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Li L, Soper AK, McCauley D, Gorter JW, Doucet S, Greenaway J, Luke A. Landscape of healthcare transition services in Canada: a multi-method environmental scan. BMC Health Serv Res 2024; 24:1114. [PMID: 39334077 PMCID: PMC11428857 DOI: 10.1186/s12913-024-11533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Poorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the "Transition Hub", established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services. METHODS Our project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers' perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method. RESULTS Fifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change. CONCLUSIONS While national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.
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Affiliation(s)
- Lin Li
- University of Toronto, Toronto, Canada.
- Centre for Addiction and Mental Health, Toronto, Canada.
| | | | | | - Jan Willem Gorter
- McMaster University, Hamilton, Canada
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Jon Greenaway
- ErinoakKids Centre for Treatment and Development, Mississauga, Canada
| | - Alison Luke
- University of New Brunswick, Saint John, Canada
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Hansen CF, Brodersen JB, Krogsgaard MR. Health-related quality of life for children with anterior cruciate ligament deficiency: Ensuring content validity of the new KIDS-KNEES-ACL questionnaire. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39101228 DOI: 10.1002/ksa.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/30/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE The existing knee-specific pediatric patient-reported outcome measures (PROMs) lack content and construct validity for children with anterior cruciate ligament (ACL) injury. This impairs their accuracy which can lead to false interpretations of data and inaccurate clinical guidelines. The purpose of this study was to develop a content-valid PROM for children with an ACL injury. METHODS The process adhered to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines for PROM development. Informants were children with ACL deficiency and sampled based on age, sex, and treatment. Semistructured interviews were conducted exploring themes within the International Classification of Functioning, Disability and Health model. Interviews continued beyond data saturation. By thematic analysis and by probing items from the adult PROM 'KNEES-ACL', new themes and items emerged. Content coverage, relevance and understandability were continuously evaluated. All interviews were recorded and transcribed verbatim. The NVivo 12 software was used for data analysis and coding of items. RESULTS A PROM of 60 items across nine subscales was formed. From cognitive interviews, 19 new items emerged. Forty-one of 55 items from KNEES-ACL were endorsed as relevant; however, all required rewording to ensure understandability. Substantial differences in the psychosocial impact between adults and children were observed. The children experienced a more considerable negative psychosocial impact caused by a loss of participation in sports, lower self-confidence and loss of social networks. This resulted in four new domains. The physical issues were similar to adults, with few exceptions. CONCLUSION The 'KIDS-KNEES-ACL' 1.0 (qualitative version) was developed. This version will be subjected to psychometric analysis, resulting in adequate measurement properties of the final KIDS-KNEES-ACL 2.0. As the only adequate pediatric ACL-specific PROM, its use in clinical trials and databases will enhance PROM data quality, and strengthen clinical guidelines and thus the treatment of children with ACL injury. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Christian Fugl Hansen
- Department of Orthopedic Surgery, Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Copenhagen University Hospital, Copenhagen, Denmark
| | - John Brandt Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
| | - Michael Rindom Krogsgaard
- Department of Orthopedic Surgery, Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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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.
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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.)
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Yiğit RE, Çağlayan Ş, Sözeri B. The cultural differences in transition assessment: Evaluation of TRANSITION-Q and STARx scales on Turkish rheumatic patients. Arch Rheumatol 2024; 39:255-264. [PMID: 38933719 PMCID: PMC11196235 DOI: 10.46497/archrheumatol.2024.10379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/15/2023] [Indexed: 06/28/2024] Open
Abstract
Objectives This study aimed to assess the readiness of our patient population for the transfer to adult care and the applicability of the TRANSITION-Q and STARx scales to the Turkish adolescent patient population. Patients and methods A total of 153 patients (92 males, 61 females; mean age: 15.5±1.9 years; range, 12 to 18 years) were included in the study between September 15, 2021, and December 15, 2021. The patients were divided into two groups according to age groups: 12 to 15 years old and 16 to 18 years old. The patients were also divided into four groups according to their diagnosis: connective tissue diseases, juvenile idiopathic arthritis, vasculitis, and autoinflammatory diseases. The TRANSITION-Q and STARx scales were administered face-to-face by a nurse and a doctor. The transition readiness of the patients was evaluated according to their scores. Results Sixty-nine (45%) patients were in the 12 to 15 age group, and 84 (55%) were in the 16 to 18 age group. Eight-four (54.9%) patients had juvenile idiopathic arthritis, 47 (30.7%) patients had an autoinflammatory disease, 14 (9.2%) patients had vasculitis, and eight (5.2%) patients had a connective tissue disease. There was no significant difference in the scale scores according to disease groups and sexes in both scales. Considering the age of the patients, the mean scores of the patients in the 16 to 18 age group were found to be significantly higher compared to the 12 to 15 age group for both the TRANSITION-Q (74.3±13.3 vs. 65.4±9.6, p<0.001) and STARx scales (51.8±8.1 vs. 44.8±9.1, p<0.001). Cronbach's alpha score was 0.71 for the STARx scale and 0.79 for the TRANSITION-Q scale. Conclusion TRANSITION-Q and STARx scales could guide the Turkish patient population in determining the pretransition needs of patients in planning individualized transition processes.
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Affiliation(s)
- Ramazan Emre Yiğit
- Department of Pediatric, Division of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Türkiye
| | - Şengül Çağlayan
- Department of Pediatric, Division of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Türkiye
| | - Betül Sözeri
- Department of Pediatric, Division of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Türkiye
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Şahin N, Sönmez HE, Aktay Ayaz N, Sözeri B. Addressing the unmet needs of transitional care in juvenile idiopathic arthritis. Rheumatology (Oxford) 2024; 63:619-629. [PMID: 37774006 PMCID: PMC10907819 DOI: 10.1093/rheumatology/kead518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES We aimed to comprehensively analyse the available literature to identify the unmet requirements in transitional programs tailored specifically for patients diagnosed with JIA. METHODS According to published guidance on narrative reviews, a systematic review of the literature on transitional care in rheumatology was conducted. Pertinent documents were collected from reputable databases, such as Web of Science, Scopus, and MEDLINE/PubMed. The search encompassed literature published from the inception of each database until January 2023. RESULTS In this study, a comprehensive analysis of the findings of 34 studies was conducted. Among these, 12 studies focused on assessing the readiness of adolescents and young adults diagnosed with JIA. Additionally, 18 studies examined the effectiveness of structured transition programs in terms of adherence and satisfaction. Finally, 4 studies investigated disease-related outcomes in this population. CONCLUSION The need for transitioning children with rheumatic diseases to adult rheumatology services for continued care is clearly evident. However, the absence of established best practice guidelines presents a challenge in facilitating this transition effectively. Although several scoring systems have been proposed to ensure organized and seamless transfers, a consensus has not yet been reached. Furthermore, the socio-economic and cultural variations across countries further complicate the development of universal guidelines for transitioning children with rheumatic diseases. To address these concerns, our objective in conducting this literature review was to emphasize the significance of this issue and identify the specific requirements based on the unmet needs in the transition process.
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Affiliation(s)
- Nihal Şahin
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
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Sözeri B, Şahin N, Açarı C, Avar Aydın PO, Baba O, Bağlan E, Bakkaloğlu S, Bakırcı S, Bilginer Y, Bozkaya BY, Çağlayan Ş, Çakan M, Çakmak F, Coşkuner T, Demir F, Demirkan FG, Doğantan Ş, Adıgüzel Dündar H, Ersözlü ED, Gücenmez S, Gürler O, İşgüder R, Küçük A, Kalyoncu M, Kılıç L, Kılıç SŞ, Kısaoğlu H, Paç Kısaarslan A, Kızıldağ Z, Kurtuluş D, Özdel S, Öztürk K, Şenol P, Tanatar A, Taşkın SN, Tuncer Kuru F, Türkuçar S, Ulu K, Ünsal E, Yazıcı A, Gezgin Yıldırım D, Yüksel S, Kasapçopur Ö, Özen S, Aktay Ayaz N, Sönmez HE. Towards a standardized program of transitional care for adolescents with juvenile idiopathic arthritis for Turkey: a national survey study. Pediatr Rheumatol Online J 2024; 22:7. [PMID: 38167070 PMCID: PMC10762787 DOI: 10.1186/s12969-023-00943-3] [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: 09/24/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a prevalent childhood chronic arthritis, often persisting into adulthood. Effective transitional care becomes crucial as these patients transition from pediatric to adult healthcare systems. Despite the concept of transitional care being recognized, its real-world implementation remains inadequately explored. This study aims to evaluate the thoughts and practices of healthcare providers regarding transitional care for JIA patients. METHODS A cross-sectional survey was conducted among pediatric and adult rheumatologists in Turkey. Based on the American Academy of Pediatrics' six core elements of transitional care, the survey included 86 questions. The respondents' demographic data, attitudes towards transitional care, and practical implementation were assessed. RESULTS The survey included 48 rheumatologists, with 43.7% having a transition clinic. The main barriers to establishing transition programs were the absence of adult rheumatologists, lack of time, and financial constraints. Only 23.8% had a multidisciplinary team for transition care. Participants agreed on the importance of coordination and cooperation between pediatric and adult healthcare services. The timing of the transition process varied, with no consensus on when to initiate or complete it. Participants advocated for validated questionnaires adapted to local conditions to assess transition readiness. CONCLUSIONS The study sheds light on the challenges and perspectives surrounding transitional care for JIA patients in Turkey. Despite recognized needs and intentions, practical implementation remains limited due to various barriers. Cultural factors and resource constraints affect the transition process. While acknowledging the existing shortcomings, the research serves as a ground for further efforts to improve transitional care and ensure better outcomes for JIA patients transitioning into adulthood.
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Affiliation(s)
- Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ceyhun Açarı
- Department of Pediatric Rheumatology, Faculty of Medicine, Inönü University, Malatya, Turkey
| | | | - Ozge Baba
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, Etlik State Hospital, Ankara, Turkey
| | - Sevcan Bakkaloğlu
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sibel Bakırcı
- Department of Rheumatology, Antalya State Hospital, Antalya, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Yücel Bozkaya
- Department of Pediatric Rheumatology, Samsun Research and Training Hospital, Samsun, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Zeynep Kamil Research and Training Hospital, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Başakşehir Çam and Sakura State Hospital, Istanbul, Turkey
| | - Taner Coşkuner
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acıbadem Hospital, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şeyda Doğantan
- Department of Pediatric Rheumatology, Mersin City Hospital, Mersin, Turkey
| | - Hatice Adıgüzel Dündar
- Department of Pediatric Rheumatology, Behçet Uz Research and Training Hospital, Izmir, Turkey
| | - Emine Duygu Ersözlü
- Department of Rheumatology, Adana City Research and Training Hospital, Adana, Turkey
| | - Sercan Gücenmez
- Department of Rheumatology, Izmir Atatürk Research and Training Hospital, Izmir, Turkey
| | - Oğuz Gürler
- Department of Rheumatology, Medikal Park Hospital, Samsun, Turkey
| | - Rana İşgüder
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Adem Küçük
- Department of Rheumatology, Faculty of Medicine, Konya Selçuk University, Konya, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Levent Kılıç
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sara Şebnem Kılıç
- Department of Pediatric Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Hakan Kısaoğlu
- Department of Pediatric Rheumatology, Kayseri City Hospital, Kayseri, Turkey
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zehra Kızıldağ
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Duygu Kurtuluş
- Department of Physical Therapy and Rehabilitation, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Semanur Özdel
- Department of Pediatric Rheumatology, Etlik State Hospital, Ankara, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Göztepe Research and Training Hospital, Istanbul, Turkey
| | - Pelin Şenol
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Nur Taşkın
- Department of Pediatric Rheumatology, Eskişehir City Hospital, Eskişehir, Turkey
| | - Fatma Tuncer Kuru
- Department of Rheumatology, Osmaniye State Hospital, Osmaniye, Turkey
| | - Serkan Türkuçar
- Department of Pediatric Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Kadir Ulu
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Erbil Ünsal
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayten Yazıcı
- Department of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Deniz Gezgin Yıldırım
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Rheumatology, Faculty of Medicine, Onsekiz Mart University, Çanakkele, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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Zucchetti G, Ciappina S, Dionisi-Vici M, Giordano M, Varetto A, Biasin E, Felicetti F, Fagioli F. Emotional Distress, Self-Management Skills, and Expectations Among Adolescents and Young Adult Childhood Cancer Survivors in Transition from Pediatric to Adult Care: A Brief Report. J Adolesc Young Adult Oncol 2023; 12:906-911. [PMID: 36867153 DOI: 10.1089/jayao.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The transition from pediatric to adult care poses several emotional and personal challenges to adolescents and young adult (AYA) childhood cancer survivors (CCSs), which need attention to avoid the risk of nonadherence and medical dropout. This brief report describes the condition of AYA-CCSs at the moment of transition in terms of emotional state, personal autonomy, and expectations regarding future care. The results provide insights for clinicians dealing with survivorship care, to enhance AYA-CCSs emotional resilience and to support them in being in charge of their health, thus facilitating their transition to adulthood.
