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Goulet O, Payen E, Talbotec C, Poisson C, Rocha A, Brion K, Madras M, Eicher I, Martinez I, Bégo C, Chasport C, Ollivier J, Godot C, Villain C, Joly F, Lambe C. An innovative educational program for adolescents on home parenteral nutrition for the "transition" to adulthood. JPGN Rep 2024; 5:126-134. [PMID: 38756138 PMCID: PMC11093938 DOI: 10.1002/jpr3.12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 05/18/2024]
Abstract
Facing with an increasing demand for transition to adult care management, our home parenteral nutrition (HPN) team designed an adolescent therapeutic educational program (ATEP) specifically intended for adolescents on long-term HPN. The aim of this study was to report on the first sessions of this program. Methods The ATEP is designed in three sessions of five consecutive days, during school holidays over the year. It includes group sessions on catheter handling, disconnecting and connecting the PN and catheter dressing, dealing with unforeseen events (e.g., fever or catheter injury), but also sessions with psychologist, social worker, sports teacher, fashion specialist, meeting with adults who received HPN since childhood. Specific course for the accompanying parents were also provided. Six months after the last session, a 3-day trip to the attraction park "le Futuroscope," Poitiers, France, was organized without any parental presence. Results After 3 ATEP courses, a total of 16 adolescents have been enrolled. They were aged between 13 and 17 years (median 14 IQR: 14-16.25). All were on long term HPN started during the neonatal period except for four who started PN at a median age of 10 years old (IQR: 1-10). At the time of the ATEP, their median PNDI was 105% (IQR: 95.5-120.8) while receiving a median of six infusions per week (IQR: 5-7). Thirteen received Taurolidine lock procedure. After the ATEP, 11 adolescents could be considered as fully autonomous, 4 as partially autonomous and one failed to gain any autonomy. Course evaluation by adolescents or parents was good to excellent. Conclusion Through the holistic and multiprofessional approach of this training and the group cohesion, the adolescents were not only able to handle catheter care and PN connections but were able to understand and accept better their illness and project themselves into their own future.
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Affiliation(s)
- Olivier Goulet
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
| | - Elise Payen
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
| | - Cécile Talbotec
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
| | - Catherine Poisson
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
- Unité transversale d'éducation thérapeutique (UTET), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris DescartesParisFrance
| | - Amelia Rocha
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
- Unité transversale d'éducation thérapeutique (UTET), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris DescartesParisFrance
| | - Karina Brion
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
- Unité transversale d'éducation thérapeutique (UTET), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris DescartesParisFrance
| | - Marie‐Bernadette Madras
- Unité transversale d'éducation thérapeutique (UTET), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris DescartesParisFrance
| | - Isabelle Eicher
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
| | - Isabelle Martinez
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
| | - Clémence Bégo
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
| | - Céline Chasport
- Hospital Pharmacy, Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris DescartesParisFrance
| | - Julie Ollivier
- Social Assistance Office, Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris DescartesParisFrance
| | - Cécile Godot
- Unité transversale d'éducation thérapeutique (UTET), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris DescartesParisFrance
| | - Claude Villain
- Division of Gastroenterology and Nutrition, Beaujon HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in adultsClichyFrance
| | - Francisca Joly
- Division of Gastroenterology and Nutrition, Beaujon HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in adultsClichyFrance
| | - Cécile Lambe
- Division of Pediatric Gastroenterology and Nutrition (DPGN), Necker‐Enfants Malades HospitalUniversity of Paris Cité‐UFR Paris Descartes, Certified Expert Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in ChildrenParisFrance
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Pitts L, Patrician PA, Landier W, Kazmerski T, Fleming L, Ivankova N, Ladores S. Parental entrustment of healthcare responsibilities to youth with chronic conditions: A concept analysis. J Pediatr Nurs 2024; 76:1-15. [PMID: 38309191 DOI: 10.1016/j.pedn.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Chronic health conditions impact nearly 40% of children in the United States, necessitating parents/caregivers to entrust healthcare responsibilities to youth aging into adulthood. Understanding the parental entrustment process may lead to tailored transition support; however, the concept lacks conceptual clarity, limiting its research and practical applications. DESIGN AND METHODS Rodgers' evolutionary concept analysis method was used to clarify the parental entrustment of healthcare responsibilities to youth with chronic health conditions. PubMed, CINAHL, and PsycINFO databases were searched without date restrictions, including full-text, English-language, primary source articles related to parent-child healthcare transition preparation. Following title, abstract, and full-text screenings, data were analyzed using a hybrid thematic approach to identify antecedents, attributes, and consequences. RESULTS Forty-three studies from August 1996 to September 2023 were identified. Antecedents encompass social cues and readiness factors, while attributes involve a) responsibility transfer, support, and facilitation, b) a dynamic process, c) balancing trust and fear, d) navigating conflict, and e) parental letting go. Consequences entail shifts in parental and adolescent roles. Parental entrustment is an iterative process wherein parents guide their maturing child through responsibility transfer via facilitation, support, conflict navigation, and trust building. CONCLUSION The clarified concept underscores the role of parents/caregivers in empowering youth to manage their health. Introducing a working definition and conceptual model contributes to understanding the processes families navigate in the larger landscape of healthcare transition. PRACTICE IMPLICATIONS This clarification holds implications for clinicians and policymakers, offering insights to enhance support and guidance for families navigating healthcare transition.
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Affiliation(s)
- Leslie Pitts
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Patricia A Patrician
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Wendy Landier
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama Heersink School of Medicine, Division of Pediatric Hematology/Oncology, 1600 7th Avenue South, Lowder 512, Birmingham, AL 35233, United States.
| | - Traci Kazmerski
- The University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University Center, 120 Lytton St.-Suite M060, Pittsburgh, PA 15213, United States.
| | - Louise Fleming
- The University of North Carolina at Chapel Hill, School of Nursing, 105 Carrington Hall, Chapel Hill, NC 37599, United States.
| | - Natalyia Ivankova
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States; The University of Alabama at Birmingham, School of Health Professions, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
| | - Sigrid Ladores
- The University of Alabama at Birmingham, School of Nursing, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Miyagishima K, Ichie K, Sakaguchi K, Kato Y. The parental involvement process regarding childhood cancer survivors becoming independent: Focus on balancing health management and social lives from adolescence to adulthood. Jpn J Nurs Sci 2024; 21:e12572. [PMID: 37937387 DOI: 10.1111/jjns.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/15/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023]
Abstract
AIM This study aimed to elucidate the parental involvement process regarding childhood cancer survivors' (CCSs') independence while balancing their health management and social lives from adolescence to adulthood to obtain suggestions for long-term support for CCSs and their parents. METHODS Semi-structured interviews were conducted with 19 parents of Japanese CCSs aged 16-25 years. The data were then qualitatively analyzed using the modified grounded theory approach. RESULTS Three "categories" and 20 "concepts" were generated. The connections among these categories and concepts revealed the parental involvement process regarding CCSs' independence while balancing their health management and social lives. The first phase in this process is to "support careful behaviors," mainly during CCSs' treatment in the outpatient clinic or shortly after discharge. As CCSs recover after cancer treatment, parents "watch over, but feel conflicted," with "conflicts between protecting their sons/daughters and giving them independence." Then, parents reach a phase in which they "acknowledge and entrust," which includes "acknowledgment of development and efforts" of their sons/daughters, and develop an "attitude to entrust medical checkups to their sons/daughters, along with their preparation." The influencing factors of the three phases include "ongoing anxieties about the late effects of therapy and recurrence" and an "expectation for their sons/daughters to acquire abilities for living independently." CONCLUSIONS These findings suggest that nurses need to accept parents' feelings and thoughts regarding conflicts with CCSs, recognition of CCSs' development, and values. These processes may help nurses and health-care professionals support parents from a comprehensive perspective.
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Affiliation(s)
- Kyoko Miyagishima
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuko Ichie
- Faculty of Nursing, Seirei Christopher University, Hamamatsu, Japan
| | | | - Yuka Kato
- Department of Nursing, Shizuoka Children's Hospital, Shizuoka, Japan
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Lykkeberg B, Noergaard MW, Bjerrum M. Experiences and expectations of parents when young people with congenital heart disease transfer from pediatric to adult care: A qualitative systematic review. J Child Health Care 2024:13674935241231024. [PMID: 38332483 DOI: 10.1177/13674935241231024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Parents encounter challenges when their child with congenital heart disease is transferred from pediatric to adult care. Until recently these parents' experiences and expectations of their child's transfer have received less attention. This systematic review aims to identify and synthesize qualitative evidence on parental experiences and expectations about their child's transfer from pediatric to adult care using a meta-aggregation approach. Six studies were included with 39 findings being aggregated into seven categories. Three syntheses were formed: Information is a prerequisite for supporting young people's transfer. The transition process should be well-prepared, individualized, and based on young people's maturity. Changing parental roles causes ambivalent feelings requiring support in the transfer process. Parents regard transfer from pediatric to adult care as a natural developmental step. However, some parents are anxious and worried while others found the transfer as feasible as other transitions in their child's life. Involving parents in the transition process enables them to facilitate their child's transfer. Parents worry their child is too young to take responsibility for their health. Parental roles from being a full caregiver to becoming a supportive person cause ambivalent feelings. These findings align with research on parents' experiences of young people with long-term conditions.
