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Yüksel Yılmaz D, Yardımcı F, Erdemir F, Karabudak R. Defining the experiences of adolescent patients with multiple sclerosis in transition from pediatric care to adult care. Mult Scler Relat Disord 2022; 68:104123. [PMID: 36058194 DOI: 10.1016/j.msard.2022.104123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/14/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the experiences of patients aged 18-24 years who were diagnosed with multiple sclerosis before the age of eighteen, during the transition from pediatric care to adult care. METHODS This research was in the type of phenomenological qualitative research. Focus group interviews were conducted between December 2020 and October 2021 with seventeen participants who had been diagnosed with multiple before the age of eighteen, aged 18-24, voluntarily having agreed to participate in the study. The views of the participants were analyzed with Maxqda Plus v10 data analysis software, and thematic coding was created by the researchers. RESULTS Of the participants, 58.9% were female, 76.5% had their first attack after the age of 13, and it was determined that 64.7% of them took oral tablets for therapeutic purposes. As a result of the content analysis; four thematic codes emerged: (a) Perceptions of the Illness and Pediatric Clinic Before Transition, (b) Perceptions of the Disease and Adult Clinic After Transition to the Adult Clinic, (c) Expectations from the Clinic They Received Service from During Their Childhood, (d) Expectations from the Clinic They Used in Adulthood. CONCLUSION This study revealed that individuals with multiple sclerosis did not receive any medical care regarding the transition from pediatric clinics to adult clinics. Describing the experiences of young adult patients with multiple sclerosis in pediatric clinics and their experiences in the transition to adult clinics allows for the definition of comprehensive, individualized and transitional nursing interventions.
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Affiliation(s)
- Didem Yüksel Yılmaz
- Research Assistant, RN, Ufuk University, School of Nursing, Mevlana Boulevard (Konya Yolu) No:86-88 Balgat, Ankara, Turkey.
| | - Figen Yardımcı
- Associate Professor, Ege University, Faculty of Nursing, Department of Child Health and Diseases, Izmir, Turkey
| | - Firdevs Erdemir
- Professor, Near East University, Faculty of Nursing, Department of Child Health and Diseases, Nicosia, Cyprus
| | - Rana Karabudak
- Professor, Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey
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Amajjar I, Malik R, van Wier M, Smeets R, Ham SJ. Transitional care of adolescents with Multiple Osteochondromas: a convergent mixed-method study 'Patients', parents' and healthcare providers' perspectives on the transfer process'. BMJ Open 2021; 11:e049418. [PMID: 34226232 PMCID: PMC8258596 DOI: 10.1136/bmjopen-2021-049418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Multiple osteochondromas (MO) is a rare hereditary disease characterised by numerous benign bone tumours. Its chronic aspect requires a well-organised transition from paediatric care to adult care; however, little is known on organising this care specific for patients with MO. This study aims to gain insight on this topic. DESIGN Convergent mixed-method study. SETTING This study was conducted at the orthopaedic and paediatrics department of an MO-expertise centre in the Netherlands. PARTICIPANTS 12 patients, 10 parents and 10 healthcare professionals were interviewed. An additional survey was completed by 2 young adults. PRIMARY AND SECONDARY OUTCOMES The (1) themes on transition, identified through template analysis and (2) transfer experience and satisfaction assessed by an 18-item On Your Own Feet-Transfer Experience Scale (OYOF-TES, range: 18-90) and by Numeric Rating Scale (NRS, range: 1-10). RESULTS The following three key themes were identified in the qualitative analysis: (1) patient and parent in the lead can be encouraged by self-management tools, (2) successful transfers need interprofessional collaboration and communication and (3) how can we prepare patients for the transitional process? Stakeholders' insights to improve transition were listed and divided into these three themes.Several important aspects were underlined, particularly within the first theme; speaking-up was difficult for patients especially when parents were not directly involved. Moreover, the high psychological impact of the disease requires coaching of self-management and psychological counselling to facilitate stakeholders in their changing roles.Twenty patients completed the quantitative survey. Mean satisfaction score with the transfer process was poor, which was assessed with the NRS (mean=5.7±2.1; range: 1-9) and the OYOF-TES (mean=56.3±14.2; range: 32-85). The OYOF-TES only showed a negative correlation (R2=0.25; p=0.026) with the number of surgical interventions in the past. CONCLUSION Overall, the transfer process was found unsatisfactory. Improvement can be achieved by supporting and guiding the patients to be in the lead of their care. Moreover, preparation for transfer and a multidisciplinary approach may enhance successful transition.