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Affiliation(s)
- Giulia Zucchetti
- Pediatric Oncohematology Department, Regina Margherita Children's Hospital, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Sabrina Ciappina
- Pediatric Oncohematology Department, Regina Margherita Children's Hospital, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Margherita Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Mario Giordano
- Pediatric Oncohematology Department, Regina Margherita Children's Hospital, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Antonella Varetto
- Transition Unit for Childhood Cancer Survivors, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Eleonora Biasin
- Pediatric Oncohematology Department, Regina Margherita Children's Hospital, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Franca Fagioli
- Pediatric Oncohematology Department, Regina Margherita Children's Hospital, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
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8
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Padley N, Moubayed D, Lanteigne A, Ouimet F, Clermont MJ, Fournier A, Racine E. Transition from Paediatric to adult health services: Aspirations and practices of human flourishing. Int J Qual Stud Health Well-being 2023; 18:2278904. [PMID: 37994797 PMCID: PMC11000676 DOI: 10.1080/17482631.2023.2278904] [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: 02/13/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Transition from paediatric to adult care is challenging for youths with a chronic condition. Most transition programmes place high value in autonomy and independence. We undertook a qualitative study to: (1) identify the needs and aspirations of youths and (2) better understand the well-being and flourishing of youths. METHODS Semi-structured interviews were conducted with youths, parents of youths and healthcare professionals recruited from four clinics. Thematic analysis focused on: (1) perceptions of transition; (2) key aspects of human flourishing during transition; and (3) salient concerns with respect to the transition and dimensions of human flourishing. RESULTS 54 interviews were conducted. Perceptions of transition clustered around: (1) apprehension about adult care; (2) lack of clarity about the transition process; (3) emotional attachment to paediatric healthcare professionals; (4) the significance of the coinciding transition into adulthood. Fourteen salient concerns (e.g., Knowledge and information about the transition, Parental involvement in healthcare) were identified with corresponding recommendations. Salient concerns related to important dimensions of human flourishing (e.g., environmental mastery, autonomy). DISCUSSION AND CONCLUSION The flourishing of youths is affected by suboptimal transition practices. We discuss the implications of our findings for environmental mastery, contextual autonomy, and the holistic and humanistic aspects of transition.
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Affiliation(s)
- Nicole Padley
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Dina Moubayed
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
| | - Amélie Lanteigne
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - François Ouimet
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Marie-José Clermont
- Département de pédiatrie, CHU Sainte-Justine, Montréal, Québec, Canada
- Département de pédiatrie, Université de Montréal, Montréal, QC, Canada
| | - Anne Fournier
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Montréal, QC, Canada
- Department of Medicine (Division of Experimental Medicine), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, 3801 Rue University, Montréal, QC, Canada
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9
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Hyde EK, Schultz AS, Ducas R, Soni R, Bekkering H, Barker D, Klippenstein A, Dave MG, Frechette C, St. Goddard-Frechette J, Lester L, Mclarty S, Chudyk AM. Multistakeholder Recommendations for Supporting Patients and Families Transitioning From Paediatric to Adult Congenital Heart Disease Care. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:225-236. [PMID: 37970217 PMCID: PMC10642106 DOI: 10.1016/j.cjcpc.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/10/2023] [Indexed: 11/17/2023]
Abstract
Background Transitioning from paediatric to adult congenital heart disease (CHD) care is a high-risk time for being lost to follow-up. Existing CHD transition programmes have not included patients, caregivers, and health care providers as partners in their development. This study aimed to develop recommendations for a CHD transition programme driven by lived and clinical experiences. Methods We used a multilevel participatory process that engaged adult and paediatric people living with CHD, their caregivers, and CHD health care providers as members of the research team. We also consulted members of these stakeholder groups through a series of 3 virtual workshops that culminated in the generation of recommendations for the essential components of a CHD transition programme. Results The Transition Essentials recommendations inform what information, education, or support is required, who should provide it, and when and how it should be provided. Information, education, and support for self-management and knowledge are required for people living with CHD. Caregivers require information, education, and support to build capacity in people living with CHD and navigate their new role in their loved ones' life. The health care team should provide this information, education, and support with peer support options when people living with CHD are 15-22 years of age. This information, education, and support should be individualized, navigate limitations, build over time, have multimodal options, and be available virtually or in person. Conclusions Engaging those with lived and clinical expertise to develop recommendations for the essential components of a CHD transition programme provides important insights missing from previous studies.
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Affiliation(s)
- Emily K. Hyde
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Annette S.H. Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Robin Ducas
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Reeni Soni
- Children’s Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Dawn Barker
- St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Andrea Klippenstein
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mudra G. Dave
- St Boniface Hospital, Winnipeg, Manitoba, Canada
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | | - Anna M. Chudyk
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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10
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Hart LC, Chisolm D. Improving the use of transition readiness measures in research and clinical care. Pediatr Res 2023; 94:926-930. [PMID: 37029237 DOI: 10.1038/s41390-023-02596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/21/2023] [Accepted: 03/22/2023] [Indexed: 04/09/2023]
Abstract
Measurement of transition readiness is considered a crucial component of effective transition. It is included as one of the Six Core Elements of Transition in national transitional care guidelines. However, the current measures of transition readiness have not been found to correlate with either current or future health outcomes for youth. In addition, there are challenges in measuring transition readiness in youth with intellectual and developmental disabilities, who may not be expected to achieve skills and knowledge that are considered essential for transition in typically developing youth. These concerns make it difficult to know how best to use transition readiness measures in research and clinical care. This article highlights the appeal of measuring transition readiness in clinical and research contexts, the current barriers that prevent us from fully achieving those benefits, and potential strategies for bridging the gap. IMPACT: Transition readiness measures were developed as an attempt to identify those patients who were ready to successfully navigate the transition from pediatric to adult health care. Thus far, the measures that have been developed do not appear to be related to health outcomes such as disease control or timely attendance of the first adult appointment in adult care. We provide suggestions for how to address the current concerns with the available transition readiness measures.
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Affiliation(s)
- Laura C Hart
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
- Departments of Pediatrics and Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Deena Chisolm
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- College of Public Health, The Ohio State University, Columbus, OH, USA
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11
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Medforth N, Boyle C. Challenges, Complexity, and Developments in Transition Services for Young People with Disabilities, Mental Health, and Long-Term Conditions: An Integrative Review. Compr Child Adolesc Nurs 2023; 46:180-200. [PMID: 37639678 DOI: 10.1080/24694193.2023.2245473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Transition to adulthood for young people is complex and multi-faceted, with additional hurdles for young people who have disabilities, long-term, or life-limiting conditions or mental health problems. The challenges in providing effective transition support are not new; researchers, policymakers, commissioners, and service providers have been grappling with the problem for several decades, with varying degrees of success. The aims of this integrative review were firstly to build on previous research to synthesize and evaluate recently published evidence. Secondly to provide an overview of the effectiveness of interventions (in one or a combination of health, social care, and education transitions) designed to support transition to adulthood in these groups of young people. A search of a range of databases retrieved published literature from January 2015 to January 2021 demonstrating global interest in the topic. Fifty-one articles were included following an appraisal of quality and eligibility. Qualitative, quantitative, mixed methods studies, and evidence synthesis were included. Some studies were clinically orientated whilst others examined the impact of the transition process, or utilized participatory approaches which give young service-users and families a voice. Transition between children's and adult health or care services as well as other life-course trajectories, such as life-skills development, education transitions, social inclusion and employability were evaluated. Thematic analysis and synthesis of articles retrieved in this review highlighted themes identified in previous reviews: timing of, and preparation for transition; perceptions and experience of transition; barriers and facilitators; transition outcomes. Additional themes included special considerations; dealing with complexity; advocacy, participation, autonomy, aspirations, and young people's rights; future work, research, and evaluation. Novel perspectives and diverse data sources contributed to holistic understanding of an ongoing priority for international policy, service development, and research: the complexity of providing effective transition support and achieving positive outcomes for young people with long-term and life-limiting health conditions, disabilities, and mental health difficulties.
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12
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Han A, Gingrich J, Yaskina M, Rankin K, San Martin-Feeney D, Mackie AS. Just TRAC it! Transitioning Responsibly to Adult Care Using Smart Phone Technology. J Adolesc Health 2023; 73:561-566. [PMID: 37306646 DOI: 10.1016/j.jadohealth.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE There is little evidence on whether smartphone technology influences transition readiness among adolescents with heart disease. Just TRAC it! is a method of using existing smartphone features (Notes, Calendar, Contacts, Camera) to manage personal health. We evaluated the impact of Just TRAC it! on self-management skills. METHODS Randomized clinical trial of 16-18 year-olds with heart disease. Participants were randomly allocated 1:1 to either usual care (education session) or intervention (education session including Just TRAC it!). The primary outcome was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes were frequency of use and perceived usefulness of Just TRAC it! Analysis was intention-to-treat. RESULTS We enrolled 68 patients (41% female, mean age 17.3 years), 68% having previous cardiac surgery and 26% had cardiac catheterization. TRANSITION-Q scores were similar at baseline and increased over time in both groups but were not significantly different between groups. Each additional point at the baseline score brought, on average, a 0.7-point increase in TRANSITION-Q score (95% CI 0.5-0.9) at each of 3 and 6 months. The Camera, Calendar and Notes apps were reported as most useful. All intervention participants would recommend Just TRAC it! to others. DISCUSSION A nurse-led transition teaching with versus without Just TRAC it! improved transition readiness, with no significant difference between groups. Higher baseline TRANSITION-Q scores were associated with greater increase in scores over time. Participants had a positive reception to Just TRAC it! and would recommend it to others. Smartphone technology may be useful in transition education.
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Affiliation(s)
- Angela Han
- Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jody Gingrich
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Kathryn Rankin
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Andrew S Mackie
- Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, Edmonton, Alberta, Canada.
