TRACER: Transition to Adulthood Through Coaching and Empowerment in Rheumatology, a Feasibility Study

Objectives The transition to adult healthcare is a vulnerable time for youth with chronic disease, with risks of disengagement and complications of inadequately managed disease. Health Coaching helps patients gain knowledge, skills, tools and confidence to become active participants in their care. Transition Coaching may be effective in psychologically and socially supporting youth as they gain the skills and tools necessary to independently manage their health. We designed the TRACER (Transition to Adulthood through Coaching and Empowerment in Rheumatology) study to assess the feasibility of conducting a multicentered RCT of a virtual Transition Coach Intervention (TCI) in youth transferring from pediatric to adult rheumatology care. Methods Youth 17-18 years old were recruited at their last pediatric rheumatology appointment at McMaster Children’s Hospital or Children’s Hospital at London Health Sciences Centre in Ontario. Participants were randomized to the TCI or control group. Participants in both groups received the Youth Transition Roadmap which informs the differences between pediatric and adult care and discusses 5 domains of healthcare transition: Self-Advocacy, Medication Management, General Health, Lifestyle Issues and Future Planning related to education and vocation. TCI group participants also received virtual one-on-one monthly coaching sessions for 8 months. Six sessions were with an advanced practice physiotherapist (APP) and two were with a social worker. Primary feasibility outcomes were overall consent rate (≥85%), enrollment from the non-primary site (>30%), coaching session attendance (≥90%), and data collection completion (≥90%). Secondary clinical outcomes collected at baseline, 8- and 11-months included the Transition-Q (transition readiness), PedsQL(TM) 4.0 (global functional assessment), active joint count and Physician Global Assessment (disease activity), and PROMIS® self-efficacy measures for people with chronic disease. Results Of 65 patients approached, 30 (46.2%) consented, and 16 (53.3%) were from London. Of those who consented, 2 withdrew after consenting but prior to collecting baseline data and starting the intervention (Table 1). TCI sessions had a 95.8% attendance rate. Participants completed 90.7% of outcome assessments. At 8 months, TCI participants appeared to have higher levels of transition readiness, PROMIS® scores were higher in certain domains, and the TCI was well accepted by participants and coaches. Table 1. Feasibility Criteria Obtained Conclusion Our study met all feasibility outcomes except the consent rate, which indicates a large-scale RCT could be feasible. This study’s findings will shape a future multicenter RCT of a virtual TCI, with the ultimate goal of enhancing the physical, mental, and social well-being of adolescents with rheumatic disease transitioning into adult care.

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