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Affiliation(s)
- Birgitte Lykkeberg
- Cardiology Clinic, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Marianne Wetendorff Noergaard
- Centre of Clinical Guidelines, Department of Clinical Medicine and Danish Centre of Systematic Reviews - JBI Centre of Excellence, University of Adelaide, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Merete Bjerrum
- Centre of Clinical Guidelines, Department of Clinical Medicine and Danish Centre of Systematic Reviews - JBI Centre of Excellence, University of Adelaide, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Nursing and Health Care, Department of Public Health, Aarhus University, Aarhus, Denmark
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5
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Yap NYS, Patil P, Phoenix C, Russell KB, Lewis C, Yates R, Kelsall W. Successful transition for adolescent survivors of CHD: the Cambridge cardiac transition pathway. Cardiol Young 2023; 33:2639-2643. [PMID: 37127728 DOI: 10.1017/s1047951123000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE National standards to ensure effective transition and smooth transfer of adolescents from paediatric to adult services are available but data on successful transition in CHD are limited. The aim of this study is to assess the effectiveness of our transition pathway. METHODS Adolescents with CHD, aged 15-19 years, who attended the joint cardiac transition clinic between 2009 and 2018 were identified from the Patient Administration Systems. Patient attendance at their first adult CHD service appointment at Royal Papworth Hospital was recorded. RESULTS 179 adolescents were seen in the joint cardiac transition clinic in the 9-year study period. The median age of the patients when seen was 16 (range 15-19) years. 145 patients were initially planned for transfer to the Royal Papworth Hospital adult CHD service. Three patients were subsequently excluded and the success of the transfer of care in 142 patients were analysed. 112 (78%) attended their first follow-up in the adult CHD clinic as planned, 28 (20%) attended after reminders were sent out with 5/28 requiring multiple reminders, and only 2 (1.4%) failed to attend. Overall, transfer of care was achieved in 140 (98.6%) patients. CONCLUSION A dedicated joint cardiac transition clinic involving multi-professional medical and nursing teams from paediatric and adult cardiology services appears to achieve high engagement rates with the adult services. This approach allows a 'face' to be put on a named clinician delivering the adult service and should be encouraged.
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Affiliation(s)
- Norah Y S Yap
- Department of Paediatric Cardiology, University Hospital Southampton, Tremona Road, SouthamptonSO16 6YD, England, UK
| | - Parth Patil
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0QQ, England, UK
| | - Carole Phoenix
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, CambridgeCB23 3RE, England, UK
| | - Katie Bradly Russell
- Department of Paediatrics, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0QQ, England, UK
| | - Clive Lewis
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, CambridgeCB23 3RE, England, UK
| | - Robert Yates
- Department of Cardiology, Great Ormond Street Hospital, Great Ormond Street, LondonWC1N 3JH, England, UK
| | - Wilf Kelsall
- Department of Paediatrics, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0QQ, England, UK
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Rhee H, Batek L, Rew L, Tumiel-Berhalter L. Parents' Experiences and Perceptions of Healthcare Transition in Adolescents with Asthma: A Qualitative Study. Children (Basel) 2023; 10:1510. [PMID: 37761471 PMCID: PMC10527731 DOI: 10.3390/children10091510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents' experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16-17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens' transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Lynn Rew
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14203, USA;
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Bokova E, Svetanoff WJ, Levitt MA, Rentea RM. Pediatric Bowel Management Options and Organizational Aspects. Children 2023; 10:children10040633. [PMID: 37189882 DOI: 10.3390/children10040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.
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Fishman LN, Shanske S, McKenna KD. Putting the Good in Goodbye: The Pediatrician's Role in Framing a Positive Transition to Adult Care. Clin Pediatr (Phila) 2022; 61:669-673. [PMID: 35678061 DOI: 10.1177/00099228221102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laurie N Fishman
- Division of Gastroenterology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan Shanske
- Department of Social Work, Boston Children's Hospital, Boston, MA, USA.,BRIDGES Adult Transition Program, Boston Children's Hospital, Boston, MA, USA
| | - Kristine D McKenna
- Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
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Geuens S, Leyen K, Raymaekers K, Prikken S, Willen J, Goemans N, De Waele L, Lemiere J, Luyckx K. Illness Perceptions and Illness Identity in Adolescents and Emerging Adults With Neuromuscular Disorders. Clin Child Psychol Psychiatry 2022:13591045221125631. [PMID: 36112900 DOI: 10.1177/13591045221125631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neuromuscular disorders (NMD) are intrusive medical conditions with implications for psychosocial development. OBJECTIVES This paper explores illness perceptions and illness identity dimensions of youth with NMD. First, we compare illness identity outcomes and illness perceptions of NMD patients with a comparison group of adolescents with type 1 diabetes mellitus (DM). Second, we report about the relationships between NMD-related variables and illness perceptions and illness identity. METHODS Scores on the Brief Illness Perception Questionnaire and the Illness Identity Questionnaire were compared between a group of NMD patients (N = 59; 12-22 years) and an age- and gender-matched group of DM patients (N = 118). NMD-related variables included time since diagnosis, prognosis, wheelchair use, and physical limitations. RESULTS Youth with NMD scored significantly higher on two of the four illness identity dimensions than youth with DM. NMD patients reported significantly less positive illness perceptions, experienced more physical symptoms, and had a lower score on understanding of their illness. Within the NMD group, wheelchair-users have a better understanding of their disease than those who are not wheelchair-bound. CONCLUSIONS The present study is the first to investigate illness identity and illness perceptions in NMD. More research is needed to provide insight in the identity formation process of the growing group of adolescents with NMDs.
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Affiliation(s)
- Sam Geuens
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Leuven, Belgium
| | - Kathelijne Leyen
- School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium
| | - Koen Raymaekers
- School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium.,60182FWO Vlaanderen (Research Foundation Flanders), Leuven, Belgium
| | - Sofie Prikken
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium.,60182FWO Vlaanderen (Research Foundation Flanders), Leuven, Belgium
| | - Joanna Willen
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Goemans
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Leuven, Belgium
| | - Liesbeth De Waele
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Child Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium.,UNIBS, 60182University of the Free State, Bloemfontein, South Africa
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10
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Ellison JL, Brown RE, Ameringer S. Parents' experiences with health care transition of their adolescents and young adults with medically complex conditions: A scoping review. J Pediatr Nurs 2022; 66:70-78. [PMID: 35653900 DOI: 10.1016/j.pedn.2022.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Health care transition (HCT) has become increasingly important as adolescents and young adults (AYAs) with complex medical conditions now live well into adulthood but little attention has been given to parents of AYAs preparing for HCT. OBJECTIVE This scoping review aimed to identify and synthesize information on parental facilitators and barriers to health care transition readiness. ELIGIBILITY CRITERIA English-language, peer-reviewed original studies focused on the parents' experience of HCT were included. Studies were excluded if AYAs were not anticipated to be independent or if AYAs had only mental health disorders. CHARTING METHODS Parent-reported facilitators and barriers were identified in each study and then categorized to identify common themes. RESULTS Themes related to parental facilitators included evidence of coordination between pediatric and adult levels of care, healthcare provider guidance for HCT, and parental awareness and acceptance of natural seasons of life. Themes related to parental barriers included relationship loss, loss of parental role, lack of knowledge and/or skills, and concerns related to the health care system in general. CONCLUSION Common facilitators and barriers were found across studies, regardless of medical diagnosis. Relationships and role change figure prominently in parents' perceptions of the HCT experience and their readiness for their AYA children to transition. These findings suggest potential areas for future research inquiry as well as potential nursing interventions designed to aid parents through HCT.
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Affiliation(s)
| | - Roy E Brown
- Health Sciences Library, Virginia Commonwealth University, USA
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11
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Violani C, Grano C, Fernandes M, Prato AP, Feitz WFJ, Wijnen R, Battye M, Schwarzer N, Lemli A, Cavalieri D, Aminoff D. The Transition of Care for Patients with Anorectal Malformations and Hirschsprung Disease: A European Survey. Eur J Pediatr Surg 2022; 33:191-197. [PMID: 35830861 DOI: 10.1055/s-0042-1749212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This study aimed at evaluating how transition of care is currently being organized in the European Reference Networks (ERNs) health care providers (HCPs) in pediatric areas and in the Anorectal Malformation Network (ARM-Net) Consortium hospitals. An online questionnaire was sent to a total of 80 surgeons, members of or affiliated members of three networks: ARM-Net Consortium, ERN eUROGEN, and ERN ERNICA. Complete information were obtained for 45 HCPs, most of which deal with transition and still see a few adult patients (ca. 10%). Gynecological, gastroenterological, urological, colorectal, and continence issues were the major problems described by adult patients to their physicians, and in line with these prevalent complaints, they are referred to the appropriate adult specialists. Forty percent of patients complain about sexual and fertility problems, but the percentage of andrologists and sexologists involved in the caring of adult patients with ARM/Hirschsprung's disease is low, just above 10.9%. Most hospitals deal with transition, but three basic criteria (i.e., presence of: [1] an official written transitional program, [2] a transitional coordinator, and [3] written information on transition to be handled to patients) are jointly met only by six HCPs. According to the responders, the most important issue requiring improvement is the lack of interest and of specific preparation by adult specialists. The overall results of this exploratory survey confirm the need for the development of comprehensive programs for transition in these rare and complex diseases, and identify the hospitals that, in collaboration with the networks, could share best practices in organizing structured transitional pathways and well follow-ups.
