Pre-Transition Consultations for Adolescents With Chronic Conditions in a General Pediatric Hospital: Lessons Learned

Abstract The objective of the study was to assess the clinically relevant features of the pre-transition consultation (PTC) offered in AD’venir transition unit (R.Debré hospital, Paris) to all adolescents with a chronic condition.PTCs include a face-to-face interview with pediatricians trained in adolescent medicine, exploring the past (disease history), present (daily life, Treatment Burden Questionnaire, family/peer relationships, school, hobbies, sexuality, drugs) and future (global life project, transition, Good2Go questionnaire). Twenty-seven PTC recordings were qualitatively analyzed (girls=56%/median age=17.7yrs) within a multidisciplinary group (clinicians/sociologists/psychologist/public health researchers). Respectively 6-months and 2-years after PTC, benefits of PTC were assessed in referent healthcare providers (questionnaire) and in adolescents (phone interview). PTCs were a form of training for adult care, adolescents meeting a practitioner alone often for the first time. Naming their chronic condition was frequently difficult. All complained of limitations experienced in their social life (notably diet, tiredness, laboratory/medical appointments), but not treatment itself. Most were willing to talk about sexuality. Feelings concerning transition were various, with poor representations of adult healthcare. Transfer was often unplanned, but this did not influence transition readiness. After PTC, healthcare providers often changed their practices. Two years later, transition was successful for most of adolescents. ConclusionThe PTC is a relevant, easily implemented tool to help empower adolescents and customize their transition preparation within a holistic approach. A dedicated and long consultation, with an external/non-prescriber practitioner, including a physical examination are key factors promoting the establishment of trust, sharing of intimate issues and the assessment of potential barriers to transition.