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13
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Marchak JG, Sadak KT, Effinger KE, Haardörfer R, Escoffery C, Kinahan KE, Freyer DR, Chow EJ, Mertens A. Transition practices for survivors of childhood cancer: a report from the Children's Oncology Group. J Cancer Surviv 2023; 17:342-350. [PMID: 36870037 PMCID: PMC9984742 DOI: 10.1007/s11764-023-01351-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Pediatric healthcare systems must support childhood cancer survivors to optimize their transition to adult care. This study aimed to assess the state of healthcare transition services provided by Children's Oncology Group (COG) institutions. METHODS A 190-question online survey was distributed to 209 COG institutions to assess survivor services, including transition practices, barriers, and implementation of services aligned with the six core elements of Health Care Transition 2.0 from the US Center for Health Care Transition Improvement. RESULTS Representatives from 137 COG sites reported on institutional transition practices. Two-thirds (66.4%) of site discharge survivors to another institution for cancer-related follow-up care in adulthood. Transfer to primary care (33.6%) was a commonly reported model of care for young adult-aged survivors. Site transfer at ≤ 18 years (8.0%), ≤ 21 years (13.1%), ≤ 25 years (7.3%), ≥ 26 years (12.4%), or when survivors are "ready" (25.5%). Few institutions reported offering services aligned with the structured transition process from the six core elements (Median = 1, Mean = 1.56, SD = 1.54, range: 0-5). The most prevalent barriers to transitioning survivors to adult care were perceived lack of late-effects knowledge among clinicians (39.6%) and perceived lack of survivor desire to transfer care (31.9%). CONCLUSIONS Most COG institutions transfer adult-aged survivors of childhood cancer elsewhere for survivor care, yet few programs report delivering recognized standards for quality healthcare transition programming to support survivors. IMPLICATIONS FOR CANCER SURVIVORS Development of best practices for survivor transition is needed to help promote increased early detection and treatment of late effects among adult survivors of childhood cancer.
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Affiliation(s)
- Jordan Gilleland Marchak
- Emory University School of Medicine, Atlanta, GA, USA.
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 2015 Uppergate Dr, GA, Atlanta, 30322, USA.
| | - Karim T Sadak
- University of Minnesota Masonic Children's Hospital and Cancer Center, Minneapolis, MN, USA
| | - Karen E Effinger
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 2015 Uppergate Dr, GA, Atlanta, 30322, USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Karen E Kinahan
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - David R Freyer
- Children's Center for Cancer and Blood Disorders, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Ann Mertens
- Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 2015 Uppergate Dr, GA, Atlanta, 30322, USA
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14
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Mulkey M, Baggett AB, Tumin D. Readiness for transition to adult health care among US adolescents, 2016-2020. Child Care Health Dev 2023; 49:321-331. [PMID: 35993998 PMCID: PMC10087515 DOI: 10.1111/cch.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Adolescence is a critical period of transition from paediatric to adult health care, but readiness for this transition has been described as low in the general adolescent population. We aimed to investigate whether transition readiness improved over time among US adolescents and to examine associations between demographic and clinical characteristics and transition readiness over time. METHODS Deidentified caregiver-reported repeated cross-sectional data from the 2016-2020 National Survey of Children's Health were analysed for caregiver-reported measures of transition readiness among adolescents age 12-17 years. Logistic regression was used to identify trends in transition readiness and change over time in factors associated with this outcome. RESULTS Among 55 022 adolescents represented in the five survey years, the proportion meeting a composite definition of transition readiness increased from 15% (95% confidence interval [CI]: 14%, 16%) in 2016 to 19% (95% CI: 17%, 20%) in 2020. After multivariable adjustment, each additional year was associated with 12% greater odds of caregiver-reported transition readiness (95% CI: +8%, +15%; P < 0.001), and transition readiness was more likely for girls, older adolescents and adolescents with special health care needs. Associations between adolescent characteristics and transition readiness did not change over the study period. CONCLUSIONS Population-level caregiver-reported transition readiness among US adolescents has increased but remains low. Factors previously associated with transition readiness (age, sex, race and ethnicity, family income and presence of special health care needs) have persisted over recent years.
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Affiliation(s)
- Mackenzie Mulkey
- Department of Anthropology, East Carolina University, Greenville, North Carolina, USA
| | - A Brooke Baggett
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.,ECU Health Medical Center, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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15
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Identifying the Distinct Profiles of Transition Readiness in Chinese Pediatric Cancer Survivors. Cancer Nurs 2023; 46:189-197. [PMID: 36693220 DOI: 10.1097/ncc.0000000000001195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transition readiness is important for pediatric cancer survivors who need to move from pediatric to adult medical care. However, their transition readiness profiles merit further exploration. OBJECTIVES The aim of this study was to use a person-centered approach to identify transition readiness profiles of Chinese pediatric cancer survivors aged 12 to 18 years, diagnosed at least 6 months before the study. METHODS Transition readiness was assessed using the Chinese TRANSITION-Q Scale, and latent class analysis was performed to identify the transition readiness profiles as well as demographic and clinical factors associated with profile classification and to examine how self-efficacy and quality of life may differ between these profiles. RESULTS A total of 139 pediatric cancer survivors were included. Three different transition readiness profiles were identified: high transition readiness, medium transition readiness, and low transition readiness. Age, treatment status, and parental working status were significantly associated with the transition readiness profile classifications. Those who were in the low transition readiness profile were likely to have lower self-efficacy and mobility scores than those in the high or medium transition readiness profiles. CONCLUSIONS Three distinct transition readiness profiles existed in a sample of Chinese pediatric cancer survivors, indicating significant heterogeneity in their transition readiness. IMPLICATIONS FOR PRACTICE Knowledge of transition readiness profiles can assist clinicians in screening pediatric cancer survivors for their profile memberships and provide targeted interventions for those with a low transition profile.
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16
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Huang Y, Wang H, Diaz-Gonzalez de Ferris M, Qin J. Translation and validation of the STAR x questionnaire in transitioning Chinese adolescents and young adults with chronic health conditions. J Pediatr Nurs 2022:S0882-5963(22)00272-X. [PMID: 36464544 DOI: 10.1016/j.pedn.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Adolescent/young adults (AYAs) with chronic conditions must undergo healthcare transition (HCT) preparation until their mid-twenties. Valid HCT readiness measures are lacking in China. METHODS The present study translated, back-translated, and adapted the Self-Management and Transition to Adulthood with Rx = Treatment (STARx) Questionnaire. We examined the psychometric properties of this tool in a relatively large in-patient sample of AYAs with various chronic health conditions at a Chinese tertiary general hospital. RESULTS We enrolled 624 AYAs aged 10-25 years (19.66 ± 3.64) with various chronic health conditions. The Chinese version of the STARx Questionnaire demonstrated excellent internal consistency (Cronbach's alpha = 0.83) and reliability with a two-week test-retest (ICC = 0.88, p < .001). Furthermore, the Chinese version revealed a three-factor structure (self-management, disease knowledge, and provider communication) consistent with the revised English version of the STARx Questionnaire. In terms of discriminant validity, the total score of the Chinese STARx Questionnaire showed a significant positive correlation with age but no gender differences were found. In terms of predictive validity, the Chinese STARx Questionnaire was significantly correlated with shorter length of hospitalization and higher frequency of emergency room visit, but the correlations became insignificant after controlling for age. CONCLUSIONS The results suggest that the Chinese version of the STARx Questionnaire is a robust HCT readiness tool in AYAs with chronic conditions and clinicians may find it useful to develop individualized interventions.
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Affiliation(s)
- Yunzhen Huang
- Division of Special Education and Counseling, California State University, Los Angeles, Los Angeles 90032, CA, United States
| | - Huaping Wang
- Department of Clinical Nutrition, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | | | - Jian Qin
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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17
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Njuguna IN, Beima-Sofie K, Mburu CW, Mugo C, Itindi J, Onyango A, Neary J, Richardson BA, Oyiengo L, Wamalwa D, John-Stewart G. Transition to independent care for youth living with HIV: a cluster randomised clinical trial. Lancet HIV 2022; 9:e828-e837. [PMID: 36309040 PMCID: PMC10308660 DOI: 10.1016/s2352-3018(22)00244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND Transitioning youth living with HIV to adult care is a crucial step in the HIV care continuum; however, tools to support transition in sub-Saharan Africa are insufficient. We assessed the effectiveness of an adolescent transition package (ATP) to improve youth readiness for transition to independent HIV care. METHODS In this hybrid type 1, multicentre, cluster randomised clinical trial, we assessed the effectiveness of an ATP (administered by routine clinic staff, which included standardised assessments and chapter books to guide discussions at scheduled clinic visits) in four counties in Kenya, with HIV clinics randomly assigned 1:1 to ATP or control (standard-of-care practice). Clinics were eligible to participate if they had at least 50 youth (aged 10-24 years) living with HIV enrolled in care. We used restricted randomisation to achieve cluster balance and an independent biostatistician used computer-generated random numbers to assign clinics. We excluded very large clinics with more than 1000 youth, clinics with fewer than 50 youth, paediatric-only clinics, clinics with logistical challenges, and the smallest clinics in Homa Bay county. Youth were eligible for the transition intervention if they were enrolled in participating clinics, were aged 15-24 years, and were aware of their positive HIV diagnosis. Study staff assessed transition readiness scores overall and by four domains (HIV literacy, self-management, communication, and support) in youth with HIV, which were then compared between groups by use of mixed-effects linear regression models. Analysis was by intention-to-treat and was adjusted for multiple comparisons. This trial is registered with ClinicalTrials.gov, NCT03574129. FINDINGS We identified 35 clinics in four counties; of these, ten were assigned to the intervention group and ten to the control group. Of 1066 youth with HIV enrolled between Nov 1, 2019, and March 18, 2020, 578 (54%) were in intervention and 488 (46%) in control sites. Mean baseline transition readiness score was 12·1 (SD 3·4) in ATP sites and 11·4 (3·7) in control sites. At 1 year, adjusting for baseline scores, age, and months since HIV disclosure, participants in the ATP group had significantly higher overall transition readiness scores (adjusted mean difference 1·7, 95% CI 0·3-3·1, p=0·024), and higher scores in HIV literacy domain (adjusted mean difference 1·0, 0·2-1·7, p=0·011). At 12 months, 15 serious adverse events were recorded, none of which were thought to be related to study participation. INTERPRETATION Integrating ATP approaches could enhance long-term HIV care in youth with HIV as they age into adulthood. FUNDING US National Institutes of Health.