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Affiliation(s)
- Cristiano Violani
- Department of Psychology, Faculty of Medicine and Psychology, University of Rome Sapienza, Roma, Lazio, Italy
| | - Caterina Grano
- Department of Psychology, Faculty of Medicine and Psychology, University of Rome Sapienza, Roma, Lazio, Italy
| | - Mariana Fernandes
- Department of Psychology, Faculty of Medicine and Psychology, University of Rome Sapienza, Roma, Lazio, Italy
| | - Alessio Pini Prato
- Umberto Bosio Center for Digestive Diseases, The Children Hospital - AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Piedmont, Italy
| | - Wout F J Feitz
- Department of Pediatric Urology, Radboud Universiteit Nijmegen, Nijmegen, Gelderland, the Netherlands
| | - Rene Wijnen
- Department of Pediatric Surgery, Erasmus MC Sophia, Rotterdam, the Netherlands
| | - Michelle Battye
- Department of Pediatric Urology, Radboud Universiteit Nijmegen, Nijmegen, Gelderland, the Netherlands
| | | | | | - Duccio Cavalieri
- Department of Biology, University of Florence, Italian Patient's Organization for Hirschsprung Disease (AMHORI), Firenze, Toscana, Italy
| | - Dalia Aminoff
- Italian Patient's Organization for ARM (AIMAR) - Patient Organization, Via Nomentana, Rome, Italy
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12
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Močnik M, Golob Jančič S, Marčun Varda N. Transition of Chronic Pediatric Nephrological Patients to Adult Care Excluding Patients on Renal Replacement Therapy with Literature Review. Children 2022; 9:959. [PMID: 35883943 PMCID: PMC9317370 DOI: 10.3390/children9070959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: The transition of children with chronic kidney disease to adult care has become a well-handled issue. However, other patients with normal or mildly decreased renal function also requiring further management and transition are neglected. (2) Methods: A questionnaire was sent to patients with kidney pathology, aged 17 years and older.(3) Results: The patients were mostly high-school (55%) or college students (39%), living with their parents (94%). One third did not know how their disease affected their choice of profession and reproductive health. Furthermore, 46% of the respondents did not know who would continue with their care, and 44% still had a primary pediatrician. (4) Conclusions: A review of the literature on the topic was performed and summarized here. Regular education is the key for successful transfer, not only in chronic kidney and transplant patients, but also in others in whom a decline in renal function can be expected in the future.
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13
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Fu N, Bollegala N, Jacobson K, Kroeker KI, Frost K, Afif W, El-Matary W, Fowler SA, Griffiths AM, Huynh HQ, Jantchou P, Karimuddin A, Nguyen GC, Otley AR, Pears C, Seow CH, Toulany A, Tersigni C, Tignanelli J, Marshall JK, Boctor M, Hansen T, Pattni C, Wong A, Benchimol EI. Canadian Consensus Statements on the Transition of Adolescents and Young Adults with Inflammatory Bowel Disease from Pediatric to Adult Care: A Collaborative Initiative Between the Canadian IBD Transition Network and Crohn’s and Colitis Canada. J Can Assoc Gastroenterol 2022; 5:105-115. [PMID: 35669843 PMCID: PMC9157291 DOI: 10.1093/jcag/gwab050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives With the increased prevalence of childhood-onset inflammatory bowel disease (IBD), there is a greater need for a planned transition process for adolescents and young adults (AYA). The Canadian IBD Transition Network and Crohn’s and Colitis Canada joined in collaborative efforts to describe a set of care consensus statements to provide a framework for transitioning AYA from pediatric to adult care. Methods Consensus statements were drafted after focus group meetings and literature reviews. An expert panel consisting of 20 IBD physicians, nurses, surgeon, adolescent medicine physician, as well as patient and caregiver representatives met, discussed and systematically voted. The consensus was reached when greater than 75% of members voted in agreement. When greater than 75% of members rated strong support, the statement was rendered a strong recommendation, suggesting that a clinician should implement the statement for all or most of their clinical practice. Results The Canadian expert panel generated 15 consensus statements (9 strong and 6 weak recommendations). Areas of focus of the statements included: transition program implementation, key stakeholders, areas of potential need and gaps in the research. Conclusions These consensus statements provide a framework for the transition process. The quality of evidence for these statements was generally low, highlighting the need for further controlled studies to investigate and better define effective strategies for transition in pediatric to adult IBD care.
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Affiliation(s)
- Nancy Fu
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Natasha Bollegala
- Division of Gastroenterology, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Karen I Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Frost
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Waqqas Afif
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Wael El-Matary
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharyle A Fowler
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anne M Griffiths
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hien Q Huynh
- Division of Pediatric GI Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Prévost Jantchou
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada
| | - Ahmer Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey C Nguyen
- Department of Medicine, Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony R Otley
- Division of Pediatric Gastroenterology & Nutrition, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alene Toulany
- Division of Adolescent Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Tersigni
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - John K Marshall
- Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Monica Boctor
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tawnya Hansen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chandni Pattni
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric I Benchimol
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Terada K, Kakuda H, Iida N, Nakajima Y, Inoue F, Yoshino M, Okimoto Y, Maeda M. A questionnaire study of support for adult survivors of childhood cancer. Pediatr Int 2022; 64:e15047. [PMID: 34727406 DOI: 10.1111/ped.15047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/10/2021] [Accepted: 11/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Childhood cancer survivors (CCSs) entering adulthood experience different problems, including late therapy-related complications. Long-term follow up (LTFU) is important for early intervention and psychosocial support for CCSs with late complications but it is frequently discontinued. This study aimed (i) to identify clearly the factors responsible for LTFU discontinuation, and (ii) to define the support needs of CCSs. METHODS From July, 2017 to March, 2019 we conducted a questionnaire survey of 121 CCSs aged ≥ 18 years at the time of the survey to investigate people who have experienced childhood cancer and identify their support needs. This was conducted in cooperation with patient associations throughout Japan. The LTFU levels were determined by CCSs themselves based on their treatment history. Long-term follow-up rates and LTFU discontinuation factors were assessed using the Kaplan-Meier method and the Cox proportional-hazards model. RESULTS Late complications were the most common problem encountered by CCSs (80%). The most common support need was "explanation of late complications by a physician," reported by 86.9% of respondents. The rate of LTFU continuation decreased over time. The LTFU was discontinued both for physicians' reasons (35.6%) and patients' reasons (64.4%). Not knowing the extent or level of one's LTFU was reported to be an independent factor (P < 0.05) preventing LTFU continuation. As necessary support to continue LTFU, 67.9% of respondents stated the need for "explanation of LTFU by a doctor" and 60.7% stated "convenience of outpatient visit". CONCLUSIONS Childhood cancer survivors require support, especially for late complications. It is necessary to continue LTFU, raising LTFU awareness among physicians and CCSs.
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Affiliation(s)
- Kazuki Terada
- Department of Hematology, Nippon Medical School, Tokyo, Japan.,NPO Millefeuille Childhood Cancer Frontiers, Chiba-City, Chiba, Japan
| | - Harumi Kakuda
- NPO Millefeuille Childhood Cancer Frontiers, Chiba-City, Chiba, Japan.,Department of Hematology/Oncology, Chiba Children's Hospital, Chiba-City, Chiba, Japan
| | - Naomi Iida
- NPO Millefeuille Childhood Cancer Frontiers, Chiba-City, Chiba, Japan
| | - Yayoi Nakajima
- NPO Millefeuille Childhood Cancer Frontiers, Chiba-City, Chiba, Japan
| | - Fumiko Inoue
- NPO Millefeuille Childhood Cancer Frontiers, Chiba-City, Chiba, Japan
| | - Mio Yoshino
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Yuri Okimoto
- NPO Millefeuille Childhood Cancer Frontiers, Chiba-City, Chiba, Japan.,Department of Hematology/Oncology, Chiba Children's Hospital, Chiba-City, Chiba, Japan
| | - Miho Maeda
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
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15
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DeLong CG, McLaughlin CJ, Kulaylat AN, Cilley RE. Development of a Standardized Program for the Collaboration of Adult and Children's Surgeons. J Surg Res 2021; 269:36-43. [PMID: 34517187 DOI: 10.1016/j.jss.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children's hospitals within larger hospitals (CH/LH) have the specific clinical advantage of easily facilitated collaboration between adult and children's surgeons. These collaborations, which we have termed hybrid surgical offerings (HSOs) are often required for disease processes requiring interventions that fall outside the customary practice of children's surgeons. Formal models to describe or evaluate these practices are lacking. METHODS HSOs within a CH/LH were identified. Principles of systems-engineering were used to develop a standardized model (Children's Hybrid Enhanced Surgical Services [CHESS]) to describe and evaluate HSOs. Face validity was established via unstructured interviews of CH leaders and HSO surgeons. Areas for improved system-wide standardization and programmatic development were identified. RESULTS HSOs were identified in collaboration with adult bariatric, minimally invasive, advanced endoscopic, endocrine, thoracic, and orthopedic trauma surgical services. The CHESS framework encompassed: 1) quality improvement metrics, 2) credentialing and oversight, 3) transitions of care, 4) pediatric family-centered care, 5) maintenance of the cycle of expertise, 6) continuing medical education, 7) scholarship. While HSOs fulfilled the majority of aforementioned programmatic domains across all six HSO-providing services, areas for improvement included maintaining a cycle of expertise (33%), quality improvement metrics (50%), and pediatric family-centered care (66%). Additional noted advantages included faster translation of adult innovation to pediatric care and facilitation of emergency interdisciplinary care. CONCLUSION Formal evaluation of HSOs is necessary to standardize and improve the quality of children's surgical care. Development of a structured framework such as CHESS addresses gaps in quality oversight and provides a basis for performance improvement, patient safety, and programmatic development.
