Family responsibility dynamics for young adults in transition to adult health care

Pat Rapley,Gwen Babel,Suzanne Brown,Joey Kaye

doi:10.4236/jdm.2013.33021

Abstract

Aim: To explore family responsibility dynamics, metabolic control, clinic attendance, and emergency admissions when young adults (YA) with type 1 diabetes transition to an adult hospital. Method: A longitudinal mixed method design with two study groups (parents, n = 28; YA intervention group, n = 23) and a YA comparison group (n = 20). Sample recruited from an outpatient diabetes centre. Demographic, clinic attendance, emergency admissions, biodata, and the Diabetes Family Responsibility Questionnaire (DFRQ) were completed on entry and sixmonths later as part of an 18-month trial of a diabetes transition coordinator (DTC). The selfreport DFRQ were analyzed using derived parent-child dyadic variables to explore differences at baseline and end of study using Wilcoxon Signed Rank Test. The relationship between metabolic control and the DFRQ patterns was explored using Spearman’s rho. Results: On completion of the study, the change in HBA1Cfor both adolescent groups was not significant but was less than ideal for 25% of adolescents in the study. The YA intervention group had significantly fewer missed appointments between them compared to the comparison group. The DFRQ indicated that the derived parent-child dyadic variable of task-discordance increased during the study. Conclusion: The clinically relevant diabetes-task dissonance between parents and young adults offers a challenge and a diagnostic opportunity for diabetes educators.

Highlights

There are approximately 10,000 15 - 25-year olds with diabetes type 1 in Australia
The study extended over 18 months, duration of individual contact with the diabetes transition coordinator (DTC) during the study varied from four to six months
The purpose of this study was to explore family responsibility dynamics when young adults (YA) with type 1 diabetes transitioned to an adult hospital with a DTC to facilitate the transition process

Summary

Introduction

There are approximately 10,000 15 - 25-year olds with diabetes type 1 in Australia. This group has the greatest risk of developing preventable complications with 30% 40% lost from specialist diabetes care during transition each year. Diabetes Australia’s National Policy Priorities 2010 [1] includes better support for young people transitioning to adult services as a key issue. Effective health care transition for adolescents with a chronic illness covers three domains: The adolescent’s emerging self-care skills and knowledge; medical management; and parents’ educational, emotional and tangible support whilst reducing involvement in their child’s diabetes-related decision-making. To this end, it has been suggested that a case-manager or diabetes transition coordinator (DTC) could support these three domains during transitioning [2,3]. The purpose of this study was to explore family responsibility dynamics, metabolic control, clinic attendance, and emergency admissions when young adults (YA) with

Objectives

Methods

Results

Discussion

Conclusion