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Abildgaard Hansen O, Clemensen J, Beier CP, Pors Klinting G, Smith AC, Kaas Larsen M. Being an adolescent with epilepsy during the transition from pediatric to adult hospital care: A qualitative descriptive study. Epilepsy Behav 2024; 155:109780. [PMID: 38640727 DOI: 10.1016/j.yebeh.2024.109780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The transition from pediatric to adult care is challenging for adolescent patients despite numerous recommendations in recent decades. However, the perspective of the patients is sparsely investigated. AIM To explore the experiences and needs of adolescents with epilepsy (AWE) during the transition from pediatric to adult hospital care. METHODS We conducted 15 semi-structured interviews with AWEs aged 13-20 years and 10 h of field observations of consultations. Interviews were audio-recorded, transcribed, anonymized, and entered into NVivo (version 12, QSR International) with the transcribed field notes. Data were analyzed using systematic text condensation. RESULTS Three themes were identified: (1) Navigating epilepsy in everyday life; (2) The difficult balance between concealment and openness about epilepsy; and (3) Being seen as an individual and not an illness. AWEs' needs in transition are closely associated with their experiences and perceptions of illness, treatment, consultations, and seizures. Notably, AWEs reveal a significant concern about being overlooked beyond their medical condition in appointments. CONCLUSIONS This study highlights the vulnerability and challenges of AWEs transitioning to adult care. Overall, AWEs seek understanding, acceptance, and autonomy in managing their epilepsy and transitioning to adult care. Their experiences underscore the importance of holistic support and communication in healthcare settings. A concerted effort from healthcare professionals (HCP) is necessary to foster the recognition of AWEs as individuals with distinct personalities, needs, and capabilities.
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Affiliation(s)
- Ole Abildgaard Hansen
- Department of Neurology, Odense University Hospital, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Denmark.
| | - Jane Clemensen
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark; Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
| | | | - Anthony C Smith
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark; Centre for Online Health, The University of Queensland, Australia; Centre for Health Services Research, The University of Queensland, Australia
| | - Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
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2
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Ma J, Zhou S, Bai X, Lei J, Wang H. Transition readiness of adolescents with cancer: A cross-sectional study based on self-determination theory. Eur J Oncol Nurs 2024; 69:102521. [PMID: 38387132 DOI: 10.1016/j.ejon.2024.102521] [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: 12/11/2023] [Revised: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE This study aimed to assess the transition readiness of adolescents with cancer in central China and to explore the paths associated with transition readiness based on self-determination theory (SDT). METHODS Self-management and transition to adulthood with Rx = treatment questionnaire, patient activation measure, perceived social support scale and general self-efficacy scale were used to measure transition readiness as well as constructs pertaining to SDT (competence, relatedness and autonomy). The factors influencing transition readiness were evaluated using multiple linear regression. Models 4 and 6 in PROCESS Macro 3.3 were used to test the mediating effects and chain mediating effects, respectively. RESULTS A total of 217 adolescents with cancer were included; their mean transition readiness score was 59.95 (11.34). Age (t = 6.086, p < 0.000), duration of diagnosis (t = 2.218, p = 0.028), completion of treatment (t = -2.036, p = 0.043), insurance, and competence (t = 11.149, p < 0.000) were significantly associated with transition readiness. The direct effects of self-efficacy and perceived social support on transition readiness were not significant. However, two chain mediating paths were observed: perceived social support - self-efficacy - patient activation - transition readiness and self-efficacy - perceived social support - patient activation - transition readiness; the effect values of these paths were 0.0678 and 0.0703, respectively. CONCLUSIONS The findings of this study add to the evidence supporting the use of SDT-related constructs to promote transition readiness among adolescents with cancer, highlight the importance of encouraging patient activation, and clarify the ancillary roles of social support and self-efficacy in patient activation development during transitional period.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Siqi Zhou
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Jun Lei
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, China.
