The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
JAMA Pediatr. 2013 Oct;167(10):939-46. doi: 10.1001/jamapediatrics.2013.2223.
That too few youth with special health care needs make the transition to adult-oriented health care successfully may be due, in part, to lack of readiness to transfer care. There is a lack of theoretical models to guide development and implementation of evidence-based guidelines, assessments, and interventions to improve transition readiness.
To further validate the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) via feedback from stakeholders (patients, parents, and providers) from a medically diverse population in need of life-long follow-up care, survivors of childhood cancer.
Mixed-methods participatory research design.
A large Mid-Atlantic children's hospital.
Adolescent and young adult survivors of childhood cancer (n = 14), parents (n = 18), and pediatric providers (n = 10).
Patients and parents participated in focus groups; providers participated in individual semi-structured interviews.
Validity of SMART was assessed 3 ways: (1) ratings on importance of SMART components for transition readiness using a 5-point scale (0-4; ratings >2 support validity), (2) nominations of 3 "most important" components, and (3) directed content analysis of focus group/interview transcripts.
Qualitative data supported the validity of SMART, with minor modifications to definitions of components. Quantitative ratings met criteria for validity; stakeholders endorsed all components of SMART as important for transition. No additional SMART variables were suggested by stakeholders and the "most important" components varied by stakeholders, thus supporting the comprehensiveness of SMART and need to involve multiple perspectives.
SMART represents a comprehensive and empirically validated framework for transition research and program planning, supported by survivors of childhood cancer, parents, and pediatric providers. Future research should validate SMART among other populations with special health care needs.
很少有有特殊医疗需求的年轻人能够成功过渡到以成人为导向的医疗保健，这可能部分是由于缺乏准备转移护理。缺乏理论模型来指导发展和实施基于证据的指南、评估和干预措施，以提高过渡准备。
通过来自需要终身随访护理的医学多样化人群（儿童癌症幸存者）的利益相关者（患者、父母和提供者）的反馈，进一步验证青少年和年轻成人过渡准备的社会-生态模型（SMART）。
混合方法参与式研究设计。
一家大型大西洋中部儿童医院。
儿童癌症的青少年和年轻幸存者（n=14）、父母（n=18）和儿科提供者（n=10）。
患者和家长参加焦点小组；提供者参加个人半结构化访谈。
通过 3 种方式评估 SMART 的有效性：（1）使用 5 分制（0-4 分；评分>2 支持有效性）对过渡准备的 SMART 组件的重要性进行评分，（2）提名 3 个“最重要”的组件，以及（3）对焦点小组/访谈记录进行定向内容分析。
定性数据支持 SMART 的有效性，对组件的定义进行了微小修改。定量评分符合有效性标准；利益相关者认为 SMART 的所有组件对过渡都很重要。利益相关者没有提出任何其他 SMART 变量，并且“最重要”的组件因利益相关者而异，因此支持 SMART 的全面性和需要涉及多个观点。
SMART 代表了一种全面且经过实证验证的过渡研究和计划框架，得到了儿童癌症幸存者、父母和儿科提供者的支持。未来的研究应该在其他有特殊医疗需求的人群中验证 SMART。
