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Pitts L, Patrician PA, Landier W, Kazmerski T, Fleming L, Ivankova N, Ladores S. Parental entrustment of healthcare responsibilities to youth with chronic conditions: A concept analysis. J Pediatr Nurs 2024; 76:1-15. [PMID: 38309191 DOI: 10.1016/j.pedn.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. DESIGN AND METHODS Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. RESULTS Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. CONCLUSION The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. PRACTICE IMPLICATIONS This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition.
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Affiliation(s)
- Leslie Pitts
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Patricia A Patrician
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Wendy Landier
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama Heersink School of Medicine, Division of Pediatric Hematology/Oncology, 1600 7th Avenue South, Lowder 512, Birmingham, AL 35233, United States.
| | - Traci Kazmerski
- The University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University Center, 120 Lytton St.-Suite M060, Pittsburgh, PA 15213, United States.
| | - Louise Fleming
- The University of North Carolina at Chapel Hill, School of Nursing, 105 Carrington Hall, Chapel Hill, NC 37599, United States.
| | - Natalyia Ivankova
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama at Birmingham, School of Health Professions, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Sigrid Ladores
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Ashaba S, Baguma C, Tushemereirwe P, Nansera D, Maling S, Tsai AC, Zanoni BC. A qualitative analysis of self-management needs of adolescents and young adults living with perinatally acquired HIV in rural, southwestern Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003037. [PMID: 38498515 PMCID: PMC10947701 DOI: 10.1371/journal.pgph.0003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
The number of adolescents living with HIV remains high in sub-Saharan Africa with poorer HIV treatment outcomes among adolescents and young adults compared to individuals in other age groups. For adolescents and young adults living with perinatally acquired HIV (AYLPHIV), the transition from pediatric to adult HIV care is a particularly high-risk period. We conducted a qualitative study to understand self-management needs of AYLPHIV in rural, southwestern Uganda as they prepare to transition to adult HIV care in order to inform relevant interventions that can enable AYLPHIV acquire the necessary skills to manage their illness as they age into adulthood. We conducted 60 in-depth interviews with AYLPHIV (n = 30), caregivers (n = 20) and health care providers (n = 10) from the HIV clinic at Mbarara Regional Referral Hospital. We used an interview guide that focused on perceptions about transition to adult HIV care, challenges with transitioning, navigating HIV care, and self-management needs for AYLPHIV (from the perspectives of AYLPHIV, their caregivers, and health care providers). We used thematic analysis to identify themes related to AYLPHIV's self-management skills. We identified several self-management needs that we grouped under two major themes; social support and empowerment for AYLPHIV to assume responsibility for their own health and to navigate adult HIV care independently. The sub-themes under social support were information support, instrumental support, and emotional support as the sub themes while sub-themes under empowerment included self-advocacy skills, interpersonal skills, self-care skills, and disclosure skills. Taken together, these findings indicate that AYLPHIV need to be supported and empowered to maximize their chances of successfully transitioning to adult HIV care. Support comes from peers and caregivers. AYLPHIV require knowledge about their HIV status and empowerment with different skills including: self-advocacy skills, interpersonal skills, self-care skills, and HIV status disclosure skills, in order to assume responsibilities related to independent HIV care.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry Mbarara University of Science and Technology, Mbarara, Uganda
| | - Charles Baguma
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Tushemereirwe
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Denis Nansera
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C. Tsai
- Department of Psychiatry Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brian C. Zanoni
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Pediatric Infectious Diseases, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
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Lykkeberg B, Noergaard MW, Bjerrum M. Experiences and expectations of parents when young people with congenital heart disease transfer from pediatric to adult care: A qualitative systematic review. J Child Health Care 2024:13674935241231024. [PMID: 38332483 DOI: 10.1177/13674935241231024] [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] [Indexed: 02/10/2024]
Abstract
Parents encounter challenges when their child with congenital heart disease is transferred from pediatric to adult care. Until recently these parents' experiences and expectations of their child's transfer have received less attention. This systematic review aims to identify and synthesize qualitative evidence on parental experiences and expectations about their child's transfer from pediatric to adult care using a meta-aggregation approach. Six studies were included with 39 findings being aggregated into seven categories. Three syntheses were formed: Information is a prerequisite for supporting young people's transfer. The transition process should be well-prepared, individualized, and based on young people's maturity. Changing parental roles causes ambivalent feelings requiring support in the transfer process. Parents regard transfer from pediatric to adult care as a natural developmental step. However, some parents are anxious and worried while others found the transfer as feasible as other transitions in their child's life. Involving parents in the transition process enables them to facilitate their child's transfer. Parents worry their child is too young to take responsibility for their health. Parental roles from being a full caregiver to becoming a supportive person cause ambivalent feelings. These findings align with research on parents' experiences of young people with long-term conditions.
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Affiliation(s)
- Birgitte Lykkeberg
- Cardiology Clinic, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Marianne Wetendorff Noergaard
- Centre of Clinical Guidelines, Department of Clinical Medicine and Danish Centre of Systematic Reviews - JBI Centre of Excellence, University of Adelaide, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Merete Bjerrum
- Centre of Clinical Guidelines, Department of Clinical Medicine and Danish Centre of Systematic Reviews - JBI Centre of Excellence, University of Adelaide, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Nursing and Health Care, Department of Public Health, Aarhus University, Aarhus, Denmark
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Liaaen JM, Söderström S. The interrelated process of becoming independent in user participation for young persons living with disabilities. Disabil Rehabil 2024; 46:714-722. [PMID: 36772814 DOI: 10.1080/09638288.2023.2175385] [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: 03/14/2022] [Accepted: 01/28/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE User participation is important in the delivery of health- and social services. Yet, our knowledge regarding how user participation is experienced from the perspective of those who use these services is limited. This study aims to develop knowledge regarding how young persons living with disabilities experience becoming independent in user participation. MATERIALS AND METHODS This qualitative study is inspired by Constructivist Grounded Theory. Nine young persons between 16 and 25 years of age and living with a disability, participated in the interviews. RESULTS The results revealed that user participation for young persons is a socially situated, relational, and skills-dependent process. User participation is characterized as a process, consisting of increasing skills, gradually reducing parental support, and responding to interactions with professionals. The three categories are strongly reciprocal and interrelated, forming the unifying core category of Striving towards independence in user participation. CONCLUSION We theorize about the Interrelated process of becoming independent in user participation for young persons with disabilities. This theory highlights the need to understand the interrelatedness of user participation, allowing for a recognition of the complexity of user participation, showing it as a process involving developing skills, and gradually becoming independent and skilled in user participation.Implications for rehabilitationYoung persons with disability rely on support from parents as well as professionals to become independent in user participationProfessionals should acknowledge that user participation is a learning process and allow for time and resources to aid this processFocusing on increasing health literacy alone is not sufficient to ensure user participation for young persons with disability.
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Affiliation(s)
- Janne Marita Liaaen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sylvia Söderström
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Thomsen EL, Hanghøj S, Esbensen BA, Hansson H, Boisen KA. Parents' views on and need for an intervention during their chronically ill child's transfer to adult care. J Child Health Care 2023; 27:680-692. [PMID: 35481769 DOI: 10.1177/13674935221082421] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parents of chronically ill adolescents play a significant role during their child's transition and transfer to adult care. Parents seek help and support, but appropriate initiatives are still lacking. Thus, there is an urgent call for knowledge regarding parents' needs and views on such support. The aim of this study was to examine, in relation to parents of chronically ill adolescents: 1) views and experiences regarding their child's transfer from paediatric to adult care, and 2) which initiatives parents preferred in relation to the transfer. The study was based on the interpretive description method, and data were collected through face-to-face or telephone interviews with parents of chronically ill adolescents aged 16-19 (n = 11). We found three overall findings: 'Feeling acknowledged vs. feeling excluded', 'Perceived differences between paediatric and adult care' and 'Feeling safe vs. entering the unknown', together with three preferred initiatives: 1) Joint consultations, 2) Educational events and 3) Online support/website. In general, we found that some parents were extremely worried about the transfer, while others were not. Our results suggest that transfer initiatives targeting parents should focus on knowledge, expectations, relationships and goals in accordance with the social-ecological model of adolescent and young adult readiness to transition (SMART).
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Affiliation(s)
- Ena L Thomsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Signe Hanghøj
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bente A Esbensen
- Center of Rheumatology and Spine Disorders, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Helena Hansson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kirsten A Boisen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
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6
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Leocadio P, Kelleher C, Fernández E, Hawkes CP. Adolescents' Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions. Sci Diabetes Self Manag Care 2023; 49:477-492. [PMID: 37927049 PMCID: PMC10666500 DOI: 10.1177/26350106231206779] [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] [Indexed: 11/07/2023]
Abstract
PURPOSE The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents' transition to self-management of type 1 diabetes (T1DM). METHODS SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies. RESULTS A total of 29 studies met the inclusion criteria. Findings indicate that adolescents' experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents' transition and adolescents' self-negotiation have been neglected. CONCLUSION Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.