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Affiliation(s)
- Irene N Njuguna
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, WA, USA.
| | | | - Caren W Mburu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Janet Itindi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Laura Oyiengo
- Neonatal and Child Health Services, Ministry of Health, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
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18
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Otth M, Denzler S, Diesch-Furlanetto T, Scheinemann K. Cancer knowledge and health-consciousness in childhood cancer survivors following transition into adult care—results from the ACCS project. Front Oncol 2022; 12:946281. [PMID: 36132129 PMCID: PMC9483214 DOI: 10.3389/fonc.2022.946281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Knowledge on chronic medical conditions in childhood cancer survivors (CCSs) is constantly growing and underlines that long-term follow-up (LTFU) care is often mandatory, also in adulthood. However, many CCSs discontinue follow-up care after transition to adult care. One reason might be that the current transition practices do not meet the needs of adolescent and young adult CCSs. We therefore aim to evaluate different transition models for Swiss CCSs by assessing their cancer knowledge, cancer worries, self-management skills, and expectations for LTFU care, following transition in two different hospital-based models. Methods Within the Aftercare of Childhood Cancer Survivors (ACCS) study, we performed a questionnaire-based survey with a cross-sectional and longitudinal part. We included 5-year CCSs aged >16 years at recruitment who were transitioned to adult care in two hospitals between 2014 and 2021. Here, we report the results of the cross-sectional part. We compared the survivors’ cancer knowledge with medical record data and assessed cancer worries (6 questions), self-management skills (15 questions), and expectations (12 questions) by validated scales. We used descriptive statistics, chi-squared test, and t-tests to describe the results. Results We analyzed 57 CCSs (response rate 44%), 60% of those were female, had a median age of 9 years at diagnosis and 23 years at the questionnaire. Most CCSs recalled their diagnosis (95%) and exposure to treatment modalities (98%) correctly. CCSs worried the most about potential late effects (47%) and issues with having children in the future (44%). At least 75% of CCSs agreed to 12 of the 15 self-management questions, indicating high self-management skills. The top three expectations included that physicians know the survivors’ cancer history, that visits start on time, and that physicians can always be called in case of questions. Conclusion CCSs receiving hospital-based LTFU care have good cancer knowledge and high self-management skills. The identified worries and expectations will help to improve the LTFU care of CCSs who transition to adult care, to further inform and educate survivors and healthcare professionals about and might be relevant for other countries with a similar healthcare system.
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Affiliation(s)
- Maria Otth
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland
- Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children’s Hospital Zurich – Eleonore Foundation, Zurich, Switzerland
- *Correspondence: Maria Otth,
| | - Sibylle Denzler
- Hematology and Oncology Department, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Tamara Diesch-Furlanetto
- Division of Pediatric Oncology and Hematology, University Children’s Hospital Basel, Basel, Switzerland
| | - Katrin Scheinemann
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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19
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Ma C, Dushnicky M, Talaat H, Thomas S, Cellucci T, Garner S, Heale L, Matsos M, Beattie K, Batthish M. Self-Reported Transition Readiness of Adolescent Patients with Rheumatic Disease: Do the Parents Agree? J Pediatr 2022; 247:155-159. [PMID: 35561803 DOI: 10.1016/j.jpeds.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Our objective was to compare transition readiness assessment scores from adolescents with rheumatic disease with their parents and analyze their level of agreement. We found that adolescents and parents generally agree on the level of the transition readiness; however, there is occasional disagreement in specific domains.
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Affiliation(s)
- Christina Ma
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Molly Dushnicky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Habeba Talaat
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Steffy Thomas
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tania Cellucci
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Liane Heale
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen Beattie
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Mannemuddhu SS, Macumber I, Samuels JA, Flynn JT, South AM. When Hypertension Grows Up: Implications for Transitioning Care of Adolescents and Young Adults With Hypertension From Pediatric to Adult Health Care Providers. Adv Chronic Kidney Dis 2022; 29:263-274. [PMID: 36084973 DOI: 10.1053/j.ackd.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
Hypertension (HTN) is an important cause of morbidity and mortality in children as well as adults. HTN and related adverse cardiovascular health develop and progress on a continuum across an individual's life course. Pediatric HTN, or even isolated elevated blood pressure as a child, increases the risk of sustained HTN and cardiovascular disease in later adulthood. Transitioning the care of adolescents and young adults who have HTN is an important but unmet health care need that could potentially have a dramatic effect on mitigating the risk of cardiovascular disease in adulthood. However, very little has been published about the transition process in this population, and considerable gaps in the field remain. We discuss the epidemiology, etiology, and management approach in youth with HTN and how they differ from adults. We contextualize HTN and cardiovascular health on a continuum across the life course. We discuss key considerations for the transition process for adolescents and young adults with HTN including the major barriers that exist. Finally, we review key immediate health care needs that are particularly important around the time of the transfer of care.
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Affiliation(s)
- Sai Sudha Mannemuddhu
- East Tennessee Children's Hospital, Knoxville, TN; Department of Medicine, University of Tennessee Health Science Center-College of Medicine, Knoxville, TN
| | - Ian Macumber
- Department of Pediatrics, Keck School of Medicine, Division of Nephrology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Joshua A Samuels
- Department of Pediatrics, Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Division of Nephrology, Seattle Children's Hospital, Seattle, WA.
| | - Andrew M South
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine and Brenner Children's Hospital, Winston Salem, NC; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC; Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston Salem, NC
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21
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Abdwani R, Al Sabri R, Al Hasni Z, Rizvi S, Al Wahshi H, Al Lawati B, Al Abrawi S, Wali Y, Al Sadoon M. Transition readiness in adolescents and young adults with chronic rheumatic disease in Oman: today's needs and future challenges. Pediatr Rheumatol Online J 2022; 20:27. [PMID: 35413991 PMCID: PMC9004032 DOI: 10.1186/s12969-022-00687-6] [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: 01/03/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In Oman, the ""transition" of health care of adolescents to adult care occurs at a young age, like many other GCC countries for cultural reasons. In order to address this concern, this study was conducted to determine the transition readiness skills of adolescents and young adults with childhood onset rheumatic diseases using a cross-cultural adaptation of the UNC TRxANSITION scale. METHODS We used a professionally translated/back translated, provider-administered UNC TRxANSITION Scale. This 32-question scale measures HCT in 10 domains including knowledge about diagnosis or treatment, diet, reproductive health, school/work, insurance, ability to self-manage and identification of new health providers. The maximum transitional score of 10, was categorized as low (1-4), moderate (4 - 7) and high (7 -10) transitional readiness scores. RESULTS We enrolled 81 Omani adolescents and young adults (AYA) with chronic childhood onset rheumatic diseases. The cohort consisted of 79% females, with mean age of 15.8 years (± 3.53) and mean disease duration of 6.95 years (± 4.83). Our cohort's overall mean score is low 5.22 (±1.68). Only 14.8% of the cohort achieved a high transition score (≥7). Significant direct relationship was observed between age and the mean transition readiness score (r = .533, P < .001). The mean transition readiness score in the younger age group (10-13 years) was 4.07 (±1.29), the middle age group (14-18 years) was 5.43 (±1.27), while the older age group (19-21 year), was 6.12 (±1.81). Mean transition score of youngest age group was found to be significantly lower than the other two age groups (p = .003). CONCLUSION Overall, the transition readiness of AYA in Oman is low compared to other western countries indicating the need to initiate a health care transition preparation program for patients with chronic diseases across the country. In addition, we need to establish regional guidelines to address the transfer and transition policies to be in line to international recommendations. As transition continues after transfer, and is preferably guided by adolescent developmental status rather than chronological age, it would be preferable to refer to the transition and transfer policies 9rather than transitional age policy) to be in line to international recommendations.
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Affiliation(s)
- Reem Abdwani
- Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman.
| | - Rumaitha Al Sabri
- Pediatric Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Zawan Al Hasni
- General Foundation Program, Oman Medical Specialty Board, Muscat, Oman
| | - Seyad Rizvi
- grid.412846.d0000 0001 0726 9430Department of Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Humaid Al Wahshi
- grid.416132.30000 0004 1772 5665Department of Medicine, Royal Hospital Muscat, Muscat, Oman
| | - Batool Al Lawati
- grid.412846.d0000 0001 0726 9430Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Safiya Al Abrawi
- grid.416132.30000 0004 1772 5665Department of Child Health, Royal Hospital Muscat, Muscat, Oman
| | - Yassir Wali
- grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman
| | - Mona Al Sadoon
- grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman
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Development of a transition readiness score for adolescents living with perinatally-acquired HIV and transitioning to adult care. AIDS Behav 2022; 26:3131-3138. [PMID: 35362907 PMCID: PMC9372012 DOI: 10.1007/s10461-022-03650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/01/2022]
Abstract
We created a transition readiness score for adolescents with perinatally-acquired HIV as they transition from pediatric to adult care. Of the 199 adolescents who transitioned to adult care, 84 (42%) had viral suppression (< 200 copies/ml) one year after transition. Adolescents on first-line ART, with documented HIV status disclosure, and higher rating on the HIV Adolescent Readiness to Transition Scale had significantly higher odds of viral suppression after transition. Conversely, females, those with older age at ART initiation, and those with prior alcohol use had significantly lower odds of viral suppression after transition. Using these data, we created a transition readiness score organized into low, intermediate, and high levels of transition readiness. This transition readiness score can be used to identify adolescents who are likely ready to transition to adult care and identify additional areas for intervention to improve the likelihood of successful transition for those with lower transition readiness scores.
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Morisaki-Nakamura M, Suzuki S, Kobayashi A, Kita S, Sato I, Iwasaki M, Hirata Y, Sato A, Oka A, Kamibeppu K. Efficacy of a Transitional Support Program Among Adolescent Patients With Childhood-Onset Chronic Diseases: A Randomized Controlled Trial. Front Pediatr 2022; 10:829602. [PMID: 35433550 PMCID: PMC9010051 DOI: 10.3389/fped.2022.829602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
It is recommended that patients with childhood-onset chronic diseases (CCD) be transferred from pediatric to adult healthcare systems when they reach adulthood. Transitional support helps adolescents with CCD transition smoothly. Transition readiness is one of the key concepts to assess the efficacy of transitional support programs. This study aims to investigate the effect of a transitional support program on transition readiness, self-esteem, and independent consciousness among Japanese adolescents with various CCD using a randomized controlled trial. Adolescents with CCD aged 12-18 years participated in a randomized controlled trial evaluating the efficacy of a transitional support program. The patients in the intervention group visited transitional support outpatient clinics twice. They answered questionnaires regarding their disease and future perspectives to healthcare professionals and independently made a short summary of their disease. All the participants answered the questionnaires four times. Eighty patients participated in this study. Among those in the intervention group, transition readiness within one, three, and 6 months after interventions, and self-esteem within 1 month after interventions were higher than that of the control group. The scores on the "dependence on parents" subscale at 6 months after interventions were lower for the intervention group as compared to the control group. This program is expected to help patients transition smoothly from pediatric to adult healthcare systems.
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Affiliation(s)
- Mayumi Morisaki-Nakamura
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seigo Suzuki
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatric Nursing, Tokyo Medical University, Tokyo, Japan
| | - Asuka Kobayashi
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Iori Sato
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwa Iwasaki
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsushi Sato
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Oka
- Saitama Children’s Medical Center, Saitama, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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John AS, Jackson JL, Moons P, Uzark K, Mackie AS, Timmins S, Lopez KN, Kovacs AH, Gurvitz M. Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025278. [PMID: 35297271 PMCID: PMC9075425 DOI: 10.1161/jaha.122.025278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is now expected that most individuals with congenital heart disease will survive to adulthood, including those with complex heart conditions. Maintaining lifelong medical care requires those with congenital heart disease to eventually transfer from pediatric to adult-oriented health care systems. Developing health care transition skills and gaining independence in managing one's own health care is imperative to this process and to ongoing medical and psychosocial success. This scientific statement reviews the recent evidence regarding transition and provides resources, components, and suggestions for development of congenital heart disease transition programs with the goals of improving patient knowledge, self-management, and self-efficacy skills to the level they are capable to eventually integrate smoothly into adult-oriented health care. Specifically, the scientific statement updates 3 sections relevant to transition programming. First, there is a review of specific factors to consider, including social determinants of health, psychosocial well-being, and neurocognitive status. The second section reviews costs of inadequate transition including the public health burden and the impairment in individual quality of life. Finally, the last section discusses considerations and suggestions for transition program design including communication platforms, a family-centered approach, and individual models. Although this scientific statement reviews recent literature surrounding transitions of care for individuals with congenital heart disease there remain significant knowledge gaps. As a field, we have yet to determine ideal timing and methods of transition, and barriers to transition and transfer remain, particularly for the underserved populations. The consequences of poor health care transition are great and garnering outcomes and information through organized, multifaceted, collaborative approaches to transition is critical to improving the lifelong care of individuals with congenital heart disease.
