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Vermé A, Wenemark M, Jungner JG, Broström E, Bartholdson C. Ready to leave? - Adolescents' and parents' perceptions of transition from paediatric to adult rheumatology care. BMC Health Serv Res 2024; 24:795. [PMID: 38987769 PMCID: PMC11234774 DOI: 10.1186/s12913-024-11265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND In Sweden, approximately 2000 children live with Juvenile Idiopathic Arthritis (JIA). About half of them continue to have an active disease and need to transfer to adult rheumatology care. This study aimed to investigate Swedish adolescents' and parents´ perceptions of readiness for transition from pediatric to adult rheumatology care. METHODS The study was a cross-sectional quantitative study. Patients at the pediatric rheumatology clinic at a university hospital in Sweden and members of The Swedish National Organization for Young Rheumatics aged 14-18 and their parents were invited to participate in the study. Data was collected with the Readiness for Transition Questionnaire (RTQ) focusing on adolescents' transition readiness, adolescents' healthcare behaviors and responsibility, and parental involvement. Data were analyzed with descriptive statistics. Comparative analyses were made using non-parametric tests with significance levels of 0.05 as well as factor analyses and logistic regression. RESULTS There were 106 adolescents (85 girls, 20 boys) and 96 parents answering the RTQ. The analysis revealed that many adolescents and parents experienced that the adolescents were ill-prepared to take over responsibility for several healthcare behaviors, such as booking specialty care appointments, calling to renew prescriptions and communicating with medical staff on phone and to transfer to adult care. Parents and adolescents alike stated that it was especially difficult for the adolescents to take responsibility for healthcare behaviors meaning that the adolescents had to have direct interaction with the healthcare professionals (HCPs) at the paediatric rheumatology clinic, for example to renew prescriptions. It was evident that the adolescents who perceived they were ready to take responsibility for the aspects related to direct interaction with HCPs were more overall ready to be transferred to adult care. CONCLUSION Adolescents need more support to feel prepared to transfer to adult care. With the results from this study, we can develop, customize, and optimize transitional care programs in Sweden for adolescents.
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Affiliation(s)
- A Vermé
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37A, 7 Floor, 171 76, Stockholm, Sweden.
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Marika Wenemark
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37A, 7 Floor, 171 76, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Unit for Public Health and Statistics, East Region, Linköping, Sweden
| | - J Granhagen Jungner
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37A, 7 Floor, 171 76, Stockholm, Sweden
| | - E Broström
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37A, 7 Floor, 171 76, Stockholm, Sweden
| | - C Bartholdson
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37A, 7 Floor, 171 76, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Kang N, Lee S. Psychological separation, health locus of control, and transition readiness in adolescents and young adults with type I diabetes. J Pediatr Nurs 2024; 76:38-44. [PMID: 38359543 DOI: 10.1016/j.pedn.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The purpose of this study was to examine the effects of psychological separation and health locus of control on the health care transition readiness of adolescents and young adults (AYAs) with type 1 diabetes. METHODS Data were collected between December 2020 and October 2021. One hundred twelve AYAs with type 1 diabetes treated at a tertiary hospital and under follow-up observation as well as AYAs with type 1 diabetes nationwide who were part of the type 1 diabetes internet community were enrolled. The Psychological Separation Inventory, the Multidimensional Health Locus of Control scale from C, and the Self-management and Transition to Adulthood with Therapeutics = Rx Questionnaire were used. RESULTS Multiple regression analysis indicated that age (β = 0.302, p = .001), hemoglobin A1c (HbA1c) (β = -0.174, p = .040), conflictual separation (β = 0.242, p = .005), functional separation (β = 0.200, p = .045) and attitudinal separation (β = -0.240 p = .015) were significantly associated with health management transition readiness; these predictors explained 27.6% of health care transition readiness (F = 8.062, p = .000). CONCLUSIONS AYAs with type 1 diabetes can enhance readiness for health care transition by fostering psychological separation from parents, effectively managing blood glucose levels, and taking into account age-related factors during the preparation process. At this point, it is essential for healthcare professionals to guide parents in recognizing adolescents' psychological independence and facilitating their supportive role through the process of redefining their roles. PRACTICE IMPLICATIONS Health care providers should promote psychological separation in AYAs. Additionally, taking into account the developmental characteristics of adolescence can facilitate a successful health care transition.