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Affiliation(s)
- Paula Leocadio
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Carol Kelleher
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Eluska Fernández
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Colin P. Hawkes
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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7
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Badour B, Bull A, Gupta AA, Mirza RM, Klinger CA. Parental Involvement in the Transition from Paediatric to Adult Care for Youth with Chronic Illness: A Scoping Review of the North American Literature. Int J Pediatr 2023; 2023:9392040. [PMID: 38045800 PMCID: PMC10691897 DOI: 10.1155/2023/9392040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023] Open
Abstract
With medical advancements and improvements in medical technology, an increasing number of children with chronic conditions survive into adulthood. There is accordant growing interest toward supporting adolescents throughout the transition from paediatric to adult care. However, there is currently a paucity of research focusing on the role that these patients' parents should play during and after the transition to adult care and if maintained parental involvement is beneficial during this transition within a North American context. Accordingly, this scoping review utilized Arksey and O'Malley's five-step framework to consider parental roles during chronically ill children's transition to adult care. APA PsycInfo, CINAHL, EMBASE, MEDLINE, ProQuest, and Scopus were searched alongside advanced Google searches. Thematic content analysis was conducted on 30 articles meeting the following inclusion criteria: (1) published in English between 2010 and 2022, (2) conducted in Canada or the United States, (3) considered adolescents with chronic conditions transitioning to adult care, (4) family being noted in the title or abstract, and (5) patient populations of study not being defined by delays in cognitive development, nor mental illness. Three themes emerged from the literature: the impacts of maintaining parental involvement during transition to adult care for patients, parents experiencing feeling loss of stability and support surrounding the transition of their child's care, and significant nonmedical life events occurring for youths at the time of transition of care. Parents assuming supportive roles which change alongside their maturing child's needs were reported as being beneficial to young peoples' transition processes, while parents who hover over or micromanage their children during this time were found to hinder successful transitions. Ultimately, the majority of reviewed articles emphasized maintained parental involvement as having a net positive impact on adolescents' transitions to adult care. As such, practice and policies should be structured to engage parents throughout the transition process to best support their chronically ill children during this time of change.
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Affiliation(s)
- Bryn Badour
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Amanda Bull
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Abha A. Gupta
- Temerty Faculty of Medicine: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
- Division of Medical Oncology, University Health Network: Princess Margaret Cancer Centre, Toronto, Ontario, Canada M5G 2C1
| | - Raza M. Mirza
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
| | - Christopher A. Klinger
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
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8
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Silvério APM, Mancini MC, Antunes FIT, Figueiredo PRP, Bueno KMP, Brandão MB. 'Thinking about myself?' Experiences of parents of adolescents with cerebral palsy: A qualitative study to guide the implementation of a service for families. Child Care Health Dev 2023. [PMID: 36597412 DOI: 10.1111/cch.13094] [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: 08/29/2022] [Revised: 11/17/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recently, there has been an increase in the development of transition services for adolescents with cerebral palsy (CP). Studies have emphasized the importance of addressing parents' needs during their children's adolescence. AIMS This study aimed to understand how parents experience the adolescence and transition to adulthood of their adolescents with CP and to identify relevant components for the development of a service for families. METHODS AND PROCEDURES A qualitative study was conducted with 18 families of adolescents with CP. Caregivers were purposely recruited from a transition programme called Adolescence in Focus Program. Individual interviews were conducted using a semistructured script. Then, the caregivers were invited to participate in focus groups. The interviews and focus groups were recorded and transcribed for content analysis. RESULTS Three categories emerged: 'The onset of adolescence', 'What will our future be?' and 'Support and services: paths to follow'. The adolescents' behavioural changes seemed to be intensified by their restricted social participation. Parents reported the desire for their adolescents to become independent in daily activities. Regarding their own future, they aimed to re-establish the occupational roles that were interrupted. CONCLUSION Information from this study guided the design of a programme for families regarding content, format and outcomes.
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Affiliation(s)
- Ana Paula M Silvério
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Associação Mineira de Reabilitação, Belo Horizonte, Brazil
| | - Marisa C Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda I T Antunes
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Priscilla R P Figueiredo
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Associação Mineira de Reabilitação, Belo Horizonte, Brazil
| | - Kátia M P Bueno
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marina B Brandão
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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9
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MacNeill L, Doucet S, Luke A. Caregiver experiences with transitions from pediatric to adult healthcare for children with complex care needs. Child Care Health Dev 2022; 48:800-808. [PMID: 35187705 DOI: 10.1111/cch.12989] [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: 08/06/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Caring for a youth with complex care needs (CCN) who is transitioning from paediatric to adult healthcare can produce many challenges. For example, caregivers must often manage their youth's care at home, coordinate care and advocate for their youth. Experiences of fragmented and uncoordinated care often result in caregivers feeling ill-prepared and uncertain about the transition process. The current study explores caregiver experiences with the transition from paediatric to adult healthcare for youth with CCN in a semi-rural Canadian province. METHODS This study used a cross-sectional qualitative descriptive design, involving semi-structured interviews with caregivers of youth with CCN who were preparing for, in the process of, or completed a transition from paediatric to adult healthcare within the province of New Brunswick, Canada. Thematic analysis focused on describing caregiver experiences with the transition from paediatric to adult healthcare. RESULTS Seventeen caregivers completed interviews for this study. Four key themes emerged relating to caregiver experiences with the transition from paediatric to adult healthcare for these youth: (1) lack of caregiver support, (2) lack of continuity of care, (3) need for collaborative care and (4) difficulty navigating transition. CONCLUSION There is a clear need to address the challenges experienced by youth with CCN and their caregivers throughout the transition from paediatric to adult healthcare. An effective transition strategy should involve early and coordinated planning between the paediatric and adult care team; continued communication across the care team throughout the transition process; and coordination among health, education and social services.
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Affiliation(s)
- Lillian MacNeill
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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10
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Brandão MB, Bueno KMP, Silvério APM, Antunes FIT, Feitosa AM, Figueiredo PRP, Mancini MC. "Listen to us!" A qualitative study of adolescents with disabilities to help plan a transition service. Child Care Health Dev 2022; 48:833-841. [PMID: 35229345 DOI: 10.1111/cch.12992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The development and implementation of transition services for adolescents with disabilities should incorporate perceptions of their needs and interests. The aim of the study was to understand the concerns of adolescents with physical disabilities during adolescence and their expectations regarding adulthood to help plan a transition programme in Brazil. METHODS This is a qualitative study, using a phenomenological approach. Eight adolescents with physical disabilities (seven with cerebral palsy, one with muscular dystrophy), aged between 15 and 17 years, participated in two focus groups. Prior to the conduction of the groups, clinicians selected topics related to adolescence and the transition to adulthood, based on their professional experience and available literature. During the focus groups, illustrative images of each topic were presented to the participants. Each adolescent was asked to select five topics that he/she considered important to be discussed in a future transition programme. The participants justified their individual choices and, in groups, reached a consensus on the groups' priorities. This strategy was chosen to motivate the discussion among the participants and to explore their concerns regarding adolescence and transition to adulthood. The focus groups were audio recorded and transcribed for content analysis. RESULTS Three themes emerged from the content analysis: (1) "Adolescents and their social relationships," (2) "Identity formation: self-awareness and development of autonomy," and (3) "What about adulthood?" CONCLUSION The themes revealed conflicts between the adolescents' desire to achieve independence and autonomy and the awareness of their limitations. The interpretation of the results helped structuring the actions of the Adolescence in Focus Programme, with two main actions: promotion of the adolescent's functional performance in daily living activities and assistance with their identity formation and preparation for adulthood.
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Affiliation(s)
- Marina B Brandão
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kátia M P Bueno
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Fernanda I T Antunes
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline M Feitosa
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Priscilla R P Figueiredo
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Associação Mineira de Reabilitação, Belo Horizonte, Brazil
| | - Marisa C Mancini
- Gradutate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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11
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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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12
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Gorter JW, Fehlings D, Ferro MA, Gonzalez A, Green AD, Hopmans SN, McCauley D, Palisano RJ, Rosenbaum P, Speller B. Correlates of Mental Health in Adolescents and Young Adults with Cerebral Palsy: A Cross-Sectional Analysis of the MyStory Project. J Clin Med 2022; 11:jcm11113060. [PMID: 35683448 PMCID: PMC9181041 DOI: 10.3390/jcm11113060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: It is important to gain a better understanding of mental health issues in adolescents and young adults (AYA) with cerebral palsy (CP). In this cross-sectional study, we explore if demographics, social and clinical questionnaire scores, and cortisol levels in hair samples from AYA with CP are associated with higher scores on anxiety and/or depression questionnaires. Methods: Data from a community-based sample of 63 AYA with CP (30 females; ages 16 to 30 (median age of 25)) were analyzed. Forty-one (65%) participants (20 females) provided a hair sample. Outcomes were assessed using bivariate linear regression analyses and hierarchical regression analyses. Results: Clinical depressive and anxiety symptoms were present in 33% and 31% of participants, respectively. Family functioning, B = 9.62 (95%CI: 5.49–13.74), fatigue, B = 0.15 (95%CI: 0.05–0.25), and pain, B = 1.53 (95%CI: 0.48–2.58) were statistically significant predictors of depressive symptoms. Fatigue, B = 0.24 (95%CI: 0.12–0.35) and pain, B = 1.63 (95%CI: 0.33–2.94) were statistically significant predictors of anxiety. Cortisol levels from hair samples were not found to be associated with depressive symptoms or anxiety. Conclusions: A high prevalence of mental health problems and co-occurring physical problems was found in AYA with CP. Integrating mental support into regular care for AYA with CP is recommended.
