Foster Alice, Chan Justin M, Wine Eytan, El-Matary Wael, Carroll Matthew W, Kroeker Karen I, deBruyn Jennifer C, Seow Cynthia H, Lawrence Sally, Evans Kathy, Kluthe Cheryl, Sharifi Nastaran, Pears Christina, Nicol Simone, Olayinka Lily, Fu Nancy, Huynh Hien Q, Bressler Brian, Bernstein Charles N, Jacobson Kevan
Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada.
Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
J Pediatr. 2023 Jul;258:113403. doi: 10.1016/j.jpeds.2023.113403. Epub 2023 Apr 3.
To examine readiness of adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) to transition to adult care.
A cross-sectional multicenter study evaluating transition readiness in individuals with IBD 16-19 years old prospectively recruited from 8 Canadian IBD centers using the validated ON Taking Responsibility for Adolescent to Adult Care (ON TRAC) questionnaire. Secondary aims included (1) screening for depression and anxiety using the 8-item Personal Health Questionnaire Depression Scale and The Screen for Child Anxiety Related Emotional Disorders questionnaires, respectively; (2) evaluating the association between depression and anxiety with readiness and disease activity; and (3) subjectively evaluating AYA readiness based on physician and parent assessments.
In total, 186 participants (139 adolescent, 47 young adult) were enrolled, mean age 17.4 years (SD, 0.87). ON TRAC scores determined that 26.6% of AYAs at pediatric and 40.4% at adult centers reached the threshold of readiness. On multivariable linear regression analysis age was positively (P = .001) and disease remission negatively (P = .03) associated with ON TRAC scores. No statistically significant differences were determined across centers. A significant percentage of AYAs reported moderate-to-severe depression (21.7%) and generalized anxiety (36%); however, neither were significantly associated with ON TRAC scores. Notably, physician and parental assessment of AYA readiness correlated poorly with ON TRAC scores (⍴ = 0.11, ⍴ = 0.24, respectively).
Assessment of transition readiness in AYAs with IBD highlighted that a large proportion do not have adequate knowledge or behavior skills needed for transition to adult care. This study infers that readiness assessment tools are essential during transition to identify deficits in knowledge and behavior skills that could be specifically targeted by the youth, caregivers, and multidisciplinary team.
研究炎症性肠病（IBD）青少年及青年（AYA）向成人护理过渡的准备情况。
一项横断面多中心研究，使用经过验证的《青少年到成人护理责任问卷》（ON TRAC）对从8个加拿大IBD中心前瞻性招募的16至19岁IBD患者的过渡准备情况进行评估。次要目标包括：（1）分别使用8项个人健康问卷抑郁量表和儿童焦虑相关情绪障碍筛查问卷筛查抑郁和焦虑；（2）评估抑郁和焦虑与准备情况及疾病活动之间的关联；（3）基于医生和家长评估主观评价AYA的准备情况。
共纳入186名参与者（139名青少年，47名青年），平均年龄17.4岁（标准差0.87）。ON TRAC评分显示，儿科中心26.6%的AYA以及成人中心40.4%的AYA达到了准备阈值。多变量线性回归分析显示，年龄与ON TRAC评分呈正相关（P = 0.001），疾病缓解与ON TRAC评分呈负相关（P = 0.03）。各中心之间未发现统计学上的显著差异。相当比例的AYA报告有中度至重度抑郁（21.7%）和广泛性焦虑（36%）；然而，两者均与ON TRAC评分无显著关联。值得注意的是，医生和家长对AYA准备情况的评估与ON TRAC评分的相关性较差（分别为⍴ = 0.11和⍴ = 0.24）。
对IBD AYA过渡准备情况的评估突出表明，很大一部分人没有向成人护理过渡所需的足够知识或行为技能。本研究推断，在过渡期间，准备情况评估工具对于识别青年、护理人员和多学科团队可以专门针对的知识和行为技能缺陷至关重要。
