DOZ047.63: Closing the gap: transitioning adolescents with esophageal atresia to adult care. (24th June 2019)

• Record Type: Journal Article
• Authors: Hawley, A D; Brooks, J-A E; Nightingale, M G; Teague, W J; Crameri, J; Culnane, E
• Is Part Of: Diseases of the esophagus. Volume 32(2019)Supplement 1
• Publication Date: 2019-06-24
• Subjects: adolescents -- adult care -- transition; Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doz047.63
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Introduction: Evidence supports engaging adolescents and carers in an individualized transition process to improve health outcomes through increased patient knowledge, skills, adherence, quality of life and ultimately, engagement with adult services. Further, a comprehensive transition process promotes confidence in navigating adult health services. While transition for chronic medical cohorts has received considerable attention over decades, there is increasing recognition of the importance of transition for adolescents with surgical conditions. Background: It is widely held that the transition of adolescents born with esophageal atresia (OA) from pediatric to adult services is important, and if not managed well, may compromise outcomes. We designed and implemented a transition process for adolescent OA patients at our hospital (with establishment of a transfer pathway in partnership with adult health services) in 2017. Methods: Following implementation of a transition process a retrospective review was undertaken in 2019 to identify themes from the dedicated Transition Support Service (TSS) Clinics (October, 2017–December, 2018) for OA patients aged 15–19 years. Patients were identified from an institutional database (Nate Myers Oesophageal Atresia Database, Royal Children's Hospital, Melbourne). These patients had previously been invited to: Attend TSS Clinics as part of routine clinical care. Re-engage in multidisciplinary follow-up (if necessary) including with a consultant surgeon, OA nurse and respiratory physician. Institutional ethics approval was obtained prior to commencement of the study (HREC #QA/51265/RCHM-2019). Results: A total of 18 adolescent OA patients and their parents attended RCH TSS and associated follow-up clinics. We observed three key themes in attendees reports and experiences: Poor health knowledge : 56% of adolescents had poor knowledge about their OA, including previous surgery, possible complications and their symptoms; Poor compliance : 54% of adolescents reported poor compliance with prescribed regular medications (e.g. anti-reflux therapy); Mental health issues: 39% of adolescents identified as having mental health concerns, e.g. low mood or clinical depression, anxiety, anger or had engaged in self-harm. Anxiety about transfer to adult services was moderate to high in the majority (61%) of adolescents and their parents. Conclusions: The themes identified in this study support the need for, and importance of, a structured process to transition adolescents born with OA to adult services.