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Vittorio J, Kosmach-Park B, Wadhwani S, Jackson W, Kerkar N, Corbo H, Vekaria P, Gupta N, Yeh H, King LY. Adult provider role in transition of care for young adult pediatric recipients of liver transplant: An expert position statement. Hepatol Commun 2024; 8:e0486. [PMID: 39023314 PMCID: PMC11262821 DOI: 10.1097/hc9.0000000000000486] [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: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/20/2024] Open
Abstract
Health care transition (HCT) is the process of changing from a pediatric to an adult model of care. Young adult pediatric recipients of liver transplant transferring from pediatric to adult health care services are highly vulnerable and subject to poor long-term outcomes. Barriers to successful transition are multifaceted. A comprehensive HCT program should be initiated early in pediatrics and continued throughout young adulthood, even after transfer of care has been completed. It is critical that pediatric and adult liver transplant providers establish a partnership to optimize care for these patients. Adult providers must recognize the importance of HCT and the need to continue the transition process following transfer. While this continued focus on HCT is essential, current literature has primarily offered guidance for pediatric providers. This position paper outlines a framework with a sample set of tools for the implementation of a standardized, multidisciplinary approach to HCT for adult transplant providers utilizing "The Six Core Elements of HCT." To implement more effective strategies and work to improve long-term outcomes for young adult patients undergoing liver transplant, HCT must be mandated as a routine part of posttransplant care. Increased advocacy efforts with the additional backing and support of governing organizations are required to help facilitate these practices.
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Affiliation(s)
- Jennifer Vittorio
- Department of Pediatrics, New York University (NYU) Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Beverly Kosmach-Park
- Department of Transplant Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sharad Wadhwani
- Department of Pediatrics, University of California-San Francisco, San Francisco, California, USA
| | - Whitney Jackson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nanda Kerkar
- Department of Pediatrics, University of Rochester Medical Center, New York, New York, USA
| | - Heather Corbo
- Department of Pharmacy, New York-Presbyterian Hospital, New York, New York, USA
| | - Pooja Vekaria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Nitika Gupta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Heidi Yeh
- Division of Transplant Surgery, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lindsay Y. King
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, North Carolina, USA
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Annesi T, Steinway C, Oluwole T, Shilly S, Szalda D, Myers R, Chen J, Jan S. Quality of Web-Based Sickle Cell Disease Resources for Health Care Transition: Website Content Analysis. JMIR Pediatr Parent 2023; 6:e48924. [PMID: 38100579 PMCID: PMC10750976 DOI: 10.2196/48924] [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: 05/15/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 12/17/2023] Open
Abstract
Background Adolescents and young adults with sickle cell disease (SCD) transitioning from pediatric to adult health care face a high-risk period associated with increased use of acute health care services and mortality. Although 59% of American citizens report using the internet for health care information, the quality of web-based, patient-facing resources regarding transition in SCD care has not been evaluated. Objective This study aimed to evaluate the quality and readability of web-based health information on SCD, especially as it pertains to the transition to adulthood for inidividuals with SCD. The study also compared the readability and content scores of websites identified in 2018 to those from 2021 to assess any change in quality over time. Methods Keywords representing phrases adolescents may use while searching for information on the internet regarding transition in SCD care, including "hydroxyurea" and "SCD transition," were identified. A web-based search using the keywords was conducted in July 2021 using Google, Yahoo, and Bing. The top 20 links from each search were collected. Duplicate websites, academic journals, and websites not related to SCD health care transition were excluded. Websites were categorized based on the source: health department, hospital or private clinician, professional society, and other websites. Websites were assessed using Health On the Net Foundation code of conduct (HONcode), Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FGL), Ensuring Quality Information for Patients (EQIP), and a novel SCD content checklist (SCDCC). EQIP and SCDCC scores range from 0- to 100. Each website was reviewed by 2 research assistants and assessed for interrater reliability. Descriptive statistics were calculated. Results Of the 900 websites collected, 67 (7.4%) met the inclusion criteria: 13 health department, 7 hospital or private clinician, 33 professional society, and 14 other websites. A total of 15 (22%) out of 67 websites had HONcode certification. Websites with HONcode certification had higher FRE and EQIP scores and lower FGL scores than those without HONcode certification, reflecting greater readability. Websites without HONcode certification had higher SCDCC scores, reflecting greater clinical content. Only 7 (10%) websites met the National Institutes of Health recommendation of a seventh-grade or lower reading level. Based on EQIP scores, 6 (9%) websites were of high quality. The mean SCDCC score was 20.60 (SD 22.14) out of 100. The interrater reliability for EQIP and SCDCC ratings was good (intraclass correlation: 0.718 and 0.897, respectively). No source of website scored significantly higher mean EQIP, FRE, FGL, or SCDCC scores than the others (all P<.05). Conclusions Although seeking health care information on the web is very common, the overall quality of information about transition in SCD care on the internet is poor. Changes to current web-based health care information regarding SCD care transitions would benefit transitioning youth by providing expectations, knowledge, skills, and tools to increase self-efficacy.
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Affiliation(s)
- Thomas Annesi
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, HempsteadNY, United States
| | - Caren Steinway
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, HempsteadNY, United States
- Division of General Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde ParkNY, United States
| | - Toyosi Oluwole
- Division of General Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde ParkNY, United States
| | - Steffi Shilly
- Columbia University School of Nursing, New YorkNY, United States
| | - Dava Szalda
- Division of Hematology, Children’s Hospital of Philadelphia, PhiladelphiaPA, United States
| | - Regina Myers
- Division of Hematology, Children’s Hospital of Philadelphia, PhiladelphiaPA, United States
| | - Jack Chen
- Division of General Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde ParkNY, United States
| | - Sophia Jan
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, HempsteadNY, United States
- Division of General Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde ParkNY, United States
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Osunkwo I, Lawrence R, Robinson M, Patterson C, Symanowski J, Minniti C, Bryant P, Williams J, Eckman J, Desai P. Sickle Cell Trevor Thompson Transition Project (ST3P-UP) protocol for managing care transitions: Methods and rationale. Contemp Clin Trials 2023; 126:107089. [PMID: 36669729 DOI: 10.1016/j.cct.2023.107089] [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: 08/09/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Emerging adults with sickle cell disease (EASCD) experience significant challenges transitioning from pediatric to adult care. Acute care utilization increases, quality of life (QOL) declines, with an increased risk of mortality. Currently, there are no practice standards to guide emerging adults through the transition process. We are creating a structured transition education (STE) based program for EASCD by customizing the Six Core Elements (6 CE) of Health Care Transition model and are evaluating the effectiveness of adding peer mentoring (PM). METHODS The Sickle Cell Trevor Thompson Transition Project (ST3P-UP) is an ongoing multi-site, cluster randomized clinical trial with a target enrollment of 537 EASCD aged 16 to 25 years in pediatric care. Each site (n = 14) comprises a pediatric clinic, adult clinic, and a sickle cell disease (SCD) community-based organization (CBO). Sites are randomized 1:1 to either STE or STE + PM. EASCDs are followed prospectively for 24 months. Rapid cycle plan-do-study-act quality improvement (QI) methods are used to implement the STE. The primary objective is to compare the effectiveness of STE + PM versus STE only at decreasing the number of acute care visits per year over 24 months. The secondary objectives are to compare overall healthcare utilization and patient-reported QOL outcomes at 24 months. CONCLUSION We aim to demonstrate the feasibility of using a QI approach to implement 6 CE-based practice standards at 14 disparate SCD clinical programs to guide EASCD through the transition process. We hypothesize that adding PM to the STE program will improve acute care reliance, QOL, and satisfaction with transition outcomes.