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Affiliation(s)
- Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Correspondence:
| | - Darcy Fehlings
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON M4G 1R8, Canada
| | - Mark A. Ferro
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - Amanda D. Green
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Sarah N. Hopmans
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Dayle McCauley
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Robert J. Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Brittany Speller
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
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Sanders C, Amyot E, Usipuik M, Crawford L, Callens N, Chanoine JP, Jones T. Lifespan healthcare transitions among individuals with intersex traits in Canada: a mixed-methods and qualitative study. BMJ Open 2022; 12:e055759. [PMID: 35396291 PMCID: PMC8996003 DOI: 10.1136/bmjopen-2021-055759] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To: (1) complete an integrative literature review of transition studies that focus on individuals with intersex traits; (2) conduct an environmental scan of the current resources (practice guidelines, policies and procedures) used by healthcare providers working with Canadians with intersex traits; (3) investigate the experiences of Canadians with intersex traits in their healthcare transitions across the lifespan and (4) assess the understanding of healthcare providers about these transitions. DESIGN A qualitative prospective community participation study was conducted. It used mixed methods including an environmental scan and semistructured engagement sessions. SETTING The environmental scan examined resources available throughout Canada. The engagement sessions took place in British Columbia and Ontario, Canada. PARTICIPANTS Sixteen participants were recruited. These included 13 individuals with intersex traits (a heterogeneous group of congenital conditions affecting the development of sex characteristics) and three caregivers. METHODS Mixed methods included an integrated literature review, environmental scan and qualitative approaches developed in collaboration with community partners. RESULTS The literature review identified gaps in transition care for individuals with intersex traits. The environmental scan uncovered no specific resources used by healthcare providers working with patients with intersex traits, though several general guidelines were used. Engaging providers in the study was problematic. Thematic analysis generated three main themes that emerged from the engagement sessions: (1) transition is a lifespan activity; (2) building personal agency is valuable and (3) well-being promotion is an application of health literacy. CONCLUSIONS Transition resources for individuals living in Canada with intersex are scarce. Transitions happen across the lifespan with ownership of thought and actions seen as acts of personal agency. Health literacy skills and knowledge change with increased age, yet the primary source of knowledge often remained important in the individual's autobiographical self.
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Affiliation(s)
- Caroline Sanders
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Emma Amyot
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Megan Usipuik
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Leigh Crawford
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Nina Callens
- Gender Chamber, Flemish Ombud service, Flemish Parliament, Brussels, Belgium
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
- University of British Columbia
| | - Tiffany Jones
- School of Education, Macquarie University, Sydney, New South Wales, Australia
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Dushnicky MJ, Scott J, McCauley D, Gorter JW, Beattie KA, Batthish M. Transition us together: development of a parent-centered toolkit to support adolescents with rheumatic disease transition to adult care. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0008] [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
Objectives
While the transition period can be a difficult time for adolescents with chronic health conditions, parents also face challenges in understanding their changing role and how to support their children. To date, minimal interventions have focused on supporting and empowering parents during this period.
Methods
We co-created a toolkit with and for parents to help prepare them for their child’s transition to adult care. The toolkit was created using an iterative process of reviewing existing resources with integrating feedback from rheumatology patients and parents. Input was sought from the Family and Youth Advisory Councils at McMaster Children’s Hospital in Hamilton, Canada.
Results
The two components of the toolkit include a Transition Road Map and a Parent Guide to Transition. Five domains of transition readiness were established as pillars of the Road Map. Within each domain, a checklist to achieve self-management was established. The Parent Guide was developed to highlight important information including defining transition, outlining differences between pediatric and adult care, and providing tips on helping and supporting adolescents.
Conclusions
A Parent Toolkit directed at the Transition from Pediatric to Adult Rheumatology Care was developed and underwent extensive review with multiple stakeholders. Ongoing research on its impact on transition readiness is underway.
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Affiliation(s)
| | - Jessica Scott
- Michael G. De Groote School of Medicine , McMaster University , Hamilton , ON , Canada
| | - Dayle McCauley
- CanChild, Department of Pediatrics , McMaster University , Hamilton , ON , Canada
| | - Jan Willem Gorter
- CanChild, Department of Pediatrics , McMaster University , Hamilton , ON , Canada
- Department of Rehabilitation, Physical Therapy Science & Sports , University Medical Center Utrecht , Utrecht , the Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation , Utrecht , the Netherlands
| | - Karen A. Beattie
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , ON , Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics , McMaster University , Hamilton , ON , Canada
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15
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Nguyen L, Davis H, Bellefeuille S, Havens J, Jack SM, Di Rezze B, Ketelaar M, Gorter JW. Canadian Resources for Siblings of Youth With Chronic Health Conditions to Inform and Support With Healthcare Management: A Qualitative Document Analysis. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:724589. [PMID: 36188805 PMCID: PMC9397918 DOI: 10.3389/fresc.2021.724589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
Background: As children and adolescents with a chronic health condition (CHC) age and transition to adulthood, many will increasingly assume responsibilities for the management of their healthcare. For individuals with CHCs, family members including siblings often provide significant and varied supports. There are a range of resources in Canada to support siblings of individuals with a CHC, but these resources are not synthesized and the extent to which they relate to healthcare management remains unclear. Purpose: The purpose of this document review was to identify, describe, and synthesize the types of resources currently available to provide general information and healthcare management information about how siblings can provide support to individuals with CHCs in Canada. Methods: Print and electronic resources were systematically identified and retrieved from the websites of organizations, treatment centers, and children's hospitals that are part of Children's Healthcare Canada. Each unique resource was treated as a text document. Documents that met the following inclusion criteria were included: addressed the topic of siblings of individuals with a CHC and written in English. Data were extracted from included documents and qualitative conventional content analysis was conducted. Throughout the process of this review, we partnered with a Sibling Youth Advisory Council. Results: The systematic search yielded 1,628 non-duplicate documents, of which 163 documents met the inclusion criteria. Of the total of 163 documents, they were delivered in the following formats: 17 (10%) general informational products (e.g., booklets, videos) about a CHC and sibling relationships, 39 about support programs and workshops (24%), 34 news articles (21%) that described the roles of siblings, and 6 (3%) healthcare management informational products (e.g., toolkit, tipsheets), 31 blogs (19%) and 39 interviews (24%) with parents and siblings. In the blogs and interviews, siblings and parents described how siblings developed knowledge and skills for healthcare management, as well as their role and identity over time. Significance: This study identified that there are limited resources available about healthcare management for siblings of CHC in Canada. Resources are needed to facilitate conversations in the family about the role of siblings with healthcare management of their sibling with a CHC.
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Affiliation(s)
- Linda Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Sibling Youth Advisory Council, Hamilton, ON, Canada
- *Correspondence: Linda Nguyen
| | - Hanae Davis
- Sibling Youth Advisory Council, Hamilton, ON, Canada
| | | | | | - Susan M. Jack
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Briano Di Rezze
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Marjolijn Ketelaar
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Centre of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Jan Willem Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
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16
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Stephens SB, Raphael JL, Zimmerman CT, Garland BH, de Guzman MM, Walsh SM, Hergenroeder AC, Wiemann CM. The Utility of Self-Determination Theory in Predicting Transition Readiness in Adolescents With Special Healthcare Needs. J Adolesc Health 2021; 69:653-659. [PMID: 34059429 DOI: 10.1016/j.jadohealth.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/10/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Adolescents and young adults with chronic health conditions must learn skills to successfully manage their health as they prepare to transition into adult-based care. Self-determination theory (SDT), an empirically based theory of human motivation, posits that competence (feeling effective), autonomy (volition to perform behaviors), and relatedness (support for autonomy from others) influence behavioral change. This study evaluates the utility of SDT constructs in predicting transition readiness among adolescents and young adults recruited into an intervention to promote successful healthcare transition. METHODS Baseline assessments were completed by 137 patients aged 17-23 years recruited from pediatric renal, gastroenterology, or rheumatology clinical services. Surveys measured transition readiness (Transition Readiness Assessment Questionnaire) as well as SDT constructs, including competence (Patient Activation Measure); provider relatedness and parent autonomy support (Health Care Climate Questionnaire); and health care-related autonomy (Treatment Self-Regulation Questionnaire). Relationships between SDT constructs and transition readiness were evaluated using linear regression. RESULTS Between 44 and 48 participants were recruited from each service. Bivariate correlation coefficients between transition readiness and SDT constructs were competence (r = .44), autonomous autonomy (r = .34), controlled autonomy (r = .27), provider relatedness (r = .46), and parental autonomy support (r = .35) (p < .01). Age positively correlated with transition readiness (r = .47, p < .001). After controlling for age, gender, and clinical service, competence (p < .001) and provider relatedness (p = .008) successfully predicted transition readiness (R2 = .423; F change; p < .001). CONCLUSIONS Findings from this cross-sectional study support the utility of SDT constructs in promoting transition readiness among adolescents and young adults with chronic conditions, underscoring the importance of building competence and provider support for autonomy during this critical period.