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The Development And Validation Of The Transition Readiness Assessment Instrument In Type 1 Diabetes “On TRAck”. Can J Diabetes 2022; 46:510-517. [DOI: 10.1016/j.jcjd.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 11/18/2022]
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Mackie AS, Rankin KN, Yaskina M, Gingrich J, Williams E, Schuh M, Kovacs AH, McCrindle BW, Nicholas D, Rempel GR. Transition Preparation for Young Adolescents with Congenital Heart Disease: A Clinical Trial. J Pediatr 2022; 241:36-41.e2. [PMID: 34619115 DOI: 10.1016/j.jpeds.2021.09.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of a novel nurse-led transition intervention program designed for young adolescents (age 13-14 years) with congenital heart disease (CHD). We hypothesized that the intervention would result in improved self-management skills and CHD knowledge. STUDY DESIGN Single-center cluster randomized controlled trial of a nurse-led transition intervention vs usual care. The intervention group received a 1-hour individualized session with a cardiology nurse, focusing on CHD education and self-management. The primary end point was change in TRANSITION-Q (transition readiness) score between baseline and 6 months. The secondary end point was change in MyHeart score (CHD knowledge). RESULTS We randomized 60 participants to intervention (n = 30) or usual care (n = 30). TRANSITION-Q score (range 0-100) increased from 49 ± 10 at baseline to 54 ± 9.0 at 6 months (intervention) vs 47 ± 14 to 44 ± 14 (usual care). Adjusted for baseline score, TRANSITION-Q scores at 1 and 6 months were greater in the intervention group (mean difference 5.9, 95% CI 1.3-10.5, P = .01). MyHeart score (range 0-100) increased from 48 ± 24 at baseline to 71 ± 16 at 6 months (intervention) vs 54 ± 24 to 57 ± 22 (usual care). Adjusted for baseline score, MyHeart scores at 1 and 6 months were greater in the intervention group (mean difference 19, 95% CI 12-26, P < .0001). Participants aged 14 years had a greater increase in TRANSITION-Q score at 6 months compared with 13-year-old participants (P < .05). CONCLUSIONS A nurse-led program improved transition readiness and CHD knowledge among young adolescents. This simple intervention can be readily adopted in other healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT02374892.
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Affiliation(s)
- Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
| | - Kathryn N Rankin
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jody Gingrich
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | | | | | - Brian W McCrindle
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Gwen R Rempel
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
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South K, George M, Smaldone A. Gaps in transition readiness measurement: a comparison of instruments to a conceptual model. JOURNAL OF TRANSITION MEDICINE 2022; 4:20220002. [PMID: 35979374 PMCID: PMC9335701 DOI: 10.1515/jtm-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Measuring transition readiness is important when preparing young people with chronic illness for successful transition to adult care. The Expanded Socioecological Model of Adolescent and Young Adult Readiness to Transition (Expanded SMART) offers a holistic view of factors that influence transition readiness and outcomes. The aim of this study was to examine conceptual congruency of transition readiness instruments with the Expanded SMART to determine the breadth and frequency of constructs measured. Methods PubMed was searched to identify observational and experimental studies that measured transition readiness across chronic illnesses. Selected instruments were first evaluated on their development and psychometric properties. Next, reviewers independently mapped each instrument item to Expanded SMART constructs: knowledge, skills/self-efficacy, relationships/communication, psychosocial/emotions, developmental maturity, beliefs/expectations, goals/motivation. If items did not map to a construct, a new construct was named inductively through group discussion. Results Three instruments (TRAQ [20 items], STARx [18 items] and TRxANSITION Index [32 items]), reported in 74 studies, were identified. Across instruments, most items mapped to three constructs: skills/self-efficacy, developmental maturity, and knowledge. The psychosocial constructs of goals/motivation and psychosocial/emotions were underrepresented in the instruments. No instrument mapped to every model construct. Two new constructs: independent living and organization were identified. Conclusions Constructs representing transition readiness in three frequently used transition readiness instruments vary considerably from Expanded SMART, a holistic conceptual model of transition readiness, suggesting that conceptualization and operationalization of transition readiness is not standardized. No instrument reflected all conceptual constructs of transition readiness and psychosocial constructs were underrepresented, suggesting that current instruments may provide an incomplete measurement of transition readiness.
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Affiliation(s)
| | - Maureen George
- Columbia University School of Nursing , New York , NY , USA
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Zucchetti G, Ciappina S, Bellini S, Dionisi Vici M, Spadea M, Biasin E, Fagioli F. The Creation of a Transition Protocol Survey for Childhood, Adolescent, and Young Adult Cancer Survivors in Transition from Pediatric to Adult Health Care in Italy. J Adolesc Young Adult Oncol 2022; 11:202-210. [DOI: 10.1089/jayao.2021.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Giulia Zucchetti
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sabrina Ciappina
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Simona Bellini
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Margherita Dionisi Vici
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Manuela Spadea
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Eleonora Biasin
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Franca Fagioli
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
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The role of family adaptation in the transition to adulthood for youth with medical complexity: a qualitative case study protocol. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
For youth with medical complexity and their families, the transition to adulthood is a stressful and disruptive period that is further complicated by the transfer from relatively integrated and familiar pediatric services to more fragmented and unfamiliar adult services. Previous studies report that families feel abandoned, overwhelmed, and unsupported during transition. In order to provide better support to families, we need to understand how families currently manage transition, what supports they need most, and how key factors influence their experiences. The aim of this study is to understand how families of youth with medical complexity adapt to the youth’s transition to adulthood and transfer to adult health care, social, and education services, and to explain how contextual factors interact to influence this process.
Methods
Informed by the Life Course Health Development framework, this study will use a qualitative explanatory case study design. The sample will include 10–15 families (1–3 participants per family) of youth with medical complexity (aged 16–30 years) who have lived experience with the youth’s transition to adulthood and transfer to adult services. Data sources will include semi-structured interviews and resources participants identified as supporting the youth’s transition. Reflexive thematic analysis will be used to analyze interview data; directed content analysis will be used for documentary evidence.
Discussion
While previous studies report that families experience significant challenges and emotional toll during transition, it is not known how they adapt to these challenges. Through this study, we will identify what is currently working for families, what they continue to struggle with, and what their most urgent needs are in relation to transition. The anticipated findings will inform both practice solutions and policy changes to address the needs of these families during transition. This study will contribute to the evidence base needed to develop novel solutions and advance policies that will meaningfully support successful transitions for families of youth with medical complexity.
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Teh KL, Hoh SF, Chan SWB, Gao X, Das L, Book YX, Arkachaisri T. Transition readiness assessment in adolescents and young adults with rheumatic diseases: The Singapore experience. Int J Rheum Dis 2022; 25:344-352. [PMID: 34989472 DOI: 10.1111/1756-185x.14277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transition from pediatric to adult care is a challenging time for adolescents and young adults (AYA) with rheumatic diseases. Validated tools have been developed to assess transition readiness. AIM To evaluate transition readiness among AYA with rheumatic diseases and to identify factors associated with transition readiness. METHODS Patients ≥15 years old were enrolled into our transition program and administered a Transition Readiness Assessment Tool (TRAT) from July 2017. The TRAT consists of 3 components: (a) patient's perception on importance of transition and confidence toward transition on a Likert scale 0-10; (b) assessment of knowledge on medical and healthcare usage using a set of 23 questions; (c) transition readiness using the Transition Readiness Assessment Questionnaire (TRAQ). Differences between groups were compared to identify factors associated with transition readiness. RESULTS Transition readiness assessment was performed in 152 patients. The median score for perception on transition importance was 7.0 (5.0-8.8) and the median score for confidence in transition was 7.0 (5.0-9.0). Majority of the patients (>50%) lack knowledge in health insurance, carrying health information, healthcare privacy changes and making own healthcare decision. Patients <20 years old were also deficient in knowledge in navigating healthcare systems. TRAQ scores were lowest in areas pertaining to healthcare insurance and obtaining financial help. CONCLUSION Healthcare insurance literacy and self-management skills were lacking in the assessment of transition readiness in AYA with rheumatic diseases. Targeted intervention in these areas will improve transition readiness and promote successful transition processes.
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Affiliation(s)
- Kai Liang Teh
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sook Fun Hoh
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Su-Wan Bianca Chan
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaocong Gao
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lena Das
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yun Xin Book
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Transition to adult care for youth with medical complexity: Assessing needs and setting priorities for a health care improvement initiative. J Pediatr Nurs 2022; 62:144-154. [PMID: 34404554 DOI: 10.1016/j.pedn.2021.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Technological advances have led to more youth with medical complexity (YMC) who are living into adulthood and being transferred from pediatric to adult care. The transition to adult care is a complex and challenging process, partly due to differences in how pediatric and adult systems deliver health care. YMC and their families need support from their health care providers to ease this transition. To identify how to better support transitioning YMC, a needs assessment was conducted to examine the current state of transitional support for youth and families cared for by a pediatric Complex Care Program. AIMS The aims of this needs assessment were to understand the transition practices of pediatric Complex Care Programs, explore transition-related needs of YMC and their families, and identify priorities for future quality improvement. METHODS This project involved three components: a literature review, a benchmarking survey of pediatric Complex Care Programs in Ontario, and key informant interviews. FINDINGS The benchmarking survey identified transition planning and transfer of care as areas of strength in the Complex Care Program, while transition readiness and transfer completion provided opportunities for improvement. Stakeholder collaboration, an early start, and knowledgeable providers facilitated a successful transition. Barriers included lack of time, poor access to adult services and resources, higher medical complexity, and inadequate support for adult health care providers. CONCLUSIONS Recommendations for improving transitional care for YMC are provided, along with resources, tools, and considerations for implementation.
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Sadun RE, Covert LT, Lawson EF. Transitioning to Adulthood with a Rheumatic Disease: A Case-Based Approach for Rheumatology Care Teams. Rheum Dis Clin North Am 2021; 48:141-156. [PMID: 34798943 DOI: 10.1016/j.rdc.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Both pediatric and adult rheumatology care teams play a central role in health care transition, the shift from child- and family-centered to adult-oriented health care. Components of transition preparation include readiness assessment, setting self-management goals, and spending time in clinical visits without a parent present. Pediatric providers and families should work together to create a transfer plan, identifying a new adult rheumatology care provider, providing a medical summary before transfer, and anticipating changes in health insurance. For high-risk transfers, direct communication between providers is recommended. Finally, adult rheumatologists need to build rapport with young adults to support future engagement in care.