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Affiliation(s)
- Ifeyinwa Osunkwo
- Sickle Cell Disease Enterprise, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Raymona Lawrence
- Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, United States of America.
| | - Myra Robinson
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Charity Patterson
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - James Symanowski
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Caterina Minniti
- Department of Hematology, Adult Comprehensive Sickle Cell Program Montefiore Medical Center, Bronx, NY, United States of America
| | - Paulette Bryant
- St. Jude's Affiliate Clinic, Hemby Children's Hospital, Novant Health, Charlotte, NC, United States of America
| | - Justina Williams
- Piedmont Health Services and Sickle Cell Agency, Greensboro, NC, United States of America
| | - James Eckman
- Emory University, Atlanta, GA, United States of America
| | - Payal Desai
- Sickle Cell Disease Enterprise, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
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Caron R, Richardson KL. Pilot longitudinal kidney transplant transition program promotes peer connections and transition readiness. Pediatr Transplant 2023; 27:e14468. [PMID: 36604843 DOI: 10.1111/petr.14468] [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: 03/18/2022] [Revised: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adolescents who have received a kidney transplant are at high risk of graft rejection and transplant-related comorbidities around the time of transition from pediatric to adult care. While there has been a progress in tracking transition readiness, further work is needed to prepare adolescents for healthcare transitions. We describe a longitudinal cohort-based transition curriculum designed to prepare kidney transplant recipients for adult transplant care. METHODS Adolescent kidney transplant recipients aged 17 and older participated in the pilot cohort of the 2-year transition curriculum. Session topics included communication with the healthcare team, insurance, job skills, reflective practice, reproductive health, medications, and adult clinic introduction. Surveys were given to obtain narrative feedback, assess participant self-management behavior, and track curriculum knowledge. RESULTS Each participant attended an average of two sessions, with 18 out of 30 eligible adolescents participating in at least one session. After transitioning to a virtual platform, there was increased attendance of participants who live greater than 150 miles from the transplant center. Adolescents highlighted the value of the program's group structure to relate to and learn from other participants. CONCLUSIONS The pilot transition program successfully provided adolescent kidney transplant recipients the opportunity to learn alongside their peers and gain interdisciplinary knowledge to prepare for healthcare transition. The program converted to a virtual platform during the COVID-19 pandemic, with increased accessibility for participants who live further from the transplant center. Group-based programming for adolescents should be enhanced to further prepare them for transitions to adult medicine.
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Affiliation(s)
- Rachel Caron
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kelsey L Richardson
- Division of Pediatric Nephrology, Oregon Health & Science University, Portland, Oregon, USA
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Kassa AM, Engvall G, Dellenmark Blom M, Engstrand Lilja H. Understanding of the transition to adult healthcare services among individuals with VACTERL association in Sweden: A qualitative study. PLoS One 2022; 17:e0269163. [PMID: 35622841 PMCID: PMC9140225 DOI: 10.1371/journal.pone.0269163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/15/2022] [Indexed: 11/18/2022] Open
Abstract
Current knowledge of transitional care from the perspective of individuals with congenital malformations is scarce. Their viewpoints are required for the development of follow-up programs and transitional care corresponding to patients’ needs. The study aimed to describe expectations, concerns, and experiences in conjunction with transfer to adult health care among adolescents, young adults, and adults with VACTERL association, (i.e. vertebral defects, anorectal malformations (ARM), cardiac defects (CHD), esophageal atresia (EA), renal, and limb abnormalities). Semi-structured telephone interviews were performed and analyzed with qualitative content analysis. Of 47 invited individuals, 22 participated (12 males and 10 females). An overarching theme emerged: Leaving the safe nest of pediatric health care for an unfamiliar and uncertain follow up yet growing in responsibility and appreciating the adult health care. The participants described expectations of qualified adult health care but also concerns about the process and transfer to an unfamiliar setting. Individuals who were transferred described implemented or absence of preparations. Positive and negative experiences of adult health care were recounted including being treated as adults. The informants described increasing involvement in health care but were still supported by their parents. Ongoing follow up of health conditions was recounted but also uncertainty around the continuation, missing follow up and limited knowledge of how to contact health care. The participants recommended information ahead of transfer and expressed wishes for continued health care with regular follow up and accessibility to a contact person. Based on the participants’ perspective, a transitional plan is required including early information about transfer and follow up to prepare the adolescents and reduce uncertainty concerning future health care. Meetings with the pediatric and adult team together with the patient and the parents are essential before transfer. Follow up should be centralized to centers with multi-professional teams well-experienced with the condition. Further studies are warranted to evaluate the transition process for adolescents and young adults with complex congenital health conditions.
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Affiliation(s)
- Ann-Marie Kassa
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Paediatric Surgery, University Children’s Hospital, Uppsala, Sweden
- * E-mail:
| | - Gunn Engvall
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Michaela Dellenmark Blom
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatric Surgery, The Queen Silvia Children’s Hospital SU/Östra, Gothenburg, Sweden
| | - Helene Engstrand Lilja
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Paediatric Surgery, University Children’s Hospital, Uppsala, Sweden
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Transition Preparation and Satisfaction of Care Among Adolescents and Young Adults With Sickle Cell Disease at the Ghana Institute of Clinical Genetics. J Pediatr Hematol Oncol 2022; 44:e682-e688. [PMID: 35319508 DOI: 10.1097/mph.0000000000002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
Expanding services in Ghana for people with sickle cell disease is expected to increase childhood survival and need for transition to adult care. Little is known about patient transition experiences in sub-Saharan Africa. We sought to understand those experiences of adolescents and young adults at an adult sickle cell clinic in Accra, Ghana. Individuals 13 to 22 years of age receiving sickle cell care at the Ghana Institute of Clinical Genetics were interviewed to recall their advance preparation and early experiences in adult sickle cell clinic. Mean age of the 100 participants interviewed was 17.9±2.9 years, 65% female. Most had hemoglobin SS (77%) or hemoglobin SC (20%). Twenty-nine participants recalled pretransition preparation; 93% of them (27) had received care at Korle Bu Pediatric Sickle Cell Clinic. Among the remaining 71 who did not recall advance preparation, 54% (34) had received pediatric care at that clinic (P<0.001). More in the group recalling preparation had positive feelings about needing to transition care compared with those not recollecting preparation (55% vs. 32%, P=0.04). Our results suggest that pretransition preparation may ease the peritransition experience. Conduct and evaluation of a program for transitioning into adult sickle cell care in Ghana may facilitate the transfer process.
