Adult Provider Perspectives on Transition and Transfer to Adult Care: A Multi-Specialty, Multi-Institutional Exploration

Gray, Wendy N.; Dorriz, Parasto; Kim, Hanae; Partain, Lauren; Benekos, Erin; Carpinelli, Anne; Zupanc, Mary L.; Grant, Ken; Weiss, Michael A.

doi:10.1016/j.pedn.2021.04.017

Cited by 14 publications

(12 citation statements)

References 31 publications

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“…This review found that psychosocial functioning is an essential element of transition programs [28,29], in line with the care needs of CCSs [46,47] and the intervention targets mentioned in SMART [17]. Transitioning is a psychological process of adapting to disruption or change and includes anxiety, uncertainty, and concern over unmet medical needs [37].…”

Section: Main Findingsmentioning

confidence: 87%

Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review

Ma,

Xiao,

Zhou

et al. 2024

Cancers

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Purpose: in this scoping review, previously reported data were described and synthesized to document transition interventions in CCSs, and the features of intervention components of the current transition studies for CCSs were summarized. Methods: A literature search was conducted in PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid, and the Cochrane Library following the PRISMA-ScR statement. All original studies (n = 9) investigating transition interventions in CCSs were included. Results: The current studies identified essential elements for transition programs, such as delivering knowledge, developing skills for coordination of care, and addressing psychosocial needs. However, the current transition interventions were generally in their infancy, and major deficits were found, including poorly reported intervention components and procedures, a limited number of relevant validated outcomes, and a failure to incorporate conceptual frameworks and international consensus statements. Conclusions: This scoping review mapped current evidence of transition interventions for CCSs and highlighted the paucity of data in this area. More high-quality and well-reported randomized controlled trials are needed for the enrichment and standardization of future transition interventions.

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Section: Main Findingsmentioning

confidence: 87%

Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review

Ma,

Xiao,

Zhou

et al. 2024

Cancers

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“…Each team requires program support, policy development, resources, staffing, and funding. The pediatric team is more commonly comprised of a large multidisciplinary team with referrals made within the team, including mental health services and case management 23 . If a YA requires these services after transfer, they often do not exist, may be limited in the adult system, or are not covered by the insurance carrier.…”

Section: Discussionmentioning

confidence: 99%

“…The pediatric team is more commonly comprised of a large multidisciplinary team with referrals made within the team, including mental health services and case management. 23 If a YA requires these services after transfer, they often do not exist, may be limited in the adult system, or are not covered by the insurance carrier. With an increased prevalence of mental health issues in YA LT recipients, 24 continued mental health assessment and support is needed following transfer of care.…”

Section: Systems Characteristicmentioning

confidence: 99%

Current approach to health care transition and integration into adult care for pediatric liver transplant recipients: A call for partnership

King

Kosmach‐Park

Parish

et al. 2023

Clinical Transplantation

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Despite the increased risk of non‐adherence, allograft rejection, and mortality following transfer from pediatric to adult care in liver transplantation (LT), there is no standardized approach to health care transition (HCT). Two electronic national surveys were developed and distributed to members of the Society for Pediatric Liver Transplantation and all adult LT programs in the United States to examine current HCT practices. Responses were received from 40 pediatric and 79 adult centers. Pediatric centers were more likely to focus on HCT noting the presence of a transition/transfer policy (60.2% vs. 39.2%), transition clinic (51.6% vs. 16.5%), and the routine use of transition readiness assessment tools (54.8% vs. 10.2%). Perceived barriers to HCT were similar among pediatric and adult respondents and included patient willingness to transfer and participate in care, failure to show for appointments, and lack of sufficient time and staffing. These results highlight the need for an increased awareness of HCT at both pediatric and adult LT centers. The path to improvement requires a partnership between pediatric and adult providers. Recognizing the importance of a comprehensive HCT program initiated in pediatrics and continued throughout young adulthood with ongoing support by the adult team is essential.

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“…Some themes are shared with qualitative research conducted with healthcare providers working on the transition in non-psychiatric chronic diseases. Families’ strong expectations towards adult care services, unsatisfying relationships with prior care providers, and the lack of resources are reported in a multi-specialty study among adult providers [ 33 ]. Concerns about the divergence in approaches, intensive care coordination and time requirements, or treatment nonadherence are found among adult endocrinologists handling the transition of patients suffering from type 1 diabetes [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Adult and child and adolescent psychiatrists' experiences of transition in anorexia nervosa: a qualitative study

et al. 2022

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Background Young patients suffering from anorexia nervosa (AN) frequently need further treatment in Adult Mental Health Services (AMHS). The transition period from Child and Adolescent Mental Health Services (CAMHS) to AMHS is a critical time, with a high risk of disengagement from healthcare. We explored physicians’ perspectives of the transition to triangulate the multiple perspectives of physicians, parents and those with a lived AN experience to more comprehensively characterize the challenges in this process of treatment transition. Methods Using purposive sampling, we recruited 16 physicians confronted with transition in AN (adult psychiatrists, child and adolescent psychiatrists and pediatrician) and conducted semi-structured interviews, which were anonymized, transcribed, and analyzed following the reflexive thematic analysis framework. Results Our analysis produced three main themes. First, a shared agreement on the transition’s malfunction, where participants depicted transition as a dissatisfying, violent event. Second, the conception of AN as a disorder with specific needs, challenging the transition process especially regarding physicians’ engagement. Finally, the ideal transition conceived as a serene experience of separation, with unanimous agreement on the necessity to start the transition depending on patients’ needs rather than their age, in order to turn transitions into moments of care. Conclusion Our results are in line with other qualitative research studying transition in AN and in other chronic diseases, either focusing on the experience of healthcare workers, families, or patients. Our research shows transition in AN as an anxiety-inducing experience for physicians, patients and families alike. Moreover, we highlight a gap in the way physicians perceive and assist the patient’s greater autonomy, depending on their specialty. Helping physicians to manage their patient’s autonomy, which is a cornerstone of the transition readiness concept, could be a very efficient way to improve transitions in AN. Plain English summary Anorexia Nervosa (AN) is a severe disease, which most of the time starts during adolescence. Transition from Child and Adolescent Mental Health Services to Adult Mental Health Services is at risk of disengagement from healthcare. In order to better understand this process, we interviewed expert physicians about their experiences of transition in AN using a qualitative thematic analysis which highlighted three main themes. First, a shared agreement on the transition’s malfunction. Second, the conception of AN as a disorder with specific needs challenging the transition process. Finally, the ideal transition conceived as a serene experience of separation, which needs to be started depending on patients’ needs rather than their age. We also show differences in the way physicians perceive and assist the patient’s greater autonomy acquired during the transition. Helping physicians to support their patients in acquiring autonomy, which is a cornerstone of the transition readiness concept, could be a very efficient way to improve transitions in AN.

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Adult Provider Perspectives on Transition and Transfer to Adult Care: A Multi-Specialty, Multi-Institutional Exploration

Cited by 14 publications

References 31 publications

Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review

Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review

Current approach to health care transition and integration into adult care for pediatric liver transplant recipients: A call for partnership

Adult and child and adolescent psychiatrists' experiences of transition in anorexia nervosa: a qualitative study

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