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Affiliation(s)
- Rebecca E Sadun
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Department of Pediatrics, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA.
| | - Lauren T Covert
- Department of Pediatrics, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA
| | - Erica F Lawson
- Department of Pediatrics, Division of Rheumatology, University of California San Francisco School of Medicine, San Francisco, CA, USA
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Huang H, Wang Y, Mao X, Qin X, Cheng L. Translation and Validation of TRANSITION-Q for Chinese Pediatric Cancer Survivors. J Pediatr Nurs 2021; 61:130-135. [PMID: 34049002 DOI: 10.1016/j.pedn.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Cancer survivorship starts at diagnosis. Transition readiness is an important indicator for pediatric cancer survivors to move from pediatric to adult medical care. Appropriate measurement of transition readiness can facilitate better cancer survivorship. This study aimed to translate and validate of the English version of the TRANSITION-Q into Chinese. DESIGN AND METHODS The translation followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) best-practice guidelines for the translation and cultural adaptation of patient-reported outcome measures (PROM). A cross- psychometric testing on reliability and validity were conducted from a convenient sample of Chinese adolescent cancer survivors aged 10-19 years. RESULTS Two hundred seventy-one pediatric cancer patients were recruited for the psychometric validation. The 14-item Chinese TRANSITION-Q demonstrated adequate reliability. In exploratory factorial analyses and confirmatory factor analysis, a two-factor structure emerged with a variance of 54.78%, demonstrating construct validity. Convergent validity test showed TRANSITION-Q score was significantly positively correlated with self-efficacy (r = -0.84, p = 0.002). The known-group validity demonstrated the older group (age ≥14 years) had a significantly higher mean TRANSITION-Q score than the younger group (age < 14 years) (p = 0.04). CONCLUSION The Chinese version of the TRANSITION-Q is reliable and valid and can be used in Chinese research and clinical settings. IMPLICATIONS FOR PRACTICE This scale can be used in Chinese clinical and research settings to investigate understanding of transition readiness in Chinese pediatric cancer survivors.
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Affiliation(s)
- Haiying Huang
- Guangzhou Women and Children's Medical Center, China
| | | | - Xiaorong Mao
- Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, China
| | - Xiuli Qin
- Tongji Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, China
| | - Lei Cheng
- School of Nursing, Fudan University, China.
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Dahdah N, Kung SC, Friedman KG, Marelli A, Gordon JB, Belay ED, Baker AL, Kazi DS, White PH, Tremoulet AH. Falling Through the Cracks: The Current Gap in the Health Care Transition of Patients With Kawasaki Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2021; 10:e023310. [PMID: 34632822 PMCID: PMC8751858 DOI: 10.1161/jaha.121.023310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Health care transition (HCT) is a period of high vulnerability for patients with chronic childhood diseases, particularly when patients shift from a pediatric to an adult care setting. An increasing number of patients with Kawasaki disease (KD) who develop medium and large coronary artery aneurysms (classified by the American Heart Association according to maximal internal coronary artery diameter Z‐scores ≥5 and ≥10, respectively) are becoming adults and thus undergoing an HCT. However, a poor transition to an adult provider represents a risk of loss to follow‐up, which can result in increasing morbidity and mortality. Methods and Results This scientific statement provides a summary of available literature and expert opinion pertaining to KD and HCT of children as they reach adulthood. The statement reviews the existing life‐long risks for patients with KD, explains current guidelines for long‐term care of patients with KD, and offers guidance on assessment and preparation of patients with KD for HCT. The key element to a successful HCT, enabling successful transition outcomes, is having a structured intervention that incorporates the components of planning, transfer, and integration into adult care. This structured intervention can be accomplished by using the Six Core Elements approach that is recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians. Conclusions Formal HCT programs for patients with KD who develop aneurysms should be established to ensure a smooth transition with uninterrupted medical care as these youths become adults.
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Betz CL, Mannino JE, Disabato JA. Survey of US pediatric nurses' role in health care transition planning: Focus on assessment of self-management abilities of youth and young adults with long-term conditions. J Child Health Care 2021; 25:468-480. [PMID: 32870717 DOI: 10.1177/1367493520953649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The survival rates of youth and young adults (YYAs) diagnosed with long-term conditions have improved considerably as 90% now enter adulthood; health care transition planning (HCTP) has emerged as a nursing practice priority. The aim of this national online survey was to investigate the extent to which nurses, recruited from two major United States pediatric nursing organizations are involved with HCTP including assessing YYA self-management abilities (SMA). Findings of a 9-item assessment of self-management abilities subscale of the nurses' role in HTCP tool are reported. The nurse respondents (n = 1269), identified the most frequently assessed SMA was the YYAs' ability to understand and speak about their condition and its treatment (M = 2.3, SD = .89). The least frequently assessed was the YYAs' ability to identify community advocates to help them become more independent (M =1.5, SD = .90). Regression analysis identified significant predictors of the frequency nurses assess YYA for SMA included nurses' level of knowledge, perceived level of importance, HCTP and skills identified in job description, and caring for YYA. Findings indicate HCTP care advancements will necessitate HCTP training and development of nurse-led service efforts to facilitate optimal outcomes for YYA.
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Affiliation(s)
- Cecily L Betz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, CA, USA
| | - Jennifer E Mannino
- Barbara H. Hagan School of Nursing, and Health Sciences 6957Molloy College, NY, USA
| | - Jennifer A Disabato
- College of Nursing and School of Medicine, 296427University of Colorado Anschutz Medical Campus, CO, USA
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Vernon-Roberts A, Rouse E, Gearry RB, Day AS. Systematic Review of Self-Management Assessment Tools for Children With Inflammatory Bowel Disease. JPGN REPORTS 2021; 2:e075. [PMID: 37205965 PMCID: PMC10191491 DOI: 10.1097/pg9.0000000000000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 05/21/2023]
Abstract
The relapsing pattern of illness and diverse management strategies for children with inflammatory bowel disease (IBD) may inhibit their opportunities to develop self-management skills. Interventions focused on the development of these skills require population-specific outcome measures. We provide a comprehensive overview of self-management skills assessment tools that are available for children with IBD that target processes and behaviors outlined as beneficial for the development of these skills. Seven health literature databases were searched using terms related to self-management, transition, IBD, Crohn's disease, ulcerative colitis, and children. Identified studies underwent a process of title and then full text review. Included studies underwent data extraction using a priori quality assessment criteria related to self-management skills, health literacy, suitability for the target population, validity and reliability testing. The searches identified 523 papers, 123 of which underwent full-text review and 10 included in the final analysis. The assessment tools identified showed great diversity in their development approach, content, methodological rigor, and health literacy considerations. The most frequently included self-management skills were related to adherence, communication, attending clinic, and disease/treatment knowledge. None of the tools satisfied the criteria of selection for use in the target population. While many chronic diseases of childhood follow a predictable disease course with established treatment pathways, IBD presents a unique set of challenges. The development of self-management skills is vital for successful disease management, but these skills should be assessed by a tool appropriate for the population and their diverse needs.
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Affiliation(s)
| | - Emma Rouse
- Department of Medicine, Otago University, Christchurch, New Zealand
| | | | - Andrew S. Day
- From the Department of Paediatrics, Otago University, Christchurch, New Zealand
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Zanoni BC, Archary M, Sibaya T, Musinguzi N, Kelley ME, McManus S, Haberer JE. Development and validation of the HIV adolescent readiness for transition scale (HARTS) in South Africa. J Int AIDS Soc 2021; 24:e25767. [PMID: 34235876 PMCID: PMC8264413 DOI: 10.1002/jia2.25767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/30/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Adolescents living with perinatally acquired HIV have low rates of retention in care and viral suppression after the transition from paediatric to adult care. In this study, we developed and validated a tool to identify adolescent transition readiness. METHODS We developed the HIV Adolescent Readiness for Transition Scale (HARTS) from June 2016 to May 2019 by iteratively adapting existing transition readiness scales for other chronic illnesses by conducting focus groups with 11 healthcare providers and 20 adolescents in South Africa. We administered a preliminary questionnaire to 131 adolescents to determine psychometric properties and assess test-retest variability. We used confirmatory factor analysis to verify the proposed scale structure using the underlying variable approach. We correlated responses to self-described transition readiness and age using linear regression. We subsequently validated the scale by prospectively administering it to 199 adolescents in a second South African setting before their transition. We then used multivariable logistic regression to assess the effects of the HARTS and relevant socio-behavioural covariates on viral suppression one year after transition. RESULTS We identified four domains relevant to transition readiness: disclosure, health navigation, self-advocacy and health literacy. Fifteen questions with a significant factor loading of 0.3 to 0.9 were identified. No significant test-retest variability was seen among 10% of participants. Positive correlations with self-described transition readiness were significant with the overall HARTS and domains of health navigation, self-advocacy and health literacy. In the prospective analysis, for adolescents not using drugs, each 10-point increase in the HARTS was associated with 0.62 odds of viral failure (95% CI 0.45 to 0.86; p = 0.004). The individual domains of self-advocacy (AOR 0.56; 95% CI 0.33 to 0.94; p = 0.029), disclosure (AOR 0.02; 95% CI 0.01 to 0.25; p = 0.002), health navigation (AOR 0.51; 95%CI 0.25 to 1.02; p = 0.056) and health literacy (AOR 0.37; 95% CI 0.10 to 1.30; p = 0.121) were associated with viral failure adjusting for age at antiretroviral therapy initiation, ART regimen, sex, disclosure status, and alcohol use in both analyses. CONCLUSIONS The HARTS is a validated scale that can be used to identify which adolescents may require additional interventions prior to transitioning to adult care to improve viral suppression after transition.
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Affiliation(s)
- Brian C Zanoni
- Emory UniversityAtlantaGAUSA
- Children’s Healthcare of AtlantaAtlantaGAUSA
| | - Moherndran Archary
- University of KwaZulu‐Natal Nelson Mandela School of MedicineDurbanSouth Africa
- King Edward VIII HospitalDurbanSouth Africa
| | - Thobekile Sibaya
- University of KwaZulu‐Natal Nelson Mandela School of MedicineDurbanSouth Africa
| | - Nicholas Musinguzi
- Global Health CollaborativeUniversity of Science and TechnologyMbararaUganda
| | - Mary E Kelley
- Emory UniversityAtlantaGAUSA
- Rollins School of Public healthAtlantaGAUSA
| | - Shauna McManus
- Emory UniversityAtlantaGAUSA
- Rollins School of Public healthAtlantaGAUSA
| | - Jessica E Haberer
- Massachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
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Kittivisuit S, Lerkvaleekul B, Soponkanaporn S, Ngamjanyaporn P, Vilaiyuk S. Assessment of transition readiness in adolescents in Thailand with rheumatic diseases: a cross-sectional study. Pediatr Rheumatol Online J 2021; 19:101. [PMID: 34193176 PMCID: PMC8243449 DOI: 10.1186/s12969-021-00602-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most childhood-onset rheumatic diseases are chronic health conditions, which need long-term care throughout adulthood. A well-organized transition care is challenging and patient assessment of transition skills is needed for transfer preparation to an adult care setting. The Transition Readiness Assessment Questionnaire (TRAQ) is used to assess transition skills in chronically ill patients. Currently, limited transition skill assessment data exist in pediatric patients with rheumatic diseases, especially in Asian countries. This study aimed to determine the transition readiness skills in patients with rheumatic diseases and ascertain predictive factors contributing to high transition readiness skills. METHODS This is a cross-sectional study. All patients with rheumatic diseases aged 15-20 years were recruited. The TRAQ was cross-culturally adapted into the Thai language with good internal consistency and reliability. Patients completed the Thai TRAQ at the recent clinic visit and took the retest at a 2-week interval. Demographic data, baseline characteristics, clinical manifestations, and disease status were collected. Descriptive and logistic regression analyses were performed. RESULTS A total of 111 patients with a mean age of 17.4 ± 1.8 years were included. Median (IQR) disease duration was 6.4 (3.2-9.0) years. The most common rheumatic disease was juvenile idiopathic arthritis (48.6%), followed by systemic lupus erythematosus (35.1%). The mean TRAQ score was 3.85 ± 0.69. Independent visits (OR 4.35, 95% CI 1.23-15.37) was a predictor of a high TRAQ score. Furthermore, dependent visits (OR 7.84, 95% CI 2.41-25.50) was a predictor of low TRAQ score in the "appointment keeping" domain, whereas inactive disease (OR 4.54, 95% CI 1.25-16.55) was a predictor of a low TRAQ score in "tracking health issues" domain. Lack of knowledge and skills on health insurance coverage, financial management, appointment arrangement, and coping with their illness were issues causing lower TRAQ score. CONCLUSIONS Patients, who had independent visits, had a higher chance to obtain higher TRAQ scores, whereas patients, who had an inactive disease or dependent visits, had less transition readiness skills. Physicians and parents should prepare to transfer patients to adult care settings, mainly encouraging independent living skills.