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Rea KE, Cushman GK, Santee T, Mee L. Biopsychosocial factors related to transition among adolescents and young adults with sickle cell disease: A systematic review. Crit Rev Oncol Hematol 2021; 167:103498. [PMID: 34656745 DOI: 10.1016/j.critrevonc.2021.103498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/02/2021] [Accepted: 10/10/2021] [Indexed: 01/19/2023] Open
Abstract
It is critical to support adolescents and young adults (AYAs) with sickle cell disease (SCD) during transition to adult healthcare. We provide a systematic review of literature related to biopsychosocial influences on transition among AYAs with SCD. Data sources included studies published between January 2010 and May 2020. Forty-four studies were included. Biopsychosocial factors related to improved transition outcomes included older AYA age, greater disease severity, intact neurocognitive functioning, and greater pain coping skills. Financial and insurance barriers were noted. The importance of cultural considerations and provider communication were noted across two qualitative studies. Ten studies assessed efficacy of transition interventions, with 80 % resulting in improvements; however, retention in programs was low and gaps in knowledge and skills remained. Incorporation of early, ongoing assessments of transition readiness and barriers into culturally-tailored interventions aimed at improving transition outcomes is recommended. Examination of longitudinal relationships and interactions across biopsychosocial influences is needed.
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Affiliation(s)
- Kelly E Rea
- University of Georgia, Department of Psychology, United States.
| | - Grace K Cushman
- University of Georgia, Department of Psychology, United States
| | - Tara Santee
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
| | - Laura Mee
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States; Emory University School of Medicine, Department of Pediatrics, United States
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Jones KE, Nyman TN, Daly BP, Jacobson LA, Tarazi RA. Executive Functioning Predicts Adaptive Functioning and Self-Care Independence in Pediatric Sickle Cell Disease. J Pediatr Psychol 2021; 47:206-214. [PMID: 34524455 DOI: 10.1093/jpepsy/jsab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study examined the impact of executive functioning (EF) on adaptive functioning and self-care independence in pre-transition youth with sickle cell disease (SCD). METHODS Thirty-four youth with SCD (ages 12-18 years) completed a brief neuropsychological battery and their caregivers completed questionnaires assessing adaptive functioning, EF behaviors, and independence in completing self-care tasks, including disease management. Hierarchical linear regression analyses were utilized to investigate if EF predicted significantly more variability in adaptive functioning and self-care independence than what is accounted for by socioeconomic status (SES), disease knowledge, and estimated intellectual functioning. RESULTS Mean performance on standardized measures assessing working memory, processing speed, and EF skills fell in the low average range. Performance-based EF and caregiver-reported EF behaviors predicted variance in adaptive functioning and self-care independence above and beyond that accounted for by SES, disease knowledge, and intelligence, with moderate to large effect sizes. CONCLUSIONS EF skills may support the ability of youth with SCD to adequately achieve independence in self-care, including medical self-care, and other adaptive skills, which may increase the likelihood of successful transition to young adulthood. These findings provide support for the role of neuropsychological screening and individualized intervention in interdisciplinary transition programs.
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Affiliation(s)
| | | | | | - Lisa A Jacobson
- Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Reem A Tarazi
- Division of Hematology, St. Christopher's Hospital for Children, Philadelphia, PA, USA.,Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA, USA
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Morisaki-Nakamura M, Suzuki S, Kobayashi A, Kita S, Sato I, Iwasaki M, Hirata Y, Sato A, Oka A, Kamibeppu K. Development and validation of a Japanese version of the TRANSITION-Q. Pediatr Int 2021; 63:270-278. [PMID: 32687648 DOI: 10.1111/ped.14398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 04/15/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The evaluation of transition readiness is indispensable for long-term follow-ups of adolescent patients with childhood-onset chronic diseases (CCD). We developed a Japanese version of the TRANSITION-Q (TRANSITION-Q-J) and used it to assess Japanese patients with CCD. METHODS The TRANSITION-Q-J was developed through forward and backward translations followed by cognitive interviews with five adolescent patients. The field test was conducted with 125 adolescent patients, and a retest was conducted with 113 adolescent patients. RESULTS Confirmatory factor analysis supported the two-factor analysis model including F1 (communication and self-management) and F2 (examination behavior). Sufficient internal consistency and test-retest reliability were demonstrated among the total 14 items, F1, and F2 (Cronbach's α > 0.80, intraclass correlation coefficient > 0.85). Convergent and discriminant validity for the 14 items and F1 were acceptable; however, F2 did not correlate significantly with the Rosenberg Self-Esteem Scale and Independent Consciousness Scale. Regarding known-groups validity, the older group had a significantly higher mean TRANSITION-Q-J score (50.05) than the younger group (43.28; P = 0.04). The same results were found for both F1 and F2. CONCLUSIONS The TRANSITION-Q-J for adolescent patients with CCD was developed and its reliability and validity were verified. This scale is easy to administer. In addition to being a tool for transition period support, it could be used to verify effective factors and in program outcome evaluation, including intervention studies.
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Affiliation(s)
- Mayumi Morisaki-Nakamura
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Seigo Suzuki
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Pediatric Nursing, Tokyo Medical University, Shinjuku-ku, Japan
| | - Asuka Kobayashi
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Sachiko Kita
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Iori Sato
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Miwa Iwasaki
- Department of, Nursing, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Yoichiro Hirata
- Department of, Pediatrics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Atsushi Sato
- Department of, Pediatrics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Akira Oka
- Department of, Pediatrics, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Kiyoko Kamibeppu
- Departments of, Department of, Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of, Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
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10
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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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11
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Varty M, Popejoy LL. Young Adults With Sickle Cell Disease: Challenges With Transition to Adult Health Care. Clin J Oncol Nurs 2020; 24:451-454. [PMID: 32678361 DOI: 10.1188/20.cjon.451-454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because life expectancy has increased greatly in the past few decades for individuals living with sickle cell disease (SCD), transition to the adult healthcare setting has become a necessity to continue disease management. Transition for young adults with SCD is associated with declining health outcomes, including increased acute care use and mortality. Nurses can assist young adults with SCD who are at risk after transition by assessing the young adult's ability to carry out disease self-management, facilitating the supportive role of the family, and recognizing young adults who may have difficulty accessing healthcare resources and providers.
