Healthcare transition in pediatric liver transplantation: The perspectives of pediatric and adult healthcare professionals.

INTRODUCTION: Transition from pediatric to adult services of young people with a liver transplant is an important priority due to increasing numbers of young people surviving into adulthood. There is increased incidence of graft loss and non-adherence following transfer to adult services. Although studies have considered the views and perceptions of young people who have undergone liver transplantation and their parents about transition, there is currently no qualitative research with healthcare professionals working in the field of liver transplantation. The aim of this study was to elicit the views of this group of stakeholders about barriers and facilitators of an effective transition process. METHODS: Semi-structured interviews were carried out with 11 HCPs from pediatric and adult liver transplant programs and from a range of professional backgrounds. Interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS: Four themes were identified: "non-adherence and psychosocial issues," "need for better psychological support," "the role of parents," and "the emotional impact of transition on healthcare professionals." Within these themes, professionals described factors which hindered or promoted an effective transition process. CONCLUSIONS: Screening tools which address psychological and social aspects of the lives of young people should be used in routine practice to identify patients requiring psychosocial support and to identify those at risk of non-adherence. All staff involved with transition should be trained in the use of psychosocial screening strategies. The development of a formal referral pathway so that young people can access psychological support in adult services is recommended.

Health professional perspectives on lifestyle behaviour change in the paediatric hospital setting: a qualitative study.

BACKGROUND: Research exists examining the challenges of delivering lifestyle behaviour change initiatives in practice. However, at present much of this research has been conducted with primary care health professionals, or in acute adult hospital settings. The purpose of this study was to identify barriers and facilitators associated with implementing routine lifestyle behaviour change brief advice into practice in an acute children's hospital. METHODS: Thirty-three health professionals (nurses, junior doctors, allied health professionals and clinical support staff) from inpatient and outpatient departments at a UK children's hospital were interviewed about their attitudes and beliefs towards supporting lifestyle behaviour change in hospital patients and their families. Responses were analysed using thematic framework analysis. RESULTS: Health professionals identified a range of barriers and facilitators to supporting lifestyle behaviour change in a children's hospital. These included (1) personal experience of effectiveness, (2) constraints associated with the hospital environment, (3) appropriateness of advice delivery given the patient's condition and care pathway and (4) job role priorities, and (5) perceived benefits of the advice given. Delivery of lifestyle behaviour change advice was often seen as an educational activity, rather than a behaviour change activity. CONCLUSION: Factors underpinning the successful delivery of routine lifestyle behaviour change support must be understood if this is to be implemented effectively in paediatric acute settings. This study reveals key areas where paediatric health professionals may need further support and training to achieve successful implementation.

'It's hard but you've just gotta get on with it'--The experiences of growing-up with a liver transplant.

The successful evolution of paediatric liver transplantation means that increasing numbers of young people survive into adulthood. Non-adherence to medication regimens leading to liver dysfunction, graft loss and patient death are prevalent in this vulnerable group. Insight into young people's experiences of living with a liver transplant (LTx) is vital to improve outcomes and guide future work in this area. Through semi-structured interviews, this study explored the experiences of living with a LTx for 13 young people transplanted as children and adolescents. Interviews were analysed using interpretative phenomenological analysis, revealing that young people felt different from their peers as a result of their LTx. Young people's perceptions of their scar, experiences of illness symptoms and taking medications acted as triggers of differences. This led to an ongoing struggle to be normal when faced with typical activities for young people and to attempts to take back control. Findings support the implementation of routine psychosocial screening to identify additional support needs and the development of a peer mentoring programme to allow young people to gain social support, thus reducing feelings of being different. It is hoped that such initiatives will have positive consequences for quality of life, self-management and adherence to medications.

Challenges of implementing routine health behavior change support in a children's hospital setting.

OBJECTIVE: Evidence indicates that health behavior change initiatives are often not implemented successfully. This qualitative study aims to understand the barriers and facilitators to implementation of health behavior change brief advice into routine practice in an acute children's hospital setting. METHODS: Semi-structured interviews were conducted with health professionals working at a UK children's hospital (n=33). Participants were purposively sampled to incorporate a range of specialties, job roles and training. RESULTS: An inductive thematic framework analysis identified two emergent themes. These capture the challenges of implementing routine health behavior change support in a children's hospital setting: (1) 'health professional knowledge, beliefs and behaviors' and (2) 'patient and family related challenges'. CONCLUSION: This study enhances findings from previous research by outlining the challenges pediatric health professionals face in relation to supporting health behavior change. Challenges include failure to assume responsibility, low confidence, prioritization of the health provider relationship with patients and families, health provider and patient knowledge, and low patient and family motivation. PRACTICE IMPLICATIONS: Skills-based behavior change training is needed for pediatric health professionals to effectively support health behavior change.

Patients' and practitioners' views on health behaviour change: a qualitative study.

OBJECTIVE: This study was designed to examine patients' and health professionals' perspectives on lifestyle behaviour change and to inform the development of a lifestyle behaviour change intervention to be used in primary care. DESIGN: Focus groups were conducted with seven patients and 13 health professionals where they were asked to discuss lifestyle behaviour change in relation to the design and development phase of a tailored lifestyle behaviour change intervention package. RESULTS: An inductive thematic analysis of transcripts suggested a range of issues that are relevant to the development and implementation of lifestyle change interventions such as time, lack of resources and starting interventions too late, as well as personal circumstances and the continuous effort that behaviour change requires. They were interpreted as two superordinate themes of 'internal and external influences on behaviour change' and 'behaviour change initiation and maintenance'. The results are discussed in relation to the implications they may have for researchers and health service commissioners designing interventions and practitioners implementing lifestyle change interventions in primary care. CONCLUSION: Many factors are involved in patients' and health care professionals' understanding of interventions and lifestyle behaviour change. These should be taken into consideration when designing interventions based on behaviour change theories.

Adolescents living with cancer: the role of computer-mediated support groups.

The present study sought to explore the types of social support being provided to adolescents with cancer accessing a computer-mediated support group. Three hundred and ninety-three messages posted to a computer-mediated support group aimed at adolescents with cancer were coded for instances of informational and emotional support and then subjected to thematic analysis. Analysis revealed frequent instances of both informational and emotional support provision and sub-themes included 'treatment concerns', 'losing friends' and 'struggling with school'. Adolescents were also found to be frequently accessing the group to make requests for social support. It is concluded that health professionals need to tailor the services they provide to adolescent patients more appropriately.