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Affiliation(s)
- Sirinthip Kittivisuit
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand ,grid.7130.50000 0004 0470 1162Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Butsabong Lerkvaleekul
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand
| | - Sirisucha Soponkanaporn
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand
| | - Pintip Ngamjanyaporn
- grid.10223.320000 0004 1937 0490Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400, Bangkok, Thailand.
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Spiegel L, Tucker L, Duffy KW, Lalloo C, Hundert A, Bourre-Tessier J, Hazel E, Luca N, Mosher D, Nguyen C, Stringer E, Victor C, Stinson J. Development and validation of the RACER (Readiness for Adult Care in Rheumatology) transition instrument in youth with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:83. [PMID: 34090474 PMCID: PMC8180033 DOI: 10.1186/s12969-021-00579-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current evidence suggests that many adolescents with juvenile idiopathic arthritis (JIA) do not successfully transfer to adult care, which can result in adverse health outcomes. Although a growing number of clinical programs have been designed to support healthcare transition, there is a lack of psychometrically sound instruments to evaluate their impact on development of transition-related knowledge and skills in youth with JIA. The purpose of this study was to develop and validate RACER (Readiness for Adult Care in Rheumatology), a self-administered instrument designed to measure stages of readiness for key transition-related skills in adolescents with JIA. METHODS A phased approach was used to develop and evaluate the validity and reliability of RACER. Phase 1 A was a consensus conference with 19 key stakeholders to inform instrument domains and items. Phase 1B determined initial content validity using a sample of 30 adolescents with JIA and 15 clinical and research experts. Finally, Phase 2 was a prospective cohort study with repeated measures to evaluate the internal consistency, test-retest reliability, construct validity and responsiveness of the instrument within a sample of adolescents with JIA. RESULTS In Phase 1 A, initial item generation yielded a total of 242 items across six domains from the consensus conference, which was subsequently reduced to a 32-item instrument. Phase 1B established the content validity of the instrument in adolescents with JIA. In the Phase 2 study, with a sample of 96 adolescents, the RACER instrument exhibited good internal consistency in five of its six subscales (Cronbach's α > 0.7), and strong test-retest reliability between the first two administrations (ICC = 0.83). It also showed robust convergent validity by highly correlating with measures of self-management (SMSAG, rho = 0.73) and transition (TRANSITION-Q, rho = 0.76). The RACER was not correlated with unrelated measures (discriminant validity; PedsQL, rho = 0.14). The RACER scores increased significantly over time as expected, supporting measure responsiveness. CONCLUSIONS The RACER is a reliable and valid instrument which is sensitive to change for assessing transition readiness in adolescents with JIA.
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Affiliation(s)
- Lynn Spiegel
- Division of Rheumatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lori Tucker
- Division of Rheumatology, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Karen Watanabe Duffy
- Division of Rheumatology, Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Amos Hundert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Josiane Bourre-Tessier
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Nadia Luca
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Dianne Mosher
- University of Calgary and Cumming School of Medicine, Calgary, Canada
| | - Cynthia Nguyen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Canada
| | - Charles Victor
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
- The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 069715, ON, M5G 0A4, Toronto, Canada.
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Mellerio H, Jacquin P. [Accompanying the pediatric/adult service transition in chronically ill patients]. SOINS. PEDIATRIE, PUERICULTURE 2021; 42:18-21. [PMID: 34099232 DOI: 10.1016/j.spp.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The transition is a key step for adolescents with chronic illnesses, as they are at risk of a disruption in care, complications and even mortality. Accompanying this process is based on two axes: autonomization of the young person (acquisition of knowledge and know-how in a perspective of empowerment) and structuring of the care pathway (transition measures, pediatric/adult service coordination).
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Affiliation(s)
- Hélène Mellerio
- Plateforme de transition AD'venir, unité de médecine d'adolescent, Hôpital Robert-Debré, AP-HP, 48 boulevard Sérurier, 75019 Paris, France; ECEVE UMR1123, Université Paris-Diderot/Inserm/CIC-EC, CIC 1426, Paris, France; Groupe français de recherche clinique en médecine et santé de l'adolescent, 97 boulevard de Port-Royal, 75014 Paris, France.
| | - Paul Jacquin
- Plateforme de transition AD'venir, unité de médecine d'adolescent, Hôpital Robert-Debré, AP-HP, 48 boulevard Sérurier, 75019 Paris, France; Groupe français de recherche clinique en médecine et santé de l'adolescent, 97 boulevard de Port-Royal, 75014 Paris, France
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Semalulu T, McColl J, Alam A, Thomas S, Herrington J, Gorter JW, Cellucci T, Garner S, Heale L, Matsos M, Beattie KA, Batthish M. The transition from pediatric to adult rheumatology care through creating positive and productive patient-provider relationships: an opportunity often forgotten. JOURNAL OF TRANSITION MEDICINE 2021. [DOI: 10.1515/jtm-2021-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The transition of patients with a chronic rheumatic disease from pediatric to adult care has been characterized by poor medical and patient-centered outcomes due to the lack of comprehensive transition programs and the paucity of evidence to guide practitioners. We describe a multidisciplinary transition program, data assessing patients’ preparedness for transition and perception of care providers, and the association between these outcomes.
Content
Patients aged 14–19 with childhood-onset systemic lupus erythematosus (cSLE) or juvenile idiopathic arthritis (JIA) were recruited from Rheumatology Transition Clinics and Young Adult Clinics at a single institution. Participants completed the TRANSITION-Q, which assesses healthcare self-management skills as a proxy for transition readiness, and the Consultation and Relational Empathy Scale (CARE) questionnaire, which measures patients’ perception of their providers’ care and empathy.
Summary
Among 63 participants, 87% had JIA (mean age 16.5 years). Age was the only patient characteristic positively associated with TRANSITION-Q scores. CARE scores revealed overwhelmingly positive interactions between patients and healthcare team members. TRANSITION-Q and CARE scores were positively correlated.
Outlook
The transition from pediatric to adult rheumatology care should be recognized as an opportunity to impact the trajectories of patients entering adult care where the patient-provider relationship may play an important role.
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Affiliation(s)
- Teresa Semalulu
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Jeanine McColl
- Department of Pediatrics , McMaster University , Hamilton , Canada
| | | | | | - Julie Herrington
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Jan Willem Gorter
- Department of Pediatrics and Director of CanChild Centre for Childhood Disability Research, Division of Physical Medicine and Rehabilitation, McMaster University , Hamilton , Canada
| | - Tania Cellucci
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Liane Heale
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Karen A. Beattie
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Michelle Batthish
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
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Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3020007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions.
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Gorter JW, Amaria K, Kovacs A, Rozenblum R, Thabane L, Galuppi B, Nguyen L, Strohm S, Mahlberg N, Via-Dufresne Ley A, Marelli A. CHILD-BRIGHT READYorNot Brain-Based Disabilities Trial: protocol of a randomised controlled trial (RCT) investigating the effectiveness of a patient-facing e-health intervention designed to enhance healthcare transition readiness in youth. BMJ Open 2021; 11:e048756. [PMID: 33771833 PMCID: PMC8006854 DOI: 10.1136/bmjopen-2021-048756] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Youth with brain-based disabilities (BBDs), as well as their parents/caregivers, often feel ill-prepared for the transfer from paediatric to adult healthcare services. To address this pressing issue, we developed the MyREADY TransitionTM BBD App, a patient-facing e-health intervention. The primary aim of this randomised controlled trial (RCT) was to determine whether the App will result in greater transition readiness compared with usual care for youth with BBD. Secondary aims included exploring the contextual experiences of youth using the App, as well as the interactive processes of youth, their parents/caregivers and healthcare providers around use of the intervention. METHODS AND ANALYSIS We aimed to randomise 264 youth with BBD between 15 and 17 years of age, to receive existing services/usual care (control group) or to receive usual care along with the App (intervention group). Our recruitment strategy includes remote and virtual options in response to the current requirements for physical distancing due to the COVID-19 pandemic. We will use an embedded experimental model design which involves embedding a qualitative study within a RCT. The Transition Readiness Assessment Questionnaire will be administered as the primary outcome measure. Analysis of covariance will be used to compare change in the two groups on the primary outcome measure; analysis will be intention-to-treat. Interviews will be conducted with subsets of youth in the intervention group, as well as parents/caregivers and healthcare providers. ETHICS AND DISSEMINATION The study has been approved by the research ethics board of each participating site in four different regions in Canada. We will leverage our patient and family partnerships to find novel dissemination strategies. Study findings will be shared with the academic and stakeholder community, including dissemination of teaching and training tools through patient associations, and patient and family advocacy groups. TRIAL REGISTRATION NUMBER NCT03852550.
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Affiliation(s)
- Jan Willem Gorter
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Khush Amaria
- CBT Associates of Toronto Cognitive Behavioural Therapy Services, Toronto, Ontario, Canada
| | - Adrienne Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science Univeristy, Portland, Oregon, USA
| | - Ronen Rozenblum
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Barbara Galuppi
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Linda Nguyen
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sonya Strohm
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nadilein Mahlberg
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alicia Via-Dufresne Ley
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Ariane Marelli
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Enhancing validity, reliability and participation in self-reported health outcome measurement for children and young people: a systematic review of recall period, response scale format, and administration modality. Qual Life Res 2021; 30:1803-1832. [PMID: 33738710 PMCID: PMC8233251 DOI: 10.1007/s11136-021-02814-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Introduction Self-report is the gold standard for measuring children’s health-related outcomes. Design of such measures is complex and challenging. This review aims to systematically appraise the evidence on recall period, response scale format, mode of administration and approaches needed to enable children and young people < 19 years to participate in valid and reliable self-reporting of their health outcomes. Method PsycInfo, Medline, CINAHL and Embase were searched from 1 January 1990 to 15 March 2020, and citation searching undertaken in Scopus. Articles were included if they were primary research or case reports of ≥ 3 participants reporting the following: recall period, response scale selection, administration modality. Quality was assessed using QualSyst, and results synthesised narratively. This review was conducted and reported according to PRISMA guidelines. Results 81 of 13,215 retrieved articles met the inclusion criteria. Children < 5 years old cannot validly and reliably self-report health outcomes. Face scales demonstrate better psychometric properties than visual analogue or Likert scales. Computerised and paper scales generally show equivalent construct validity. Children prefer computerised measures. Children ≤ 7 years old think dichotomously so need two response options. Those > 8 years old can reliably use a 3-point scale. Conclusion The results of this review have both clinical and research implications. They can be used to inform appropriate choice of PROM for use with CYP in the clinical setting. We also give eight recommendations for future development of self-reported outcome measures for children and young people. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02814-4.