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3
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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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Wilson N, Whittaker K, Arnott J, Burke L, Beresford MW, Peak M. Stuck in transit: A qualitative study of the transitional care needs of young people with epilepsy and juvenile idiopathic arthritis. J Child Health Care 2023; 27:435-449. [PMID: 35235476 PMCID: PMC10472714 DOI: 10.1177/13674935221074777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transition services for young people with long-term conditions often fall short. This qualitative study explored perspectives on service features that enable effective transition in epilepsy and juvenile idiopathic arthritis. Patients, parents, clinicians and service commissioners took part in semi-structured interviews (n = 18). Thematic analysis was used to identify key features, barriers and facilitators of effective transition across participant groups. Analysis led to the development of nine sub-themes which mapped to overarching domains of communication, capability, continuity and capacity. Findings include the need for age appropriate communication, the link between parental dependence, self-care and patient knowledge, the value of service integration for continuity and the impact of capacity on flexible and age appropriate transition services.
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Affiliation(s)
- Neil Wilson
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Karen Whittaker
- Visiting Fellow, School of Nursing, University of Central Lancashire, Preston, UK
| | - Janine Arnott
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lauren Burke
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
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5
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Cassidy M, Doucet S, Luke A, Goudreau A, MacNeill L. Improving the transition from paediatric to adult healthcare: a scoping review on the recommendations of young adults with lived experience. BMJ Open 2022; 12:e051314. [PMID: 36572498 PMCID: PMC9806082 DOI: 10.1136/bmjopen-2021-051314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The goal of this review was to identify recommendations within the literature on how to improve the transition from paediatric to adult healthcare from the perspective of young adults (YAs) living with chronic conditions who have gone through the process. DESIGN This review was conducted in accordance with JBI methodology for scoping reviews. SEARCH STRATEGY We searched MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO) and EMBASE (Elsevier) databases, and conducted a grey literature search for relevant material. The databases were searched in December 2019, and re-searched June 2020 and September 2020, while the grey literature was searched in April 2020. This scoping review focused on the recommendations of YAs with chronic conditions who have transitioned from paediatric to adult healthcare, in any setting (eg, hospital, clinic or community), and across all sectors (eg, health, education and social services). RESULTS Eighteen studies met inclusion criteria for this review. These studies included YAs with 14 different chronic conditions, receiving primary health services in North America (67%) and Europe (33%). YAs' recommendations for improving the transition from paediatric to adult healthcare (n=number of studies reported) included: improving continuity of care (n=12); facilitating patient-centred care (n=9); building strong support networks (n=11) and implementing transition education preparedness training (n=7). CONCLUSION Review findings can benefit service delivery by addressing important barriers to health, education, and social services for youth transitioning to adult healthcare.
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Affiliation(s)
- Monique Cassidy
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alex Goudreau
- UNB Libraries, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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6
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Thomsen EL, Boisen KA, Hanghøj S, Hansson H, Grabow Scheelhardt HCV, Christensen ST, Esbensen BA. A comprehensive transfer program from pediatrics to adult care for parents of adolescents with chronic illness (ParTNerSTEPs): study protocol for a randomized controlled trial. Trials 2022; 23:1034. [PMID: 36539857 PMCID: PMC9768961 DOI: 10.1186/s13063-022-06997-0] [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: 10/18/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous research shows that adolescents with a chronic illness have more successful transfers to adult care if their parents are involved during the transition. However, there is a lack of structured and evaluated transfer programs for parents. Our aim will be to test a comprehensive transfer program for parents of adolescents with chronic illness during the transfer from pediatric to adult care and to evaluate the program's effectiveness, acceptability, and costs. METHODS The overall design for this protocol will be a randomized controlled trial. A total of 62 dyads consisting of an adolescent (age 16.5-17.5) and at least one parent will be recruited from one of four pediatric outpatient clinics (nephrology, hepatology, neurology, or rheumatology) at Copenhagen University Hospital - Rigshospitalet, Denmark. The dyads will be randomized to receive the transfer program in addition to usual care or to receive usual care only. The program includes an informative website, bi-annual online educational events, and transfer consultations across pediatric and adult care. Outcome measures will include transition readiness, allocation of responsibility, parental uncertainty level, and transfer satisfaction. Data will be collected from participants at baseline, every 6 months until transfer, at transfer, and 3 months after transfer. The parents' acceptance of and satisfaction with the program will be explored through semi-structured interviews. Cost, barriers, and facilitators affecting future implementation will be identified in interviews with health care professionals, using the Normalization Process Theory as a framework for the process analysis. DISCUSSION To our knowledge, this transfer program is one of the first interventions for parents of adolescents with a chronic illness during their child's transfer to adult care. Our trial will include parental and adolescent measures allowing us to examine whether a transfer program for parents will improve transfer to adult care for both parents and adolescents. We believe that results from our trial will be helpful in forming recommendations to ensure better involvement of parents in transitional care. TRIAL REGISTRATION ClinicalTrials.gov NCT04969328 . Retrospectively registered on 20 July 2021.