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12
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Strini V, Daicampi C, Trevisan N, Marinetto A, Prendin A, Marinelli E, De Barbieri I. Transition of care in pediatric oncohematology: a systematic literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:48-64. [PMID: 32573506 DOI: 10.23750/abm.v91i6-s.9876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The transition of medical care from a pediatric to an adult environment is a psychological change, a new orientation that requires a self-redefinition of the individual, to understand that changes are taking place in his life. Up to 60 percent of pediatric patients who transition to adult services will experience one or more disease or treatment-related complication as they become adults. A nurse who knows how to recognize potential barriers at an early stage can play a pivotal role in the educational plan for the transition process. MATERIALS AND METHODS A literature search was undertaken of PUBMED, CINAHL and The Cochrane Library, with specific inclusion and exclusion criteria, including articles published in the lasts ten years.This literature review has been performed according to the PRISMA statement. RESULTS Using the keywords in different combination 38 articles were found in The Cochrane Library, 5877 in PUBMED, 274 in CINAHL. 88 articles were selected after the abstract screening. 31 after removing the duplicates and reading the full text. DISCUSSION The main themes surrounding transition of care that emerged from the synthesis are the organization of care within common models of transition, innovative clinical approaches to transition, and the experience of patients and caregivers. The transition from pediatric to adult care of cancer or SCD survivors is an emerging topic in pediatric nursing. The organization of care is affected by the lack of clear and well-structured organizational models. Further research is needed to deepen the understanding of some aspects of the transition.
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Strini V, Daicampi C, Trevisan N, Prendin A, Marinelli E, Marinetto A, de Barbieri I. Transition of care in pediatric oncohematology: a systematic literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91. [PMID: 32573506 PMCID: PMC7975840 DOI: 10.23750/abm.v91i6-s.98976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The transition of medical care from a pediatric to an adult environment is a psychological change, a new orientation that requires a self-redefinition of the individual, to understand that changes are taking place in his life. Up to 60 percent of pediatric patients who transition to adult services will experience one or more disease or treatment-related complication as they become adults. A nurse who knows how to recognize potential barriers at an early stage can play a pivotal role in the educational plan for the transition process. MATERIALS AND METHODS A literature search was undertaken of PUBMED, CINAHL and The Cochrane Library, with specific inclusion and exclusion criteria, including articles published in the lasts ten years.This literature review has been performed according to the PRISMA statement. RESULTS Using the keywords in different combination 38 articles were found in The Cochrane Library, 5877 in PUBMED, 274 in CINAHL. 88 articles were selected after the abstract screening. 31 after removing the duplicates and reading the full text. DISCUSSION The main themes surrounding transition of care that emerged from the synthesis are the organization of care within common models of transition, innovative clinical approaches to transition, and the experience of patients and caregivers. The transition from pediatric to adult care of cancer or SCD survivors is an emerging topic in pediatric nursing. The organization of care is affected by the lack of clear and well-structured organizational models. Further research is needed to deepen the understanding of some aspects of the transition.
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Affiliation(s)
- Veronica Strini
- Clinical Research Unit-University-Hospital of Padua, Padua, Italy
| | - Chiara Daicampi
- Department of Mother and Child-University-Hospital of Padua, Padua, Italy
| | - Nicola Trevisan
- Department of Mother and Child-University-Hospital of Padua, Padua, Italy
| | - Angela Prendin
- Department of Mother and Child-University-Hospital of Padua, Padua, Italy
| | - Elena Marinelli
- Department of Mother and Child-University-Hospital of Padua, Padua, Italy
| | - Anna Marinetto
- Department of Mother and Child-University-Hospital of Padua, Padua, Italy
| | - Ilaria de Barbieri
- Department of Mother and Child-University-Hospital of Padua, Padua, Italy
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The Adolescent and Caregiver Sickle Cell Disease Self-management Skills Checklist: Preliminary Reliability and Validity. J Pediatr Hematol Oncol 2020; 42:12-19. [PMID: 31688630 DOI: 10.1097/mph.0000000000001618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adolescents with sickle cell disease (SCD) need assistance in developing the knowledge and skills that contribute to increased disease self-management and successful transition to adult-based health care. This study evaluated the preliminary psychometric properties of the Self-Management Skills Checklist (SMSC and SMSC-C; Adolescent and Caregiver versions), a measure of perceived SCD-specific knowledge and skills. A retrospective cohort study included 114 adolescents (mean=15.6 y) and their caregivers. We examined internal structure and reliability, score changes over time, and group differences. Cronbach coefficient alphas were 0.79 and 0.74 for caregiver-reported Skills and caregiver-reported knowledge, respectively, and 0.77 and 0.44 for adolescent-reported skills and adolescent-reported knowledge, respectively, indicating good internal consistency for 3 of the subscales. Poor reliability in the adolescent-reported knowledge summary score and factor analysis suggest an interpretation item-by-item, independent of one another. Participant group differences in age and chronic transfusion treatment existed in both summary and subscale scores of the SMSC and SMSC-C. Follow-up administrations of the scales indicated an increase in caregiver-reported skills for their adolescents from time 1 scores (M=3.72±0.83) to time 2 scores (M=3.99±0.63) (t16=2.178, P=0.045). Findings provide preliminary support for the usage of the SMSC and continued development to improve its psychometrics.
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Clayton-Jones D, Matthie N, Treadwell M, Field JJ, Mager A, Sawdy R, George Dalmida S, Leonard C, Koch KL, Haglund K. Social and Psychological Factors Associated With Health Care Transition for Young Adults Living With Sickle Cell Disease. J Transcult Nurs 2019; 32:21-29. [PMID: 31889479 DOI: 10.1177/1043659619896837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Due to advances in disease management, mortality rates in children with sickle cell disease (SCD) have decreased. However, mortality rates for young adults (YA) increased, and understanding of social and psychological factors is critical. The aim of this study was to explore factors associated with health care transition experiences for YA with SCD. Method: This was a qualitative descriptive study. A 45-minute semistructured interview was conducted with 13 YA (M = 21.5 years, SD = 1.73). Results: Results suggest that social and psychological factors and self-management experiences influence health care transition. Eight themes emerged: "need for accessible support"; "early assistance with goal setting"; "incongruence among expectations, experiences, and preparation"; "spiritual distress"; "stigma"; "need for collaboration"; "appreciation for caring providers"; and "feeling isolated." Discussion: Consideration of cultural contexts will guide nurses in supporting health care transition. Designing culturally relevant interventions that address unique needs for YA living with SCD is warranted.
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Affiliation(s)
- Dora Clayton-Jones
- Marquette University College of Nursing, Milwaukee, WI, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nadine Matthie
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | | | | | - Amy Mager
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Sawdy
- Marquette University College of Nursing, Milwaukee, WI, USA
| | - Safiya George Dalmida
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Cynthia Leonard
- Froedtert Hospital Sickle Cell Disease Clinic, Milwaukee, WI, USA
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Saulsberry AC, Porter JS, Hankins JS. A program of transition to adult care for sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:496-504. [PMID: 31808907 PMCID: PMC6913425 DOI: 10.1182/hematology.2019000054] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most children with sickle cell disease (SCD) today survive into adulthood. Among emerging adults, there is a marked increase in acute care utilization and a rise in mortality, which can be exacerbated by not establishing or remaining in adult care. Health care transition programs are therefore essential to prepare, transfer, and integrate emerging adults in the adult care setting. The Six Core Elements of Health Care Transition, created by the Center for Health Care Transition Improvement, define the basic components of health care transition support as follows: (1) transition policy, (2) tracking and monitoring progress, (3) assessing transition readiness, (4) planning for adult care, (5) transferring to adult care, and (6) integrating into adult care. Programs that implement the Six Core Elements have experienced significant declines in care abandonment during adolescence and young adulthood and higher early adult care engagement. Most of the core transition activities are not currently reimbursable, however, posing a challenge to sustain transition programs. Ongoing studies are investigating interventions in comparative effectiveness trials to improve health-related quality of life and reduce acute care utilization among emerging adults with SCD. Although these studies will identify best practices for health care transition, it is also important to define how the transition outcomes will be measured, as no consensus definition exists for successful health care transition in SCD. Future research is needed to define best practices for health care transition, systematically assess transition outcomes, and revise payment models to promote sustainability of health care transition programs.