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Affiliation(s)
- Ihsane Amajjar
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Romana Malik
- Department of Education, OLVG, Amsterdam, The Netherlands
| | - Marieke van Wier
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Rehabilitation Medicine, CIR Revalidatie, Eindhoven, The Netherlands
| | - S John Ham
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
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Kittivisuit S, Lerkvaleekul B, Soponkanaporn S, Ngamjanyaporn P, Vilaiyuk S. Assessment of transition readiness in adolescents in Thailand with rheumatic diseases: a cross-sectional study. Pediatr Rheumatol Online J 2021; 19:101. [PMID: 34193176 PMCID: PMC8243449 DOI: 10.1186/s12969-021-00602-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most childhood-onset rheumatic diseases are chronic health conditions, which need long-term care throughout adulthood. A well-organized transition care is challenging and patient assessment of transition skills is needed for transfer preparation to an adult care setting. The Transition Readiness Assessment Questionnaire (TRAQ) is used to assess transition skills in chronically ill patients. Currently, limited transition skill assessment data exist in pediatric patients with rheumatic diseases, especially in Asian countries. This study aimed to determine the transition readiness skills in patients with rheumatic diseases and ascertain predictive factors contributing to high transition readiness skills. METHODS This is a cross-sectional study. All patients with rheumatic diseases aged 15-20 years were recruited. The TRAQ was cross-culturally adapted into the Thai language with good internal consistency and reliability. Patients completed the Thai TRAQ at the recent clinic visit and took the retest at a 2-week interval. Demographic data, baseline characteristics, clinical manifestations, and disease status were collected. Descriptive and logistic regression analyses were performed. RESULTS A total of 111 patients with a mean age of 17.4 ± 1.8 years were included. Median (IQR) disease duration was 6.4 (3.2-9.0) years. The most common rheumatic disease was juvenile idiopathic arthritis (48.6%), followed by systemic lupus erythematosus (35.1%). The mean TRAQ score was 3.85 ± 0.69. Independent visits (OR 4.35, 95% CI 1.23-15.37) was a predictor of a high TRAQ score. Furthermore, dependent visits (OR 7.84, 95% CI 2.41-25.50) was a predictor of low TRAQ score in the "appointment keeping" domain, whereas inactive disease (OR 4.54, 95% CI 1.25-16.55) was a predictor of a low TRAQ score in "tracking health issues" domain. Lack of knowledge and skills on health insurance coverage, financial management, appointment arrangement, and coping with their illness were issues causing lower TRAQ score. CONCLUSIONS Patients, who had independent visits, had a higher chance to obtain higher TRAQ scores, whereas patients, who had an inactive disease or dependent visits, had less transition readiness skills. Physicians and parents should prepare to transfer patients to adult care settings, mainly encouraging independent living skills.
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Affiliation(s)
- Sirinthip Kittivisuit
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand ,grid.7130.50000 0004 0470 1162Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Butsabong Lerkvaleekul
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand
| | - Sirisucha Soponkanaporn
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand
| | - Pintip Ngamjanyaporn
- grid.10223.320000 0004 1937 0490Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400, Bangkok, Thailand.