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Affiliation(s)
- Nuri Kang
- Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
| | - Sunhee Lee
- College of Nursing, the Catholic University of Korea, Seoul, Republic of Korea.
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3
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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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Allen CC, Swanson BL, Zhang X, Coller RJ, Olson KR. Quality Improvement Identifies Healthcare Transition Disparities in Adolescents with Congenital Heart Disease and Disabilities. Pediatr Qual Saf 2024; 9:e732. [PMID: 38807581 PMCID: PMC11132416 DOI: 10.1097/pq9.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/28/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction We aim to implement healthcare transition (HCT) education for youth with congenital heart disease (CHD) and assess HCT preparedness for cardiac self-care. Methods An HCT clinic was implemented at an academic pediatric cardiology clinic for CHD youth 17 years of age and older. An educator used transition readiness assessment questionnaires and discussed HCT material. The percentage of eligible youth who received HCT education and the cause for missed occurrences were tracked. Plan-do-study-act cycles began in August 2020 to improve the number of youths reached. Secondary analyses assessed improvement differences among those without cardiac procedures or disabilities. Results HCT education provision improved from a mean of 38% to 73% in the 17-year and older age group by December 2022. Communication failure was the leading cause of missed visits in 2021 (30%), reduced to 0 by 2022 following plan-do-study-act cycles. Other missed HCT visits included clinic add-ons after screening, limited staff availability, and unidentified eligibility. Readiness assessments were similar for youth with and without prior cardiac procedures, for example, confidence in taking charge of their health care (P = 0.47) and moving to adult care (P = 0.22). Adolescents with disabilities were significantly less confident than those without disabilities in taking charge of their heart health care (6.3 versus 7.5, P = 0.04) and moving to adult care (4.9 versus 7.4, P < 0.001). Conclusions Implementation of a CHD HCT clinic improved successful education delivery. Provider engagement and clinic staffing are important for sustainability. HCT knowledge gaps exist for all adolescents, yet those with disabilities had the greatest deficits.
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Affiliation(s)
- Catherine C. Allen
- From the Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Briana L. Swanson
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Xiao Zhang
- From the Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Ryan J. Coller
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Krisjon R. Olson
- From the Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
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Mooney-Doyle K, Ventura Castellon E, Lindley LC. Factors Associated With Transitions to Adult Care Among Adolescents and Young Adults With Medical Complexity. Am J Hosp Palliat Care 2024; 41:245-252. [PMID: 37199720 DOI: 10.1177/10499091231177053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
Introduction: Thanks to advances in healthcare and technology, adolescents with medical complexity (AMC) and life-threatening conditions are living longer lives and may be expected to transition to adult health care. Yet, current systems and policies of transition care may not reflect their needs, those of their family, or the impact of social determinants of health. The goal of this study was to describe the relationship between social determinants of health and high-quality transition care. Methods: Retrospective cohort study of the 2019-2020 National Survey of Children's Health. The main outcome variable was any support for transition to adult health care. Independent variables were based on a social determinants of health framework. Weighted logistic regression was used to evaluate the association between social determinants and any support for transition to adult health care. Results: Final weighted sample included 444,915 AMC. AMC were distributed across income levels, most commonly lived in the South, and in supportive, resilient communities. More than 50% experienced adverse childhood events and less than 50% had adequate insurance. Less than one third received any transition support from providers; those who did reported time alone with the provider or active management. Social determinants related to missed days of school, community support/family context, and poverty were associated with both receipt and absence of transition care. Conclusion: AMC and their families navigate complex environments and associated stressors. Social determinants of health, particularly economic, community/social, and healthcare exert significant and nuanced influence. Such impacts should be incorporated into transition care.
