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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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Wolverson M, O'Hare P, Patel V. An eye opener: improving attendance rates of retinopathy screening within the paediatric diabetes clinic. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Paul O'Hare
- Warwick Medical School University of Warwick Warwick UK
| | - Vinod Patel
- Warwick Medical School University of Warwick Warwick UK
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Sharpe D, Rajabi M, Harden A, Moodambail AR, Hakeem V. Supporting disengaged children and young people living with diabetes to self-care: a qualitative study in a socially disadvantaged and ethnically diverse urban area. BMJ Open 2021; 11:e046989. [PMID: 34645656 PMCID: PMC8515452 DOI: 10.1136/bmjopen-2020-046989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To explore how to enhance services to support the self-care of children and young people (CYP) clinically considered 'disengaged' by diabetes services. DESIGN Qualitative study. SETTING Two diabetes clinics in an ethnically diverse and socially disadvantaged urban area in the UK. Eligible participants were CYP living with type 1 or type 2 diabetes aged between 10 and 25 years who did not attend their last annual hospital appointment. PARTICIPANTS 22 CYP (14 female and 8 male) aged between 10 and 19 years old took part. The sample was diverse in terms of ethnicity, age at diagnosis, family composition and presence of diabetes among other family members. DATA COLLECTION Semistructured interviews. DATA ANALYSIS Data were analysed thematically. RESULTS Analysis of participant accounts confirmed the crucial importance of non-medicalised care in CYP diabetes care. A life plan was considered as important to participants as a health plan. Participants valued the holistic support provided by friends, family members and school teachers. However, they found structural barriers in their health and educational pathways as well as disparities in the quality of support at critical moments along the life course. They actively tried to maximise their well-being by balancing life priorities against diabetes priorities. Combined, these features could undermine participants engagement with health services where personal strategies were often held back or edited out of clinical appointments in fear of condemnation. CONCLUSION We demonstrate why diabetes health teams need to appreciate the conflicting pressures experienced by CYP and to coproduce more nuanced health plans for addressing their concerns regarding identity and risk taking behaviours in the context of their life-worlds. Exploring these issues and identifying ways to better support CYP to address them more proactively should reduce disengagement and set realistic health outcomes that make best use of medical resources.
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Affiliation(s)
- Darren Sharpe
- Institute for Connected Communities (ICC), University of East London, London, UK
| | | | - Angela Harden
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, UK
| | | | - Vaseem Hakeem
- Royal Free London NHS Foundation Trust, Barnet and Chase Farm Hospitals NHS Trust, London, UK
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Brewster S, Bartholomew J, Holt RIG, Price H. Non-attendance at diabetes outpatient appointments: a systematic review. Diabet Med 2020; 37:1427-1442. [PMID: 31968127 DOI: 10.1111/dme.14241] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance. METHODS PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. RESULTS Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. CONCLUSIONS Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.
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Affiliation(s)
- S Brewster
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
| | - J Bartholomew
- CRN Wessex, NIHR Clinical Research Network (CRN), University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Price
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
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Lee RRS, Samsudin MI, Thirumoorthy T, Low LL, Kwan YH. Factors affecting follow-up non-attendance in patients with Type 2 diabetes mellitus and hypertension: a systematic review. Singapore Med J 2019; 60:216-223. [PMID: 31187148 PMCID: PMC6535449 DOI: 10.11622/smedj.2019042] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This is a systematic review of the factors and reasons associated with follow-up non-attendance (FUNA) in patients with Type 2 diabetes mellitus and hypertension in an outpatient setting. We performed a systematic literature search using electronic databases and related keywords with the PRISMA-P checklist, focusing on the factors, types of studies and number of studies that showed a positive, negative or neutral association with FUNA. Data was presented in three categories: patient, disease and medication, and healthcare provider factors. In total, 4,822 articles were reviewed. Among the 24 articles that were relevant to the stated objective, 83 factors were found to be associated with FUNA. A target-board model for FUNA was presented for clinicians to better understand the various aspects contributing to and implications involved in FUNA. Greater awareness and understanding of the multifactorial nature of FUNA and taking a multifaceted approach are important to effectively reduce this problem.