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Affiliation(s)
- Sara B Stephens
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Cortney T Zimmerman
- Section of Psychology, Renal Service, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Beth H Garland
- Sections of Adolescent Medicine & Sports Medicine and Psychology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Marietta M de Guzman
- Section of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Seema M Walsh
- Section of Gastroenterology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Albert C Hergenroeder
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Constance M Wiemann
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
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17
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Wong Chung R, Willemen A, Voorman J, Ketelaar M, Becher J, Schuengel C. Professionals' motivation to support parental self-management regarding children with physical disability in Dutch rehabilitation services: 'Please mind your gap'. Child Care Health Dev 2021; 47:685-696. [PMID: 34014585 PMCID: PMC8453492 DOI: 10.1111/cch.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 01/05/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Professionals in child healthcare increasingly endorse the support of self-management in paediatric rehabilitation services for children with physical disability. Less understood though are their views regarding the role of the children's parents, as well as their own role in supporting parents. This study aimed to investigate the motivation of rehabilitation professionals to support self-management of parents regarding their child with physical disability, professionals' beliefs about parental self-management, and the perceptions underlying their motivation. METHODS A mixed-methods strategy was followed using a survey among rehabilitation professionals (n = 175) and consecutive semi-structured interviews (n = 16). Associations between autonomous (intrinsic) versus controlled (extrinsic) motivation and beliefs on parental self-management were tested. For deeper understanding of their motivation, directed content analysis was used to address key themes in the qualitative data extracts. RESULTS Professionals reported autonomous motivation for parental self-management support more often than controlled motivation (t[174] = 29.95, p < .001). Autonomous motivation was associated with the beliefs about the importance of parental self-management (r = .29, p < .001). Approximately 90% of the professionals believed that parents should have an active role, though less than 10% considered it important that parents also are independent actors and initiative takers in the rehabilitation process. Interviews revealed that individual professionals struggled with striking a balance between keeping control and 'giving away responsibility' to parents. A 'professional-like' attitude was expected of parents with 'involvement' and 'commitment' as essential preconditions. Furthermore, professionals expressed the need for additional coaching skills to support parental self-management. CONCLUSION Professionals were predominantly autonomously motivated to support self-management of parents. However, the dilemmas in giving or taking responsibilities within the partnership with parents may limit their effectiveness in empowering parents. Reflection on the potential gaps between professionals' motivation, beliefs and actual behaviour might be crucial to support parental self-management.
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Affiliation(s)
- Ruud Wong Chung
- Merem Medical RehabilitationAlmereThe Netherlands,Amsterdam Public Health research institute and Department of Educational and Family studies, Faculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Agnes Willemen
- Amsterdam Public Health research institute and Department of Educational and Family studies, Faculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jeanine Voorman
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CentreUniversity Medical Centre Utrecht and De Hoogstraat Rehabilitation UtrechtUtrechtThe Netherlands,Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's HospitalUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Marjolijn Ketelaar
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CentreUniversity Medical Centre Utrecht and De Hoogstraat Rehabilitation UtrechtUtrechtThe Netherlands
| | - Jules Becher
- Amsterdam Movement Sciences and Department of Rehabilitation MedicineAmsterdam UMC, VU Medical Centre, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Carlo Schuengel
- Amsterdam Public Health research institute and Department of Educational and Family studies, Faculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
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18
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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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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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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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King G, Kingsnorth S, Morrison A, Gorter JW, DeFinney A, Kehl B. Parents' perceptions of the foundational and emergent benefits of residential immersive life skills programs for youth with disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 110:103857. [PMID: 33453694 DOI: 10.1016/j.ridd.2021.103857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To examine parents' views of the benefits of residential immersive life skills programs for youth with disabilities. METHOD Three- and 12-month post-session interviews were held with ten parents of youth with disabilities who had attended one of three residential immersive life skills programs in one of three years of data collection. A deductive thematic analysis was conducted to describe the types of benefits reported by parents. RESULTS Parents discussed foundational benefits that were common to youth and more individualized emergent benefits. The foundational benefits included acquisition of life skills, greater awareness of future possibilities, and enhancements to self-confidence. The emergent benefits included greater comfort in new situations, and changes in motivation and initiative, maturity and responsibility, and community involvement. CONCLUSIONS Parents reported diverse benefits from involvement in these youth transition programs. In the eyes of parents, these programs prepared youth for transition to adult roles by enhancing awareness of life possibilities, amplifying existing capacities, and accelerating growth in adaptability, motivation, and maturity, as well as community involvement. The findings indicate the utility of RILS programs, and can be used to explain the diverse effects of these programs to parents and youth contemplating enrollment.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Toronto, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
| | - Shauna Kingsnorth
- Bloorview Research Institute, Toronto, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Andrea Morrison
- Children's Developmental Rehabilitation Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- CanChild and Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Andrea DeFinney
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Barbara Kehl
- ErinoakKids Centre for Treatment and Development, Mississauga, Ontario, Canada
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The Development of Health Self-Management Among Adolescents With Chronic Conditions: An Application of Self-Determination Theory. J Adolesc Health 2021; 68:394-402. [PMID: 32713740 DOI: 10.1016/j.jadohealth.2020.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to better understand the progressive development of health self-management among adolescents and emerging adults (AEAs) with chronic medical conditions in order to identify opportunities to prepare AEA for transition to adult-based care. METHODS Twenty-three AEA aged 17-20 years with renal, inflammatory bowel, or rheumatologic diseases, and their parents, completed individual semistructured interviews describing each AEA's health self-management. Self-Determination Theory was used to frame interview questions, including the constructs of competence, autonomy, and autonomy support. Transcripts were analyzed using directed content analysis. RESULTS Four themes emerged: Development of Competence in Self-Management; Autonomy: Motivations to Self-Manage; Ways Important Others Support or Hinder Independence; and Normal Adolescent Development. AEA's competency and autonomy increased as they progressed from lack of knowledge about self-management to having knowledge without doing tasks, and, ultimately, to independent completion of tasks. Motivations to self-manage included avoiding sickness/weakness and wanting to engage in activities. Parents and providers supported AEA's autonomy through teaching and transferring responsibility. Parental fear/lack of trust in AEA's ability to self-manage hindered development of AEA's autonomy, producing anxiety. Normal adolescent development impacted timing of self-management task mastery. CONCLUSIONS As AEA gain competence in increasingly complex self-management tasks, they assume greater responsibility for managing their health. Competence and autonomy are facilitated by a feedback loop: AEA successful self-management increased parent trust, enabling the parent to transfer responsibility for more complex tasks. Conversely, parents' fear of the AEA doing wrong hinders transfer of responsibility, limiting competence and autonomy. Health-care providers play an important role in fostering autonomy.
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Huurneman KAM, Lankhorst IMF, Baars ECT, van Wijk I, van der Sluis CK. Opinions on rehabilitation care of young adults with transversal upper limb reduction deficiency in their transition to adulthood. J Pediatr Rehabil Med 2021; 14:103-112. [PMID: 33720858 DOI: 10.3233/prm-200690] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Young adults with transversal upper limb reduction deficiency experience limitations regarding education, employment and obtaining a driver's license. Contribution of rehabilitation care within these domains has been reported to be inadequate. This study evaluates the needs and suggestions of participants in rehabilitation care. METHODS Two online focus groups with young adults and parents met during 4 consecutive days. Health care professionals joined a face-to-face focus group. Data analysis was based on framework analysis. RESULTS The rehabilitation team was mainly consulted for problems with residual limb or for prostheses. Young adults and their parents were mostly unaware of resources regarding education, job selection or obtaining a driver's license. Professionals stated that these subjects were addressed during periodic appointments. Young adults didn't always attend these appointments due to limited perceived benefit. To improve rehabilitation care, participants suggested methods for providing relevant information, facilitating peer contact and offering dedicated training programs to practice work-related tasks, prepare for job interviews or enhance self-confidence. CONCLUSION Periodic appointments do not fulfil needs of young adults with transversal upper limb reduction deficiency. To improve care, rehabilitation teams should offer age-relevant information, share peer stories, and create dedicated training programs.
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Affiliation(s)
| | | | | | - Iris van Wijk
- Department of Rehabilitation Medicine, Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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24
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Thomas SN, Hovick SR. The indirect effect of family communication patterns on young adults' health self-disclosure: Understanding the role of descriptive and injunctive norms in a test of the integrative model of behavioral prediction. COMMUNICATION REPORTS (PULLMAN, WASH.) 2021; 34:121-136. [PMID: 34776607 PMCID: PMC8589271 DOI: 10.1080/08934215.2021.1924213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Family communication patterns (FCP) are relational schema theorized to influence behaviors indirectly via cognitive processes, including perceived norms. However, relatively little is known about the indirect effect of FCP on health self-disclosure via perceived norms. We examine FCP's associations with young adults' health self-disclosure to their parents, assessing the theory of normative social behavior and the integrative model of behavioral prediction. Young adults (N = 504) completed a cross-sectional survey. Mediation analysis showed the effect of conversation orientation on health self-disclosure via communication efficacy and descriptive norms. Injunctive norms moderated the indirect effect of descriptive norms on self-disclosure. Results suggest conversation, but not conformity orientation, influenced young adults' self-disclosure, while norms and efficacy act as predominant drivers of disclosure behavior.