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Kelly A, Niddrie F, Tunnicliffe DJ, Matus Gonzalez A, Hanson C, Jiang I, Major G, Singh-Grewal D, Tymms K, Tong A. Patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology: a qualitative systematic review. Rheumatology (Oxford) 2021; 59:3737-3750. [PMID: 32413124 DOI: 10.1093/rheumatology/keaa168] [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: 12/23/2019] [Accepted: 02/19/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES We aimed to describe patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology to inform patient-centred transitional care programmes. METHODS We searched MEDLINE, EMBASE, PsycINFO and CINAHL to August 2019 and used thematic synthesis to analyse the findings. RESULTS From 26 studies involving 451 people with juvenile-onset rheumatic conditions we identified six themes: a sense of belonging (comfort in familiarity, connectedness in shared experiences, reassurance in being with others of a similar age, desire for normality and acceptance); preparedness for sudden changes (confidence through guided introductions to the adult environment, rapport from continuity of care, security in a reliable point of contact, minimizing lifestyle disruptions); abandonment and fear of the unknown (abrupt and forced independence, ill-equipped to hand over medical information, shocked by meeting adults with visible damage and disability, vulnerability in the loss of privacy); anonymous and dismissed in adult care (deprived of human focus, sterile and uninviting environment, disregard of debilitating pain and fatigue); quest for autonomy (controlled and patronized in the paediatric environment, liberated from the authority of others, freedom to communicate openly); and tensions in parental involvement (overshadowed by parental presence, guilt of excluding parents, reluctant withdrawal of parental support). CONCLUSION Young people feel dismissed, abandoned, ill-prepared and out of control during transition. However, successful transition can be supported by preparing for changes, creating a sense of belonging and negotiating parental involvement and autonomy. Incorporating patient-identified priorities into transitional services may improve satisfaction and outcomes in young people with juvenile-onset rheumatic conditions.
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Affiliation(s)
- Ayano Kelly
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle
| | - David J Tunnicliffe
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | | | - Camilla Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | - Ivy Jiang
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,School of Medicine, University of New South Wales, Randwick
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,School of Medicine and Public Health, University of Newcastle, Newcastle
| | - Davinder Singh-Grewal
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,Department of Rheumatology, The Children's Hospital at Westmead, Westmead.,Discipline of Paediatrics and Child Health, The University of Sydney, Sydney.,School of Maternal and Child Health, University of New South Wales, Randwick.,Department of Rheumatology, Liverpool Hospital, Liverpool, NSW
| | - Kathleen Tymms
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Canberra Rheumatology, Canberra, ACT, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
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Jiang I, Major G, Singh-Grewal D, Teng C, Kelly A, Niddrie F, Chaitow J, O'Neill S, Hassett G, Damodaran A, Bernays S, Manera K, Tong A, Tunnicliffe DJ. Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study. BMJ Open 2021; 11:e039670. [PMID: 33397662 PMCID: PMC7783517 DOI: 10.1136/bmjopen-2020-039670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare. SETTING Face-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia. PARTICIPANTS Fourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14-25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting. RESULTS We identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal-professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety). CONCLUSIONS During transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.
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Affiliation(s)
- Ivy Jiang
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Claris Teng
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ayano Kelly
- Rheumatology, Canberra Rheumatology, Canberra City, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeffrey Chaitow
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Sean O'Neill
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Arvin Damodaran
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney School of Public Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
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6
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Kelly A, Tymms K, Fallon K, Sumpton D, Tugwell P, Tunnicliffe D, Tong A. Qualitative Research in Rheumatology: An Overview of Methods and Contributions to Practice and Policy. J Rheumatol 2021; 48:6-15. [PMID: 32669447 DOI: 10.3899/jrheum.191368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
Patient-centered care is widely advocated in rheumatology. This involves collaboration among patients, caregivers, and health professionals and is particularly important in chronic rheumatic conditions because the disease and treatment can impair patients' health and well-being. Qualitative research can systematically generate insights about people's experiences, beliefs, and attitudes, which patients may not always express in clinical settings. These insights can address complex and challenging areas in rheumatology, such as treatment adherence and transition to adult healthcare services. Despite this, qualitative research comprises 1% of studies published in top-tier rheumatology journals. A better understanding about the effect and role, methods, and rigor of qualitative research is needed. This overview highlights the recent contributions of qualitative research in rheumatology, summarizes the common approaches and methods used, and outlines the key principles to guide appraisal of qualitative studies.
