Schwartz L A, Tuchman L K, Hobbie W L, Ginsberg J P
Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Child Care Health Dev. 2011 Nov;37(6):883-95. doi: 10.1111/j.1365-2214.2011.01282.x.
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.
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.
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.
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.
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.
与青少年及青年成人（AYA）向成人护理过渡相关的政策和研究主要集中在患者年龄、疾病技能和知识方面。
为了拓宽对过渡的概念化理解，并超越孤立的患者变量，开发了一种新的AYA过渡准备社会生态模型（SMART）。
SMART的开发参考了相关理论、文献、专家意见以及通过一份问卷进行的试点数据收集，该问卷用于评估在一家儿童癌症幸存者诊所连续100名患者中提供者对SMART组件的报告。
文献、专家意见和试点数据收集支持了SMART组件的相关性以及过渡的社会生态概念化。提供者报告显示，许多组件，不仅仅是年龄、疾病知识和技能，与提供者转移患者的计划相关。
SMART由患者、父母和提供者相互关联的结构组成，重点关注易于干预的变量。结果支持SMART对过渡准备的拓宽概念化以及评估多个利益相关者对患者过渡准备看法的必要性。将开发一种SMART的配套测量工具，患者、父母和提供者都可以完成，以针对干预领域，促进最佳过渡准备。需要开展类似的研究项目来建立基于证据的过渡测量方法和干预措施。
