASEL, SWITZERLAND) 2024; 11:881. [PMID: 39062330 PMCID: PMC11276097 DOI: 10.3390/children11070881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE Adolescents with chronic rheumatic disease must increasingly take on more responsibility for disease management from parents as they transition from pediatric to adult care. Yet, there are limited resources to inform and support parents about transition. Here, we evaluate the impact of a Transition Toolkit, geared towards parents and adolescents, on transition readiness, and explore the potential impact of parent-adolescent communication. METHODS A prospective cohort study of youths aged 14-18 years old and their parents was performed. Participant demographics, disease characteristics, transition readiness scores (Transition-Q, max 100), and parent-adolescent communication scores (PACS, max 100) were collected at enrollment (when the Transition Toolkit was shared with adolescents and their parents. Generalized estimating equation (GEE) analyses determined the influence of the Toolkit on transition readiness and explored the role of parent-adolescent communication quality. Subgroup analyses were conducted by sex. RESULTS A total of 21 patients were included; 19 completed one post-intervention Transition-Q and 16 completed two. Transition-Q scores increased over time and the rate of increase doubled after the Toolkit was shared (β = 7.8, p < 0.05, and β = 15.5, p < 0.05, respectively). CONCLUSION Transition readiness improved at each follow-up, the greatest increase was seen after the Toolkit was shared. Parent-adolescent communication quality did not appear to impact changes in transition readiness.
Collapse
Affiliation(s)
- Simran Heera
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada; (S.H.); (B.D.); (J.H.)
| | - Karen Beattie
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada (M.M.)
| | - Briano DiRezze
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada; (S.H.); (B.D.); (J.H.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Julie Herrington
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada; (S.H.); (B.D.); (J.H.)
| | - Tania Cellucci
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
| | - Liane Heale
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
| | - Mark Matsos
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada (M.M.)
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Michelle Batthish
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
| |
Collapse
|
2
|
Murray CB, Murphy LK, Jordan A, Owens MT, McLeod D, Palermo TM. Healthcare Transition Among Young Adults With Childhood-Onset Chronic Pain: A Mixed Methods Study and Proposed Framework. THE JOURNAL OF PAIN 2022; 23:1358-1370. [PMID: 35301116 DOI: 10.1016/j.jpain.2022.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain extends from childhood to adulthood for many young people. The transition from pediatric to adult care is a critical, yet understudied, healthcare task facing young adults with chronic pain. The aims of this observational, sequential mixed methods study were to 1) document the healthcare transition status of young adults with chronic pain (Stage 1, quantitative aim), 2) examine young adults' perspectives of barriers and facilitators of healthcare transition (Stage 2, qualitative aim), and 3) integrate findings to construct a theoretical framework of healthcare transition. A cohort was identified with childhood chronic pain and prior care in one of 15 multidisciplinary pediatric pain clinics across the United States and Canada. Approximately 6 years later, 189 young adults (M age = 21.0; age range = 18-24; 81.5% female) from this cohort with continuing chronic pain completed surveys for Stage 1, and a subsample (n = 17) completed qualitative interviews for Stage 2. Quantitative findings demonstrated that young adults may experience lapses in care, with 41.8% indicating they had not transitioned to adult pain services. Qualitative analysis revealed young adults experienced significant barriers (eg, abrupt departure from pediatric care) as well as facilitators (eg, acceptance of pain prognosis) of healthcare transition. Quantitative and qualitative findings were integrated to construct a healthcare transition framework for chronic pain, which highlights transition as a complex process involving multiple pathways, outcomes, and stakeholders. Advancements in research and practice are needed to develop transition services to bridge gaps in care and optimize health outcomes for young people with chronic pain. PERSPECTIVE: This mixed-methods study demonstrated that 41.8% of young adults with chronic pain experience lapses in adult-centered pain care and identified key barriers and facilitators to successful healthcare transition. Findings were integrated to construct the first healthcare transition framework for youth with chronic pain.
Collapse
Affiliation(s)
- Caitlin B Murray
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington.
| | - Lexa K Murphy
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
| | - Michele Tsai Owens
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dorothy McLeod
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
3
|
OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4097-4106. [DOI: 10.1093/rheumatology/keac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Indexed: 11/13/2022] Open
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Palman J, McDonagh JE. Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology. Open Access Rheumatol 2020; 12:309-321. [PMID: 33324121 PMCID: PMC7732171 DOI: 10.2147/oarrr.s228083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022] Open
Abstract
Consideration of the mental health and emotional wellbeing is an important component of health care for all young people, irrespective of setting. Mental health disorders are common during adolescence and young adulthood and young people with rheumatic musculoskeletal diseases (RMD) are not exempt. For such young people, risks of poor outcomes are related to both mental health as well as their RMD. Times of change during adolescence and young adulthood-transitions-are potentially vulnerable life stages for young people with RMD and warrant specific attention in health care provision. Such transitions include those occurring at puberty, during education, training, and employment, socially with moves away from the parental home, as well as from child to adult-centered health services. There is great potential for rheumatology professionals to support young people with RMD at these transitions in view of their frequent encounters and ongoing therapeutic relationships. In this review, we aim to assess the impact of mental health on RMD during adolescence and young adulthood with particular reference to transitional care provision and how rheumatology professionals can be involved in addressing mental health issues during this time of change.
Collapse
Affiliation(s)
- Jason Palman
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Manchester, UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| |
Collapse
|