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Affiliation(s)
- Ayano Kelly
- A. Kelly, MBBS, FRACP, College of Health and Medicine, Australian National University, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Canberra Rheumatology, Canberra, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia;
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Kieran Fallon
- K. Fallon, FACSEP, College of Health and Medicine, Australian National University, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Peter Tugwell
- P. Tugwell, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Tunnicliffe
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Wright J, Elwell L, McDonagh J, Kelly D, McClean P, Ferguson J, Wray J. Healthcare transition in pediatric liver transplantation: The perspectives of pediatric and adult healthcare professionals. Pediatr Transplant 2019; 23:e13530. [PMID: 31240785 DOI: 10.1111/petr.13530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/20/2019] [Accepted: 05/25/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Transition from pediatric to adult services of young people with a liver transplant is an important priority due to increasing numbers of young people surviving into adulthood. There is increased incidence of graft loss and non-adherence following transfer to adult services. Although studies have considered the views and perceptions of young people who have undergone liver transplantation and their parents about transition, there is currently no qualitative research with healthcare professionals working in the field of liver transplantation. The aim of this study was to elicit the views of this group of stakeholders about barriers and facilitators of an effective transition process. METHODS Semi-structured interviews were carried out with 11 HCPs from pediatric and adult liver transplant programs and from a range of professional backgrounds. Interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS Four themes were identified: "non-adherence and psychosocial issues," "need for better psychological support," "the role of parents," and "the emotional impact of transition on healthcare professionals." Within these themes, professionals described factors which hindered or promoted an effective transition process. CONCLUSIONS Screening tools which address psychological and social aspects of the lives of young people should be used in routine practice to identify patients requiring psychosocial support and to identify those at risk of non-adherence. All staff involved with transition should be trained in the use of psychosocial screening strategies. The development of a formal referral pathway so that young people can access psychological support in adult services is recommended.
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Affiliation(s)
- Jessica Wright
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Laura Elwell
- Health and Wellbeing, National Grid, Warwick, UK
| | - Janet McDonagh
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Deirdre Kelly
- Liver Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Patricia McClean
- Liver Unit, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - James Ferguson
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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8
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Raunsbæk Knudsen L, de Thurah A, Bjerrum M. Transition from child to adult care in an outpatient clinic for adolescents with juvenile idiopathic arthritis: An inductive qualitative study. Nurs Open 2018; 5:546-554. [PMID: 30338100 PMCID: PMC6177547 DOI: 10.1002/nop2.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 04/25/2018] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this study was to investigate experiences and needs in the transition from child to adult care in an outpatient clinic from the perspective of adolescents with juvenile idiopathic arthritis and their parents focusing on which aspects in the transition could ease the process. DESIGN A qualitative design with an inductive approach. METHODS Inductive content analysis was used to analyse individual interviews with three parents and three adolescents from a rheumatology clinic in Denmark. RESULTS Three descriptive categories emerged: "Information during transition," "Personalized care" and "A change of roles." The comparative analysis of the categories revealed two explanatory themes: "To move from something known to something unknown" and "To develop and change." We found that preparation for transition, information of organisational and procedural changes when entering adult care, continuity and relationships with health professionals characterised by trust as well as involvement of adolescents and parents will ease the process of transition.
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Affiliation(s)
| | - Annette de Thurah
- Department of RheumatologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Merete Bjerrum
- Department of Public Health, Section of NursingAarhus UniversityAarhusDenmark
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9
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Foster HE, Minden K, Clemente D, Leon L, McDonagh JE, Kamphuis S, Berggren K, van Pelt P, Wouters C, Waite-Jones J, Tattersall R, Wyllie R, Stones SR, Martini A, Constantin T, Schalm S, Fidanci B, Erer B, Demirkaya E, Ozen S, Carmona L. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis 2016; 76:639-646. [PMID: 27802961 DOI: 10.1136/annrheumdis-2016-210112] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 02/06/2023]
Abstract
To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks.