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Affiliation(s)
| | | | | | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
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Mistry B, Van Blyderveen S, Punthakee Z, Grant C. Condition-related predictors of successful transition from paediatric to adult care among adolescents with Type 1 diabetes. Diabet Med 2015; 32:881-5. [PMID: 25764182 DOI: 10.1111/dme.12746] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
Abstract
AIMS To describe patient attendance for adult treatment after completion by young people of a structured Diabetes Transition Clinic and to identify the predictors of non-attendance at adult clinics by young people with Type 1 diabetes transitioning from paediatric care. METHODS Young people with Type 1 diabetes were consecutively enrolled on a Diabetes Transition Clinic programme at a Canadian paediatric teaching hospital, beginning in December 2007. Data from clinical interviews completed by an adolescent medicine specialist and an adult endocrinologist were prospectively collected at the Diabetes Transition Clinic visit in the patient's 18(th) year, before he/she was transferred at age 18 years to the adult clinic and at the first adult clinic visit. RESULTS As of June 2011, 136 young people participating in the Diabetes Transition Clinic programme had been discharged from paediatric care at least 1 year earlier. Of these, 43 participants were lost to follow-up. Loss to follow-up was more frequent among: those who were diagnosed with diabetes before the age of 12 years; those who were taking insulin twice or three times daily rather than by pump or multiple daily injections; those who had higher HbA1c levels; those who had fewer diabetes physician visits in the year preceding the Diabetes Transition Clinic visit; and those who did not ask questions at the Diabetes Transition Clinic visit. CONCLUSIONS Several factors easily ascertained at a clinical encounter before transition can predict the likelihood of attendance in adult care, including age at diagnosis, mode of insulin administration, frequency of physician visits, and questions asked by patients during a transition visit.
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Affiliation(s)
- B Mistry
- McMaster University, Hamilton, Ontario, Canada
| | | | - Z Punthakee
- McMaster University, Hamilton, Ontario, Canada
| | - C Grant
- McMaster University, Hamilton, Ontario, Canada
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McLeod H, Heath G, Cameron E, Debelle G, Cummins C. Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study. BMJ Qual Saf 2015; 24:377-84. [DOI: 10.1136/bmjqs-2014-003687] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/14/2015] [Indexed: 01/10/2023]
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Ashurst EJ, Jones RB, Abraham C, Jenner M, Boddy K, Besser RE, Hammersley S, Pinkney J. The diabetes app challenge: user-led development and piloting of internet applications enabling young people with diabetes to set the focus for their diabetes consultations. MEDICINE 2.0 2014; 3:e5. [PMID: 25654312 PMCID: PMC4318679 DOI: 10.2196/med20.3032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/03/2014] [Accepted: 09/01/2014] [Indexed: 11/13/2022]
Abstract
Background Traditionally, some teenagers and young adults with diabetes have not engaged well at diabetes appointments, giving rise to concerns about long-term health risks. We considered that apps might help this group of patients to improve preparation for, and therefore engagement at their appointments. Although there are already many apps for young people with type 1 diabetes (YPD), we thought that by supporting YPD themselves to develop apps, the resulting products would have greater “authenticity” and relevance. Objective To test the feasibility of an online competition to (1) recruit and support YPD to develop apps (mobile or Internet based) to help prepare for clinic appointments, and (2) for these apps to be tested and rated by YPD. Methods The “Diabetes App Challenge” was a United Kingdom (UK) national competition, run between June and October 2012 for teams including at least one YPD (aged 16-25) to pilot the design and development of apps for use by other YPD prior to clinic appointments. The competition was advertised by social media, email, AdWords and postings on the Diabetes UK website. Registrants for the competition were supported via email and discussion forum. After app development, other YPD were invited (November 2012-February 2013) to trial the apps, choose and use one prior to a clinic appointment, and review their experiences. Results Of 56 people (including 28 YPD) who expressed interest in the competition, 6 teams (14 people) developed and submitted an app. Two apps aimed to facilitate agenda setting in clinic consultations, 2 enabled data logging and 2 helped insulin dose calculation. Of 135 YPD who registered to trial the apps, 83 (61.5%) took part (mean age 18.98, 37/83 male). Agenda setting apps were considered most useful for preparing for and setting the focus of clinic appointments (P=.02). Just over half (46/83, 55%) said they would use their chosen app again and 4/5 (67/83, 81%) would recommend it to a friend. Conclusions This competition to engage YPD in developing and reviewing apps proved successful. App designers and testers saw a need for a range of functions. However, this may, in part, reflect a lack of detailed knowledge of all existing apps and be limited by the technical skills of YPD. App competitions appear worth applying to other patient groups, but future competitions should include a review stage and perhaps focus on ideas for app design for subsequent professional implementation.
