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Factors impacting transition readiness in young adults with neuropathic bladder
Joshua D Roth1, Konrad M Szymanski1, Mark P Cain1
1Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, 46202, USA.
Insights
Young adults with spina bifida (SB) are not fully ready for adult care, with older age being the only factor associated with better transition readiness. Further attention to the transition process is needed for this population.
Area of Science:
- Neurology
- Pediatric Medicine
- Healthcare Transition
Background:
- Spina bifida (SB) patients often experience cognitive impairments, complicating the transition to adult care.
- Effective transition readiness is crucial for young adults with SB to manage their complex healthcare needs.
Purpose of the Study:
- To identify patient factors influencing transition readiness in young adults with spina bifida.
- To test the hypothesis that greater healthcare exposure correlates with higher transition readiness.
Main Methods:
- The Transition Readiness Assessment Questionnaire (TRAQ) was administered to 96 adult SB patients (age ≥18).
- TRAQ assesses 20 skills across five domains, with scores ranging from 1 (do not know) to 5 (always do).
- Demographic data, ambulatory status, shunt status, and prior augmentations were collected and analyzed using non-parametric statistics and linear regression.
Main Results:
- Overall median TRAQ score was 4.0/5.0, indicating patients were beginning to transition.
- Older age (>25 years) was significantly associated with higher TRAQ scores across multiple domains and overall.
- Female gender showed an association with higher scores in specific domains (e.g., Appointment Keeping) on univariate analysis, but this was not significant in bivariate analysis.
Conclusions:
- Young adults with spina bifida demonstrate partial readiness for healthcare transition, with older age being the primary associated factor.
- Demographic factors and specific clinical characteristics did not independently predict transition readiness.
- The findings highlight the need for targeted interventions and a potentially extended transition period for individuals with SB.
Introduction:
Patients with spina bifida (SB) often have cognitive impairments making the difficult transition process to adult care even more challenging.
Objective:
The objective of this study was to identify what patient factors impact transition readiness in this population. It is hypothesized that young adults with SB with more healthcare exposure were more likely to report readiness to transition.
Methods:
Consecutive patients ≥18 years old in the adult SB clinic were evaluated using the validated Transition Readiness Assessment Questionnaire (TRAQ, 8/17-5/18). Five TRAQ domains assess 20 skills necessary to transition. Responses are 1 No, I do not know how"; 2 No, but I want to learn"; 3 No, but I am learning how to do this"; 4 Yes, I have started doing this"; 5 Yes, I always do this when I need to" (considered "fully transitioned"). Demographics, ambulatory status, shunt status, shunt revisions, number of medications, and prior bladder augmentation were assessed. Domain and total TRAQ scores were analyzed using non-parametric statistics and linear regression.
Results:
Ninety-six patients (60.4% females, 70.8% shunted) participated at median age 25.5 years. Overall median TRAQ score was 4.0/5.0, indicating that patients were starting to transition. On univariate analysis, age >25 years was associated with higher TRAQ scores across every domain and overall (P ≤ 0.01). Female gender was also associated with higher TRAQ scores for "Appointment Keeping," "Tracking Health Issues" and overall (P ≤ 0.03). Race, ambulatory status, shunt status, number of shunt revisions, number of medications, and prior bladder augmentation were not associated with TRAQ scores (P ≥ 0.12). After adjusting for gender on bivariate analysis, age >25 years was associated with higher TRAQ scores for "Appointment Keeping," "Tracking Health Issues," "Talking with Providers," and "Managing Daily Activities" domains and overall (P ≤ 0.03), but not the "Managing Medications" domain (P = 0.07). Female gender was not independently associated with higher domain or overall TRAQ scores (P≥0.10).
Discussion:
The transition readiness of young adults with SB compared based on demographic factors and factors increasing healthcare exposure is described. Limitations include the small sample size, potentially limiting generalizability, as well as cross-sectional nature.
Conclusion:
Transitioning adults with SB had TRAQ scores indicating that they were not yet fully transitioned in terms of their healthcare-related behavior. Older age was the only factor associated with transition readiness, which was not impacted by other demographics. Increased attention to transition readiness and consideration of a longer transition process in this population is necessary.
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