The transition from childhood to adulthood in diabetes care: A qualitative evidence synthesis.

Abstract

To systematically review and synthesise findings from qualitative studies regarding the transition process and transfer from paediatric to adult diabetes care, including perceived strengths and limitations of transition practices. Synthesising qualitative evidence from key stakeholders offers an opportunity to better understand how transition readiness is experienced, how it may influence engagement and outcomes, and why transition programs vary in effectiveness across settings. Qualitative evidence synthesis was completed of the diabetes transition process with articles published in English between 2018 and 2023, which is in line with our previously published quantitative systematic review. Studies were systematically identified and screened by searching six databases and PRISMA criteria were used. Search terms included the following MESH headings and keywords: (type 1 diabetes OR type 2 diabetes OR diabetes mellitus) AND (transfer to adult care OR transition to adult care OR transition readiness). Risk of bias and quality assessments were performed using the Critical Appraisal Skills Programme. Both the strengths of weaknesses of each transition programme were extracted, as well as data integration across studies using a thematic synthesis approach. In total, 15 publications were included of which two-thirds were from North America. Data were obtained from patients, parents/caregivers and healthcare professionals, using semi-structured interviews, surveys and focus groups, covering the full transition period. Three key themes were identified: (1) Expectation of greater autonomy/independence for the person with diabetes (PWD), (2) Loss of paediatric provider and insecurity about new healthcare provider (HCP), and (3) Lack of formal preparation for the transition from paediatrics to adult care. Perceived strengths and weaknesses of the different transition programmes underscore the need for a proactive approach, supporting a smooth transfer and facilitating the young person's independence and self-management capacity. This systematic review of qualitative studies highlights the need to address the unique challenges of adolescents and young adults when transferred from paediatric to adult diabetes care and improve quality transition programmes. A smooth transition process demands a personalised approach from HCPs and system-level coordination across care teams is essential for supporting successful engagement within adult diabetes care.

Abstract as supplied by the indexing source. © the authors / publisher.