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16
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Yeung NCY, Cheung KC, Chau HC, Leung AWK, Li CK, Lam TTN, Cheng HY, Cheung YT. Transition from Acute Treatment to Survivorship: Exploring the Psychosocial Adjustments of Chinese Parents of Children with Cancer or Hematological Disorders. Int J Environ Res Public Health 2021; 18:ijerph18157815. [PMID: 34360108 PMCID: PMC8345777 DOI: 10.3390/ijerph18157815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023]
Abstract
Objectives: Parents of children diagnosed with critical illnesses face multiple challenges during their caregiving experience. However, relevant studies have been limited in the Chinese context. Guided by the stress and coping model, we conducted a qualitative study to identify the stressors, coping strategies, and adjustment experiences of Hong Kong parents of children with cancer or hematological disorders. Methods: We recruited 15 parents of children with cancer or hematological disorders requiring bone marrow transplantation and were currently >2 years post-treatment. They participated in a 30-min semi-structured interview. Thematic analysis was performed using the grounded theory approach. Results: The stressors reported by parents included a high caregiving burden during their children’s diagnosis and treatment stages. The fear of recurrence, the need for information, and concerns about late effects were also common among the parents during their children’s transition/survivorship stage. To cope with these stressors, the parents commonly used problem-focused (e.g., seeking help from professionals and support groups) and emotion-focused (e.g., behavioral distractions, venting, and crying) strategies. Despite these stressors, parents reported positive changes through the caregiving experience, such as improved family relationships, developing health-protective habits, and the reprioritization of different aspects of life. Conclusions: Parents encounter different stressors during the cancer care continuum. Using different coping strategies, parents experience positive changes amidst caregiving. Future studies should explore culturally relevant adaptive coping strategies to enhance parents’ psychosocial adjustment.
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Affiliation(s)
- Nelson Chun Yiu Yeung
- Faculty of Medicine, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Correspondence: (N.C.Y.Y.); (Y.T.C.)
| | - Ka Chun Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
| | - Ho Cheung Chau
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
| | - Alex Wing Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong; (A.W.K.L.); (C.K.L.)
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Chi Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong; (A.W.K.L.); (C.K.L.)
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Teddy Tai Ning Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
- Little Life Warriors Society Hong Kong, Hong Kong
| | - Ho Yu Cheng
- Faculty of Medicine, Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong;
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
- Correspondence: (N.C.Y.Y.); (Y.T.C.)
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Abstract
PURPOSE OF REVIEW Many pediatric liver transplant patients are surviving to adulthood, and providers have come to recognize the importance of effectively transitioning these patients to an adult hepatologist. The review aims to analyze the most recent literature regarding patient outcomes after transition, barriers to successful transition, recommendations from clinicians and medical societies regarding transition programs, and to provide personal insights from our experience in transitioning liver transplant recipients. RECENT FINDINGS While results were variable between studies, many recent reports show significant morbidity and mortality in patients following transition to adult care. Medical non-adherence is frequently seen in adolescents and young adults both prior to and after transition, and is consistently associated with higher rates of rejection, graft loss, and death. In general, transplant programs with a formal transition process had better patient outcomes though recent findings are mostly-single center and direct comparison between programs is difficult. Societal recommendations for how to create a transition program contain a number of common themes that we have categorized for easier understanding. Successful transition is vital to the continued health of pediatric liver transplant patients. While an effective transition program includes a number of key components, it should be individualized to best function within a given transplant center. Here, we have reviewed a number of recent single-center retrospective studies on transition, but multi-site retrospective or prospective data is lacking, and is a fertile area for future research.
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Affiliation(s)
- James P Stevens
- Department of Pediatrics, Division of Gastronterology, Hepatology and Nutrition, Emory University School of Medicine, Atlanta, GA, USA.,Transplant Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lori Hall
- Transplant Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Nitika Arora Gupta
- Department of Pediatrics, Division of Gastronterology, Hepatology and Nutrition, Emory University School of Medicine, Atlanta, GA, USA. .,Transplant Services, Children's Healthcare of Atlanta, Atlanta, GA, USA. .,, Atlanta, USA.
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18
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Vergne C, Blin N, Mallet J, Thomas B, Moles MP, Schmidt A, Proust S. [Transition to adulthood: An essential period in the follow up of young patients]. Bull Cancer 2021; 108:151-158. [PMID: 33446332 DOI: 10.1016/j.bulcan.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/25/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
In recent decades, follow-up of cancer survivors has taken on its full meaning with the gradual improvement in the survival of children and adolescents with cancer. This follow-up is associated specially for adolescents with a multitude of transitions: the transition from therapeutic management to the monitoring for possible relapse, the transition into long-term follow-up after childhood cancer, the transition from a pediatric system to an adult care system. If this transition can be perceived as difficult by patients, it gives young people the opportunity to access more autonomous follow-up and support in becoming an adult. Supporting the transition should make caregivers attentive to this time of consolidation of adolescence, favorable to the emergence of a sense of stable, mature identity that guarantees a certain autonomy. This is a key to a successful transition limiting breakdown of care and promoting "the work of the disease". The double contribution of adult and pediatric oncology provides support tailored to these psychic and societal issues. AYA teams can actively participate in this process by facilitating the acculturation of pediatric and adult care teams to the specificity of this group, thus allowing a continuum of care.
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Affiliation(s)
- Céline Vergne
- Équipe coordinatrice AJA Pays de la Loire, CHU d'Angers, 4, rue Larrey, 49100 Angers
| | - Nicolas Blin
- Équipe coordinatrice AJA Pays de la Loire, CHU d'Angers, 4, rue Larrey, 49100 Angers; Service des Maladies du Sang, CHU Nantes, 5, allée de l'Île Gloriette, 44093 Nantes Cedex 01
| | - Jérémie Mallet
- Service d'onco-hémato-immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49100 Angers
| | - Bénédicte Thomas
- Service des Maladies du sang, CHU Angers, 4, rue Larrey, 49100 Angers
| | | | - Aline Schmidt
- Service des Maladies du sang, CHU Angers, 4, rue Larrey, 49100 Angers; CRCINA, Inserm, Université Nantes-Angers, Institut de Recherche en Santé de l'Université de Nantes, 8, quai Moncousu - BP 70721, 44007 Nantes cedex 1; FHU GOAL, 4, rue Larrey, 49933 Angers Cedex 9
| | - Stéphanie Proust
- Équipe coordinatrice AJA Pays de la Loire, CHU d'Angers, 4, rue Larrey, 49100 Angers; Service d'onco-hémato-immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49100 Angers.
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19
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Amin EK, Austin ED, Parker C, Colglazier E, Nawaytou H, Leary PJ, Hemnes AR, Teitel D, Fineman JR. Novel Documentation of Onset and Rapid Advancement of Pulmonary Arterial Hypertension without Symptoms in BMPR2 Mutation Carriers: Cautionary Tales? Am J Respir Crit Care Med 2020; 202:1587-1589. [PMID: 32692583 DOI: 10.1164/rccm.202005-1611le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Elena K Amin
- University of California San Francisco, San Francisco, California
| | - Eric D Austin
- Vanderbilt University School of Medicine, Nashville, Tennessee and
| | - Claire Parker
- University of California San Francisco, San Francisco, California
| | | | - Hythem Nawaytou
- University of California San Francisco, San Francisco, California
| | | | - Anna R Hemnes
- Vanderbilt University School of Medicine, Nashville, Tennessee and
| | - David Teitel
- University of California San Francisco, San Francisco, California
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20
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Butalia S, McGuire KA, Dyjur D, Mercer J, Pacaud D. Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study. Health Sci Rep 2020; 3:e181. [PMID: 32782975 PMCID: PMC7410016 DOI: 10.1002/hsr2.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS When youth with diabetes transition from pediatric to adult diabetes care, they are at high risk for loss to follow up and worsening glucose control. We aimed to gain insight on how to improve the transition of youth with type 1 diabetes from pediatric to adult diabetes care from the patients' and parents' perspective. METHODS We conducted focus groups in youth with type 1 diabetes in transition from pediatric to adult diabetes care and their parents, in Calgary, Alberta, between June and August 2014. Eligibility criteria included: (a) type 1 diabetes; (b) aged 15 to 25 years; (c) have or had received care at the pediatric hospital; and, (d) either pre or post-transfer; or, (e) parents of recently transferred youth. Purposive sampling was used, and the theoretical framework used was the Integrated Behaviour Model. Participants were asked about positive, negative, or challenging experiences related to diabetes and transition, solutions to challenges, and tools and strategies to improve and better support transition. Thematic analysis was conducted after focus groups were recorded and transcribed. RESULTS Three focus groups were conducted: pre-transfer youth with diabetes (4 females and 3 males; median age 17.5 years, IQR 1.3 years); post-transfer young adults with diabetes (2 females and 2 males; median age 23.5 years, IQR 1.2 years); and parents of recently transferred young adults with diabetes (n = 3). Main themes were: (a) communication technology; (b) the need for more transition and diabetes education and preparation during transition; and, (c) the importance and need for social and peer support. CONCLUSION This study describes specific areas that may improve diabetes transfer and transition from pediatric to adult diabetes care. This information can help inform clinical care delivery for transition and the development of programs, strategies, and interventions to improve transition care.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- O'Brien Institute for Public Health, Cumming School of Medicine, CalgaryUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Ashlee McGuire
- Provincial Primary Health CareAlberta Health ServicesCalgaryAlbertaCanada
- Department of Family Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David Dyjur
- Diabetes Centre CalgaryAlberta Health ServicesCalgaryAlbertaCanada
| | - Julia Mercer
- Alberta Children's Hospital, Diabetes ClinicAlberta Health ServicesCalgaryAlbertaCanada
| | - Daniele Pacaud
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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21
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Gaydos LM, Sommerhalter K, Raskind-Hood C, Fapo O, Lui G, Hsu D, Van Zutphen A, Glidewell J, Farr S, Rodriguez FH, Hoffman T, Book W. Health Care Transition Perceptions Among Parents of Adolescents with Congenital Heart Defects in Georgia and New York. Pediatr Cardiol 2020; 41:1220-1230. [PMID: 32500288 PMCID: PMC9109153 DOI: 10.1007/s00246-020-02378-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
With increasing survival trends for children and adolescents with congenital heart defects (CHD), there is a growing need to focus on transition from pediatric to adult specialty cardiac care. To better understand parental perspectives on the transition process, a survey was distributed to 451 parents of adolescents with CHD who had recent contact with the healthcare system in Georgia (GA) and New York (NY). Among respondents, 90.7% reported excellent, very good or good health-related quality of life (HRQoL) for their adolescent. While the majority of parents (77.8%) had been told by a provider about their adolescent's need to transition to adult specialty cardiac care, most reported concerns about transitioning to adult care. Parents were most commonly concerned with replacing the strong relationship with pediatric providers (60.7%), locating an appropriate adult provider (48.7%), and accessing adult health insurance coverage (43.6%). These findings may offer insights into transition planning for adolescents with CHD.
