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Journal of Pediatrics, The

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Transition Readiness in Youth with Inflammatory Bowel Disease - 05/07/23

Doi : 10.1016/j.jpeds.2023.113403 
Alice Foster, MD 1, ∗, Justin M. Chan, MSc, PhD candidate 1, ∗, Eytan Wine, MD, PhD 2, Wael El-Matary, MD, MSc 3, Matthew W. Carroll, BSc, BMed(Hons), MHSc 2, Karen I. Kroeker, MD, MSc 4, Jennifer C. deBruyn, MD, MSc 5, Cynthia H. Seow, MBBS (Hons), MSc 6, Sally Lawrence, MBChB 1, Kathy Evans, RN 1, Cheryl Kluthe, RN 2, Nastaran Sharifi, MD 6, Christina Pears, RN 7, Simone Nicol, MMed, MBChB 8, Lily Olayinka, PhD 4, Nancy Fu, MD, MHSc 9, Hien Q. Huynh, MBBS 2, Brian Bressler, MD, MS 7, 9, Charles N. Bernstein, MD 10, Kevan Jacobson, MBBCh 1, 11, ⁎
1 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 
2 Department of Pediatrics, Division of Gastroenterology, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada 
3 Department of Pediatrics, Division of Gastroenterology, Winnipeg Children’s Hospital, University of Manitoba, Winnipeg, Manitoba, Canada 
4 Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada 
5 Departments of Pediatrics and Community Health Sciences, Division of Gastroenterology, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada 
6 Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 
7 IBD Center of BC, Vancouver, British Columbia, Canada 
8 Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada 
9 Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 
10 University of Manitoba Inflammatory Bowel Disease Clinical and Research Center and Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health sciences, University of Manitoba, Winnipeg, Manitoba, Canada 
11 Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada 

∗Reprint requests: Kevan Jacobson, MBBCh, FRCPC, FCP, AGAF, CAGF Professor of Paediatrics, Head, Division of Gastroenterology, Hepatology and Nutrition Senior Clinician Scientist, British Columbia’s Children’s Hospital and Child and Family Research Institute University of British Columbia, 4480 Oak St, Room K4-184, Vancouver, British Columbia V6H 3V4, Canada.Division of Gastroenterology, Hepatology and Nutrition Senior Clinician ScientistBritish Columbia’s Children’s Hospital and Child and Family Research Institute University of British Columbia, 4480 Oak StRoom K4-184, VancouverBritish ColumbiaV6H 3V4Canada

Abstract

Objectives

To examine readiness of adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) to transition to adult care.

Study design

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.

Results

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).

Conclusions

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.

Le texte complet de cet article est disponible en PDF.

Keywords : inflammatory bowel disease, Crohn’s disease, ulcerative colitis, pediatrics, transition, depression, anxiety

Abbreviations : AYA, CD, IBD, ON TRAC, PGA, PHQ-8, SCARED, TRAQ, UC


Plan


 Funding by Janssen Pharmaceutic Inc. EW reports advisory board: AbbVie, Janssen, Nestle; and speaker: AbbVie, Nestle. WM reports advisory board: AbbVie, Janssen, Merck; investigator-initiated research support: Janssen; Speaker AbbVie. MC reports advisory board: AbbVie, Janssen. KK reports advisory board: AbbVie, Janssen. JB reports advisory board: AbbVie, Janssen, Merck, Amgen; speaker: AbbVie, Pfizer. CS reports advisory boards: Janssen, AbbVie, Takeda, Ferring, Shire, Pfizer, Sandoz, Pharmascience, Fresenius Kabi, Amgen; speaker: Janssen, AbbVie, Takeda, Ferring, Shire, Pfizer, Pharmascience. SL reports advisory board: Janssen; speaker: AbbVie. SN reports advisory board: AbbVie. HH reports advisory board: AbbVie, Janssen, Merck; research support: Janssen. BB reports advisor/speaker: Ferring, Janssen, AbbVie, Takeda, Pfizer, Novartis, BMS, Merck, Sandoz, Organon; advisor: Alimentiv, Gilead, Iterative Scopes, AMT, Celgene, Microbiome Insights, Merck, Amgen, Pendopharm, Genentech, BMS, Allergan, Protagonist, Fresenius Kabi, Mylan, Viatris, Bausch Health, Celltrion Healthcare, Jamp Pharma, Eupraxia; research support: Janssen, AbbVie, GSK, BMS, Amgen, Genentech, Merck, BI, Qu Biologic; stock options: Qu Biologic. CB consulted to AbbVie Canada, Amgen Canada, Avir Pharma, Bristol Myers Squibb Canada, JAMP Pharmaceuticals, Janssen Canada, Pfizer Canada, Roche Canada, Sandoz Canada, Canada, Takeda Canada, Mylan Pharmaceuticals. He has received investigator-initiated grants from Amgen Canada, AbbVie Canada, Pfizer Canada, Takeda Canada, and Sandoz Canada and has received unrestricted educational grants from AbbVie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada. He has been on speakers bureaus of AbbVie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada. KJ reports advisory board: AbbVie, Janssen, Amgen; Merck; Viatris; Mckesson Canada; speaker bureau: AbbVie, Janssen; investigator-initiated research support: Janssen; stock options: Engene. All other authors have no conflicts of interest to disclose.


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Vol 258

Article 113403- juillet 2023 Retour au numéro
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