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Affiliation(s)
| | - Jerlym S Porter
- Psychology, St. Jude Children's Research Hospital, Memphis, TN
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Darbari I, Jacobs E, Gordon O, Weiss D, Winship K, Casella JF, Strouse JJ, Takemoto CM. Correlates of successful transition in young adults with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27939. [PMID: 31429531 DOI: 10.1002/pbc.27939] [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: 03/27/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Abstract
The transition period from pediatric care to adult care for patients with sickle cell disease (SCD) is associated with increased mortality and morbidity. Identification of risk factors for unsuccessful transition may aid in developing strategies to improve the transition process and health outcomes in this population. We examined factors associated with unsuccessful transition from pediatric to adult care for patients with SCD at the Johns Hopkins Hospital. We found that public insurance and increased hospitalization rates were associated with poor transition to adult care. The findings provide possible areas of intervention.
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Affiliation(s)
- Isha Darbari
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Emily Jacobs
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Olivia Gordon
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Diane Weiss
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Kim Winship
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - James F Casella
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - John J Strouse
- Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Clifford M Takemoto
- Division of Pediatric Hematology, Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland.,Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
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18
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Gray WN, Schaefer MR, Resmini-Rawlinson A, Wagoner ST. Barriers to Transition From Pediatric to Adult Care: A Systematic Review. J Pediatr Psychol 2019; 43:488-502. [PMID: 29190360 DOI: 10.1093/jpepsy/jsx142] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/05/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Transition research in each disease group is developing in its own "silo." A comprehensive review of barriers to transition within and across chronic illness groups is needed to facilitate information sharing and larger-scale efforts to overcome barriers and improve patient care. This study systematically reviews and identifies the barriers to transition from pediatric to adult care across pediatric illness populations. Methods Medline, CINAHL, PsychINFO, Social Services Abstracts, Web of Science, and the Cochrane library databases were searched. Peer-reviewed English articles presenting original data on barriers to transition to adult care, focused on a specific pediatric chronic illness population, and conducted in the United States were included. Study design, population, and barriers were extracted. Barriers were categorized according to the Socioecological Model of Adolescent/Young Adult Readiness to Transition. Articles were evaluated for study quality. Results Fifty-seven articles were included. The most common barriers to transition fell within the "Relationships" domain (e.g., difficulties letting go of long-standing relationships with pediatric providers) followed by "Access/Insurance" (e.g., difficulty accessing/finding qualified practitioners, insurance issues), and "Beliefs/Expectations" (e.g., negative beliefs about adult care). Barriers related to "Knowledge" (e.g., limited patient/caregiver knowledge about medication/illness and the transition process) and "Skills/Efficacy" (e.g., lack of self-management skills) were also common. While relationship barriers were commonly reported by all, some barriers varied by transfer status (pre- vs. posttransfer). Conclusions Each chronic illness group experiences illness-specific challenges but certain barriers transcend chronic illness populations. Suggestions to overcome these barriers are provided.
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Allemang B, Allan K, Johnson C, Cheong M, Cheung P, Odame I, Ward R, Williams S, Mukerji G, Kuo KHM. Impact of a transition program with navigator on loss to follow-up, medication adherence, and appointment attendance in hemoglobinopathies. Pediatr Blood Cancer 2019; 66:e27781. [PMID: 31045326 DOI: 10.1002/pbc.27781] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Transition from pediatric to adult care is a period of high risk for loss to follow-up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow-up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. PROCEDURE A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. RESULTS The transition program with TN reduced loss to follow-up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985). CONCLUSIONS A transition program with TN significantly reduced loss to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.
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Affiliation(s)
- Brooke Allemang
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kate Allan
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Johnson
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Melina Cheong
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Patrina Cheung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Odame
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard Ward
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suzan Williams
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Kevin H M Kuo
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Melita N, Diaz-Linhart Y, Kavanagh PL, Sobota A. Developing a Problem-solving Intervention to Improve Self-Management and Transition Readiness in Adolescents with Sickle Cell Disease. J Pediatr Nurs 2019; 46:26-32. [PMID: 30826724 DOI: 10.1016/j.pedn.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE Adolescents and young adults (AYA) with sickle cell disease (SCD) are at risk for serious complications including increased morbidity and early mortality during their transition from pediatric to adult care. Self-management support may help improve transition outcomes in this vulnerable population. Interventions based on teaching problem solving skills have been shown to improve adherence to therapy for AYA with other chronic disease and is a promising intervention in SCD. We sought patient and parent perspectives on improving self-management and input on the development of a problem-solving education (PSE) intervention. DESIGN AND METHODS We held focus groups with AYA with SCD and caregivers to discuss barriers and facilitators of self-management, acceptability of PSE and intervention content and delivery. RESULTS Five focus groups were held with AYA (n = 17) and caregivers (n = 15). Groups participated jointly to discuss self-management and then separately to discuss PSE. Data were analyzed using grounded theory and double-coded until thematic saturation was achieved. CONCLUSIONS Both groups endorsed PSE as an acceptable intervention. Barriers to self-management included wanting to fit in with peers (AYA) and trouble letting go (parents); facilitators included having a regular routine (AYA) and sharing responsibility (parents). Participants suggested meeting in small groups for PSE sessions rather than individually and adding group sessions for parents. PRACTICAL IMPLICATIONS Understanding AYA and caregivers' perceptions of barriers and facilitators of transition in SCD can help us better prepare AYA for transition. The specifics both groups identified as helpful will guide intervention development.
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Affiliation(s)
- Nicole Melita
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America
| | - Yaminette Diaz-Linhart
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America
| | - Patricia L Kavanagh
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America
| | - Amy Sobota
- Department of Pediatrics, Boston University Medical Center, Boston, MA, United States of America.