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Affiliation(s)
- Ena Lindhart Thomsen
- grid.475435.4Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kirsten Arntz Boisen
- grid.475435.4Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Signe Hanghøj
- grid.475435.4Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Helena Hansson
- grid.475435.4Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 60B, 2100 Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Heidi-Christina V. Grabow Scheelhardt
- grid.475435.4Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Susanne Thing Christensen
- grid.475435.4Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bente Appel Esbensen
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark ,grid.475435.4Copenhagen Center for Arthritis Research (COPECARE), Center of Rheumatology and Spine Disorders, Centre of Head and Orthopaedics, Copenhagen University Hospital – Rigshospitalet, Valdemar Hansens Vej 1, 2600 Glostrup, Denmark
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7
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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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Goselink RJM, Olsson I, Malmgren K, Reilly C. Transition to adult care in epilepsy: A systematic review. Seizure 2022; 101:52-59. [PMID: 35901664 DOI: 10.1016/j.seizure.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022] Open
Abstract
The transfer from paediatric to adult care can be a complex process in children with epilepsy. Inadequate care during this phase can affect long-term medical and psychosocial outcomes. The aim of this study was to review studies on transitional care from paediatric to adult healthcare for young persons with epilepsy in order to synthesize evidence for best practice. We undertook a systematic review following PRISMA guidelines and employed narrative synthesis. A total of 36 articles were included, of which 11 were interventional studies and 25 observational studies. Study quality was rated as 'good' for only four studies. Interventions included joint or multidisciplinary clinics, education (patient and health professional education) and extended service provision (Saturday clinics, peer-groups). All studies observed a positive effect experienced by the participants, regardless of intervention type. Observational studies showed that transition plans/programmes are asked for but frequently not existing or not adapted to subgroups with intellectual disability or other neurodevelopmental conditions. The results of this systematic review on transitional care in epilepsy suggest that a planned transition process likely enhances medical and psychosocial outcomes for young people with epilepsy, but the body of evidence is limited and there are significant gaps in knowledge of what efficacious transition constitutes. More studies are needed employing qualitative and quantitative methods to further explore the needs of young people with epilepsy and their families but also robust study designs to investigate the impact of interventions on medical and psychosocial outcomes.
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Affiliation(s)
- Rianne J M Goselink
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden; Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Ingrid Olsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neuropaediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden.
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, SE-413 45, Sweden.
| | - Colin Reilly
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neuropaediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden; Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, United Kingdom.
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9
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Spiegel L, Tucker L, Duffy KW, Lalloo C, Hundert A, Bourre-Tessier J, Hazel E, Luca N, Mosher D, Nguyen C, Stringer E, Victor C, Stinson J. Development and validation of the RACER (Readiness for Adult Care in Rheumatology) transition instrument in youth with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:83. [PMID: 34090474 PMCID: PMC8180033 DOI: 10.1186/s12969-021-00579-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current evidence suggests that many adolescents with juvenile idiopathic arthritis (JIA) do not successfully transfer to adult care, which can result in adverse health outcomes. Although a growing number of clinical programs have been designed to support healthcare transition, there is a lack of psychometrically sound instruments to evaluate their impact on development of transition-related knowledge and skills in youth with JIA. The purpose of this study was to develop and validate RACER (Readiness for Adult Care in Rheumatology), a self-administered instrument designed to measure stages of readiness for key transition-related skills in adolescents with JIA. METHODS A phased approach was used to develop and evaluate the validity and reliability of RACER. Phase 1 A was a consensus conference with 19 key stakeholders to inform instrument domains and items. Phase 1B determined initial content validity using a sample of 30 adolescents with JIA and 15 clinical and research experts. Finally, Phase 2 was a prospective cohort study with repeated measures to evaluate the internal consistency, test-retest reliability, construct validity and responsiveness of the instrument within a sample of adolescents with JIA. RESULTS In Phase 1 A, initial item generation yielded a total of 242 items across six domains from the consensus conference, which was subsequently reduced to a 32-item instrument. Phase 1B established the content validity of the instrument in adolescents with JIA. In the Phase 2 study, with a sample of 96 adolescents, the RACER instrument exhibited good internal consistency in five of its six subscales (Cronbach's α > 0.7), and strong test-retest reliability between the first two administrations (ICC = 0.83). It also showed robust convergent validity by highly correlating with measures of self-management (SMSAG, rho = 0.73) and transition (TRANSITION-Q, rho = 0.76). The RACER was not correlated with unrelated measures (discriminant validity; PedsQL, rho = 0.14). The RACER scores increased significantly over time as expected, supporting measure responsiveness. CONCLUSIONS The RACER is a reliable and valid instrument which is sensitive to change for assessing transition readiness in adolescents with JIA.