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Affiliation(s)
- Laura M Gaydos
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | | | - Olushola Fapo
- New York State Department of Health, Albany, NY, USA
| | - George Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford School of Medicine, Stanford, CA, USA
| | - Daphne Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Alissa Van Zutphen
- New York State Department of Health, Albany, NY, USA
- University at Albany School of Public Health, Rensselaer, NY, USA
| | - Jill Glidewell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sherry Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Trenton Hoffman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Wendy Book
- Emory University School of Medicine, Atlanta, GA, USA
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22
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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 Biomed 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Brown AE, Bradbrook KE, Casey FE. A Survey of Adult and Pediatric Cardiology Fellows on Training Received in Family Planning Counseling. J Womens Health (Larchmt) 2020; 29:237-241. [DOI: 10.1089/jwh.2018.7186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy E. Brown
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida
| | - Keighly E. Bradbrook
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Frances E. Casey
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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24
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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 Biomed 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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Reekie J. Flying the nest: are we doing enough to achieve successful transition in young people with congenital heart disease? Heart 2020; 106:87-88. [DOI: 10.1136/heartjnl-2019-315727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Travis K, Wood A, Yeh P, Allahabadi S, Chien LC, Curtis S, Hammond A, Kohn J, Ogugbuaja C, Rees M, Shumway J, Sheehan V. Pediatric to Adult Transition in Sickle Cell Disease: Survey Results from Young Adult Patients. Acta Haematol 2019; 143:163-175. [PMID: 31307033 DOI: 10.1159/000500258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 04/09/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIMS We surveyed sickle cell disease (SCD) patients who transitioned from pediatric care at Texas Children's Hematology Center (TCHC) to adult care to determine the characteristics of patients with an adult SCD provider, continuation rates of pre-transition therapies, and patient perceptions of the transition process. METHODS A cross-sectional study was conducted by telephone survey of 44 young adults with SCD, aged 19-29 years, who transitioned from TCHC to adult care within the last 15 years. RESULTS Findings of the 23-item questionnaire revealed that transitioned patients with current adult providers (68.2%) were more likely to have seen a provider within 6 months of transition (p = 0.023) and to have been on hydroxyurea and/or monthly blood transfusions pre-transition (p = 0.021) than transitioned patients without a provider; 83% of patients on pre-transition hydroxyurea reported continuing hydroxyurea after transition. Transition challenges included inadequate preparation, difficulty finding knowledgeable adult providers, and lack of healthcare insurance/coverage. CONCLUSION Transition to adult providers is predicted by establishing care with an adult SCD provider within 6 months of transition and being on pre-transition disease-modifying therapy. Transition may be improved if pediatric hematology centers assist and verify adult provider contact within 6 months of transition and engage patients of all disease severity during transition.
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Affiliation(s)
- Kate Travis
- Baylor College of Medicine, Houston, Texas, USA
| | | | - Peter Yeh
- Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Sara Curtis
- Baylor College of Medicine, Houston, Texas, USA
| | | | - Jaden Kohn
- Baylor College of Medicine, Houston, Texas, USA
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27
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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: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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28
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Abstract
Purpose: The purpose of this study was to explore the transition experience of young adults with chronic pain in Canada from the pediatric health care setting to the adult health care setting. Materials and Methods: A qualitative descriptive approach using semistructured interviews was used to capture the transition experiences of young people with chronic pain who have recently transferred from the pediatric setting to the adult health care setting. Participants were recruited from west, central, and the east coast of Canada to situate the findings within the context of Canada. Interviews were transcribed and analyzed using qualitative inductive content analysis. Results: Nine participants were interviewed, three from each part of Canada (west, central, and east). Five common categories were determined to describe the transition experience of young adults with chronic pain which include (1) independence (I can do it, maybe?), (2) pain trajectory (stress and pain along for the ride), (3) social support networks (need a shoulder to lean on), (4) parental support (obviously they are there), and (5) collaborative systems (the bridge). Conclusion: Young people with chronic pain experience unique challenges when faced with transitioning to the adult health care setting. Supporting the young person and his or her family in preparation and readiness and collaboration between the pediatric and adult health care settings are essential to ensure a smooth transition and avoid negative transition outcomes. Further research is needed to determine the best ways to prepare young people for transition and the care activities required in both pediatric and adult health care settings to improve pain-related outcomes posttransition.
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Affiliation(s)
- Andrea Higginson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Forgeron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anaesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Denise Harrison
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - G. Allen Finley
- Department of Anesthesia & Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Canada
| | - Bruce D. Dick
- Depts. of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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29
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Morsa M, Lombrail P, Boudailliez B, Godot C, Jeantils V, Gagnayre R. A qualitative study on the educational needs of young people with chronic conditions transitioning from pediatric to adult care. Patient Prefer Adherence 2018; 12:2649-2660. [PMID: 30587937 PMCID: PMC6296184 DOI: 10.2147/ppa.s184991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Although patient education is recommended to facilitate the transition from pediatric to adult care, a consensus has not been reached for a particular model. The specific skills needed for the transition to help in facilitating the life plans and health of young people are still poorly understood. This study explored the educational needs of young people with diverse chronic conditions during their transition from pediatric to adult care. METHODS Qualitative semi-structured interviews were conducted with 17 young people with chronic conditions. A thematic analysis was conducted to examine the data. RESULTS Five themes emerged from the data, identified through the following core topics: learning how to have a new role, learning how to adopt a new lifestyle, learning how to use a new health care service, maintaining a dual relationship with pediatric and adult care, and having experience sharing with peers. CONCLUSION A shift in perspective takes place when the transition is examined through the words of young people themselves. To them, moving from pediatric to adult care is not viewed as the heart of the process. It is instead a change among other changes. In order to encourage a transition in which the needs of young people are met, educational measures could focus on the acquisition of broad skills, while also being person-centered.
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Affiliation(s)
- Maxime Morsa
- Laboratory of Education and Health Practices (EA3412), Université Paris 13, Bobigny, Paris, France,
| | - Pierre Lombrail
- Laboratory of Education and Health Practices (EA3412), Université Paris 13, Bobigny, Paris, France,
- Department of Public Health, Paris Seine St-Denis Hospital, AP-HP, Paris, France
| | - Bernard Boudailliez
- Pediatric Department, Amiens University Hospital Center, Amiens, France
- Medicine Faculty, University of Picardie Jules Verne, Amiens, France
| | - Cécile Godot
- Department of Endocrinology, Diabetology and Gynecology of Children and Adolescents, Necker Hospital, AP-HP, Paris, France
| | - Vincent Jeantils
- Infectious Diseases Unit, Jean Verdier Hospital, AP-HP, Paris, France
| | - Rémi Gagnayre
- Laboratory of Education and Health Practices (EA3412), Université Paris 13, Bobigny, Paris, France,
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30
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White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 397] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
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Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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31
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Ghotme KA, Alvarado-Gomez F, Lampe C, White KK, Solano-Villareal M, Giugliani R, Harmatz PR. Spinal cord issues in adult patients with MPS: transition of care survey. Childs Nerv Syst 2018; 34:1759-1765. [PMID: 29804213 DOI: 10.1007/s00381-018-3834-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/13/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aims to raise awareness of the need for research and appropriate guidelines for managing spinal cord issues in adult patients with mucopolysaccharidosis (MPS) and transition of these patients from pediatric to adult care. METHODS Pediatric/adult neurosurgeons, orthopedic spine surgeons, and treating physicians with expertise in metabolic disorders and spinal cord issues were invited to complete a survey to assess their experience with spinal cord problems in MPS and their opinion on transitioning routes from pediatric to adult care. RESULTS Twenty specialists completed the survey; 16 had treated spinal cord issues in patients with MPS. Foramen magnum and cervical stenosis (87%), atlanto-axial instability (67%), and lumbar spine instability (33%) were the main spinal cord issues encountered; 28% had treated adult patients for one or more spinal cord issues. In 40% of cases, this concerned an intervention or procedures performed during childhood. The main specialist responsible for the care of adult patients with MPS differed considerably between institutions and included both pediatric and adult specialists (30% pediatric neurosurgeons, 10% pediatric spine orthopedic surgeons, 30% adult spine neurosurgeons, 20% general adult surgeons). The preferred option (> 50%) for the transition of care was an interdisciplinary team of pediatric and adult specialists. CONCLUSIONS Further work needs to be done to address problems of managing spinal cord issues in adult patients with MPS. Currently, the responsibility for the care of patients with MPS with spinal cord issues is inconsistent. The best strategy for transitioning these patients from pediatric to adult care is likely an interdisciplinary approach.
