Pediatric residents’ attitudes and practice patterns regarding transition to adult-oriented care

Abstract

Background: Most youth with chronic illness will survive into adulthood. The complexity of the medical history and care in these patients necessitates a well-planned and coordinated transition over several years as they move from pediatric to adult-oriented health care. Methods: We assessed pediatric residents’ practice patterns and attitudes regarding transition communication by administering a survey about transition to pediatric, combined internal medicine-pediatrics, pediatric neurology, and combined psychiatry-child psychiatry-pediatric residents. Results: Among 110 residents who were contacted, 66 completed the survey, for a response rate of 61%. Surveyed residents report discussing transition with their patients when their patients are age 18 or older, when guidelines suggest a discussion should begin around age 12. Most residents felt that transition should be initially addressed one year prior to transfer. Residents also reported barriers such as lack of experience with transition and lack of role modeling by supervisors as barriers to providing transitional care. Conclusions: The practice patterns and attitudes of pediatric residents in this study do not reflect the recommendations that have been published regarding transitional care services to prepare patients and families for transfer from pediatric to adult-oriented care. In particular, most residents report that they start transition discussions when a patient is near the age of 18, rather than the age of 12 as guidelines suggest and as families would prefer. Pediatric residents need further education regarding transition, with particular emphasis on the need for early and frequent discussions with patients and families regarding transition.

Practical Steps to Help Transition Pediatric Patients to Adult Care

“…Guidelines recommend starting a conversation about transition when a patient is 12 to 14 years old. 1,3 Many pediatricians feel that is too early, [4][5][6] but as shown in the interview, connecting to services is time-consuming. Starting a transition conversation early allows families to consider and plan for a health care transition as well as transitions in other life domains.…”

Provider Educational Needs and Preferences Regarding Transition from Pediatric to Adult Care in a Pediatric Health System

“…Previous surveys have focused on transition practices with minimal exploration of educational preferences. 6,7 We plan to incorporate preferences identified in this work into educational endeavors in our health system to optimize provider engagement.…”

“…4,5 Furthermore, research focusing on providers has demonstrated that pediatric and adult providers, including residents and attendings, do not follow transition guidelines. 6,7 To improve transition, professional organizations have recommended increased education for providers during training and Continuing Medical Education (CME). 1 Given these recommendations, we sought to devise an educational intervention within a pediatric health system to improve knowledge of best practices around transition.…”

“…4,5 Furthermore, research focusing on providers has demonstrated that pediatric and adult providers, including residents and attendings, do not follow transition guidelines. 6,7 To improve transition, professional organizations have recommended increased education for providers during training and Continuing Medical Education (CME). 1…”

Transition from child-centred to adult-oriented healthcare systems for young people with neurodisability: a scoping review protocol

“…However, the transition process is frequently turbulent and experienced negatively by CYP, their families and caregivers 20 . Obstacles to successfully implementing transition include funding limitations, lack of continuity and coordination between child and adult services 21 – 23 and limited training opportunities and specialist expertise in the adult system 24 – 27 . In addition, there are significant changes to healthcare provider relationship and reduced support levels in the adult environment 28 .…”