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21
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Singer DE, Chen L, Shao S, Goldsmith J, Byrne C, Niebuhr DW. The Association Between Sickle Cell Trait in U.S. Service Members with Deployment, Length of Service, and Mortality, 1992-2012. Mil Med 2019. [PMID: 29514337 DOI: 10.1093/milmed/usx037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Sickle cell trait (SCT) affects an estimated 5.02% of non-Hispanic blacks, 1.08% of Hispanics, and 0.1% of Whites in the U.S. military. Policies for SCT screening and occupational restrictions vary by service. Population-based studies of SCT with quantification of military-relevant outcomes are lacking. Methods The study design was a retrospective cohort of 15,081 SCT-positive versus 60,320 SCT-negative U.S. active duty personnel enlisted from 1992 to 2012 and followed through 2013. Military-relevant outcome included number and days of deployment, length of service, and cause of death. Results SCT-positive versus SCT-negative service members experienced more deployments (p < 0.01) and longer number of days deployed for all services, especially the Army (p < 0.001). The median length of service was longer for SCT-positive service members stratified by service and by gender (p < 0.05). The adjusted risk of length of service greater than 5 yr by SCT status was 1.37 (95% confidence interval 1.31-1.43) with greater than a three-fold higher risk in the Navy and Air Force compared with the Army. Crude mortality rate was not significantly different by SCT status, although deaths due to suicide, self-directed violence, and other non-specific causes were more common in SCT-positive service members. Conclusion We found that SCT-positive service members deployed more frequently, for greater lengths of time, and remained in service longer. No significant difference in crude mortality ratio was discovered. Additional research on military-relevant outcomes and a cost-effectiveness analysis of SCT screening practices are needed to inform evidence-based SCT enlistment policies.
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Affiliation(s)
- Darrell E Singer
- Department of Preventive Medicine and Biostatistics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ligong Chen
- Department of Preventive Medicine and Biostatistics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Stephanie Shao
- Department of Preventive Medicine and Biostatistics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 4494 North Palmer Road, Bethesda, MD 20889
| | - Jonathan Goldsmith
- Office of New Drugs/Center for Drug Evaluation and Research/Food and Drug Administration, Department of Health and Human Services, Mail Stop 6311, 10903 New Hampshire Avenue, Silver Spring, MD 20993
| | - Celia Byrne
- Department of Preventive Medicine and Biostatistics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - David W Niebuhr
- Department of Preventive Medicine and Biostatistics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Shah N, Bhor M, Xie L, Halloway R, Arcona S, Paulose J, Yuce H. Evaluation of Vaso-occlusive Crises in United States Sickle Cell Disease Patients: A Retrospective Claims-based Study. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2019; 6:106-117. [PMID: 32685584 PMCID: PMC7299444 DOI: 10.36469/9667] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Sickle cell disease (SCD) is a life-threatening vascular disease that burdens affected persons physically. SCD-related vaso-occlusive crises (VOCs) are one of the primary causes of morbidity and mortality. Our objective was to examine the epidemiology of pain crises and the relationship between pain crises and major acute complications among SCD patients. Using the Medicaid Analytic Extracts from 2009-2013, patients with SCD were selected and the first clinical claim indicating SCD during the identification period was defined as the index date. Patients were required to have continuous Medicaid enrollment for ≥6 months pre- and 12 months post-index period. Clinical outcomes included mortality, inpatient pain crises, and complications. Cox regressions were applied to examine the relationship between pain crises and deaths or acute complications, respectively. A total of 20 909 patients were included with a mean age of 17.9 years. The rate of VOC events in 100 person-years was 142.20 for adults and 53.91 for pediatric patients. Patients with VOCs were associated with a higher risk for death (hazard ratio=1.56; 95% confidence interval: [1.19-2.05]) or acute complications including acute chest syndrome, stroke, pulmonary embolism, splenic sequestration, and pulmonary hypertension. SCD patients have a substantial burden of disease-related complications. This study suggests that inpatient vaso-occlusive crisis is a key risk factor for acute complications.
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Affiliation(s)
| | - Menaka Bhor
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Lin Xie
- SIMR, Inc., Ann Arbor, MI
- New York City College of Technology, CUNY, New York, NY
| | | | - Steve Arcona
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Jincy Paulose
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Huseyin Yuce
- New York City College of Technology, CUNY, New York, NY
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Speller-Brown B, Varty M, Thaniel L, Jacobs MB. Assessing Disease Knowledge and Self-Management in Youth With Sickle Cell Disease Prior to Transition. J Pediatr Oncol Nurs 2018; 36:1043454218819447. [PMID: 30565490 PMCID: PMC6675670 DOI: 10.1177/1043454218819447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transition of medical care from pediatrics to adult can be challenging and difficult. Until the 1970s, only half of patients diagnosed with sickle cell disease (SCD) reached adulthood. As a result of patients living longer, there is a growing need to understand factors that influence readiness to transition. This descriptive study examined age-specific SCD knowledge, self-management skills of patients, and education goals in a convenience sample of patients and their parents. METHOD One hundred eighty-three transition surveys were distributed during scheduled hematology clinic visits. Surveys were analyzed with descriptive statistics to determine differences of knowledge between age groups, self-care skills, vocational supports, and educational goals. The parent group consists of children aged 0 to 4 years (32), 5 to 8 years (52), 9 to 11 years (12); the child group consists of children aged 9 to 11 years (24) and 12 to 15 years (31); and adolescent and young adult (AYA) group consists of children aged 16 to 21 years (32). RESULTS Indeed, 50% of parents of the 0 to 4 years age group and 33% of 5 to 8 years age group knew their child's baseline hemoglobin. Only 38% of patients aged 16 to 21 years knew their baseline hemoglobin. However, 79% of patients aged 9 to 11 years, 74% of patient aged 12 to 15 years, and 78% of AYAs could name their hematology provider. Only 66% of patients aged 16 to 21 years knew what symptoms required medical attention. DISCUSSION Most patients and parents had adequate basic knowledge regarding SCD. AYAs lack the disease knowledge necessary to transition care away from parents to become more independent. An assessment for transition readiness should be ongoing to include disease-specific knowledge and self-management skills.
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Affiliation(s)
- Barbara Speller-Brown
- 1 Children's National Health System, Washington, DC, USA
- 2 The George Washington University, Washington, DC, USA
| | - Maureen Varty
- 3 MedStar Georgetown University Hospital, Washington, DC, USA
- 4 University of Missouri, Columbia, MO, USA
| | - Lisa Thaniel
- 1 Children's National Health System, Washington, DC, USA
| | - Marni B Jacobs
- 1 Children's National Health System, Washington, DC, USA
- 2 The George Washington University, Washington, DC, USA
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24
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Shay LA, Schmidt S, Cornell SD, Parsons HM. "Making My Own Decisions Sometimes": A Pilot Study of Young Adult Cancer Survivors' Perspectives on Medical Decision-Making. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1341-1346. [PMID: 28752237 PMCID: PMC5787043 DOI: 10.1007/s13187-017-1256-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to provide a better understanding of the medical decision-making preferences and experiences of young adult survivors of pediatric, adolescent, and young adult cancers. We conducted key informant interviews and a cross-sectional mailed survey with young adult survivors (currently aged 18-39 years) of pediatric, adolescent, and young adult cancers in South Texas. Of the responding survivors, almost all wanted to be actively involved in medical decision-making, but preferences regarding family and doctor involvement varied. In open-ended responses, the most commonly reported concerns related to medical decision-making were feelings of uncertainty and fear of receiving bad news. Survivors reported that they desired more information in order to feel better about medical decision-making. Due to the variety of preferences regarding decision-making and who to include in the process, physicians should be prepared to ask and accommodate patients regarding their decision-making preferences.