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Affiliation(s)
- Sarah N. Thomas
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University, St. Louis, MO, United States
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Shelly R. Hovick
- School of Communication, The Ohio State University, Columbus, OH, United States
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25
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Ludvigsen MS, Hall EOC, Westergren T, Aagaard H, Uhrenfeldt L, Fegran L. Being cross pressured-parents' experiences of the transfer from paediatric to adult care services for their young people with long term conditions: A systematic review and qualitative research synthesis. Int J Nurs Stud 2020; 115:103851. [PMID: 33360499 DOI: 10.1016/j.ijnurstu.2020.103851] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Family members of young people (13-24 years) with long-term conditions tend to experience multiple challenges when their children transfer from paediatric to adult care, as do the patients themselves. OBJECTIVES To identify, interpret and theoretically conceptualise the meaning of parents' experiences of the transfer from paediatric to adult care of their young people with long-term conditions. DESIGN A qualitative research synthesis. DATA SOURCES We obtained articles from Medline, CINAHL, PsycINFO, EMBASE, Scopus, and Web of Science. Unpublished theses and dissertations were searched for using Google Scholar, Mednar, and ProQuest Dissertations and Theses. REVIEW METHODS Based on a previously published protocol, we followed the guidelines from the Joanna Briggs Institute. Sandelowski and Barroso's qualitative research synthesis approach guided the metasynthesis. Articles published between 1999 and March 2019 were systematically searched for. FINDINGS Twenty-three reports from seven Western countries representing 454 parents including significant others such as aunts and grandparents of 462 young people with various diagnoses contributed to the review. 'Being cross-pressured' was the metasynthesis found to reflect parents' experiences of the transfer from paediatric to adult care of their young people with long-term conditions. The metasynthesis comprised four themes: 'Fluctuating between parental roles', 'Navigating contrasting healthcare contexts', 'Making decisions in the face of inner conflict', and 'Trusting their child's self-management ability'. CONCLUSIONS Our metasynthesis finding of parents' experiences of being cross-pressured provides a new way of thinking about the study phenomena which is supported by transitions theory holding that multiple transitions can take place simultaneously involving myriads of concurrent and conflicting demands. The cross pressure may overwhelm parents. The clinical implications are to recognise parents' experiences and distress in healthcare planning to promote safe and predicable transfers of their young people. Provision of healthcare to parents during transfer needs to be tailored to a collaborative decision-making process between parents, their young people, and involved practitioners across paediatric and adult healthcare services. Tweetable abstract: Parents experienced being cross-pressured when their young people with long-term conditions were transferred from paediatric to adult care.
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Affiliation(s)
- Mette S Ludvigsen
- Department of Clinical Medicine - Randers Regional Hospital, Aarhus University, Østervangsvej 70,2, 8930 Randers NØ, Denmark; Faculty of Nursing and Health Sciences, Nord University, Universitetsalléen 11, 8049 Bodø, Norway; Danish Centre of Clinical Guidelines and Danish Centre of Systematic Reviews, A Joanna Briggs Institute Centre of Excellence, Aalborg University, Aalborg, Denmark.
| | - Elisabeth O C Hall
- Department of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark; Faculty of Health Sciences and Nursing, University of Faroe Islands, Torshavn, Faroe Islands.
| | - Thomas Westergren
- Department of Health and Nursing Science, University of Agder, Campus Kristians and, Universitetsveien 25, 4630 Kristiansand, Norway.
| | - Hanne Aagaard
- Department of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark; Lovisenberg Diaconal University College, Lovisenberggata 15b, 0456 Oslo, Norway.
| | - Lisbeth Uhrenfeldt
- Faculty of Nursing and Health Sciences, Nord University, Universitetsalléen 11, 8049 Bodø, Norway; Danish Centre of Clinical Guidelines and Danish Centre of Systematic Reviews, A Joanna Briggs Institute Centre of Excellence, Aalborg University, Aalborg, Denmark.
| | - Liv Fegran
- Department of Health and Nursing Science, University of Agder, Campus Kristians and, Universitetsveien 25, 4630 Kristiansand, Norway.
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McDowell ME, Litchman ML, Guo JW. The transition experiences of adolescents with type 1 diabetes from paediatric to adult care providers. Child Care Health Dev 2020; 46:692-702. [PMID: 32697881 DOI: 10.1111/cch.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/14/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Emerging adults with type 1 diabetes (T1D) are at increased risk for poor health outcomes as they transition from paediatric to adult healthcare providers. This is in part due to the complexities of young adult life as individuals with T1D enter the workforce, leave home or start college while learning to manage the disease on their own. We sought to identify the barriers and facilitators adolescents face during their emerging adult years with T1D. METHODS Young adults, aged 24-35, who lived with T1D during their adolescent years were recruited online to complete a survey regarding their experience with care transition. Categorical data were analysed using descriptive statistics. A thematic analysis, guided by the Framework for Emerging Adults with T1D, was used to explore the free-text data. RESULTS In total, 25 adults (84% female) with mean age of 28 ± 3.2 years participated. Themes that arose from the analysis of the paediatric to adult care transition experiences included (1) importance of support from key players, (2) challenges navigating the healthcare system, (3) mental health needs of emerging adults with T1D, (4) managing day-to-day life with T1D and (5) early independence to ease transition. CONCLUSION Individuals with T1D face a variety of challenges as they transition from paediatric to adult care providers. A proactive approach in educating adolescents is needed.
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Affiliation(s)
- Megan E McDowell
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA.,College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Michelle L Litchman
- College of Nursing, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Utah Diabetes and Endocrinology Center, Salt Lake City, Utah, USA
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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Varty M, Speller-Brown B, Phillips L, Kelly KP. Youths' Experiences of Transition from Pediatric to Adult Care: An Updated Qualitative Metasynthesis. J Pediatr Nurs 2020; 55:201-210. [PMID: 32966960 PMCID: PMC7722194 DOI: 10.1016/j.pedn.2020.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
PROBLEM Improvements in chronic disease management has led to increasing numbers of youth transitioning to adult healthcare. Poor transition can lead to high risks of morbidity and mortality. Understanding adolescents and young adults (AYA) perspectives on transition is essential to developing effective transition preparation. The aim of this metasynthesis was to synthesize qualitative studies assessing the experiences and expectations of transition to adult healthcare settings in AYAs with chronic diseases to update work completed in a prior metasynthesis by Fegran, Hall, Uhrenfeldt, Aagaard, and Ludvigsen (2014). ELIGIBILITY CRITERIA A search of PubMed, Medline, PsycINFO, and CINAHL was conducted to gather articles published after February 2011 through June 2019. SAMPLE Of 889 articles screened, a total of 33 articles were included in the final analysis. RESULTS Seven main themes were found: developing transition readiness, conceiving expectations based upon pediatric healthcare, transitioning leads to an evolving parent role, transitioning leads to an evolving youth role, identifying barriers, lacking transition readiness, and recommendations for improvements. CONCLUSIONS Findings of this metasynthesis reaffirmed previous findings. AYAs continue to report deficiencies in meeting the Got Transition® Six Core Elements. The findings highlighted the need to create AYA-centered transition preparation which incorporate support for parents. IMPLICATIONS Improvements in transition preparation interventions need to address deficiencies in meeting the Got Transition® Six Core Elements. More research is needed to identify and address barriers implementing the transition process.
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Affiliation(s)
- Maureen Varty
- UCHealth University of Colorado Hospital, CO, United States of America; University of Missouri-Columbia Sinclair School of Nursing, S235 School of Nursing, University of Missouri, MO, United States of America.
| | - Barbara Speller-Brown
- Children's National Hospital, DC, United States of America; The George Washington University, DC, United States of America.
| | - Leslie Phillips
- Children's National Hospital, DC, United States of America; The George Washington University, DC, United States of America.
| | - Katherine Patterson Kelly
- Children's National Hospital, DC, United States of America; The George Washington University, DC, United States of America.
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Jahnsen R, Ramstad K, Myklebust G, Elkjaer S, Pripp AH, Klevberg GL. Independence of young people with cerebral palsy during transition to adulthood: a population-based 3 year follow-up study. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2019-0002] [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
AbstractBackgroundThis study describes developmental and service transitions during a 3-year period among young people with cerebral palsy (CP) as measured by the Rotterdam Transition Profile (RTP) and evaluates the test-retest reliability of the RTP. The RTP is a questionnaire developed to classify phases of transition across nine participation domains.MethodsA three-step design was applied: Step I consisted of a translation and test-retest reliability study of the RTP, Step II was a comparison of independence between youth with and without CP and Step III was a follow-up survey of youth with CP describing changes of independence after a 3-year transition period. A sample of 103 typically developing youth were recruited for Steps I and II, and a population-based sample of 76 (response rate = 59%) youth with CP (males = 40) from South-Eastern Norway aged 16–17 years were recruited for Steps II and III. The subtypes of CP were classified as spastic unilateral (n = 30), spastic bilateral (n = 37), dyskinetic (n = 8) and ataxic (n = 1) CP. The levels of gross motor function followed the categories of the Gross Motor Function Classification System (GMFCS) as level I (n = 30), level II (n = 17), level III (n = 6), level IV (n = 8) and level V (n = 15).ResultsTwenty-six participants had epilepsy and 13 had gastrostomy. Forty-four of the youth with CP (response rate = 58%) responded to the 3-year follow-up survey in Step III. The test-retest study of the RTP showed excellent reliability (Kw 0.76–0.93). At baseline (Step II), the reference group was significantly more independent than the youth with CP in all the participation domains. At the 3-year follow-up (Step III), the levels of independence had increased significantly for all the participation domains in the youth with CP except for transportation and leisure. Despite increased independence during the transition period regarding health services, only 25% independently formulated their own care needs or applied for services and assistance at 19–20 years of age. Youth who responded to the RTP by a caregiver proxy more often had a diagnosis of epilepsy and/or gastrostomy and higher GMFCS levels. These individuals were significantly less independent than those who self-reported, both at baseline and at follow-up.ConclusionsIn conclusion, the excellent test-retest results support the use of the RTP as a tool for classifying phases of transition among youth with CP. The youth with CP were significantly less independent than their typically developing peers at baseline, yet increased their independence during a 3-year period. Those who self-reported to the RTP were generally more independent than those who proxy-reported, which supports the need to distinguish between the service needs of subgroups during the transition phase.