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Affiliation(s)
- Lynn Spiegel
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lori Tucker
- grid.17091.3e0000 0001 2288 9830Division of Rheumatology, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Karen Watanabe Duffy
- grid.28046.380000 0001 2182 2255Division of Rheumatology, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Canada
| | - Chitra Lalloo
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Amos Hundert
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Josiane Bourre-Tessier
- grid.410559.c0000 0001 0743 2111Division of Rheumatology, Centre hospitalier de l’Université de Montréal, Montreal, Quebec Canada
| | - Elizabeth Hazel
- grid.63984.300000 0000 9064 4811McGill University Health Centre, Montréal, Quebec Canada
| | - Nadia Luca
- grid.413571.50000 0001 0684 7358Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Canada
| | - Dianne Mosher
- grid.22072.350000 0004 1936 7697University of Calgary and Cumming School of Medicine, Calgary, Canada
| | - Cynthia Nguyen
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Elizabeth Stringer
- grid.55602.340000 0004 1936 8200Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Canada
| | - Charles Victor
- grid.17063.330000 0001 2157 2938Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada ,grid.418647.80000 0000 8849 1617Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada. .,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. .,The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 069715, ON, M5G 0A4, Toronto, Canada.
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10
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Rose K, Tanjinatus O, Ettienne EB. The Term "Juvenile Idiopathic Arthritis (JIA)" is Misleading. It Will not be Sufficient to Just Replace this Term. Pharmaceut Med 2021; 35:143-146. [PMID: 33453041 DOI: 10.1007/s40290-021-00379-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Klaus Rose
- klausrose Consulting, Pediatric Drug Development & More, Aeussere Baselstrasse 308, 4125, Riehen, Switzerland.
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11
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Fortune J, Murphy P, Merchant N, Kerr C, Kroll T, Walsh A, Norris M, Lavelle G, Ryan J. Transition from child-centred to adult-oriented healthcare systems for young people with neurodisability: a scoping review protocol. HRB Open Res 2020; 3:61. [PMID: 33215059 PMCID: PMC7656277 DOI: 10.12688/hrbopenres.13095.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background: The transition from child-centred to adult-oriented healthcare is a challenging time for young people with neurodisability. As the prevalence of neurodisability increases, greater numbers of young people will eventually transfer to the adult healthcare system. While there is a growing recognition of the importance of providing quality, transitional care, little is known about how to manage and optimise this process for young people with neurodisability. The objective of this scoping review is to examine and map existing literature related to the transition from child-centred to adult-oriented healthcare systems for young people with neurodisability. Methods: Systematic literature searches of OVID MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and Web of Science will be conducted from inception to present. A structured iterative search of grey literature will be conducted. This review will consider all study designs examining the transition from child to adult health services in neurodisability. Two reviewers will independently screen each retrieved title and abstract and assess full-text articles against the inclusion criteria to determine eligibility. Data will be extracted and synthesised quantitatively and qualitatively. The process and reporting will follow PRISMA-ScR guidelines. Conclusion: This review will provide a broad and systematically mapped synthesis of the extent and nature of the available published and unpublished literature on transition from child-centred to adult-oriented healthcare systems in neurodisability. The results will be used to determine gaps in the current evidence base in order to prioritise areas for future research.