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Affiliation(s)
| | | | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN, USA
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Tyagi A, Sontakke T. The Transition of Children Living With Congenital Heart Disease to Adult Care. Cureus 2023; 15:e50179. [PMID: 38186454 PMCID: PMC10771806 DOI: 10.7759/cureus.50179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
The article explores the significance of the timely transition of a child living with congenital heart disease (CHD) to adult care and the role played by multidisciplinary care. Due to recent healthcare advances, more children with CHD survive to adulthood without surgical intervention. This survival is mainly due to the lesion being compatible with life and its management being done medically. However, further management requires meeting the child's needs and helping him transition to become a healthy, independent adult with almost equal life expectancy as his counterparts. The article reviews the comprehensive framework of transition through multidisciplinary care. Highlighting the necessity of training physicians to acquire expertise in the management of CHD is a foundational aspect of this review article. Introduction to transition requires assessment of the child's needs through all phases of life and informative counseling of both parents and child. It highlights the approach to educating patients and families with the knowledge to safeguard compliance. Multidisciplinary collaboration from various fields such as cardiology, pediatric physiatrist, nursing, and psychology has been stressed. Patients also need to cultivate skills in self-management and independence and be educated to comprehend their condition, including the potential health issues. This collaborative and multidisciplinary process necessitates the cooperation of patients, families, and the adult congenital heart disease (ACHD) team. Emphasis has been given to individualized counseling for girls to address their sexual health. The article also highlights the possible obstacles and how to tackle them to improve healthcare adherence. Timely transition and follow-up can be measured using various tools or through indices measuring the quality of life and average life expectancy. The global patterns of transition to ACHD care have also been emphasized, as well as the need for research studies to develop reliable indicators for assessing transition success.
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Affiliation(s)
- Ashu Tyagi
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tushar Sontakke
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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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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Grosch IB, Andresen B, Diep LM, Diseth TH, Möller T. Quality of life and emotional vulnerability in a national cohort of adolescents living with Fontan circulation. Cardiol Young 2022; 32:874-882. [PMID: 34387177 DOI: 10.1017/s1047951121003188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION To investigate quality of life and mental health after Fontan completion, we aimed to characterise outcomes in a representative group of adolescent patients. The study was part of the pre-transition clinical work-up in adolescents with Fontan-type palliation of univentricular CHD. The programme covers the entire paediatric Fontan patient population in Norway. METHODS Our cross-sectional study included 42 adolescents with Fontan circulation aged 15-18. We recruited a control group of 29 healthy peers. Quality of life was measured by the Pediatric Quality of Life Inventory Questionnaire, while mental health was assessed with the Strength and Difficulties Questionnaire. RESULTS Fontan patients scored lower than healthy controls on the Pediatric Quality of Life Inventory total (p = 0.004), the physical (p < 0.001) and social (p = 0.001) functioning subscale, and the Strength and Difficulties Questionnaire subscale of emotional symptoms (p = 0.035). Compared to two of the healthy teens (7%), seven patients (16%) in the Fontan group scored as having impaired mental health (p = 0.224). The female/male ratio for individuals with impaired health was 7:2 (p = 0.003). CONCLUSIONS Compared to healthy controls, adolescents after Fontan-type palliation in Norway have good health-related quality of life and mental health, despite having slightly lower score than healthy individuals, mainly in physical domains and school functioning. Compared to healthy controls and healthy teenagers, these adolescents have somewhat more emotional problems, and compared to male patients, female patients more often have impaired mental health.