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Affiliation(s)
- Helen E Foster
- Newcastle University, Institute of Cellular Medicine (Rheumatology), Newcastle, UK
| | - Kirsten Minden
- Children's University hospital Charité, Campus Virchow, SPZ, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Clemente
- Paediatric Rheumatology Unit, Hospital Infantil Universitario "Niño Jesús", Madrid, Spain
| | - Leticia Leon
- Hospital Cí-nico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Madrid, Spain.,Health Sciences, Universidad Camilo José Cela, Madrid, Madrid, Spain
| | - Janet E McDonagh
- University of Manchester, Centre for Musculoskeletal Research, Manchester, Manchester, UK
| | - Sylvia Kamphuis
- Immunology and Infectiology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | | | - Philomine van Pelt
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Rachel Tattersall
- University of Sheffield, School of Health and Related Research, Sheffield, Sheffield, UK
| | - Ruth Wyllie
- Paediatric Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | - Alberto Martini
- Pediatria II, Universita degli Studi di Genova Scuola di Scienze Mediche e Farmaceutiche, Genova, Liguria, Italy
| | | | - Susanne Schalm
- Transitionssprechstunde am Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Berna Fidanci
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey, Ankara, Turkey
| | - Burak Erer
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erkan Demirkaya
- Gulhane Military Medical Faculty, Pediatric Rheumatology Unit, FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Etlik, Ankara 06018, Turkey, Ankara, Turkey
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey
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10
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Nehring WM, Betz CL, Lobo ML. Uncharted Territory: Systematic Review of Providers' Roles, Understanding, and Views Pertaining to Health Care Transition. J Pediatr Nurs 2015; 30:732-47. [PMID: 26228310 DOI: 10.1016/j.pedn.2015.05.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Health care transition (HCT) for adolescents and emerging adults (AEA) with special health care needs is an emerging field of interdisciplinary field of practice and research that is based upon an intergenerational approach involving care coordination between pediatric and adult systems of health care. Informed understanding of the state of the HCT science pertaining to this group of providers is needed in order to develop and implement service programs that will meet the comprehensive needs of AEA with special health care needs. METHODS The authors conducted a systematic review of the literature on the transition from child to adult care for adolescents and emerging adults (AEA) with special health care needs from 2004 to 2013. Fifty-five articles were selected for this review. An adaptation of the PRISMA guidelines was applied because all studies in this review used descriptive designs. RESULTS Findings revealed lack of evidence due to the limitations of the research designs and methodology of the studies included in this systematic review. Study findings were categorized the following four types: adult provider competency, provider perspectives, provider attitudes, and HCT service models. The discipline of medicine was predominant; interdisciplinary frameworks based upon integrated care were not reported. Few studies included samples of adult providers. CONCLUSIONS Empirical-based data are lacking pertaining to the role of providers involved in this specialty area of practice. Evidence is hampered by the limitations of the lack of rigorous research designs and methodology.