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Affiliation(s)
- Reidun Jahnsen
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kjersti Ramstad
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Gerd Myklebust
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
| | - Sonja Elkjaer
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Gunvor Lilleholt Klevberg
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
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29
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Moseley CA, Vulimiri M, Saunders RS, Bleser WK, Perrin EM, Armstrong SC, Wang GX, Ubel PA, McClellan M, Wong CA. Medicaid and CHIP Child Health Beneficiary Incentives: Program Landscape and Stakeholder Insights. Pediatrics 2019; 144:peds.2018-3161. [PMID: 31289193 PMCID: PMC6855824 DOI: 10.1542/peds.2018-3161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To describe the landscape of Medicaid and the Children's Health Insurance Program beneficiary incentive programs for child health and garner key stakeholder insights on incentive program rationale, child and family engagement, and program evaluation. METHODS We identified beneficiary health incentive programs from 2005 to 2018 through a search of peer-reviewed and publicly available documents and through semistructured interviews with 80 key stakeholders (Medicaid and managed-care leadership, program evaluators, patient advocates, etc). This study highlights insights from 23 of these stakeholders with expertise on programs targeting child health (<18 years old) to understand program rationale, beneficiary engagement, and program evaluation. RESULTS We identified 82 child health-targeted beneficiary incentive programs in Medicaid and the Children's Health Insurance Program. Programs most commonly incentivized well-child checks (n = 77), preventive screenings (n = 30), and chronic disease management (n = 30). All programs included financial incentives (eg, gift cards, premium incentives); some also offered incentive material prizes (n = 12; eg, car seats). Loss-framed incentives were uncommon (n = 1; eg, lost benefits) and strongly discouraged by stakeholders. Stakeholders suggested family engagement strategies including multigenerational incentives or incentives addressing social determinants of health. Regarding evaluation, stakeholders suggested incentivizing evidence-based preventive services (eg, vaccinations) rather than well-child check attendance, and considering proximal measures of child well-being (eg, school functioning). CONCLUSIONS As the landscape of beneficiary incentive programs for child health evolves, policy makers have unique opportunities to leverage intergenerational and social approaches for family engagement and to more effectively increase and evaluate programs' impact.
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Affiliation(s)
- Connor A. Moseley
- Department of Pediatrics, School of Medicine,,Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Madhulika Vulimiri
- Sanford School of Public Policy, and,Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Robert S. Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - William K. Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Eliana M. Perrin
- Department of Pediatrics, School of Medicine,,Duke Center for Childhood Obesity Research, Durham, North Carolina; and
| | - Sarah C. Armstrong
- Department of Pediatrics, School of Medicine,,Duke Center for Childhood Obesity Research, Durham, North Carolina; and,Duke Clinical Research Institute, Durham, North Carolina
| | - Gary X. Wang
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | | | - Mark McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Charlene A. Wong
- Department of Pediatrics, School of Medicine,,Sanford School of Public Policy, and,Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina;,Duke Center for Childhood Obesity Research, Durham, North Carolina; and,Duke Clinical Research Institute, Durham, North Carolina
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30
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Colver A, Rapley T, Parr JR, McConachie H, Dovey-Pearce G, Couteur AL, McDonagh JE, Bennett C, Hislop J, Maniatopoulos G, Mann KD, Merrick H, Pearce MS, Reape D, Vale L. Facilitating the transition of young people with long-term conditions through health services from childhood to adulthood: the Transition research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background
As young people with long-term conditions move from childhood to adulthood, their health may deteriorate and their social participation may reduce. ‘Transition’ is the ‘process’ that addresses the medical, psychosocial and educational needs of young people during this time. ‘Transfer’ is the ‘event’ when medical care moves from children’s to adults’ services. In a typical NHS Trust serving a population of 270,000, approximately 100 young people with long-term conditions requiring secondary care reach the age of 16 years each year. As transition extends over about 7 years, the number in transition at any time is approximately 700.
Objectives
Purpose – to promote the health and well-being of young people with long-term conditions by generating evidence to enable NHS commissioners and providers to facilitate successful health-care transition. Objectives – (1) to work with young people to determine what is important in their transitional health care, (2) to identify the effective and efficient features of transitional health care and (3) to determine how transitional health care should be commissioned and provided.
Design, settings and participants
Three work packages addressed each objective. Objective 1. (i) A young people’s advisory group met monthly throughout the programme. (ii) It explored the usefulness of patient-held health information. (iii) A ‘Q-sort’ study examined how young people approached transitional health care. Objective 2. (i) We followed, for 3 years, 374 young people with type 1 diabetes mellitus (150 from five sites in England), autism spectrum disorder (118 from four sites in England) or cerebral palsy (106 from 18 sites in England and Northern Ireland). We assessed whether or not nine proposed beneficial features (PBFs) of transitional health care predicted better outcomes. (ii) We interviewed a subset of 13 young people about their transition. (iii) We undertook a discrete choice experiment and examined the efficiency of illustrative models of transition. Objective 3. (i) We interviewed staff and observed meetings in three trusts to identify the facilitators of and barriers to introducing developmentally appropriate health care (DAH). We developed a toolkit to assist the introduction of DAH. (ii) We undertook a literature review, interviews and site visits to identify the facilitators of and barriers to commissioning transitional health care. (iii) We synthesised learning on ‘what’ and ‘how’ to commission, drawing on meetings with commissioners.
Main outcome measures
Participation in life situations, mental well-being, satisfaction with services and condition-specific outcomes.
Strengths
This was a longitudinal study with a large sample; the conditions chosen were representative; non-participation and attrition appeared unlikely to introduce bias; the research on commissioning was novel; and a young person’s group was involved.
Limitations
There is uncertainty about whether or not the regions and trusts in the longitudinal study were representative; however, we recruited from 27 trusts widely spread over England and Northern Ireland, which varied greatly in the number and variety of the PBFs they offered. The quality of delivery of each PBF was not assessed. Owing to the nature of the data, only exploratory rather than strict economic modelling was undertaken.
Results and conclusions
(1) Commissioners and providers regarded transition as the responsibility of children’s services. This is inappropriate, given that transition extends to approximately the age of 24 years. Our findings indicate an important role for commissioners of adults’ services to commission transitional health care, in addition to commissioners of children’s services with whom responsibility for transitional health care currently lies. (2) DAH is a crucial aspect of transitional health care. Our findings indicate the importance of health services being commissioned to ensure that providers deliver DAH across all health-care services, and that this will be facilitated by commitment from senior provider and commissioner leaders. (3) Good practice led by enthusiasts rarely generalised to other specialties or to adults’ services. This indicates the importance of NHS Trusts adopting a trust-wide approach to implementation of transitional health care. (4) Adults’ and children’s services were often not joined up. This indicates the importance of adults’ clinicians, children’s clinicians and general practitioners planning transition procedures together. (5) Young people adopted one of four broad interaction styles during transition: ‘laid back’, ‘anxious’, ‘wanting autonomy’ or ‘socially oriented’. Identifying a young person’s style would help personalise communication with them. (6) Three PBFs of transitional health care were significantly associated with better outcomes: ‘parental involvement, suiting parent and young person’, ‘promotion of a young person’s confidence in managing their health’ and ‘meeting the adult team before transfer’. (7) Maximal service uptake would be achieved by services encouraging appropriate parental involvement with young people to make decisions about their care. A service involving ‘appropriate parental involvement’ and ‘promotion of confidence in managing one’s health’ may offer good value for money.
Future work
How might the programme’s findings be implemented by commissioners and health-care providers? What are the most effective ways for primary health care to assist transition and support young people after transfer?
Study registration
This study is registered as UKCRN 12201, UKCRN 12980, UKCRN 12731 and UKCRN 15160.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Allan Colver
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Complex Neurodevelopmental Disorders Service, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gail Dovey-Pearce
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Complex Neurodevelopmental Disorders Service, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Janet E McDonagh
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Jennifer Hislop
- Health Economics Group, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kay D Mann
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah Merrick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark S Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Debbie Reape
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Luke Vale
- Health Economics Group, Newcastle University, Newcastle upon Tyne, UK
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Marko-Holguin M, Cordel SL, Van Voorhees BW, Fogel J, Sykes E, Fitzgibbon M, Glassgow AE. A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach. JMIR Mhealth Uhealth 2019; 7:e11833. [PMID: 31042152 PMCID: PMC6658312 DOI: 10.2196/11833] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/18/2019] [Accepted: 01/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. Objective The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. Methods We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. Results The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients’ ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. Conclusions Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff.
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Affiliation(s)
- Monika Marko-Holguin
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Stephanie Luz Cordel
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,All Voices Consulting, LLC, Phoenix, AZ, United States
| | | | - Joshua Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY, United States
| | - Emily Sykes
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Marian Fitzgibbon
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Anne Elizabeth Glassgow
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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"My Child May Be Ready, but I Am Not": Parents' Experiences of Their Children's Transition to Inclusive Fitness Settings. Adapt Phys Activ Q 2019; 36:282-301. [PMID: 30795688 DOI: 10.1123/apaq.2018-0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Parents play an essential role in the transition from separate physical activity programs to inclusive settings for their children. The purpose of this study was to explore experiences of parents as they anticipate and prepare for their children experiencing disability to transition, understand strategies used to address transition, and gain insights into the supports important to families during transition. Using an interpretative phenomenological analysis research approach, semistructured one-on-one interviews were conducted with 8 parents whose children were undergoing the transition from separate to inclusive community fitness contexts. Four themes described the experiences of parents as they anticipated, prepared for, and supported their child to transition: My child may be ready, but I am not; fear of outside judgment; playing by their rules; and reframing our thinking. Using Schlossberg's model, the tensions parents faced as they negotiated new roles, relationships, routines, and assumptions as they moved through the transition process were uncovered. The parents experienced transition alongside their children, providing insights for fitness and health-promotion professionals. Without preparation for transition, apprehensions and hesitancy may postpone or prevent their children's transition to community programs.
