03 Best practice for transition from paediatric complex pain care: A scoping review
Bibliographic record
Abstract
Abstract Background Many adolescent and young adults (AYA) experiencing chronic pain often continue to have pain in adulthood and thus must make the transition from paediatric care to adult care. Persistent pain and disability due to chronic pain throughout young adulthood can disrupt the attainment of important developmental milestones at transition to adulthood that impact quality of life. Inadequate transition planning may be associated with poor health outcomes and increased health utilization. However, only few studies have described the specific transition protocol from paediatric to adult care that AYA with chronic pain must make. Objectives To improve understanding of transitional care needs during transition planning and after transition (quality of care), this paper will determine known barriers to successful transition from paediatric chronic pain care to adult care as well as factors associated with successful transition from paediatric multidisciplinary paediatric chronic pain care, identify patient care needs at transition from paediatric chronic pain care, and finally describe the best practice (existing frameworks) to support youth at transition from paediatric chronic pain care. Design/Methods This scoping review used previously published Arksey and O’Malley framework and followed the PRISMA guidelines. It sought to answer the following questions. What are the barriers to successful transition and what factors are associated with successful transition from paediatric chronic pain care to adult care? What are patient care needs at transition from paediatric chronic pain care? How can we best support youth at transition from interdisciplinary paediatric chronic pain care? A literature search was carried on Ovid Medline and 12 studies (11 research articles and 1 dissertation) published from 2015 to 2022 were included in the review, with only one theoretical transition framework that may be useful in the Canadian healthcare setting. Results In this scoping review, interpersonal, organizational, and systemic barriers and enablers for successful transition were identified. The most frequently identified barriers to successful transition include lack of self-efficacy, trust, communication, coordination of care between paediatric and adult care. A need of early transition, an individualized approach, fluid and dynamic transition process, and age-appropriate resources were identified as primary patient care needs during transition. Four frameworks supporting transitional care for AYA with chronic health conditions were identified. Conclusion Limited evidence suggests that there is lack of standardized transition protocol for clinical use. There is an urgent need for an evidence-based transition tools for clinical use for AYA with chronic pain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.113 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.009 |
| Bibliometrics | 0.031 | 0.025 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.009 | 0.010 |
| Open science | 0.005 | 0.006 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".