Implementing transition readiness screening by nurses in pediatric oncology long-term follow-up care during the COVID-19 pandemic: Barriers and facilitators
Abstract
This study aimed to 1) describe adolescent cancer survivors’ transition readiness and self-reported goals in a limited clinical sample; and 2) investigate healthcare providers’ (HCPs’) perspectives about a nurse-led clinical utilization of the Transition Readiness Assessment Questionnaire (TRAQ) and its subsequent discontinuation in a long-term follow-up (LTFU) pediatric oncology clinic. Data were collected from adolescent survivors (n = 7) at a tertiary pediatric hospital, while in-depth interviews were conducted with HCPs (n = 3) from the LTFU oncology clinic. Qualitative data revealed barriers, facilitators, and strategies for TRAQ implementation, relating to the tool, HCPs, adolescents, and the clinical context. The understanding of the barriers and facilitators to TRAQ use will support a structured implementation plan for TRAQ use in future clinical practice. Analysis revealed varying levels of readiness for transition to adult care services among patients and identified themes in their self-set goals, supporting the need for transition readiness supports in this population.
10.5737/23688076354554
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Anelli, C. G., Len, C. A., Terreri, M., Russo, G. C. S., & Reiff, A. O. (2019). Translation and validation of the Transition Readiness Assessment Questionnaire (TRAQ). Jornal de Pediatria, 95(2), 180–187. https://doi.org/10.1016/j.jped.2017.12.013
Braun, V., & Clarke, V. (2012). Thematic Analysis (Vol. Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological). DC: American Psychological Association. https://doi.org/10.1037/13620-004
Brown, M. C., Haste, A., Araújo-Soares, V., Skinner, R., & Sharp, L. (2021). Identifying and exploring the self-management strategies used by childhood cancer survivors. Journal of Cancer Survivorship, 15(2), 344–357. https://doi.org/10.1007/s11764-020-00935-2
Canadian Cancer Society. Canadian Cancer Statistics 2021. https://www.cancer.ca/Canadian-Cancer-Statistics-2021-EN
Chapados, P., Aramideh, J., Lamore, K., Dumont, É., Lugasi, T., Clermont, M.-J., Laberge, S., Scott, R., Laverdière, C., & Sultan, S. (2021). Getting ready for transition to adult care: Tool validation and multi-informant strategy using the Transition Readiness Assessment Questionnaire in pediatrics. Child: Care, Health and Development, 47(5), 645–653. https://doi.org/https://doi.org/10.1111/cch.12872
Chapados, P., Provencher, S., Aramideh, J., Dumont, É., Lugasi, T., Laverdière, C., Sultan, S., & Desjardins, L. (2024). Transition Readiness Assessment Questionnaire: Skill gaps and psychosocial predictors of transition readiness among adolescents and young adults with chronic medical conditions. Child: Care, health and development, 50(1), e13156.
Clark, S. J., Beimer, N. J., Gebremariam, A., Fletcher, L. L., Patel, A. D., Carbone, L., Guyot, J. A., & Joshi, S. M. (2020). Validation of EpiTRAQ, a transition readiness assessment tool for adolescents and young adults with epilepsy. Epilepsia Open, 5(3), 487–495. https://doi.org/10.1002/epi4.12427
Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17(1), 75. https://doi.org/10.1186/s13012-022-01245-0
Darabos, K., Tucker, C. A., Brumley, L., King-Dowling, S., Butler, E., Stevens, E., O’Hagan, B., Henry-Moss, D., Deatrick, J. A., Szalda, D., Barakat, L. P., & Schwartz, L. A. (2023). Development and validation of a measure of adolescent and young adult goal-based quality of life (MAYA-GQOL). Quality of Life Research, 32(8), 2305–2317. https://doi.org/10.1007/s11136-023-03392-3
De Cunto, C. L., Eymann, A., Britos, M. L., González, F., Roizen, M., Rodríguez Celin, M. L., & Soriano Guppy, E. (2017). Cross-cultural adaptation of the Transition Readiness Assessment Questionnaire to Argentinian Spanish. Archivos Argentinos de Pediatria, 115(2), 181–187. https://doi.org/10.5546/aap.2017.eng.181
Faugno, E. (2016). A quality improvement initiative to implement a yearly Transition Readiness Assessment Questionnaire (TRAQ) for youth with sickle cell disease. Boston University.