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Affiliation(s)
- Emily J Ashurst
- Plymouth University, School of Nursing and Midwifery, Plymouth, United Kingdom
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Abstract
PURPOSE A systematic review of the literature was conducted to identify the level of evidence and to describe the evidence on the transition from pediatric to adult healthcare services among youth with diabetes. BACKGROUND The transition from pediatric to adult healthcare services is an expectation of youth with diabetes; however, little is known to guide policy and procedures on such transitions. DESCRIPTION OF PROJECT The literature was first searched and screened according to predetermined criterion and then evaluated for level of evidence. OUTCOME There were 16 mixed qualitative and/or quantitative studies, 23 quantitative studies, and 2 expert opinion articles reviewed. Most of the evidence was from uncontrolled studies. Youth report challenges in making the transition in services. Delay in seeking adult services and poor clinic attendance are issues for these youth. However, it is unclear if these problems are a result of the transition in services. Several promising transition programs have been evaluated and, overall, are found acceptable and useful by youth. In general, evidence suggests that these programs improve glycemic control. CONCLUSIONS More research is needed in this challenging area to guide policies and procedures. IMPLICATIONS Expert opinion is a guide for policy and procedures at this point in time.
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Affiliation(s)
- Kathleen M Hanna
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA.
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Fegran L, Hall EOC, Uhrenfeldt L, Aagaard H, Ludvigsen MS. Adolescents' and young adults' transition experiences when transferring from paediatric to adult care: a qualitative metasynthesis. Int J Nurs Stud 2013; 51:123-35. [PMID: 23490470 DOI: 10.1016/j.ijnurstu.2013.02.001] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 01/28/2013] [Accepted: 02/03/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The objective of this study was to synthesize qualitative studies of how adolescents and young adults with chronic diseases experience the transition from paediatric to adult hospital care. DESIGN The review is designed as a qualitative metasynthesis and is following Sandelowski and Barroso's guidelines for synthesizing qualitative research. DATA SOURCES Literature searches were conducted in the databases PubMed, Ovid, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, and Nordic and German databases covering the period from 1999 to November 2010. In addition, forward citation snowball searching was conducted in the databases Ovid, CINAHL, ISI Web of Science, Scopus and Google Scholar. REVIEW METHODS Of the 1143 records screened, 18 studies were included. Inclusion criteria were qualitative studies in English, German or Nordic languages on adolescents' and young adults' transition experiences when transferring from paediatric to adult care. There was no age limit, provided the focus was on the actual transfer process and participants had a chronic somatic disease. The studies were appraised as suitable for inclusion using a published appraisal tool. Data were analyzed into metasummaries and a metasynthesis according to established guidelines for synthesis of qualitative research. RESULTS Four themes illustrating experiences of loss of familiar surroundings and relationships combined with insecurity and a feeling of being unprepared for what was ahead were identified: facing changes in significant relationships, moving from a familiar to an unknown ward culture, being prepared for transfer and achieving responsibility. CONCLUSIONS Young adults' transition experiences seem to be comparable across diagnoses. Feelings of not belonging and of being redundant during the transfer process are striking. Health care professionals' appreciation of young adults' need to be acknowledged and valued as competent collaborators in their own transfer is crucial, and may protect them from additional health problems during a vulnerable phase. Further research including participants across various cultures and health care systems is needed.
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Affiliation(s)
- Liv Fegran
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.
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Abstract
AIMS To study the reasons for attendance behaviour from the patient viewpoint at a young adult diabetes outpatient clinic. METHODS Attendance rates for 231 clinic appointments over 19 months for 102 patients were calculated. Semi-structured interviews were conducted with a purposive sample of 17 of the 102. The interviews encouraged participants to describe routines, thoughts and feelings around clinic appointments. Observations were made of the clinic system. Themes arising from patients' emotional and practical issues around attendance were generated from the data. RESULTS 'Did not attend' rates for the clinic over the study period were 15.7%. However, bureaucratic problems created many 'missed' appointments; most instances of 'did not attend' investigated were attributable to communication failures. Participants did not divide neatly into 'attenders'/'non-attenders'; many had complex mixed attendance records. Most weighed the value of attendance against immediate obstacles such as incompatible work/clinic hours. Reminders were seen as important, particularly for this age group. Respondents identified fear of being judged for 'poor control' as a major factor in attendance decisions, suggesting that having a high HbA1c level may lead to non-attendance, rather than vice versa. CONCLUSIONS Health professionals' supportive, non-judgemental attitude is important to patients considering clinic attendance. In this study, improved communication, reminders and flexible hours might reduce 'did not attend' rates.
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Affiliation(s)
- R Snow
- NIHR King's Patient Safety and Service Quality Research Centre, King's College London, UK.
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