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Affiliation(s)
| | - Brith Andresen
- Department of Thoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lien My Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo, Norway
| | - Trond H Diseth
- Department of Child and Adolescent Mental Health in Hospitals, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Möller
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
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Patel N, Klamer B, Davis S, Nahata L. Patient-parent perceptions of transition readiness in Turner syndrome and associated factors. Clin Endocrinol (Oxf) 2022; 96:155-164. [PMID: 34553783 DOI: 10.1111/cen.14584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/07/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Medical care transition to adult care presents challenges for individuals with complex medical conditions such as Turner syndrome (TS). The goals of this study were to: (1) identify factors associated with transition readiness; (2) examine associations and differences between patients' and parents' perceptions of readiness using Transition Readiness Assessment Questionnaire (TRAQ). METHODS In a prospective cross-sectional study, girls with TS 12-25 years and one parent were recruited from 11/2019 to 12/2020. Three questionnaires were administered (demographic/clinical questionnaire, TRAQ, and TS Transition Readiness Assessment Questionnaire [TS-TRAQ]). Medical records were reviewed for karyotype and personal medical history. Descriptive statistics, Spearman's correlation, paired sample t tests, and linear regression were used to examine readiness and associated factors. RESULTS Of 44 eligible patients, 35 patients and 30 parents completed the study. Patient age, education, and life skills were associated with a higher TRAQ score (p < .001). Greater TS knowledge was associated with higher readiness (p < .05). Readiness score for patient and parental perception of patient's readiness were correlated (r = .83; p < .01). Within patient-parent dyads, patients had higher readiness (p < .01). TRAQ and TS-TRAQ scores were correlated (r = .69; p < .01). CONCLUSIONS Increasing patient age, patient education, life skills, confidence, and higher social/emotional scores were associated with a higher total TRAQ. Patient and parent perceived readiness were correlated and scores within dyads were different. Patients had higher perceived readiness. Positive correlations between TRAQ and TS-TRAQ suggest this tool may be a useful resource. Given the unique neurocognitive profile and social/emotional challenges among girls with TS, future research should include both patients and parents, and focus on validating TS-specific transition readiness tools.
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Affiliation(s)
- Nisha Patel
- Department of Pediatrics, Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Brett Klamer
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, Ohio, USA
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinary Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Leena Nahata
- Department of Pediatrics, Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, Ohio, USA
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Zimmerman C, Garland BH, Enzler CJ, Hergenroeder AC, Wiemann CM. The roles of quality of life and family and peer support in feelings about transition to adult care in adolescents with gastroenterology, renal, and rheumatology diseases. J Pediatr Nurs 2022; 62:193-199. [PMID: 34116868 DOI: 10.1016/j.pedn.2021.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Transition to adult healthcare is a critical time in the lives of adolescents with chronic medical conditions, with clear impacts on health outcomes. Little is known about factors that impact feelings about healthcare transition, including HRQOL, family and peer support, and utilization of a framework such as the SMART Model can guide exploration of these factors. The goal of this study is to examine how HRQOL (i.e., functional impact of disease) and family and peer support may impact adolescents' feelings about healthcare transition. DESIGN AND METHODS 135 adolescents (17-23 years) with chronic gastroenterology, renal, or rheumatology disease completed four questionnaires as part of a larger study examining health, relationships, and healthcare transition. Questions assessed current HRQOL (i.e., number of days health was "not good"), peer and family support, and feelings about transition. Data were analyzed using SPSSv25 and linear regressions were performed. RESULTS Lower HRQOL (β = 0.283, p < .01) and less peer support (β = -0.198, p < .05) were associated with worse feelings about transition (R2 = 0.203, p < .001). Family support was significantly correlated at the bivariate level. There were no differences by type of disease, race/ethnicity, or gender that impacted study findings. CONCLUSION(S) Results are concerning as healthcare transition is a milestone for every patient. Lower HRQOL (i.e., greater functional impact of disease) and less peer support were associated with worse feelings about transition. PRACTICE IMPLICATIONS This study highlights potential targets for intervention such as improving HRQOL (e.g., acceptance and commitment therapy) and increasing peer support (e.g., social skills training, family facilitation) to improve transition to adult care for pediatric patients with chronic diseases.
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Affiliation(s)
- CortneyT Zimmerman
- Section of Psychology and Renal Service, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin, Houston, TX 77030, USA.
| | - Beth H Garland
- Sections of Adolescent Medicine & Sports Medicine and Pediatric Psychology, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
| | - Cassandra J Enzler
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
| | - Albert C Hergenroeder
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
| | - Constance M Wiemann
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin, Suite 1710, Houston, TX 77030, USA.