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Affiliation(s)
| | - Cecily L Betz
- Clinical Pediatrics, USC Keck School of Medicine, Department of Pediatrics, University of Southern California University Center of Excellence for Developmental Disabilities at Children's Hospital Los Angeles
| | - Marie L Lobo
- University of New Mexico, College of Nursing, Albuquerque, NM
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11
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Dean L, Black S. Exploring the experiences of young people nursed on adult wards. ACTA ACUST UNITED AC 2015; 24:229-36. [DOI: 10.12968/bjon.2015.24.4.229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Linda Dean
- Senior Lecturer in Children's Nursing, University of Bedfordshire
| | - Sharon Black
- Director of Nurse Education and Deputy Head of School, University of Lincoln
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12
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Voices not heard: A systematic review of adolescents' and emerging adults' perspectives of health care transition. Nurs Outlook 2013; 61:311-36. [DOI: 10.1016/j.outlook.2013.01.008] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/23/2013] [Accepted: 01/28/2013] [Indexed: 11/20/2022]
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13
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Fuchs CE, van Geelen SM, van Geel R, Sinnema G, van de Putte EM, Hermans HJM, Kuis W. Health and identity: Self-positioning in adolescent chronic fatigue syndrome and juvenile idiopathic arthritis. Clin Child Psychol Psychiatry 2013; 18:383-97. [PMID: 23060600 DOI: 10.1177/1359104512455814] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of this study is to gain more insight into basic aspects of identity, in relation to adolescent chronic fatigue syndrome (CFS) and juvenile idiopathic arthritis (JIA). In dialogical self theory, identity is regarded as incorporating multiple self-positions, such as 'I as tired', 'I as pessimistic', or 'I as decisive'. Physical and psychosocial impairment might alter the organization of these self-positions. The Personal Position Repertoire procedure, a quantitative method to analyse the prominence of self-positions, the Child Health Questionnaire, assessing health-related functioning, and the Checklist Individual Strength, measuring fatigue, were completed by 42 adolescents with CFS, 37 adolescents with JIA and 23 healthy teenagers. Adolescents with JIA report impaired physical functioning and general health. However, they position themselves very similar to healthy teenagers - i.e. as strong and healthy. While this self-positioning approach might be adequate and sustainable in adolescence, it could prove too strenuous to maintain throughout adult life. Adolescents with CFS, besides indicating severe physical difficulties, also report more psychosocial problems. They position themselves as significantly less strong and more unwell. With this emphasis on positions relating to their illness, there seems to be little room left for stronger positions. It is regarded of clinical importance to address these issues in this crucial developmental period.
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Affiliation(s)
- Coralie E Fuchs
- Division of Paediatric Psychology, University Medical Centre Utrecht, 3584 EA, Lundlaan 6, KE.04.133.1, Utrecht, The Netherlands.
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14
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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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15
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Hilderson D, Eyckmans L, Van der Elst K, Westhovens R, Wouters C, Moons P. Transfer from paediatric rheumatology to the adult rheumatology setting: experiences and expectations of young adults with juvenile idiopathic arthritis. Clin Rheumatol 2012; 32:575-83. [DOI: 10.1007/s10067-012-2135-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 11/14/2012] [Accepted: 11/26/2012] [Indexed: 11/29/2022]
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16
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van Staa AL, Jedeloo S, van Meeteren J, Latour JM. Crossing the transition chasm: experiences and recommendations for improving transitional care of young adults, parents and providers. Child Care Health Dev 2011; 37:821-32. [PMID: 22007982 DOI: 10.1111/j.1365-2214.2011.01261.x] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transition from paediatric to adult healthcare has received little attention in the Netherlands. This study aimed to: (i) map experiences with the transfer to adult care of young adults with chronic conditions; and (ii) identify recommendations for transitional care of young adults, their parents and healthcare providers. METHODS Semi-structured interviews with 24 young adults after transfer (aged 15-22 years; diagnosed with haemophilia, diabetes mellitus, spina bifida, congenital heart disorders, cystic fibrosis, juvenile rheumatoid arthritis or sickle cell disease), 24 parents and 17 healthcare providers. Thematic analysis was performed. RESULTS Only the haemophilia department offered a structured transition programme, most patients had not been prepared for transition. Experiences and views of patients, parents and professionals mainly overlapped and were condensed into four core themes. Two are related to moving to adult care: (1) 'leaving paediatric care is a logical step'. Leaving familiar surroundings was harder for parents than for young adults who displayed a positive 'wait-and-see' attitude; and (2) 'transition is complicated by cultural gaps between paediatric and adult services'. Young adults and parents felt lost after transfer and recommended their peers 'to be alert and involved'. Providers also recognized the cultural chasm between both services and worried about non-compliance, lost to follow-up and lack of independence. Two other themes indicated priorities for improvement: (3) 'better patient and parent preparation' for differences between healthcare settings and for new roles and responsibilities with respect to self-management; and (4) 'more collaboration and personal links' between paediatric and adult care providers. CONCLUSIONS Action is required to cross the chasm between paediatric and adult-oriented care. Preparation for transition should start early and focus on strengthening adolescents' independency without undermining parental involvement. Building bridges between services, gaining trust and investing in new personal relations is a challenge for all parties involved: transition is about responding and bonding.
