Assessment of transition readiness in adolescents and young adults with chronic health conditions

Abstract

BackgroundTransition from pediatric to adult health care is a vulnerable period for adolescents and young adults. Challenges include paucity of validated measures to assess patients’ transition readiness. We evaluated the Transition Readiness Assessment Questionnaire (TRAQ) in adolescents and young adults with rheumatic, gastrointestinal, and endocrine disorders. We examined whether baseline TRAQ scores and other demographic variables predicted transition to adult care over a three year follow up period.MethodsIn this descriptive study at a single institution, eighty-nine adolescents at a single pediatric academic medical center completed demographic and medical history surveys and the TRAQ and were followed over 3 years by telephone interview to determine whether they had transitioned to adult subspecialty care. Transition was defined as attending at least one adult subspecialty appointment. Multivariable logistic regression and Cox proportional hazards regression models were used to determine whether TRAQ scores predicted time to transition.ResultsOf the participants, 56% had rheumatic, 21% endocrine, and 23% gastrointestinal conditions. The TRAQ self-management domain score was not significantly associated with age, gender, socioeconomic status, or specialty. The TRAQ self-advocacy score increased with age. Baseline TRAQ scores did not predict transition or time to transition over three years.ConclusionIn this cohort of adolescents and young adults who were 16 to 23 years of age at enrollment, 48% transitioned to adult care over three years of follow up. Nearly half reported not discussing transition with provider or seeing provider independently for part of visit. Older age but not other demographic variables nor baseline TRAQ score predicted transition or time to transition to an adult subspecialty provider; however, a there was a trend towards shorter time to transition with the highest quartile TRAQ scores.

How Do Health Literacy, Numeric Competencies, and Patient Activation Relate to Transition Readiness in Adolescents and Young Adults With Rheumatic Diseases?

“…Item scores were averaged to produce an overall score . The TRAQ can be used for any chronic medical condition and has been validated or studied in populations including healthy individuals and patients with cystic fibrosis, congenital heart disease, sickle cell disease, and those with rheumatologic, gastroenterologic, and endocrinous disorders . The TRAQ has been utilized as a key measure in interventional and transition observational studies .…”

<p>Pre-Transition Readiness in Adolescents and Young Adults with Four Chronic Medical Conditions in South East Nigeria – An African Perspective to Adolescent Transition</p>

“…Some guidelines 6,28 have suggested ages as early as 12 to 14 years to move a child to adult care, but consensus opinion tend to rather adopt an individualized approach based on the transition readiness of each child. 29 As seen also in other studies 10,26,30 those who were not willing to move to adult-oriented care, expressed reasons related to strong paediatric staff (doctors and nurses) attachment. This highlights the need for early pre-transition preparations so that when it is time, it is a seamless transfer to adultoriented care even within our African context.…”

“…25 In some studies, transition-related benefits expressed by adolescents that had moved on smoothly to adult care, included feeling of satisfaction in being treated as adults and having a sense of independence in adult-oriented care. [26][27][28] This may have been impacted by possible early preparedness and telling the adolescents on time what to expect. Within our African cultural settings, with the inhibitory effect of respect for elders and not wanting to be quickly moved into same clinic with the elders, such organized and early process will be of great benefit.…”

“…In another study, up to 5% of the study population in a paediatric service were also noted to be between the ages of 22 to 23 years. 26 This finding of older children still being seen in paediatric care may be improved if early initiation of transition is routinely practiced, with conscious efforts made at pre-transition preparations. In Nigeria, despite the cultural influence, the adult age of independence that accord some privileges like voting rights have remained at 18 years.…”

Provider-Patient Communication and Transition Readiness Among Adolescents with Type 1 Diabetes

“…The TRAQ measures transition readiness across a variety of chronic health conditions (e.g. diabetes, IBD, cystic fibrosis) (Jensen et al, 2017;Wood et al, 2014). Originally developed by Sawicki and colleagues (2011), the TRAQ is a self-report questionnaire consisting of 29 items completed by the adolescent to assess the extent of self-management behaviors (e.g., "Do you fill a prescription if you need to," "Do you manage your money & budget household expenses?…”