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McColl J, Semalulu T, Beattie KA, Alam A, Thomas S, Herrington J, Gorter JW, Cellucci T, Garner S, Heale L, Matsos M, Batthish M. Transition Readiness in Adolescents With Juvenile Idiopathic Arthritis and Childhood-Onset Systemic Lupus Erythematosus. ACR Open Rheumatol 2021; 3:260-265. [PMID: 33711192 PMCID: PMC8063142 DOI: 10.1002/acr2.11237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The transition from pediatric to adult rheumatology care represents a particularly vulnerable time for patients with juvenile idiopathic arthritis (JIA) and childhood‐onset systemic lupus erythematosus (cSLE). Improving self‐management skills is important in optimizing health care transition. The study’s objectives were to 1) examine variability in transition readiness of adolescents and young adults within and between different ages, sexes, and disease types; 2) determine the association between age and transition readiness; and 3) identify specific challenges to transition readiness for adolescents. Methods Over 1 year, patients 14 to 20 years of age with JIA or cSLE were recruited from pediatric transition and young adult clinics at a single academic institution. Participants completed the 14‐item Transition‐Q at a single time point. Total scores range from 0 to 100; higher scores indicate greater health care self‐management skills as a proxy for transition readiness. Descriptive statistics summarized patient characteristics and Transition‐Q scores for the population. Regression analyses determined the association between age, sex, and disease type and Transition‐Q score. Results Among 70 participants, 61 had JIA and 9 cSLE (mean disease duration 4.6 years). The mean (SD) total Transition‐Q score was 59.8 (14.9). Age was significantly associated with Transition‐Q score (standardized β = 0.372l P = 0.002). The most commonly reported challenges were seeing the physician alone (without parents), making one’s own appointments, picking up prescriptions, and independent transportation for appointments. Conclusion Transition readiness appears to increase with patient age. There is significant variability in Transition‐Q scores between patients of the same age, suggesting that an individualized approach to improving self‐management skills is necessary.
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Affiliation(s)
| | | | | | - Arzoo Alam
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- McMaster University, Hamilton, Ontario, Canada
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Morisaki-Nakamura M, Suzuki S, Kobayashi A, Kita S, Sato I, Iwasaki M, Hirata Y, Sato A, Oka A, Kamibeppu K. Development and validation of a Japanese version of the TRANSITION-Q. Pediatr Int 2021; 63:270-278. [PMID: 32687648 DOI: 10.1111/ped.14398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 04/15/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The evaluation of transition readiness is indispensable for long-term follow-ups of adolescent patients with childhood-onset chronic diseases (CCD). We developed a Japanese version of the TRANSITION-Q (TRANSITION-Q-J) and used it to assess Japanese patients with CCD. METHODS The TRANSITION-Q-J was developed through forward and backward translations followed by cognitive interviews with five adolescent patients. The field test was conducted with 125 adolescent patients, and a retest was conducted with 113 adolescent patients. RESULTS Confirmatory factor analysis supported the two-factor analysis model including F1 (communication and self-management) and F2 (examination behavior). Sufficient internal consistency and test-retest reliability were demonstrated among the total 14 items, F1, and F2 (Cronbach's α > 0.80, intraclass correlation coefficient > 0.85). Convergent and discriminant validity for the 14 items and F1 were acceptable; however, F2 did not correlate significantly with the Rosenberg Self-Esteem Scale and Independent Consciousness Scale. Regarding known-groups validity, the older group had a significantly higher mean TRANSITION-Q-J score (50.05) than the younger group (43.28; P = 0.04). The same results were found for both F1 and F2. CONCLUSIONS The TRANSITION-Q-J for adolescent patients with CCD was developed and its reliability and validity were verified. This scale is easy to administer. In addition to being a tool for transition period support, it could be used to verify effective factors and in program outcome evaluation, including intervention studies.
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Affiliation(s)
- Mayumi Morisaki-Nakamura
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Seigo Suzuki
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Pediatric Nursing, Tokyo Medical University, Shinjuku-ku, Japan
| | - Asuka Kobayashi
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Sachiko Kita
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Iori Sato
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Miwa Iwasaki
- Department of, Nursing, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Yoichiro Hirata
- Department of, Pediatrics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Atsushi Sato
- Department of, Pediatrics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Akira Oka
- Department of, Pediatrics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Kiyoko Kamibeppu
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
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Teh KL, Hoh SF, Arkachaisri T. The Coming-of-Age Transition Care for Adolescents with Rheumatic Disease-Where Are We and What Have We Done in Asia? J Clin Med 2021; 10:jcm10040821. [PMID: 33671413 PMCID: PMC7923028 DOI: 10.3390/jcm10040821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022] Open
Abstract
The transition from pediatric to adult health care is a challenging yet important process in rheumatology as most childhood-onset rheumatic diseases persist into adulthood. Numerous reports on unmet needs as well as evidence of negative impact from poor transition have led to increased efforts to improve transition care, including international guidelines and recommendations. In line with these recommendations, transition programs along with transition readiness assessment tools have been established. Despite these efforts, there are still a lot of work to be done for transition care in rheumatology. This review article focuses on how transition care in rheumatology has developed in recent years and highlights the gaps in current practices.
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Affiliation(s)
- Kai Liang Teh
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
| | - Sook Fun Hoh
- Division of Nursing, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
- Pediatric Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Correspondence:
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Zanoni BC, Archary M, Subramony T, Sibaya T, Psaros C, Haberer JE. "It was not okay because you leave your friends behind": A prospective analysis of transition to adult care for adolescents living with perinatally-acquired HIV in South Africa. VULNERABLE CHILDREN AND YOUTH STUDIES 2021; 16:206-220. [PMID: 34484412 PMCID: PMC8414445 DOI: 10.1080/17450128.2021.1876965] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine facilitators and barriers to successful transition to adult care for adolescents living with perinatally-acquired HIV in South Africa. METHODS We prospectively enrolled 30 adolescents living with perinatally-acquired HIV after their pediatrician deemed them ready for transition to adult care but prior to their transition. Eighteen months after enrollment, we measured transition status, engagement in care (i.e., viral load within 12 months of transition), and viral suppression (<200 copies/ml). Additionally, we conducted in-depth interviews with adolescents before and after transition to explore facilitators and barriers to successful transition. RESULTS A total of 19/30 (63%) adolescents transitioned to adult care. Of those who transitioned, 11 (58%) were retained in care and 7 (37%) were virally suppressed one year after transition to adult care. Insufficient staff training, lack of availability of pediatric ART formulations in adult clinics, and insufficient clinical monitoring contributed to delayed transition. Rigid clinical scheduling that interfered with school and loss of clinic relationships with peers and clinical staff were major factors in contributing to poor engagement in care after transition. Maturity of the adolescent, reduced distance to clinic, and reduced length of time in the clinic were seen as facilitators to transition to adult care. CONCLUSION Improved preparation for transition by pediatric and adult clinical staff, including restructuring of care delivery, may improve successful transition of adolescents living with perinatally acquired HIV to adult care. Transition readiness assessments are needed to determine optimal timing of transition and which adolescents are ready to transition to adult care.
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Affiliation(s)
- Brian C. Zanoni
- Emory University, Atlanta, Georgia, United States of America
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Moherndran Archary
- University of KwaZulu-Natal Nelson Mandela School of Medicine, Durban, South Africa
| | | | - Thobekile Sibaya
- University of KwaZulu-Natal Nelson Mandela School of Medicine, Durban, South Africa
| | - Christina Psaros
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jessica E. Haberer
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Vernon-Roberts A, Frampton C, Gearry RB, Day AS. Development and Validation of a Self-management Skills Assessment Tool for Children With Inflammatory Bowel Disease: The Inflammatory Bowel Disease-Skills Tasks and Abilities Record (IBD-STAR). J Pediatr Gastroenterol Nutr 2021; 72:67-73. [PMID: 32804909 DOI: 10.1097/mpg.0000000000002905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES For children with inflammatory bowel disease (IBD), the development of self-management skills has the potential to improve disease outcomes. No assessment tools are aimed at measuring self-management skills in this population. A tool was developed called the IBD-Skills Tasks and Abilities Record (IBD-STAR) which measures children's allocation of responsibility for specific skills. IBD-STAR contains 18 items, scored whether completed independently (score 2), with help (score 1) or not at all (score 0). METHODS Children with IBD completed IBD-STAR; one parent and a gastroenterologist completed a series of visual analogue scales that corresponded with each IBD-STAR section. Children's IBD-STAR scores were examined against independent variables and compared with the parent and clinician visual analogue scale scores. Reliability was calculated using Cronbach's alpha. RESULTS Twenty-five Cronbach's alpha with IBD participated, mean age 14 years (standard deviation (SD) 1.7), 14 (56%) were boys, and 21 (84%) had Crohn's disease. The mean IBD-STAR score was 27.1 (SD 5.7), equivalent to a score of 75%. Age was the only independent variable significantly associated with scores (P = 0.017). Parents consistently underestimated their children in all sections, but clinician assessments were more closely aligned. Reliability for IBD-STAR was good with an overall Cronbach's alpha of 0.84. CONCLUSION IBD-STAR reports the allocation of responsibility for self-management skills with good agreement between children and clinician, and with comprehensible differences with their parents. Such a tool may be used to identify children with IBD in need of support or to measure the efficacy of targeted interventions.
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Affiliation(s)
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Diesch-Furlanetto T, Gabriel M, Zajac-Spychala O, Cattoni A, Hoeben BAW, Balduzzi A. Late Effects After Haematopoietic Stem Cell Transplantation in ALL, Long-Term Follow-Up and Transition: A Step Into Adult Life. Front Pediatr 2021; 9:773895. [PMID: 34900873 PMCID: PMC8652149 DOI: 10.3389/fped.2021.773895] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
Haematopoietic stem cell transplant (HSCT) can be a curative treatment for children and adolescents with very-high-risk acute lymphoblastic leukaemia (ALL). Improvements in supportive care and transplant techniques have led to increasing numbers of long-term survivors worldwide. However, conditioning regimens as well as transplant-related complications are associated with severe sequelae, impacting patients' quality of life. It is widely recognised that paediatric HSCT survivors must have timely access to life-long care and surveillance in order to prevent, ameliorate and manage all possible adverse late effects of HSCT. This is fundamentally important because it can both prevent ill health and optimise the quality and experience of survival following HSCT. Furthermore, it reduces the impact of preventable chronic illness on already under-resourced health services. In addition to late effects, survivors of paediatric ALL also have to deal with unique challenges associated with transition to adult services. In this review, we: (1) provide an overview of the potential late effects following HSCT for ALL in childhood and adolescence; (2) focus on the unique challenges of transition from paediatric care to adult services; and (3) provide a framework for long-term surveillance and medical care for survivors of paediatric ALL who have undergone HSCT.
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Affiliation(s)
- Tamara Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel (UKB), University of Basel, Basel, Switzerland
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Alessandro Cattoni
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Adriana Balduzzi
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
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