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Affiliation(s)
- Jennifer Fortune
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nabil Merchant
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Kerr
- Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Aisling Walsh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Jennifer Ryan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Brunel University London, London, England, UK
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12
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Pilot data and case example of the initial visit in a multidisciplinary transition-age program (TAP). Epilepsy Behav 2020; 111:107242. [PMID: 32629414 DOI: 10.1016/j.yebeh.2020.107242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/25/2020] [Accepted: 06/07/2020] [Indexed: 11/22/2022]
Abstract
The process of transition from pediatric to adult epilepsy care has received increased attention and emphasis in recent literature, particularly related to the assertion that effective transition is likely to lead to improved medical and psychosocial outcomes. However, the majority of current transition literature focuses on the structure of a transition program, with very little research providing relevant clinical data during the transition period and beyond. The current paper attempts to address this gap in the literature by providing pilot data on participants who engaged in the initial visit of a multidisciplinary transition-focused program housed in a level 4 epilepsy center in the Midwest. Pilot data are presented on 28 participants (36% female) who completed the initial transition appointment. All but one participant presented with a positive history for a neurobehavioral comorbidity, the most common of which included anxiety (61%), attention-deficit/hyperactivity disorder (ADHD; 39%) and depression (36%). Seventy-seven percent of participants further identified a current neurobehavioral comorbidity that was impacting their psychosocial functioning. Recommendations provided most frequently involved increased independence with epilepsy management (64%), increased independence with self-care/independent living (82%), psychological intervention (43%), and increased socialization (43%). A case example is also provided to further highlight program process and outcomes of the initial visit. Pilot results emphasize the value of multidisciplinary care involving psychosocial providers to facilitate a smooth transition between pediatric and adult healthcare.
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Abstract
Introduction: To coordinate care effectively for rare conditions, we need to understand what coordinated care means. This review aimed to define coordinated care and identify components of coordinated care within the context of rare diseases; by drawing on evidence from chronic conditions. Methods: A systematic scoping review. We included reviews that reported or defined and outlined components of coordinated care for chronic or rare conditions. Thematic analysis was used to develop a definition and identify components or care coordination. Stakeholder consultations (three focus groups with patients, carers and healthcare professionals with experience of rare conditions) were held to further explore the relevance of review findings for rare conditions. Results: We included 154 reviews (n = 139 specific to common chronic conditions, n = 3 specific to rare conditions, n = 12 both common/rare conditions). A definition of coordination was developed. Components were identified and categorised by those that: may need to be coordinated, inform how to coordinate care, have multiple roles, or that contextualise coordination. Conclusions: Coordinated care is multi-faceted and has both generic and context-specific components. Findings outline many ways in which care may be coordinated for both rare and common chronic conditions. Findings can help to develop and eventually test different ways of coordinating care for people with rare and common chronic conditions.
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14
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Bond J, Shanske S, Hoffman R, Ross AM. Piloting a structured developmental tool to assess transition readiness for youth with special health-care needs: A mixed-methods exploration of health-care provider experiences. J Child Health Care 2020; 24:92-105. [PMID: 30773898 DOI: 10.1177/1367493518823899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This mixed-methods study examined providers' experiences using a structured developmentally sensitive tool to assess transition readiness for youth with special health-care needs moving from pediatric to adult care. Twenty-eight health-care providers from three pediatric specialty clinics reported their experiences using the tool by surveys and semistructured telephone interviews. Qualitative data were analyzed using thematic analysis. Most (96%) believed routine practice should include a structured tool; 65.7% incorporated information from the tool into patient care plans. Salient themes pertained to practice behavior changes and implementation barriers. Integrating structured tools into standard clinical practice has the potential to optimize transition and improve patient care.
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Affiliation(s)
- Judy Bond
- Boston Children's Hospital, Boston, MA, USA
| | | | | | - Abigail M Ross
- Fordham Graduate School of Social Service, New York, NY, USA
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15
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Cui C, Li SZ, Zheng XL, Cheng WJ, Xia Q. Health Assessment of Chinese Adolescents with Epilepsy in the Preparatory Phase of Transition Process from Pediatric to Adulthood:A Single-Center Study Using the Omaha System. J Pediatr Nurs 2019; 49:e2-e7. [PMID: 31229347 DOI: 10.1016/j.pedn.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Epilepsy is one of the most common childhood-onset neurological disorder characterized by both seizures and the related comorbidities. The preparatory phase in transition refers to a dynamic process of identifying and resolving health issues to ensure seamless continuing care from childhood to adulthood. This study identifies the health issues of the preparatory phase in transition from children to adulthood using the Omaha System. METHODS This prospective, single-center study enrolled 86 adolescents with epilepsy in China. The Problem Classification Scheme and Problem Rating Scale for Outcomes of Omaha System were used to evaluate transition-induced health problems. RESULTS These health problems cover all four domains of the problem classification scheme of the Omaha System, and the specific distribution is related to the type of epilepsy. The results of the four-category classification evaluation showed that the most common health problem is health-related behavioral problems (46.1%), followed by psychosocial problems (23.0%), physiological problems (20.6%), and environmental problems (10.3%). The distribution of these health problems in generalized seizures, focal seizures, and generalized-focal seizures are significantly different (P < 0.01). The results of the outcome rating scale showed that 83.4% of the children had minimal knowledge, 84.2% had inconsistently appropriate behaviors, and 86.7% had moderate symptoms. CONCLUSIONS The health problems of patients with epilepsy during the preparatory phase of transition process from pediatric to adulthood should be emphasized. Identification of health problems though the Omaha System can improve management for adolescents with epilepsy, including prevention, nursing care, social support, and therapeutic interventions.