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Affiliation(s)
- A L van Staa
- Expertise Centre Transitions of Care, Rotterdam University, Rotterdam, The Netherlands.
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Lugasi T, Achille M, Stevenson M. Patients' perspective on factors that facilitate transition from child-centered to adult-centered health care: a theory integrated metasummary of quantitative and qualitative studies. J Adolesc Health 2011; 48:429-40. [PMID: 21501800 DOI: 10.1016/j.jadohealth.2010.10.016] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 10/28/2010] [Accepted: 10/30/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this review was twofold. First, to summarize systematically the state of the research conducted on the perspective of patients on transition from child-centered care to adult-centered care (ACC). Second, based on this review of patients' perspective, to identify factors that facilitate transition to ACC. METHODS Using a metasummary methodology, we extracted, grouped, and abstracted the findings from 46 qualitative and descriptive quantitative studies involving patients before and/or after their transfer to ACC. RESULTS Empirical results on transition fall into four groups: (1) patients' feelings and concerns; (2) patients' recommendations about transition; (3) outcomes after transfer; and (4) mode of transfer. CONCLUSIONS Results are discussed within a theoretical transition framework that emphasizes the importance of fulfilling five conditions that will lead to successful transition. Given our findings, this synthesis and framework can be used to tailor transition care and direct future research.
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Affiliation(s)
- Tziona Lugasi
- Department of Psychology, Universitè de Montrèal, Montreal, Quebec, Canada.
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Abstract
A number of studies published over the past 10 years have examined the long-term health, functional and quality of life outcomes of adults with childhood-onset rheumatic diseases such as juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis and localized scleroderma. As increasing numbers of patients with these conditions survive into adulthood, understanding the adult outcomes of these pediatric conditions has become ever-more important. Identifying modifiable risk factors for poor outcomes is vital to improving care for these patients. In addition, as these conditions and their treatments can affect cardiovascular health, bone health and fertility, particular attention needs to be paid to these outcomes. Preparing patients and their families for a successful transition from pediatric to adult rheumatology care is an important first-step in the long-term management strategy for this expanding patient population.
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Östlie IL, Johansson I, Möller A. Struggle and adjustment to an insecure everyday life and an unpredictable life course. Disabil Rehabil 2009; 31:666-74. [DOI: 10.1080/09638280802305986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moons P, Pinxten S, Dedroog D, Van Deyk K, Gewillig M, Hilderson D, Budts W. Expectations and experiences of adolescents with congenital heart disease on being transferred from pediatric cardiology to an adult congenital heart disease program. J Adolesc Health 2009; 44:316-22. [PMID: 19306789 DOI: 10.1016/j.jadohealth.2008.11.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/04/2008] [Accepted: 11/12/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the expectations and experiences of adolescents on transferring from a pediatric cardiology program to an adult congenital heart disease program. METHODS A qualitative, phenomenologic study was conducted, in which semi-structured, in-depth interviews were performed with 14 adolescents (aged 15-17 years) with congenital heart disease. Interviews were tape-recorded and transcribed verbatim. Data were analyzed using procedures described by Colaizzi. RESULTS The study identified six themes that characterized adolescents' views of the transfer process: leaving pediatric cardiology was viewed as normal; leaving behind familiar surroundings; a positive wait-and-see attitude toward the adult congenital heart disease program; adjusting to a new environment; a need for better information; and a shift in roles between the adolescent and his parents. CONCLUSION Although adolescents with congenital heart disease have a positive attitude toward transferring to an adult congenital heart disease program, they identified aspects of the transfer that healthcare professionals need to address. Patients and their families should be prepared for the transfer by informing them about the adult program and its healthcare providers. A formal transition program can play a role in this respect.
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Affiliation(s)
- Philip Moons
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium.
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