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Affiliation(s)
- L Aubree Shay
- UTHealth School of Public Health in San Antonio, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, USA.
| | - Susanne Schmidt
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Stephanie D Cornell
- UTHealth School of Public Health in San Antonio, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, USA
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Helen M Parsons
- University of Minnesota School of Public Health, Minneapolis, MN, USA
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Kulandaivelu Y, Lalloo C, Ward R, Zempsky WT, Kirby-Allen M, Breakey VR, Odame I, Campbell F, Amaria K, Simpson EA, Nguyen C, George T, Stinson JN. Exploring the Needs of Adolescents With Sickle Cell Disease to Inform a Digital Self-Management and Transitional Care Program: Qualitative Study. JMIR Pediatr Parent 2018; 1:e11058. [PMID: 31518307 PMCID: PMC6716437 DOI: 10.2196/11058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/16/2018] [Accepted: 08/21/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Accessible self-management interventions are critical for adolescents with sickle cell disease to better cope with their disease, improve health outcomes and health-related quality of life, and promote successful transition to adult health care services. However, very few comprehensive self-management and transitional care programs have been developed and tested in this population. Internet and mobile phone technologies can improve accessibility and acceptability of interventions to promote disease self-management in adolescents with sickle cell disease. OBJECTIVE The aim of this study was to qualitatively explore the following from the perspectives of adolescents, parents, and their health care providers: (1) the impact of sickle cell disease on adolescents to identify challenges to their self-management and transitional care and (2) determine the essential components of a digital self-management and transitional care program as the first phase to inform its development. METHODS A qualitative descriptive design utilizing audio-recorded, semistructured interviews was used. Adolescents (n=19, aged 12-19 years) and parents (n=2) participated in individual interviews, and health care providers (n=17) participated in focus group discussions and were recruited from an urban tertiary care pediatric hospital. Audio-recorded data were transcribed verbatim and organized into categories inductively, reflecting emerging themes using simple content analysis. RESULTS Data were categorized into 4 major themes: (1) impact of sickle cell disease, (2) experiences and challenges of self-management, (3) recommendations for self-management and transitional care, and (4) perceptions about a digital self-management program. Themes included subcategories and the perspectives of adolescents, parents, and health care providers. Adolescents discussed more issues related to self-management, whereas health care providers and parents discussed issues related to transition to adult health services. CONCLUSIONS Adolescents, parents, and health care providers described the continued challenges youth with sickle cell disease face in terms of psychosocial impacts and stigmatization. Participants perceived a benefit to alleviating some of these challenges through a digital self-management tool. They recommended that an effective digital self-management program should provide appropriate sickle cell disease-related education; guidance on developing self-advocacy and communication skills; empower adolescents with information for planning for their future; provide options for social support; and be designed to be engaging for both adolescents and parents to use. A digital platform to deliver these elements is an accessible and acceptable way to address the self-management and transitional care needs of adolescents.
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Affiliation(s)
- Yalinie Kulandaivelu
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Chitra Lalloo
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Richard Ward
- Division of Haematology, University Health Network, Toronto, ON, Canada
| | - William T Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT, United States
| | - Melanie Kirby-Allen
- Departments of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vicky R Breakey
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Isaac Odame
- Departments of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Khush Amaria
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ewurabena A Simpson
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Cynthia Nguyen
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tessy George
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer N Stinson
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
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26
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Porter JS, Wesley KM, Zhao MS, Rupff RJ, Hankins JS. Pediatric to Adult Care Transition: Perspectives of Young Adults With Sickle Cell Disease. J Pediatr Psychol 2018. [PMID: 28637291 DOI: 10.1093/jpepsy/jsx088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives The aim of this study was to explore perspectives of transition and transition readiness of young adult patients (YAs) with sickle cell disease (SCD) who have transitioned to adult health care. Methods In all, 19 YAs with SCD (ages 18-30 years) participated in one of three focus groups and completed a brief questionnaire about transition topics. Transcripts were coded and emergent themes were examined using the social-ecological model of adolescent and young adult readiness for transition (SMART). Results Themes were consistent with most SMART components. Adult provider relationships and negative medical experiences emerged as salient factors. YAs ranked choosing an adult provider, seeking emergency care, understanding medications/medication adherence, knowing SCD complications, and being aware of the impact of health behaviors as the most important topics to include in transition programming. Conclusions The unique perspectives of YAs can inform the development and evaluation of SCD transition programming by incorporating the identified themes.
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Affiliation(s)
- Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Kimberly M Wesley
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Mimi S Zhao
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rebecca J Rupff
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jane S Hankins
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
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Kwarteng-Siaw M, Paintsil V, Toboh CK, Owusu-Ansah A, Green NS. Assessment of Transition Readiness in Adolescents with Sickle Cell Disease and their Caretakers, A single institution experience. ACTA ACUST UNITED AC 2017; 3:171-179. [PMID: 30035240 PMCID: PMC6054488 DOI: 10.17554/j.issn.2409-3548.2017.03.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Sickle Cell Disease (SCD) is associated with high child mortality and birth incidence in sub-Saharan Africa. Improved SCD medical services in Ghana aims to enhance survival into adulthood, creating emerging need for transition from pediatric to adult care. Anticipating transition for adolescents with SCD, we sought to understand patient and caretaker perspectives on transition to adult care within Ghana. MATERIALS AND METHODS Structured interviews were conducted with a sample of patients ages 12–15 years and accompanying adults at Ghana’s Komfo Anokye Teaching Hospital Sickle Cell Clinic (KATH SCC) covering four areas: SCD medical knowledge, symptom self-management, psychosocial impact, and transition preparation. RESULTS In total, 46 children (mean age 13 years) paired with 46 adults were interviewed. Most children and caretakers had some knowledge about SCD and disease management. At least one-third lacked knowledge about SCD as an inherited condition. Youth were significantly more concerned about family burden and social stigmatization than adults. Most were unaware that patients are expected to switch care to adult medical providers by age 15 years, but were willing to transfer if needed. CONCLUSIONS Our clinic-based assessment at KATH SCC identified needs of adolescents and caretakers for education and counseling about disease, self-management, transition, family burden, and stigmatization. These findings provide insights into perspectives and educational gaps of families treated for SCD. Results suggest consideration of transition planning for adolescents with SCD and their caretakers in Ghana. Generalizability of our findings and practical methods to address needs for transition within Africa remain to be tested.
