Barriers to Transition From Pediatric to Adult Care: A Systematic Review

Gray, Wendy N.; Schaefer, Megan R.; Resmini-Rawlinson, Alana; Wagoner, Scott T.

doi:10.1093/jpepsy/jsx142

Cited by 195 publications

(171 citation statements)

References 81 publications

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“…Many in this study found the shift from the long‐standing relationships in the paediatric service to the impersonal consultations in the adult service difficult which echoes prior research (Fegran et al, ). A systematic review conducted in the United States concluded that “letting‐go of long‐standing relationships” was the most common barrier to transition (Gray, Schaefer, Resmini‐Rawlinson, & Wagoner, ). Given that AYAs value a trusting relationship with professionals, having an opportunity to get to know the adult team before transition can be particularly helpful for adjustment to the new team and adult environment.…”

Section: Discussionmentioning

confidence: 99%

Healthcare transition for adolescents and young adults with long‐term conditions: Qualitative study of patients, parents and healthcare professionals’ experiences

Coyne

Sheehan

Heery

et al. 2019

Journal of Clinical Nursing

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Aim and objectives To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long‐term conditions: diabetes, cystic fibrosis and congenital heart disease. Background Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long‐term conditions. Yet, limited empirical evidence exists regarding transition experiences. Design Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). Methods Semi‐structured interviews with AYAs aged 14–25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed‐methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. Results Transfer occurred between the ages of 16–early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self‐management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following‐up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults’ prerogative. Conclusions The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. Relevance to clinical practice Nurses in collaboration with the multidisciplinary team can help AYAs develop their self‐management skills and guide parents on how to relinquish responsibility gradually prior to transition.

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Section: Discussionmentioning

confidence: 99%

Healthcare transition for adolescents and young adults with long‐term conditions: Qualitative study of patients, parents and healthcare professionals’ experiences

Coyne

Sheehan

Heery

et al. 2019

Journal of Clinical Nursing

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“…A challenge in many chronic diseases with youth onset is the continuation of disease management through the transition from pediatric to adult care providers [20]. Indicators of disease management through this transition, as evidenced by glycemic control (HbA1c ≥ 75 mmol/mol [9.0%]), were examined in SEARCH in 182 young adults with type 2 diabetes who were initially receiving care through a pediatric provider, who reached age 18–25 while enrolled in SEARCH, and who had at least one follow-up in SEARCH after reaching age 18.…”

Section: Disease Managementmentioning

confidence: 99%

Type 2 Diabetes in Youth: New Lessons from the SEARCH Study

Jensen

Dabelea

2018

Curr Diab Rep

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This body of evidence illustrates that type 2 diabetes continues to increase in incidence, although this increase may be partially attributable to increased surveillance. Disease management is influenced by the transition from adolescent to adult care and psychosocial factors may also contribute. This evidence also describes a high prevalence of disease-associated complications and comorbidities. Risk factors for cardiovascular disease are also highly prevalent. The SEARCH for Diabetes in Youth study continues to inform our understanding of the descriptive epidemiology and natural history of type 2 diabetes in youth. As the cohort matures, new opportunities emerge for building on our understanding of how youth-onset type 2 diabetes impacts future health.

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“…Central to an effective transition is the completion of comprehensive assessments and care plans, required to inform future treatments, interventions and support needs (Rochester‐Eyeguokan, Pincus, Patel, & Reitz, ). Nurses are in a key position to ensure collaboration and effective information sharing with other nurses in primary and acute care as well as specialist ID services (Gray, Schaefer, Resmini‐Rawlinson, & Wagoner, ).…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

Transition from child to adult health services: A qualitative study of the views and experiences of families of young adults with intellectual disabilities

Brown

Higgins

MacArthur

2019

Journal of Clinical Nursing

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Aims and objectives To explore the experiences of the families of young adults with intellectual disabilities at the point of transition from child to adult health services. Background The population of people with intellectual disabilities is changing rapidly, with young people with increasingly complex needs surviving into adulthood and requiring transition from child to adult health services. Design An interpretative qualitative design. Methods Semi‐structured interviews were held with ten family carers of young adults with intellectual disabilities and complex care needs, who were in the process of or had recently completed a transition from child to adult health services in Scotland. Data were analysed using thematic analysis. The COREQ checklist was used. Results Transition emerged as a highly emotional and challenging period for family carers. Their experiences were captured in five main themes: “a deep sense of loss,” “an overwhelming process,” “parents making transitions happen,” “a shock to the adult healthcare system” and “the unbearable pressure.” Nurses were often seen as instrumental to counteracting some of these challenges. Conclusions There is an urgent need to respond to the challenges experienced by carers at the point of transition and beyond, by ensuring early and coordinated planning, effective information sharing and communication and clear transition processes and guidelines. A person‐centred and family‐centred approach is required to minimise negative impact on the health and well‐being of the young adult with intellectual disabilities and their carers. Relevance to clinical practice Registered nurses have a key role in providing information and support, along with coordinating care at the time of transition from child to adult health services for young adults with complex intellectual disabilities. It is vital that their input is person‐centred and responds effectively to the expert knowledge of family carers, while at the same time ensuring their needs for information and support are also addressed.

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Barriers to Transition From Pediatric to Adult Care: A Systematic Review

Abstract: Each chronic illness group experiences illness-specific challenges but certain barriers transcend chronic illness populations. Suggestions to overcome these barriers are provided.

Cited by 195 publications

References 81 publications

Healthcare transition for adolescents and young adults with long‐term conditions: Qualitative study of patients, parents and healthcare professionals’ experiences

Healthcare transition for adolescents and young adults with long‐term conditions: Qualitative study of patients, parents and healthcare professionals’ experiences

Type 2 Diabetes in Youth: New Lessons from the SEARCH Study

Transition from child to adult health services: A qualitative study of the views and experiences of families of young adults with intellectual disabilities

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