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Affiliation(s)
- Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chia, Colombia. .,Neurosurgery Unit, Fundación Santafé de Bogotá, Bogota, Colombia.
| | - Fernando Alvarado-Gomez
- Department of Orthopedics, Spine Surgery Section, Fundación Santafé de Bogotá, Bogota, Colombia.,Spine Surgery Section, Instituto de Ortopedia Infantil Roosevelt, Bogota, Colombia
| | - Christina Lampe
- Center for Rare Diseases, Clinic for Children and Adolescents, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Klane K White
- Department of Orthopedics and Sport Medicine, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | | | - Roberto Giugliani
- Med Genet Serv HCPA, Dep Genet UFRGS & INAGEMP, Porto Alegre, Brazil
| | - Paul R Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
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32
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van der Bent A, Duggan EM, Fishman LN, Dickie BH. Reality check: What happens when patients with anorectal malformations grow up? A pilot study of medical care transition from the adult patient perspective. J Pediatr Surg 2018; 53:1722-1726. [PMID: 29605261 DOI: 10.1016/j.jpedsurg.2018.02.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND There has been an increased focus on transition of pediatric and adolescent patients to adult centered care. For patients with rare and complex conditions, such as anorectal malformations (ARM), difficulties are compounded by the absence of structured transition protocols and lack of adult provider expertise. We sought to explore the actual experiences of adult patients with ARM and distinguish if there are factors that influence the ability to achieve satisfactory transition to adult centered medical care. METHODS Patients older than 18years with ARM were identified through a hospital database and social support networks, and invited to participate in an anonymous questionnaire. Patients were asked to describe their transition experience as well as report their demographics, and functional outcomes (bowel and bladder function). RESULTS Twenty-six surveys were completed. Comparison of those respondents (53%) who had transitioned to adult providers to those that had not yet transferred care demonstrated no difference in satisfaction with bowel and bladder function, presence of ostomy, and education level. There was a slight trend for patients with more complex malformations to seek further medical care with adult providers. Of those who transitioned, 67% reported no discussion prior to their transition and 71% received no recommendations for follow-up providers. CONCLUSIONS This pilot project suggests that a significant number of adult patients with ARM lack transition preparation and fail to find adult providers with expertise. Future studies will need to find optimal ways to address these issues. TYPE OF STUDY Survey. Retrospective Study LEVELS OF EVIDENCE: Level II.
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Affiliation(s)
- Annelotte van der Bent
- Department of Pediatric Gastroenterology, VU University Medical Center, Hemonystraat 64-3, 1074, BT, Amsterdam, The Netherlands.
| | - Eileen M Duggan
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States,.
| | - Laurie N Fishman
- Department of Gastroenterology & Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States
| | - Belinda Hsi Dickie
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States,.
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Catena G, Rempel GR, Kovacs AH, Rankin KN, Muhll IV, Mackie AS. "Not such a kid thing anymore": Young adults' perspectives on transfer from paediatric to adult cardiology care. Child Care Health Dev 2018; 44:592-598. [PMID: 29574895 DOI: 10.1111/cch.12564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Transfer of adolescents with congenital heart disease from paediatric cardiology providers to specialized adult congenital heart disease (ACHD) care providers is becoming a standard practice. However, some paediatric cardiologists continue to provide care for their patients into adult life. Little is known about the perspectives of young adult patients who have been transferred to ACHD clinics versus those who continue to receive their cardiology care in paediatric settings. METHODS Content and thematic analysis of structured telephone interviews with 21 young adults age 18-25 (13 transferred to ACHD clinic and 8 who had not transferred) was conducted to identify similarities and differences in patient characteristics of those in ACHD versus paediatric settings. RESULTS There were no appreciable differences in gender, age, heart disease type, and independence between those transferred to ACHD care versus those not transferred. Participants in both groups were aware of differences between the paediatric and ACHD care settings and providers, with some favouring the familiarity offered by the paediatric setting and providers. Participants had varying views on parental involvement in their care; most of them had attended clinic appointments on their own. Those who had transferred to ACHD care acknowledged that it would take time to adjust to new relationships. Positive perspectives on actual or anticipated transfer to ACHD care included a growing sense of autonomy and responsibility, as well as access to reproductive information relevant to ACHD patients. CONCLUSIONS The absence of patient characteristics distinguishing those in ACHD care versus those still followed in paediatric care suggests that system, provider, and parent factors, rather than patient factors, may account for patients' perspectives on transfer to ACHD care.
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Affiliation(s)
- G Catena
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - G R Rempel
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - A H Kovacs
- Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, University of Toronto, Toronto, ON, Canada
| | - K N Rankin
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - I V Muhll
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - A S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Division of Cardiology, Stollery Children's Hospital, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
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34
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Burström Å, Öjmyr-Joelsson M, Bratt EL, Lundell B, Nisell M. Adolescents With Congenital Heart Disease and Their Parents: Needs Before Transfer to Adult Care. J Cardiovasc Nurs 2016; 31:399-404. [PMID: 26296247 DOI: 10.1097/JCN.0000000000000288] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with congenital heart disease (CHD) are in need of lifelong healthcare. For adolescents with CHD, this transfer to adult-care clinic can be difficult. OBJECTIVE The aim was to identify and describe the needs of adolescents with CHD and their parents during the transition before transfer to adult cardiologic healthcare. METHODS This study has an exploratory design with a qualitative approach, where 13 adolescents with CHD and their parents (n = 12) were individually interviewed. The interviews were analyzed with content analysis. RESULTS The analysis of the adolescents' interviews resulted in 3 categories: change of relationships, knowledge and information, and daily living. The theme that emerged depicting the meaning of the categories found was Safety and control, indicating needs of continuity, knowledge, and taking responsibility. Analysis of the parents' answers gave 2 categories: change of relationship and daily living. The theme that emerged was safety and trust, indicating needs of continuity and shifting responsibility. CONCLUSIONS The transition must be carefully planned to ensure that adolescents can master new skills to manage the transfer to adult cardiologic healthcare. A structured program may facilitate and fulfill the needs of the adolescents and their parents, taking into consideration the aspects of trust, safety, and control. However, the content and performance of such a program must also be examined. We plan to undertake an extensive research project in the area, and this study will be a baseline for further research.
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Bratt EL, Burström Å, Hanseus K, Rydberg A, Berghammer M. Do not forget the parents-Parents' concerns during transition to adult care for adolescents with congenital heart disease. Child Care Health Dev 2018; 44:278-284. [PMID: 28980341 DOI: 10.1111/cch.12529] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/26/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing up with congenital heart disease (CHD) often means transfer to adult care and lifelong medical follow-up. An optimal transition process usually involves a multipart collaboration between the patient, their parents and other family members, and the healthcare providers. Taking an active role while knowing when it is time to step aside can be difficult for all the concerned parties, even the healthcare professionals. The aim of the present study therefore, was to explore parents' expectations and needs during their adolescent's transition to adult care. METHOD Semi-structured interviews were conducted with 18 parents of 16 adolescents (aged 13-18 years) with CHD in 4 pediatric cardiology settings in Sweden. The interviews were analysed with qualitative content analysis. RESULTS The analysis resulted in 2 main themes: (a) Feeling secure-the importance of being prepared and informed. This theme focused on the need to be prepared and informed about transition and future transfer to adult care. (b) Recognizing when to hand over at the right time. This theme addressed the process of handing over the responsibility from the parent to the adolescents and contained handing over from pediatric care to adult care. CONCLUSION Being prepared and informed about the upcoming transition process was essential. The parents underlined the importance of being involved in the transition planning for gradually handing over responsibility to the adolescent. They also considered establishing contact with the adult healthcare team before transfer as important and needed to be assured that CHD-related information of importance for the young person's daily life would be given.
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Affiliation(s)
- E L Bratt
- Institution of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Å Burström
- Institution for Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - K Hanseus
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - A Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - M Berghammer
- University West, Department of Health Science, Trollhättan, Sweden.,Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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Frederick NN, Bober SL, Berwick L, Tower M, Kenney LB. Preparing childhood cancer survivors for transition to adult care: The young adult perspective. Pediatr Blood Cancer 2017; 64. [PMID: 28383822 DOI: 10.1002/pbc.26544] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/23/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCSs) remain at risk for developing treatment-associated health conditions as they age; however, many do not obtain recommended follow-up, putting them at unnecessary risk for morbidity. Educational interventions targeted at providing survivors with the knowledge and skills necessary for healthcare independence might improve adherence and outcomes as they transition care to the adult medical system. OBJECTIVE To identify informational needs, educational preferences, and support that young adult CCSs perceive as beneficial for transition from pediatric to adult medical care. DESIGN/METHOD Sixteen young adult CCSs (ages 22-39 years) who have transitioned to adult care participated in focus groups led by a trained moderator and analyzed using a thematic analysis approach. RESULTS Four major themes emerged: (1) education preferences-pediatric oncology provider as the primary source of information and guidance, enhanced by other formats, and early and ongoing engagement in education; (2) family role in transition-desire for independence and acknowledgement of need for ongoing parental support; (3) expectations for adult providers, such as close relationships, open communication, and care coordination; and (4) knowledge deficits regarding disease/treatment history, risk for long-term complications, and navigation of the adult medical system. CONCLUSION Transition education as described by young adult CCSs should be a developmentally appropriate process beginning in early adolescents, primarily administered by pediatric oncology providers, and delivered in multiple formats. While healthcare independence is a goal for young adult CCSs, all stakeholders must recognize that families and providers continue to have an important role supporting survivors with transition logistics and medical decision-making.