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Affiliation(s)
- Miriam Kwarteng-Siaw
- Department of Pediatrics, Columbia University Medical Center, New York, NY, the United States
| | - Vivian Paintsil
- Sickle Cell Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Amma Owusu-Ansah
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine; Center for Translational and International Hematology, Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA. the United States
| | - Nancy S Green
- Department of Pediatrics, Columbia University Medical Center, New York, NY, the United States
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28
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Margolis R, Wiener L, Pao M, Malech HL, Holland SM, Driscoll P. Transition From Pediatric to Adult Care by Young Adults With Chronic Granulomatous Disease: The Patient's Viewpoint. J Adolesc Health 2017; 61:716-721. [PMID: 28947348 PMCID: PMC5701857 DOI: 10.1016/j.jadohealth.2017.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Children with chronic illnesses are living longer, prompting health care provider attention to the transition from pediatric to adult care. Transition of care is successful when youth are independent in managing their health. The aims of this study were to identify the strengths and barriers to transition from pediatric to adult care and to determine strategies that could enhance the transition process. METHODS A survey was administered via a structured interview to 33 young adult participants (19-27 years of age), living with chronic granulomatous disease all of whom transitioned from pediatric to adult care. The participants were predominately male (88%) and Caucasian (73%). Topics covered in the survey included understanding of disease and treatment, adherence, advance care planning, and barriers to transition. Data were analyzed using a conventional content analysis approach. RESULTS Seventy-six percent of the participants did not understand their disease process and only 50% understood their prophylactic medication regimen. Seventy-five percent of participants perceived their transition as uneventful. Ninety-four percent were independent in self-management skills such as making appointments and 90% in refilling prescriptions. More than half of the participants thought that the transition process needed improvement. Specific suggestions to create a practical approach to transition were offered. CONCLUSIONS Gaps in disease-related knowledge and transition planning were identified by adolescents and young adults living with chronic granulomatous disease. The findings suggest the need for enhancing the transition process utilizing interdisciplinary collaboration to develop a transition policy and program.
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Affiliation(s)
- Rachel Margolis
- Laboratory of Clinical Infectious Diseases, National Institute of
Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for
Cancer Research, National Institutes of Health, Bethesda, MD
| | - Maryland Pao
- National Institute of Mental Health, National Institutes of Health,
Bethesda, MD
| | - Harry L. Malech
- Laboratory of Host Defenses, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Steven M. Holland
- Laboratory of Clinical Infectious Diseases, National Institute of
Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Patricia Driscoll
- Intramural Clinical Management and Operations Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
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Sobota AE, Shah N, Mack JW. Development of quality indicators for transition from pediatric to adult care in sickle cell disease: A modified Delphi survey of adult providers. Pediatr Blood Cancer 2017; 64. [PMID: 27905689 DOI: 10.1002/pbc.26374] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/25/2016] [Accepted: 10/30/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transition from pediatric to adult care is a vulnerable time for young adults with sickle cell disease (SCD); however, improvements in transition are limited by a lack of quality indicators. The purpose of this study was to establish quality indicators for transition in SCD and to determine the optimal timing between the final pediatric visit and the first adult provider visit. PROCEDURE We conducted a modified Delphi survey to reach a consensus on which quality indicators are most important for a successful transition. Our expert panel consisted of members of the Sickle Cell Adult Provider Network. In the first round, the participants ranked a list of quality indicators by importance. In the second round, the participants chose their "top 5" quality indicators in terms of importance and also ranked them on feasibility. RESULTS The response rates for the two rounds were 68 and 96%, respectively. Nine quality indicators were chosen as "top 5" by a majority of respondents, including communication between pediatric and adult providers, timing of first adult visit, patient self-efficacy, quality of life, and trust with their adult provider. Based on the comments from round 1, respondents were also asked for the optimal timing between leaving pediatric care and entering adult care. Most recommended a first adult visit within 2 months of the final pediatric visit. CONCLUSIONS By using these quality indicators chosen by the majority of respondents, we can better develop and evaluate transition programs for young adults with SCD and improve health outcomes for these vulnerable patients.
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Affiliation(s)
- Amy E Sobota
- Boston University School of Medicine, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Nishita Shah
- Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer W Mack
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Comorbidity, Pain, Utilization, and Psychosocial Outcomes in Older versus Younger Sickle Cell Adults: The PiSCES Project. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4070547. [PMID: 28459058 PMCID: PMC5387810 DOI: 10.1155/2017/4070547] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/08/2017] [Indexed: 01/24/2023]
Abstract
Background. Patients with SCD now usually live well into adulthood. Whereas transitions into adulthood are now often studied, little is published about aging beyond the transition period. We therefore studied age-associated SCD differences in utilization, pain, and psychosocial variables. Methods. Subjects were 232 adults in the Pain in Sickle Cell Epidemiology Study (PiSCES). Data included demographics, comorbidity, and psychosocial measures. SCD-related pain and health care utilization were recorded in diaries. We compared 3 age groups: 16–25 (transition), 26–36 (younger adults), and 37–64 (older adults) years. Results. Compared to the 2 adult groups, the transition group reported fewer physical challenges via comorbidities, somatic complaints, and pain frequency, though pain intensity did not differ on crisis or noncrisis pain days. The transition group utilized opioids less often, made fewer ambulatory visits, and had better quality of life, but these differences disappeared after adjusting for pain and comorbidities. However, the transition group reported more use of behavioral coping strategies. Conclusion. We found fewer biological challenges, visits, and better quality of life, in transition-aged versus older adults with SCD, but more behavioral coping. Further study is required to determine whether age-appropriate health care, behavioral, or other interventions could improve age-specific life challenges of patients with SCD.
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31
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Naik H, Stoecker M, Sanderson SC, Balwani M, Desnick RJ. Experiences and concerns of patients with recurrent attacks of acute hepatic porphyria: A qualitative study. Mol Genet Metab 2016; 119:278-283. [PMID: 27595545 PMCID: PMC5083146 DOI: 10.1016/j.ymgme.2016.08.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The acute hepatic porphyrias (AHPs) are rare inborn errors of heme biosynthesis, characterized clinically by life-threatening acute neurovisceral attacks. Patients with recurrent attacks have a decreased quality of life (QoL); however, no interactive assessment of these patients' views has been reported. We conducted guided discussions regarding specific topics, to explore patients' disease experience and its impact on their lives. METHODS Sixteen AHP patients experiencing acute attacks were recruited to moderator-led online focus groups. Five groups (3-4 patients each) were conducted and thematic analyses to identify, examine, and categorize patterns in the data was performed. RESULTS All patients identified prodromal symptoms that began days prior to acute severe pain; the most common included confusion ("brain fog"), irritability, and fatigue. Patients avoided hospitalization due to prior poor experiences with physician knowledge of AHPs or their treatment. All patients used complementary and alternative medicine treatments to avoid hospitalization or manage chronic pain and 81% reported varying degrees of effectiveness. All patients indicated their disease impacted personal relationships due to feelings of isolation and difficulty adjusting to the disease's limitations. CONCLUSION Patients with recurrent attacks recognize prodromal warning symptoms, attempt to avoid hospitalization, turn to alternative treatments, and have markedly impaired QoL. Counseling and individualized support is crucial for AHP patients with recurrent attacks.
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Affiliation(s)
- Hetanshi Naik
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, Unites States.
| | - Mikayla Stoecker
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, Unites States.
| | - Saskia C Sanderson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, Unites States.
| | - Manisha Balwani
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, Unites States.
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, Unites States.
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