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Tesfaye R, Courchesne V, Yusuf A, Savion-Lemieux T, Singh I, Shikako-Thomas K, Mirenda P, Waddell C, Smith IM, Nicholas D, Szatmari P, Bennett T, Duku E, Georgiades S, Kerns C, Vaillancourt T, Zaidman-Zait A, Zwaigenbaum L, Elsabbagh M. Assuming ability of youth with autism: Synthesis of methods capturing the first-person perspectives of children and youth with disabilities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1882-1896. [PMID: 30915852 PMCID: PMC6779014 DOI: 10.1177/1362361319831487] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most research regarding youth with autism spectrum disorder has not focused on their first-person perspectives providing limited insight into methodologies best suited to eliciting their voices. We conducted a synthesis of methods previously used to obtain the first-person perspectives of youth with various disabilities, which may be applicable to youth with autism spectrum disorder. Two-hundred and eighty-four articles met the inclusion criteria of our scoping review. We identified six distinct primary methods (questionnaires, interviews, group discussion, narratives, diaries, and art) expressed through four communication output modalities (language, sign language and gestures, writing, and images). A group of parents who have children with autism spectrum disorder were then presented with a synthesis of results. This parent consultation was used to build on approaches identified in the literature. Parents identified barriers that may be encountered during participant engagement and provided insights on how best to conduct first-person research with youth with autism spectrum disorder. Based on our findings, we present a novel methodological framework to capture the perspectives of youth with various communication and cognitive abilities, while highlighting family, youth, and expert contributions.
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Nguyen T, Palisano RJ, Graham I. Perspectives and Experiences with Engaging Youth and Families in Research. Phys Occup Ther Pediatr 2019; 39:310-323. [PMID: 30216094 DOI: 10.1080/01942638.2018.1496966] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Engaging youth with disabilities and families in research is critical in facilitating knowledge utilization to impact processes and outcomes of services and interventions. Organizations such as INVOLVE in the United Kingdom, the Canadian Institutes of Health Research and the Patient-Centered Outcomes Research Institute in the United States advocate for engaging stakeholders in all aspects of the research process. Despite these efforts, there is a need for research to identify best practices and approaches for stakeholder engagement in research as current descriptions around processes are lacking. In this perspective paper, we share our insights and experiences with engaging youth with disabilities and families as members of the research team. We offer considerations and strategies for stakeholder engagement, as well as identify relevant frameworks to facilitate stakeholder engagement in research. We encourage researchers to share and document their experiences with stakeholder engagement in research to provide guidance for others with shared interests. We hope this paper will initiate conversations among researchers about best practices to maximize the full potential of stakeholders' time and input.
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Affiliation(s)
- Tram Nguyen
- a School of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada.,b CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Ontario , Canada.,c School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Robert J Palisano
- b CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Ontario , Canada.,d Department of Physical Therapy and Rehabilitation Sciences , Drexel University , Philadelphia , Pennsylvania , USA
| | - Ian Graham
- a School of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada.,e Clinical Epidemiology Program , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
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Singh N, McDonald PJ. Transitioning in hydrocephalus: Current practices in Canadian Paediatric Neurosurgery centres. Paediatr Child Health 2018; 23:e150-e155. [PMID: 30374224 DOI: 10.1093/pch/pxy016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Advances in perinatal care in the developed world have resulted in more children living into adulthood with complex chronic health conditions. Transition is a process to improve and maximize the functional status of adolescents via the provision of adequate and appropriate health services in adulthood. This process is frequently disjointed, fragmented and inconsistent and inadequate transition increases morbidity, hospital admissions and urgent interventions. Ten thousand children are diagnosed with hydrocephalus annually in North America. Most survive to adulthood yet there are few transitioning programs and little research data on successful programs for this population. Methods An email survey of paediatric neurosurgical centres in Canada was carried out to establish current transition practices and attitudes for adolescents with hydrocephalus. Data were analyzed descriptively. Results Eleven out of 12 centres responded. The age of transition ranged from 16 to 18 years. Four centres have access to a dedicated Adult Hydrocephalus Clinic. Referral practices vary between centres and we highlight inconsistencies in care to this cohort of patients in Canada. There is little satisfaction among neurosurgeons with current transition arrangements in Canada. Several suggestions were made on how to improve this process. Conclusion We recommend research into the needs of patients with hydrocephalus in order to formalize appropriate standards for transitioning patients with a view to developing national guidelines to standardize the transition process. This will require input from patients, families and the wider medical and allied health professional groups.
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Affiliation(s)
- Navneet Singh
- Division of Neurosurgery, BC Children's Hospital, Vancouver, British Columbia
| | - Patrick J McDonald
- Division of Neurosurgery, BC Children's Hospital, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia.,Department of Surgery, University of British Columbia, Vancouver, British Columbia.,National Core for Neuroethics, University of British Columbia, Vancouver, British Columbia
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Colver A, McConachie H, Le Couteur A, Dovey-Pearce G, Mann KD, McDonagh JE, Pearce MS, Vale L, Merrick H, Parr JR. A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions. BMC Med 2018; 16:111. [PMID: 30032726 PMCID: PMC6055340 DOI: 10.1186/s12916-018-1102-y] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/18/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Most evidence about what works in transitional care comes from small studies in single clinical specialties. We tested the hypothesis that exposures to nine recommended features of transitional healthcare were associated with better outcomes for young people with long-term conditions during transition from child-centred to adult-oriented health services. METHODS This is a longitudinal, observational cohort study in UK secondary care including 374 young people, aged 14-18.9 years at recruitment, with type 1 diabetes (n = 150), cerebral palsy (n = 106) or autism spectrum disorder with an associated mental health problem (n = 118). All were pre-transfer and without significant learning disability. We approached all young people attending five paediatric diabetes centres, all young people with autism spectrum disorder attending four mental health centres, and randomly selected young people from two population-based cerebral palsy registers. Participants received four home research visits, 1 year apart and 274 participants (73%) completed follow-up. Outcome measures were Warwick Edinburgh Mental Wellbeing Scale, Mind the Gap Scale (satisfaction with services), Rotterdam Transition Profile (Participation) and Autonomy in Appointments. RESULTS Exposure to recommended features was 61% for 'coordinated team', 53% for 'age-banded clinic', 48% for 'holistic life-skills training', 42% for 'promotion of health self-efficacy', 40% for 'meeting the adult team before transfer', 34% for 'appropriate parent involvement' and less than 30% for 'written transition plan', 'key worker' and 'transition manager for clinical team'. Three features were strongly associated with improved outcomes. (1) 'Appropriate parent involvement', example association with Wellbeing (b = 4.5, 95% CI 2.0-7.0, p = 0.001); (2) 'Promotion of health self-efficacy', example association with Satisfaction with Services (b = - 0.5, 95% CI - 0.9 to - 0.2, p = 0.006); (3) 'Meeting the adult team before transfer', example associations with Participation (arranging services and aids) (odds ratio 5.2, 95% CI 2.1-12.8, p < 0.001) and with Autonomy in Appointments (average 1.7 points higher, 95% CI 0.8-2.6, p < 0.001). There was slightly less recruitment of participants from areas with greater socioeconomic deprivation, though not with respect to family composition. CONCLUSIONS Three features of transitional care were associated with improved outcomes. Results are likely to be generalisable because participants had three very different conditions, attending services at many UK sites. Results are relevant for clinicians as well as for commissioners and managers of health services. The challenge of introducing these three features across child and adult healthcare services, and the effects of doing so, should be assessed.
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Affiliation(s)
- A Colver
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. .,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK.
| | - H McConachie
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - A Le Couteur
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Newcastle upon Tyne, NE3 3XT, UK
| | - G Dovey-Pearce
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - K D Mann
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - J E McDonagh
- Centre for Musculoskeletal Research and Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Rd, Manchester, M13 9PT, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, UK
| | - M S Pearce
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - L Vale
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - H Merrick
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - J R Parr
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Newcastle upon Tyne, NE3 3XT, UK.,Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.,Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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Higginson A, Forgeron P, Dick B, Harrison D. Moving on: A survey of Canadian nurses’ self-reported transition practices for young people with chronic pain. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2018; 2:169-181. [PMID: 35005377 PMCID: PMC8730587 DOI: 10.1080/24740527.2018.1484663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Practices to support the transition of a young person from the pediatric to the adult health care setting have been examined for many chronic illness populations. However, specific transition practices to support young people with chronic pain have not been examined. Aim The aim of this study was to describe the current nursing practices used in the pediatric and the adult health care to support transition of young people with chronic pain in Canada. Methods An online survey of pediatric and adult chronic pain nurses’ self-reported transition practices was conducted. Results Twenty-two nurses completed the survey, 10 (45.5%) from the pediatric chronic pain setting and 12 (54.4%) from the adult chronic pain setting. Of the pediatric nurses surveyed none reported using a psychometrically valid tool to assess a young person’s readiness of general transition skills; however, one reported using a tool to assess understanding of chronic pain. Most health care facilities in which these pediatric nurses worked offered a general transition clinic, but only one of these facilities also had a chronic pain transition clinic. Nurses in both settings perceived that young people experience increased levels of distress during transition yet most did not report using formal transition practices in their care. Conclusion Nursing practices and clinic resources to support the transition of young people with chronic pain may not meet the needs of this population. Practices may benefit from the use of psychometrically validated tools to assess general transition preparedness. Research is needed to adapt tools and determine best transition practices for the chronic pain population.
