Factors Impacting Transition Readiness in Young Adults with Neuropathic Bladder
Joshua D. Roth, MD, Konrad M. Szymanski, MD, MPH, Mark P. Cain, MD, Rosalia Misseri, MD.
Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
BACKGROUND: Patients with neuropathic bladder (NB) due to spinal pathology often have cognitive impairments making the difficult transition process to adult care even more challenging. We aimed to identify what patient factors impact transition readiness in this population. We hypothesize that young adults with bladder augmentation were more likely to report readiness to transition due to increased health care exposure and those with ventriculoperitoneal shunts, particularly if revised, were less likely to report readiness due to greater cognitive impairment.
METHODS: Consecutive patients in the transitional NB clinic were evaluated using the validated Transition Readiness Assessment Questionnaire (TRAQ, 8/17-4/18). Five TRAQ domains assess 20 skills necessary to transition. Responses are: 1 “No, I do not know how”; 2 “No, but I want to learn”; 3 “No, but I am learning how to do this”; 4 “Yes, I have started doing this”; 5 “Yes, I always do this when I need to” (considered “fully transitioned”). Demographics, ambulatory status, shunt status, number of shunt revisions, number of medications and prior bladder augmentation were assessed. Domain and total TRAQ scores were analyzed using non-parametric statistics and linear regression.
RESULTS: Ninety-six patients (60.4% females, 70.8% shunted) participated at median age 25.5 years. Importantly, older patients were more likely to be female (p=0.02). Overall median TRAQ score was 4.0/5.0, indicated that patients were starting to transition, with only 1 of 5 domains being fully transitioned (“Talking with Providers”). On univariate analysis, age >25 was associated with higher TRAQ scores across every domain and overall (p≤0.01). Female gender was also associated with higher TRAQ scores for “Appointment Keeping,” “Tracking Health Issues” and overall (p≤0.03). Race, ambulatory status, shunt status, number of shunt revisions, number of medications and prior bladder augmentation were not associated with differences in TRAQ scores (p≥0.12).
After adjusting for gender on bivariate analysis, age >25 was associated with higher TRAQ scores for “Appointment Keeping,” “Tracking Health Issues,” “Talking with Providers,” and “Managing Daily Activities” domains and overall (p≤0.03), but not the “Managing Medications” domain (p=0.07). Female gender was not independently associated with higher domain or overall TRAQ scores (p≥0.10).
CONCLUSIONS: Transitioned patients with NB had TRAQ scores indicating that they were not yet fully transitioned in terms of their healthcare-related behavior. Older age was the only factor associated with transition readiness, which was not impacted by other demographics, ambulatory status, shunt status or urological reconstruction. Increased attention to transition readiness in this population is necessary.
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