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Transition of patients with sickle cell disease from pediatric to adult care: Assessing patient readiness

Authors

  • Marianne McPherson MD,

    1. Fellow, Pediatric Hematology-Oncology, Emory University School of Medicine, Atlanta, Georgia
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  • Lisa Thaniel LICSW,

    1. Clinical Social Worker, Children's National Medical Center, Washington, District of Columbia
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  • Caterina P. Minniti MD

    Corresponding author
    1. Staff Clinician, National Institutes of Health, Bethesda, Maryland
    • Staff Clinician, National Institutes of Health, National Heart, Lung, and Blood Institute, Pulmonary and Vascular Medicine Branch, 9000 Rockville Pike, Building 10CRC, Room 5-5140, Bethesda MD 20892.
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Abstract

Background

Transfer of care from pediatric to adult-oriented providers is challenging for adolescents with sickle cell disease (SCD). The need for transition programs is known, however many SCD patients leave pediatric care without adequate preparation. This study has two aims: to assess adolescent SCD patients' preparation for transition and to identify variables that predict patient readiness.

Procedure

Adolescent patients receiving care at a pediatric SCD center received a survey regarding essential steps of the transition process. Patients' level of prior thought, interest, anticipated difficulty, and perceived importance of transition were graded on a scale of 0 to 3. Knowledge of individual transition plans was scaled 0 to 4. Responses were analyzed according to age, sex, and disease severity.

Results

Seventy patients ages 14 to 20 years (median 16.7 years) were assessed. Mean readiness scores were low, with greatest deficiencies in prior thought (mean 0.88 [0.66–1.09]), knowledge (mean 0.85 [0.61–1.09]), anticipated difficulty (mean 1.42 [1.23–1.61]), and interest (mean 1.71 [1.47–1.95]). Perceived importance of transition received the highest score (mean 2.71 [2.58–2.84]). Younger age (≤16 years) was associated with less knowledge (P = 0.003) and interest (P = 0.023); disease severity (≥3 crises/year) was associated with lower interest (P = 0.043) but greater anticipated difficulty (P = 0.001). Anticipated difficulty trended higher among females (P = 0.028).

Conclusions

Adolescents with SCD acknowledge the importance but demonstrate poor preparation for transition to adult-oriented care. Readiness improves with age but remains insufficient. This analysis highlights the need for improvements in anticipatory guidance for transition during adolescence. Pediatr Blood Cancer 2009;52:838–841. © 2009 Wiley-Liss, Inc.

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