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Affiliation(s)
- Andrea Higginson
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Forgeron
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Health Sciences, School of Nursing, Dalhousie University , Halifax, Canada
| | - Bruce Dick
- Departments of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta , Edmonton, Canada
- Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta , Edmonton, Canada
| | - Denise Harrison
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Nursing Care of Children, Youth and Families, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
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38
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Wells F, Manning J. Transition of care from children's to adult services. Nurs Child Young People 2018; 29:30-34. [PMID: 29115770 DOI: 10.7748/ncyp.2017.e897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 11/09/2022]
Abstract
Transition service development is high on the agenda in contemporary healthcare improvement and there is a wealth of literature focusing on the shortcomings of many existing transition services. This literature review aims at identify and summarise research on the issues and needs surrounding transitional care from children's to adult services, and to explore, critique and evaluate the effectiveness of interventions, processes and systems relating to supporting transitions for young people between children's and adult services. Many studies focus on the transition of young people from children's to adult services. Some areas of transitional care have been researched thoroughly, including the self-reported experiences of young people. A large number of studies have explored specific interventions aimed at young people and healthcare systems. A single approach or intervention to support transition appears to be neither beneficial for all young people, nor appropriate for all services. The effect of specific interventions is largely inconclusive.
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Affiliation(s)
- Francesca Wells
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, England
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39
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Zoni S, Verga ME, Hauschild M, Aquarone-Vaucher MP, Gyuriga T, Ramelet AS, Dwyer AA. Patient Perspectives on Nurse-led Consultations Within a Pilot Structured Transition Program for Young Adults Moving From an Academic Tertiary Setting to Community-based Type 1 Diabetes Care. J Pediatr Nurs 2018; 38:99-105. [PMID: 29357987 DOI: 10.1016/j.pedn.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices. DESIGN AND METHODS A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction - short scale). HbA1c values were compared to guideline recommendations. RESULTS Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5±0.5) while patients reported the lowest adherence to diet recommendations (2.9±0.8). Overall satisfaction with nurse-led consultations was high (4±0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations. CONCLUSIONS Young adults found the nurse-led consultations with therapeutic education to develop T1DM self-care skills are an important complement to medical management during transition. PRACTICE IMPLICATIONS Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management.
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Affiliation(s)
- Sandra Zoni
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland
| | - Marie-Elise Verga
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Haute école de santé Fribourg, Fribourg Switzerland
| | - Michael Hauschild
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Marie-Paule Aquarone-Vaucher
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Teresa Gyuriga
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Department of Maternal and Child Health, Lausanne, Switzerland
| | - Andrew A Dwyer
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Endocrinology, Diabetes and Metabolism Service, Lausanne, Switzerland.
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McNeilly P, Macdonald G, Kelly B. The participation of parents of disabled children and young people in health and social care decisions. Child Care Health Dev 2017; 43:839-846. [PMID: 28795422 DOI: 10.1111/cch.12487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 06/08/2017] [Accepted: 06/21/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is widespread acceptance that parents should be fully involved in decisions about their son or daughter's health and social care. This is reflected in partnership models of practice as well as local and national policy across the United Kingdom. Previous research indicates that parents' experiences of decision making with professionals are mixed. AIM The research reported here aimed to explore parents' experiences of participating in decisions made with professionals about their disabled son or daughter's care. DESIGN This research used mixed methods including survey methodology and qualitative in depth interviews. SETTING AND PARTICIPANTS The research was conducted in one Trust in Northern Ireland. Participants were 77 parents of children and young people with a range of impairments aged between 3 and 28 years. RESULTS Three themes emerged from the data: taking the lead, not knowing, and getting the balance right. Parents wanted to be involved in all aspects of decision making. Although parents reported many examples of good practice, there were also times when they did not feel listened to or did not have enough information to inform decisions. DISCUSSION AND CONCLUSION Parents in this research recounted positive as well as negative experiences. Parents took on a protective role when decisions were made about their son or daughter and at times, reported the need to "fight" for their child. The provision of information remains problematic for these families, and at times, this created a barrier to parents' participation in decision making. Partnership approaches to care that recognize parents' expertise are particularly important to parents when decisions are made with professionals.
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Affiliation(s)
- P McNeilly
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - G Macdonald
- School for Policy Studies, University of Bristol, Bristol, UK
| | - B Kelly
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
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Culen C, Ertl DA, Schubert K, Bartha-Doering L, Haeusler G. Care of girls and women with Turner syndrome: beyond growth and hormones. Endocr Connect 2017; 6:R39-R51. [PMID: 28336768 PMCID: PMC5434744 DOI: 10.1530/ec-17-0036] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 01/10/2023]
Abstract
Turner syndrome (TS), although considered a rare disease, is the most common sex chromosome abnormality in women, with an incident of 1 in 2500 female births. TS is characterized by distinctive physical features such as short stature, ovarian dysgenesis, an increased risk for heart and renal defects as well as a specific cognitive and psychosocial phenotype. Given the complexity of the condition, patients face manifold difficulties which increase over the lifespan. Furthermore, failures during the transitional phase to adult care result in moderate health outcomes and decreased quality of life. Guidelines on the optimal screening procedures and medical treatment are easy to find. However, recommendations for the treatment of the incriminating psychosocial aspects in TS are scarce. In this work, we first reviewed the literature on the cognitive and psychosocial development of girls with TS compared with normal development, from disclosure to young adulthood, and then introduce a psychosocial approach to counseling and treating patients with TS, including recommendations for age-appropriate psychological diagnostics. With this work, we aim to facilitate the integration of emphasized psychosocial care in state-of-the-art treatment for girls and women with TS.
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Affiliation(s)
- Caroline Culen
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Diana-Alexandra Ertl
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Katharina Schubert
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Lisa Bartha-Doering
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Gabriele Haeusler
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
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Abstract
Adolescence can be a particularly challenging period for individuals with a chronic health condition or disability. We present a new mnemonic, THRxEADS (T for Transition, H for Home, Rx for Medication and Treatment, E for Education and Eating, A for Activities and Affect, D for Drugs and S for Sexuality), which can be used as a complement to the adolescent HEADS (Home-Education-Activities-Drugs-Sexuality) assessment. THRxEADS may serve as a clinical tool to explore key issues that are often not covered in subspecialty clinic visits such as transition, coping, adherence and understanding of illness, as they apply to youth with special health care needs. THRxEADS may be used as a vehicle to highlight successes and to promote resilience. It may also be used as an educational tool with medical trainees to allow a deeper understanding of the realities of adolescents with chronic health care needs. A short list of sample chronic illness and disability-specific questions is provided.
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Transitioning from pediatric to adult care after thoracic transplantation. J Heart Lung Transplant 2017; 36:823-829. [PMID: 28342709 DOI: 10.1016/j.healun.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/24/2017] [Accepted: 02/24/2017] [Indexed: 11/23/2022] Open
Abstract
With improving outcomes after thoracic transplantation, more children are surviving to adulthood and requiring specialized adult care. A systematic and effective program is essential to transition these patients from a pediatric to adult health care setting. In this review, we discuss the concept of transition and the factors leading to an effective transfer to an adult care provider, including administrative support, patient/provider preparation, and the navigation of potential barriers. Notably, there is a paucity of data for many details of transition, making this a significant opportunity for future research.
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Samyn M. Parents and carers of young people with liver transplantation: Lost in transition? Pediatr Transplant 2017; 21. [PMID: 27981692 DOI: 10.1111/petr.12855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Marianne Samyn
- Pediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
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Nguyen T, Henderson D, Stewart D, Hlyva O, Punthakee Z, Gorter JW. You never transition alone! Exploring the experiences of youth with chronic health conditions, parents and healthcare providers on self-management. Child Care Health Dev 2016; 42:464-72. [PMID: 27103590 PMCID: PMC5021141 DOI: 10.1111/cch.12334] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/21/2016] [Accepted: 02/04/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent evidence suggests that fostering strategies to enable youth with chronic health conditions to work towards gradual self-management of their health is key in successful transition to adult healthcare. To date, there is limited research on self-management promotion for youth. The purpose of this study is to explore self-management from the perspectives of youth, parents and healthcare providers in transition to adult healthcare. METHODS Part of a larger longitudinal transition (TRACE-2009-2013) study, interpretive phenomenology was used to explore the meaning of the lived experiences and perceptions of youth, parents, and healthcare providers about transition to adult healthcare. Purposeful sampling was utilized to select youth with a range of chronic health conditions from the TRACE cohort (spanning 20 diagnoses including developmental disabilities and chronic conditions), their parents and healthcare providers. RESULTS The emerging three themes were: increasing independence of youth; parents as safety nets and healthcare providers as enablers and collaborators. The findings indicate that the experiences of transitioning youth, parents and service providers are interconnected and interdependent. CONCLUSIONS Results support a dynamic and developmentally appropriate approach when working with transitioning youth and parents in practice. As youth depend on parents and healthcare providers for support in taking charge of their own health, parents and healthcare providers must work together to enable youth for self-management. At a policy level, adequate funding, institutional support and accreditation incentives are recommended to allow for designated time for healthcare providers to foster self-management skills in transitioning youth and parents.
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Affiliation(s)
- T Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | | | - D Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - O Hlyva
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Z Punthakee
- Department of Pediatrics, McMaster University, Hamilton, Canada
- School of Medicine, McMaster University, Hamilton, Canada
| | - J W Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
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