Fox, N. (2008). Post-positivism. In: Given, L.M. (ed.) The SAGE encyclopaedia of qualitative research methods. Sage.
Gebauer, J., Higham, C., Langer, T., Denzer, C., & Brabant, G. (2019). Long-term endocrine and metabolic consequences of cancer treatment: A systematic review. Endocrine Reviews, 40(3), 711–767. https://doi.org/10.1210/er.2018-00092
Goetsch Weisman, A., Haws, T., Lee, J., Lewis, A. M., Srdanovic, N., & Radtke, H. B. (2020). Transition readiness assessment in adolescents and young adults with neurofibromatosis Type 1 (NF1). Comprehensive Child and Adolescent Nursing, 1–17. https://doi.org/10.1080/24694193.2020.1806402
González, F., Roizen, M., Celin, M. d. l. M. R., Carmen De Cunto, M., Eymann, A., Mato, R., Arrigoni, P. G., Staciuk, R., Ugo, F., & Fano, V. (2017). Validation of the Argentinian Spanish version of the Transition Readiness Assessment Questionnaire for adolescents with chronic conditions. Archivos Argentinos de Pediatria, 115(1), 18–27.
Got Transition/Center for Health Care Transition Improvement. (2014). Six core elements of health care transition. http://www.gottransition.org/providers/index.cfm
Hamilton, R., Nguyen, C., Mills, D., Stinson, J. N., & Jibb, L. A. (2024). Facilitators and barriers to the implementation of a digital pain assessment tool in pediatric oncology practice: A qualitative evaluation of a quality improvement project. Journal of Pediatric Hematology/Oncology Nursing, 41(4), 283–291.
Larsen, M. H., Larsen, E. H., Ruud, E., Mellblom, A., Helland, S., & Lie, H. C. (2022). “I have to do things differently now, but I make it work”– Young childhood cancer survivors’ experiences of self-management in everyday living. Journal of Cancer Survivorship, 16(4), 728–740. https://doi.org/10.1007/s11764-021-01066-y
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., Eccles, M. P., Cane, J., & Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81–95. https://doi.org/10.1007/s12160-013-9486-6
Mulder, R. L., van der Pal, H. J. H., Levitt, G. A., Skinner, R., Kremer, L. C. M., Brown, M. C., Bárdi, E., Windsor, R., Michel, G., & Frey, E. (2016). Transition guidelines: An important step in the future care for childhood cancer survivors. A comprehensive definition as groundwork. European Journal of Cancer, 54, 64–68. https://doi.org/https://doi.org/10.1016/j.ejca.2015.10.007
Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), 1–13. https://doi.org/https://doi.org/10.1186/s13012-015-0242-0
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Acadic Medicine, 89(9), 1245–1251. https://doi.org/10.1097/acm.0000000000000388
Okumura, M. J., Ong, T., Dawson, D., Nielson, D., Lewis, N., Richards, M., Brindis, C. D., & Kleinhenz, M. E. (2014). Improving transition from paediatric to adult cystic fibrosis care: Programme implementation and evaluation. BMJ Quality and Safety, 23(Suppl 1), i64–i72. https://doi.org/10.1136/bmjqs-2013-002364
Parfeniuk, S., Petrovic, K., MacIsaac, P. L., Cook, K. A., & Rempel, G. R. (2020). Transition readiness measures for adolescents and young adults with chronic health conditions: A systematic review. Journal of Transition Medicine, 2(1). https://doi.org/doi:10.1515/jtm-2020-0020
Pauley, A. (2022). Improving the healthcare transition for adolescents with asthma: Implementing a transition readiness assessment [Dissertation, University of Kentucky]. Lexington (KY). https://uknowledge.uky.edu/dnp_etds/375
Prasad, M., & Goswami, S. (2021). Barriers to long-term follow-up in adolescent and young adult survivors of childhood cancer: Perspectives from a low-middle income setting. Pediatric Blood Cancer, 68(12), e29248. https://doi.org/10.1002/pbc.29248
Proudfoot, K. (2023). Inductive/deductive hybrid thematic analysis in mixed methods research. Journal of Mixed Methods Research, 17(3), 308–326. https://doi.org/10.1177/15586898221126816
