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A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions

Authors

  • L. A. Schwartz,

    1. Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
    2. Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • L. K. Tuchman,

    1. Division of Adolescent and Young Adult Medicine and Center for Clinical and Community Research, Children's National Medical Center, Washington, DC, and
    2. Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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  • W. L. Hobbie,

    1. Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • J. P. Ginsberg

    1. Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
    2. Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Lisa A. Schwartz and Lisa K. Tuchman are co-first authors.

Lisa A. Schwartz, PhD, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, CHOP North #1484, Philadelphia, PA 19104, USA. E-mail: schwartzl@email.chop.edu

Abstract

Background  Policy and research related to transition to adult care for adolescents and young adults (AYAs) has focused primarily on patient age, disease skills and knowledge.

Objective  In an effort to broaden conceptualization of transition and move beyond isolated patient variables, a new social-ecological model of AYA readiness for transition (SMART) was developed.

Methods  SMART development was informed by related theories, literature, expert opinion and pilot data collection using a questionnaire developed to assess provider report of SMART components with 100 consecutive patients in a childhood cancer survivorship clinic.

Results  The literature, expert opinion and pilot data collection support the relevance of SMART components and a social-ecological conceptualization of transition. Provider report revealed that many components, representing more than age, disease knowledge and skills, related to provider plans for transferring patients.

Conclusions  SMART consists of inter-related constructs of patients, parents and providers with emphasis on variables amenable to intervention. Results support SMART's broadened conceptualization of transition readiness and need for assessment of multiple stakeholders' perspectives of patient transition readiness. A companion measure of SMART, which will be able to be completed by patients, parents and providers, will be developed to target areas of intervention to facilitate optimal transition readiness. Similar research programmes to establish evidence-based transition measures and interventions are needed.

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