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Affiliation(s)
- Cui Cui
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Shuang-Zi Li
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xian-Lan Zheng
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Jin Cheng
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Xia
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
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16
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Brown M, Higgins A, MacArthur J. Transition from child to adult health services: A qualitative study of the views and experiences of families of young adults with intellectual disabilities. J Clin Nurs 2019; 29:195-207. [DOI: 10.1111/jocn.15077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Brown
- School of Nursing & Midwifery Queen's University Belfast UK
| | - Anna Higgins
- School of Health & Social Care Edinburgh Napier University Edinburgh UK
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17
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Russet F, Humbertclaude V, Dieleman G, Dodig-Ćurković K, Hendrickx G, Kovač V, McNicholas F, Maras A, Paramala S, Paul M, Schulze UME, Signorini G, Street C, Tah P, Tuomainen H, Singh SP, Tremmery S, Purper-Ouakil D. Training of adult psychiatrists and child and adolescent psychiatrists in europe: a systematic review of training characteristics and transition from child/adolescent to adult mental health services. BMC MEDICAL EDUCATION 2019; 19:204. [PMID: 31196080 PMCID: PMC6567390 DOI: 10.1186/s12909-019-1576-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/24/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Profound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training. METHODS A systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training. RESULTS Thirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively. CONCLUSION Three models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training.
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Affiliation(s)
- Frederick Russet
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
| | - Veronique Humbertclaude
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Gaelle Hendrickx
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | | | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science and Geary Institute, University College Dublin, Dublin, Ireland
| | - Athanasios Maras
- Yulius Academy, Rotterdam, Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Santosh Paramala
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Stratford Child and Adolescent Health Service, Coventry and Warwickshire Partnership Trust, Stratford on Avon, UK
| | - Ulrike M. E. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Brescia, Italy
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Priya Tah
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran P. Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
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18
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Mc Govern EM, Maillart E, Bourgninaud M, Manzato E, Guillonnet C, Mochel F, Bourmaleau J, Lubetzki C, Baulac M, Roze E. Making a ‘JUMP’ from paediatric to adult healthcare: A transitional program for young adults with chronic neurological disease. J Neurol Sci 2018; 395:77-83. [DOI: 10.1016/j.jns.2018.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/16/2018] [Accepted: 09/25/2018] [Indexed: 12/18/2022]
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Sabbagh S, Ronis T, White PH. Pediatric rheumatology: addressing the transition to adult-orientated health care. Open Access Rheumatol 2018; 10:83-95. [PMID: 30013406 PMCID: PMC6037274 DOI: 10.2147/oarrr.s138370] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The transition from pediatric to adult health care is often a challenging process due to multiple interwoven complexities, especially for children with chronic medical conditions. Health care transition (HCT) is a process of moving from a pediatric to an adult model of health care with or without a transfer to a new clinician. This paper focuses on what is known about HCT for youth and young adults (Y/YA) with rheumatic diseases within a larger context of HCT recommendations. HCT barriers for youth, families, and providers and current evidence for a structured HCT processes are reviewed. Practical advice is offered on how to approach transition for Y/YA, what tools are available to assist in a successful transition process, and what are the areas of future research that are needed to improve the HCT evidence base.
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Affiliation(s)
- Sara Sabbagh
- Department of Rheumatology, Children's National Health System, Washington DC, USA
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Tova Ronis
- Department of Rheumatology, Children's National Health System, Washington DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
| | - Patience H White
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
- Department of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
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