BACKGROUND: Characterized as inflammation of the gastrointestinal tract, pediatric inflammatory bowel disease has become increasingly more prevalent throughout the world. Inflammatory bowel disease is chronic, and no definitive cure exists. Instead, patients aim to achieve remission from flair-ups. Adequate transition into adult gastrointestinal care has been shown to be critical for future patient outcomes. Hence, successful transition from pediatric to adult inflammatory bowel disease care plays an important role in maintaining patient wellbeing. Identifying factors that contribute to patient transition readiness may be able to improve the transition process.
OBJECTIVE: To elucidate sociodemographic and disease related parameters that influence transition, synthesize models that can predict transition readiness, and make recommendations to improve the process.
METHODS: As part of a larger quality improvement project conducted by Massachusetts General Hospital for Children, 274 patients with inflammatory bowel disease ranging from ages 12 to 27 were enrolled between June 2019 and October 2020. Sociodemographic information was gathered via chart review. The Abbreviated Pediatric Crohn’s Disease Activity Index, Disease Activity Index Score, and Physician Global Assessment were completed by patients and physicians to assess disease severity. Patients also completed PROMIS questionnaires to assess anxiety, depression, sleep disturbance and impairment. Patients completed the Transition Readiness Assessment Questionnaire to gauge transition readiness. Bivariate analyses were conducted to elucidate the relationships between sociodemographic information, disease related parameters, and transition readiness. Multivariate regressions were conducted to synthesize models aimed at predicting transition readiness.
RESULTS: Females had significantly worse disease severity, mental health, and sleep quality compared to males. Poor sleep quality had a significant relationship with disease severity and mental health status. Females had significantly higher transition readiness scores compared to males. Older age had a significant relationship with greater transition readiness. More patient anxiety was significantly associated with weaker communication skills. Otherwise, no disease related parameters significantly correlated with transition readiness. Disease duration demonstrated a significant positive relationship with transition readiness, particularly for patients diagnosed between the ages of 10 – 17. Models synthesized to predict transition readiness demonstrated substantial variability in predictive value.
CONCLUSION: Transitioning from pediatric to adult inflammatory bowel disease care is a complex process. Future research should be aimed at elucidating discrepancies in transition readiness between genders, and further understanding the role disease duration plays in the transition process. Providers should work towards incorporating structured transition programs and improving patients’ disease-related knowledge, as well as patient familiarity with logistical aspects of the current US healthcare system. / 2023-11-09T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43328 |
| Date | 10 November 2021 |
| Creators | Cerel, Benjamin Matthew |
| Contributors | Moussavi, Mina, Winter, Harland |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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