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Differences in perceptions of transition readiness between parents and teens with congenital heart disease: do parents and teens agree? Cardiol Young 2021; 31:957-964. [PMID: 33423711 DOI: 10.1017/s1047951120004813] [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: 01/30/2023]
Abstract
BACKGROUND Amongst patients with CHD, the time of transition to adulthood is associated with lapses in care leading to significant morbidity. The purpose of this study was to identify differences in perceptions between parents and teens in regard to transition readiness. METHODS Responses were collected from 175 teen-parent pairs via the validated CHD Transition Readiness survey and an information request checklist. The survey was distributed via an electronic tablet at a routine clinic visit. RESULTS Parents reported a perceived knowledge gap of 29.2% (the percentage of survey items in which a parent believes their teen does not know), compared to teens self-reporting an average of 25.9% of survey items in which they feel deficient (p = 0.01). Agreement was lowest for long-term medical needs, physical activities allowed, insurance, and education. In regard to self-management behaviours, agreement between parent and teen was slight to moderate (weighted κ statistic = 0.18 to 0.51). For self-efficacy, agreement ranged from slight to fair (weighted κ = 0.16 to 0.28). Teens were more likely to request information than their parents (79% versus 65% requesting at least one item) particularly in regard to pregnancy/contraception and insurance. CONCLUSION Parents and teens differ in several key perceptions regarding knowledge, behaviours, and feelings related to the management of heart disease. Specifically, parents perceive a higher knowledge deficit, teens perceive higher self-efficacy, and parents and teens agree that self-management is low.
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Thomet C, Schwerzmann M, Budts W, De Backer J, Chessa M, Diller G, Eicken A, Gabriel H, Gallego P, Giamberti A, Roos-Hesselink J, Swan L, Webb G, Moons P. Transfer and transition practices in 96 European adult congenital heart disease centres. Int J Cardiol 2020; 328:89-95. [PMID: 33276020 DOI: 10.1016/j.ijcard.2020.11.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Irrespective of initial treatment for congenital heart disease (CHD) in childhood, CHD is a lifelong condition, leaving patients at risk for complications. To support uninterrupted, age- and development-based care for young persons with CHD, guidelines and consensus papers emphasise the need for formal transition programmes, including transfer to adult CHD (ACHD) clinics. Here, we surveyed existing transfer and transition programmes in European ACHD centres. Our aims were to provide a contemporary view of transitional care for patients with CHD and to evaluate progress over the last decade. METHODS We conducted a descriptive, cross-sectional survey in 96 ACHD centres in Europe. A specific survey form was developed that sampled the practices of transfer and/or transition. We used a transfer-transition index to quantify adherence to quality indicators of successful transfer and transition. RESULTS Of the 96 ACHD centres, 40 (41.7%) offered a formal transition, and 85 (88.5%) had structured transfer from paediatric to ACHD care. Although 31% of the centres performed at a 'good' level on the transfer-transition index, only 4 (4.2%) satisfied all criteria. Most centres with a transition programme offered education and support through a dedicated transition specialist, who was a master's-prepared nurse in most centres. A minority of the ACHD centres offered a flexible transition process, starting at least two years before transfer. CONCLUSIONS Nearly half of the included ACHD centres offered a formal transition programme, and almost 90% offered structured transfer. Despite some improvements since 2009, most of the programmes lacked an age- and development-based approach.
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Affiliation(s)
- Corina Thomet
- Center of Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium.
| | - Markus Schwerzmann
- Center of Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Julie De Backer
- Department of Cardiology, Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milano, Italy
| | - Gerhard Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Andreas Eicken
- Division of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany
| | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Alessandro Giamberti
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milano, Italy
| | | | - Lorna Swan
- Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Canada
| | - Gary Webb
- Cincinnati Children's Hospital Heart Institute, Cincinnati, OH, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Moons P, Prikken S, Luyckx K. Chronic illness as a ‘family disease’: The need for appropriate scientific methods for dyadic research. Eur J Cardiovasc Nurs 2020; 19:98-99. [DOI: 10.1177/1474515120902376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Sofie Prikken
- School Psychology and Development in Context, KU Leuven, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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