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Affiliation(s)
- Natasha N Frederick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sharon L Bober
- Harvard Medical School, Boston, Massachusetts.,Dana-Farber Cancer Institute Perini Family Survivors Center, Boston, Massachusetts
| | | | - Mary Tower
- Long Term Follow-up Clinic in Pediatric Oncology at Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa B Kenney
- Harvard Medical School, Boston, Massachusetts.,Dana-Farber Cancer Institute Perini Family Survivors Center, Boston, Massachusetts
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Morsa M, Gagnayre R, Deccache C, Lombrail P. Factors influencing the transition from pediatric to adult care: A scoping review of the literature to conceptualize a relevant education program. Patient Educ Couns 2017; 100:1796-1806. [PMID: 28528694 DOI: 10.1016/j.pec.2017.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/24/2017] [Accepted: 05/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To give a comprehensive overview of the factors that influence the transition from pediatric services to adult care, and to conceptualize a relevant education program. METHOD An evaluation grid was used to analyze the literature and classify factors depending on whether they were related to the patients, to the health care organization, to health care personnel, to the interaction between medical staff and patient, or to the illness and its treatment. RESULTS We based our analysis on a selection of 20 publications. The following factors were identified and classified in an integrative framework: self-management skills, trust in adult care, the feeling of self-efficacy, social support, the patient's gender and social position, the trust between child carers and adult carers, interdisciplinary cooperation, and the medical staff's consideration of the patient's projects. CONCLUSIONS AND PRACTICE IMPLICATIONS The current analysis makes it possible to formulate educational aims and to design a way of integrating them to a transition plan. However, the collected studies mainly focus on knowledge of the illness, on treatment, and on the health care system. Psychosocial dimensions at play at the time of the transition - such as identity development - are not sufficiently explored in the research.
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Affiliation(s)
- Maxime Morsa
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Rémi Gagnayre
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Carole Deccache
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Pierre Lombrail
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France; Department of Public Health, Paris Seine St-Denis hospital, AP-HP, France.
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Feingold B, Mahle WT, Auerbach S, Clemens P, Domenighetti AA, Jefferies JL, Judge DP, Lal AK, Markham LW, Parks WJ, Tsuda T, Wang PJ, Yoo SJ. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e200-e231. [DOI: 10.1161/cir.0000000000000526] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Everitt IK, Gerardin JF, Rodriguez FH, Book WM. Improving the quality of transition and transfer of care in young adults with congenital heart disease. CONGENIT HEART DIS 2017; 12:242-250. [DOI: 10.1111/chd.12463] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/15/2017] [Accepted: 03/05/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ian K. Everitt
- Emory University School of Medicine; Atlanta Georgia, USA
| | - Jennifer F. Gerardin
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
| | - Fred H. Rodriguez
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
- Sibley Heart Center Cardiology, Emory University School of Medicine; Atlanta Georgia, USA
| | - Wendy M. Book
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
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Wright RJ, Howard EJ, Newbery N, Gleeson H. 'Training gap' - the present state of higher specialty training in adolescent and young adult health in medical specialties in the UK. Future Healthc J 2017; 4:80-95. [PMID: 31098440 PMCID: PMC6502624 DOI: 10.7861/futurehosp.4-2-80] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Young people often experience worse health outcomes and more dissatisfaction with healthcare compared with other age groups. This survey sought to determine the state of adolescent and young adult health training across medical specialties in the UK. An online questionnaire was distributed to higher specialty trainees in adult medical specialties. Training in adolescent/young adult health/transition was rated as minimal/non-existent by 70/73% of respondents, respectively; 52% reported that they had received no formal training and 61% had never attended a dedicated young person's or transition clinic. The most significant barrier to delivering good adolescent and young adult healthcare was felt to be lack of training to deal with adolescent issues. This survey has identified a 'training gap'; a lack of preparation to meet the specific care needs of the adolescent and young adult population. Improved interventions are required to help drive improvement in care for young people in the UK.
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Affiliation(s)
| | | | - Nina Newbery
- Medical Workforce Unit, Royal College of Physicians, London, UK
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Dahourou DL, Gautier-Lafaye C, Teasdale CA, Renner L, Yotebieng M, Desmonde S, Ayaya S, Davies MA, Leroy V. Transition from paediatric to adult care of adolescents living with HIV in sub-Saharan Africa: challenges, youth-friendly models, and outcomes. J Int AIDS Soc 2017; 20:21528. [PMID: 28530039 PMCID: PMC5577723 DOI: 10.7448/ias.20.4.21528] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/14/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition. AREAS COVERED We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10-24 years with information on transition were eligible. RESULTS Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older adults. There is a need to identify sub-groups at higher risk of loss to follow-up for targeted care and peer support. EXPERT COMMENTARY Although the available HIV-related data on adolescent transition outcomes are limited, there is evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa.
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Affiliation(s)
- Désiré Lucien Dahourou
- Centre of International Research for Health, Faculty of Health Sciences, University of Ouagadougou, Ouagadougou, Burkina Faso
- Clinical Research Department, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | - Chloe A. Teasdale
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Marcel Yotebieng
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA
| | | | | | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Valériane Leroy
- Inserm, Laboratoire d’Epidémiologie et Analyses en Santé Publique (LEASP) - UMR 1027, Université Toulouse 3, Toulouse, France
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Mubanga N, Baumgardner DJ, Kram JJF. Health Care Transitions for Adolescents and Young Adults With Special Health Care Needs: Where Are We Now? J Patient Cent Res Rev 2017; 4:90-95. [PMID: 31413975 DOI: 10.17294/2330-0698.1406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Eventually, all adolescents must "graduate" from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children's hospitals. This topic synopsis aims to draw attention to this important issue, review the rationale behind current recommendations and report the current status of transitional programs in North America. Moreover, the steps that individual clinicians, practices and health systems may take to plan for successful health care transitions are discussed.
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Affiliation(s)
- Nicole Mubanga
- Department of Family Medicine, Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI
| | - Dennis J Baumgardner
- Department of Family Medicine, Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica J F Kram
- Department of Family Medicine, Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
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Garvey KC, Foster NC, Agarwal S, DiMeglio LA, Anderson BJ, Corathers SD, Desimone ME, Libman IM, Lyons SK, Peters AL, Raymond JK, Laffel LM. Health Care Transition Preparation and Experiences in a U.S. National Sample of Young Adults With Type 1 Diabetes. Diabetes Care 2017; 40:317-324. [PMID: 28007779 PMCID: PMC5319474 DOI: 10.2337/dc16-1729] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/03/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. We developed a survey to evaluate transition experiences in two groups of young adults with type 1 diabetes, before (PEDS) and after (ADULT) transition to adult care. RESEARCH DESIGN AND METHODS We fielded an electronic survey to young adults (18 to <30 years) at 60 T1D Exchange Clinic Registry centers. RESULTS Surveys were completed by 602 young adults, 303 in the PEDS group (60% female, age 20 ± 2 years) and 299 in the ADULT group (62% female, age 24 ± 3 years). In the PEDS group, mean anticipated transition age was 22 ± 2 years; 64% remained in pediatric care because of emotional attachment to the provider. The ADULT group transitioned at age 19 ± 2 years, mainly after pediatric provider recommendation. More than 80% of respondents reported receiving counseling on type 1 diabetes self-management and screening tests from pediatric providers, but less than half (43% PEDS and 33% ADULT) reported discussing reproductive health. In the PEDS group, half had discussed transfer with pediatric providers. Of the ADULT participants, 63% received an adult provider referral, and 66% felt mostly/completely prepared to transition. ADULT participants with fewer pretransition pediatric visits or who felt unprepared for transition had increased odds of gaps >6 months between pediatric and adult care. Receipt of transition preparation counseling was not associated with self-reported hemoglobin A1c <7.0% in either group. CONCLUSIONS These results support the need for intensive efforts to integrate transition preparation counseling and care coordination into pediatric type 1 diabetes care.