Ryan, B. L., Brown, J. B., Tremblay, P. F., & Stewart, M. (2019). Measuring patients’ perceptions of health care encounters: Examining the Factor Structure of the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire. Journal of Patient Centered Reseach and Reviews, 6(3), 192–202. https://doi.org/10.17294/2330-0698.1696
Sawicki, G. S., Lukens-Bull, K., Yin, X., Demars, N., Huang, I.-C., Livingood, W., Reiss, J., & Wood, D. (2011). Measuring the transition readiness of youth with special healthcare needs: validation of the TRAQ--Transition Readiness Assessment Questionnaire. Journal of Pediatric Psychology, 36(2), 160–171. https://doi.org/10.1093/jpepsy/jsp128
Schmidt, A., Ilango, S. M., McManus, M. A., Rogers, K. K., & White, P. H. (2020). Outcomes of pediatric to adult health care transition interventions: An updated systematic review. Journal of Pediatric Nursing, 51, 92–107. https://doi.org/https://doi.org/10.1016/j.pedn.2020.01.002
Schwartz, L. A., & Parisi, M. L. (2013). Self-identified goals of adolescents with cancer and healthy peers: Content, appraisals, and correlates. Journal of Pediatric Psychology, 38(2), 151–161. https://doi.org/10.1093/jpepsy/jss105
Segal, S., & Cofer, C. (1960). The effect of recency and recall on word-association.
Signorelli, C., Wakefield, C. E., Fardell, J. E., Wallace, W. H. B., Robertson, E. G., McLoone, J. K., & Cohn, R. J. (2017). The impact of long-term follow-up care for childhood cancer survivors: A systematic review. Critical Reviews in Oncology/Hematology, 114, 131–138. https://doi.org/10.1016/j.critrevonc.2017.04.007
Society of Adolescent Health and Medicine. (2020). Transition to adulthood for youth with chronic conditions and special health care needs. Journal of Adolescent Health, 66(5), 631–634. https://doi.org/https://doi.org/10.1016/j.jadohealth.2020.02.006
Vainman, S., Heller False Speiser, M. M., Posadas Martinez, M. L., Pérez, L., Aguirre, M. A., Cortines Lapalma, M. C., Sánchez, M. C., Mulli, V., & De Cunto, C. L. (2022). Experience with the transition process of adolescents with chronic diseases from pediatric to adult care in a general hospital. Archivos Argentinos de Pediatria, 120(6), 398–404. https://doi.org/10.5546/aap.2022.eng.398
van den Oever, S. R., Pluijm, S. M. F., Skinner, R., Glaser, A., Mulder, R. L., Armenian, S., Bardi, E., Berger, C., Ehrhardt, M. J., Gilleland Marchak, J., Haeusler, G. M., Hartogh, J. D., Hjorth, L., Kepak, T., Kriviene, I., Langer, T., Maeda, M., Márquez-Vega, C., Michel, G., … Kremer, L. C. M. (2022). Childhood cancer survivorship care during the COVID-19 pandemic: An international report of practice implications and provider concerns. Journal of Cancer Survivorship, 16(6), 1390–1400. https://doi.org/10.1007/s11764-021-01120-9
Velez, J. (2019). Successful transition of care of youths with chronic disease to adult providers [dissertation] Grand Canyon University]. Phoenix (AZ).
Whelan, N. C. (2020). Healthcare transition from pediatric to adult care: Implementation of a readiness assessment tool. https://doi.org/https://doi.org/doi:10.7282/t3-d5ec-tt10
Wood, D. L., Sawicki, G. S., Miller, M. D., Smotherman, C., Lukens-Bull, K., Livingood, W. C., Ferris, M., & Kraemer, D. F. (2014). The Transition Readiness Assessment Questionnaire (TRAQ): Its factor structure, reliability, and validity. Academic Pediatrics, 14(4), 415–422. https://doi.org/10.1016/j.acap.2014.03.008
World Health Organization. (2021). Childhood cancer. https://www.who.int/news-room/fact-sheets/detail/cancer-in-children.
Zhang, L. F., Ho, J. S., & Kennedy, S. E. (2014). A systematic review of the psychometric properties of transition readiness assessment tools in adolescents with chronic disease. BMC pediatrics, 14(1), 1–10.
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