Review article
Patients' Perspective on Factors That Facilitate Transition From Child-centered to Adult-centered Health Care: A Theory Integrated Metasummary of Quantitative and Qualitative Studies

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Abstract

Purpose

The purpose of this review was twofold. First, to summarize systematically the state of the research conducted on the perspective of patients on transition from child-centered care to adult-centered care (ACC). Second, based on this review of patients' perspective, to identify factors that facilitate transition to ACC.

Methods

Using a metasummary methodology, we extracted, grouped, and abstracted the findings from 46 qualitative and descriptive quantitative studies involving patients before and/or after their transfer to ACC.

Results

Empirical results on transition fall into four groups: (1) patients' feelings and concerns; (2) patients' recommendations about transition; (3) outcomes after transfer; and (4) mode of transfer.

Conclusions

Results are discussed within a theoretical transition framework that emphasizes the importance of fulfilling five conditions that will lead to successful transition. Given our findings, this synthesis and framework can be used to tailor transition care and direct future research.

Section snippets

Retrieval

We retrieved articles by searching three electronic databases (MEDLINE, PsycINFO, CINAHL) using variations and Boolean connections of terms related to transition (e.g., transfer and adolesc* and care; transition and adolesc* and care). Detailed search strings are available on request. We increased the database searches by scrutinizing the retrieved articles' references to identify additional relevant publications. The search was last updated in April 2009.

Inclusion and exclusion criteria

To be included in our review, articles

Studies' findings

We reviewed studies that varied with regard to the methodology, the population, and the timing of transfer (Table 1 for specific characteristics). After the extraction and abstraction of findings, we concluded that the body of findings falls into four broad categories: (1) patients' feelings and concerns, (2) patients' recommendations, (3) outcomes after transition, and (4) effects of the mode of transfer.

Patients' feelings and concerns

Across several studies, patients described CCC as a familiar and comfortable environment,

Discussion

The metasummary we presented provides a comprehensive synthesis of the available qualitative and quantitative literature on the experience of patients with physical chronic illness of their transition from CCC to ACC. Our approach allowed us to highlight the predominance of four themes that are currently central to this literature: patient's concerns and feelings regarding transition, patients' recommendations for transition, outcome of transition, and mode of transfer.

In an effort to discuss

Conclusions

The results of our metasummary offer a detailed overview of patients' experience of transition to ACC. Conditions that seem to ease the transition process include (1) presenting transition as a normative event (meaning), (2) clarifying and discussing the patient's expectations about the transition process, (3) starting preparation early to ensure that the patient has the necessary knowledge and skills for autonomous behavior at the time of transition and after, (4) joint planning with the

Acknowledgments

The authors acknowledge the financial support of a graduate scholarship from Fonds de la recherche sur la nature et les technologies awarded to T.L. and from operating grants by Fonds de la recherche en santé du Québec (#8380/#14344) awarded to M.A.

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