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Affiliation(s)
| | | | - Shivani Agarwal
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Marisa E Desimone
- State University of New York Upstate Medical University, Syracuse, NY
| | | | | | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Burström Å, Bratt EL, Frenckner B, Nisell M, Hanséus K, Rydberg A, Öjmyr-Joelsson M. Adolescents with congenital heart disease: their opinions about the preparation for transfer to adult care. Eur J Pediatr 2017; 176:881-889. [PMID: 28508990 PMCID: PMC5486562 DOI: 10.1007/s00431-017-2917-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/21/2016] [Accepted: 04/27/2017] [Indexed: 12/24/2022]
Abstract
UNLABELLED The aim of the study was to explore what adolescents with congenital heart disease (CHD) view as important in the preparation for the transfer to adult care. We performed interviews in four focus groups with adolescents (14-18 years old) at four university hospitals in Sweden. Data was analysed using qualitative content analysis. The analysis revealed one main category; Becoming a manager of the condition and four subcategories; Sufficient knowledge about the health, Be a participant in the care, Parental support, and Communicate with others about the health. The adolescents' ages differentiated the discussion in the groups. The older adolescents seemed to have more interest in transition planning, information and transfer. The younger described more frustrations about communication and handling the disease. CONCLUSION To become a manager of the CHD in daily life, the adolescents want disease specific knowledge, which should be communicated in a developmentally appropriate way. Adolescents want to participate and be involved in the transition process. They need support and guidance in how to communicate their CHD. Parental support is fundamental but it change over time. Moreover, peer-support is becoming more significant during the transition process. What is Known: • Transition during adolescence and transfer to adult care for adolescents with CHD is complex, and there is a shift in roles. • Adolescents often have poor knowledge and understanding about their heart condition and the consequences. What is New: • Adolescents call for disease specific information regarding health issues of importance for them in daily life. • Communicating the disease with other is a challenge- peer support from other adolescents with CHD could be a facilitator.
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Affiliation(s)
- Åsa Burström
- Institution for Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
| | - Ewa-Lena Bratt
- Institution of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden ,Department of Pediatric Cardiology, The Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Björn Frenckner
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| | - Margret Nisell
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,The Red Cross University College, Stockholm, Sweden
| | - Katarina Hanséus
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Maria Öjmyr-Joelsson
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
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Mohammed A, Nadeem M, Yousif T. Towards safe and effective transition from adolescence to adult care. Sudan J Paediatr 2017; 17:10-13. [PMID: 29213164 PMCID: PMC5621851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Transitional care is an important step in patients' care. This article aims to give some guidance towards a safe and smooth transition from adolescence to adult care. It highlights the definition, elements, steps, effects and benefits of an effective transition system.
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Affiliation(s)
- Amani Mohammed
- Medical Registrar St Michael’s Hospital, Dublin, Ireland
| | - Montasser Nadeem
- General Paediatrics, National Children’s Hospital, Dublin, Ireland
| | - Taha Yousif
- Paediatric Gastroenterology, National children’s Hospital, Dublin, Ireland
- Corresponding author
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Suris JC, Larbre JP, Hofer M, Hauschild M, Barrense-Dias Y, Berchtold A, Akre C. Transition from paediatric to adult care: what makes it easier for parents? Child Care Health Dev 2017; 43:152-155. [PMID: 27625071 DOI: 10.1111/cch.12405] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/09/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess differences between parents of adolescents with chronic illness (CI) going through a self-reported easy or difficult transfer. METHODS Seventy-two parents of CI youths who had already transferred to adult care were divided according to whether they considered that the transfer had been easy (n = 45) or difficult (n = 27). We performed a bivariate analysis comparing both groups and variables with a significance level < .1 were included in a logistic regression. Results are presented as adjusted odds ratio (aOR). RESULTS Over one third of parents (27/72) reported a difficult transfer. At the multivariate level, higher socioeconomic status (aOR: 7.74), parents feeling ready for transfer (aOR: 6.54) and a good coordination between teams (aOR: 7.66) were associated with an easy transfer. CONCLUSIONS An easy transfer for parents is associated with feeling ready and considering that the coordination between teams is good. Health providers should consider these requisites for a successful transfer.
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Affiliation(s)
- J-C Suris
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,General Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - J-P Larbre
- Adult Rheumatology, Centre hospitalier Lyon-Sud, Lyon, France
| | - M Hofer
- Pediatric Rheumatology Unit of Western Switzerland, Lausanne University Hospital and Geneva University Hospital, Lausanne, Switzerland
| | - M Hauschild
- Pediatric Endocrinology and Diabetology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Y Barrense-Dias
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Berchtold
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Social Sciences and LIVES, University of Lausanne, Lausanne, Switzerland
| | - C Akre
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Abstract
OBJECTIVES Transition and transfer to adult-oriented health care is an important yet challenging task for adolescents and young adults with chronic medical conditions. Transition practices vary widely, but a paucity of data makes determination of best practices difficult. We described North American pediatric gastroenterologists' preferences and present transition practice patterns and explored whether experience affected providers' perspectives. METHODS An online survey was distributed via e-mail to members of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. Participation was voluntary and answers were anonymous. Quantitative and qualitative analysis was performed. RESULTS Almost three quarters of the 175 respondents describe providing transition or self-care management education, but only 23% use structured readiness assessments. Most respondents (88%) report having age cutoffs above which they no longer accept new referrals, with the most common age being 18 years (57%). One third report the ability to provide age-appropriate care to patients older than 21 years. Only 6% indicate that their practice or institution should provide care for individuals older than 25 years. Many (63%) indicate that their practice or institution has a policy regarding age of transfer, but most (79%) are flexible. Provider preferences for triggers to transfer to adult care diverge widely between age, milestones, and comorbidities. Overall, parent (81%) and patient (74%) attachment to pediatric health care providers are cited as the most common barriers to transition. CONCLUSIONS Preferences and practices surrounding transition preparation and transfer to adult care vary widely, reflecting continued uncertainty regarding optimal transition strategies.
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Sillman C, Morin J, Thomet C, Barber D, Mizuno Y, Yang HL, Malpas T, Flocco SF, Finlay C, Chen CW, Balon Y, Fernandes SM. Adult congenital heart disease nurse coordination: Essential skills and role in optimizing team-based care a position statement from the International Society for Adult Congenital Heart Disease (ISACHD). Int J Cardiol 2016; 229:125-131. [PMID: 28340978 DOI: 10.1016/j.ijcard.2016.10.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/19/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with congenital heart disease (CHD) worldwide. Among ISACHD's objectives is to "promote a holistic team-based approach to the care of the adult with CHD that is comprehensive, patient-centered, and interdisciplinary" (http://www.isachd.org). This emphasis on team-based care reflects the fact that adults with CHD constitute a heterogeneous population with a wide spectrum of disease complexity, frequent association with other organ involvement, and varied co-morbidities and psychosocial issues. METHODS Recognizing the vital role of the adult CHD (ACHD) nurse coordinator (ACHD-NC) in optimizing team-based care, ISACHD established a task force to elucidate and provide guidance on the roles and responsibilities of the ACHD-NC. Acknowledging that nursing roles can vary widely from region to region based on factors such as credentials, scopes of practice, regulations, and local culture and tradition, an international panel was assembled with experts from North America, Europe, East Asia, and Oceania. The writing committee was tasked with reviewing key aspects of the ACHD-NC's role in team-based ACHD care. RESULTS/CONCLUSION The resulting ISACHD position statement addresses the ACHD-NC's role and skills required in organizing, coordinating, and facilitating the care of adults with CHD, holistic assessment of the ACHD patient, patient education and counseling, and support for self-care management and self-advocacy.
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Affiliation(s)
- Christina Sillman
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States.
| | - Joanne Morin
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Deena Barber
- Akron Children's Hospital, Akron, OH, United States
| | | | | | - Theresa Malpas
- The Prince Charles Hospital, Adult Congenital Heart Disease Service, Brisbane, Australia
| | - Serena Francesca Flocco
- Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | | | | | - Yvonne Balon
- Peter Lougheed Hospital, Calgary, Alberta, Canada
| | - Susan M Fernandes
- Stanford University, Palo Alto, CA, Departments of Pediatrics and Medicine and Divisions of Pediatric Cardiology and Cardiovascular Medicine, United States
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Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services - an integrative review. J Clin Nurs 2016; 25:3113-3130. [PMID: 27145890 PMCID: PMC5096007 DOI: 10.1111/jocn.13326] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES This paper aims to provide an updated comprehensive review of the research-based evidence related to the transitions of care process for adolescents and young adults with chronic illness/disabilities since 2010. BACKGROUND Transitioning adolescent and young adults with chronic disease and/or disabilities to adult care services is a complex process, which requires coordination and continuity of health care. The quality of the transition process not only impacts on special health care needs of the patients, but also their psychosocial development. Inconsistent evidence was found regarding the process of transitioning adolescent and young adults. DESIGN An integrative review was conducted using a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. METHODS A search was carried out using the EBSCOhost, Embase, MEDLINE, PsycINFO, and AustHealth, from 2010 to 31 October 2014. The key search terms were (adolescent or young adult) AND (chronic disease or long-term illness/conditions or disability) AND (transition to adult care or continuity of patient care or transfer or transition). RESULTS A total of 5719 records were initially identified. After applying the inclusion criteria a final 61 studies were included. Six main categories derived from the data synthesis process are Timing of transition; Perceptions of the transition; Preparation for the transition; Patients' outcomes post-transition; Barriers to the transition; and Facilitating factors to the transition. A further 15 subcategories also surfaced. CONCLUSIONS In the last five years, there has been improvement in health outcomes of adolescent and young adults post-transition by applying a structured multidisciplinary transition programme, especially for patients with cystic fibrosis and diabetes. However, overall patients' outcomes after being transited to adult health care services, if recorded, have remained poor both physically and psychosocially. An accurate tracking mechanism needs to be established by stakeholders as a formal channel to monitor patients' outcomes post- transition.
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Affiliation(s)
- Huaqiong Zhou
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia
| | - Pamela Roberts
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia
| | - Satvinder Dhaliwal
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia
| | - Phillip Della
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, WA, Australia.
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