Evaluation of Transition With a Heart, a Transition Program for Adolescents With Congenital Heart Disease and Parents

A Prospective Quasi-Experimental Study to Evaluate Transition With a Heart, a Transition Project for Adolescents With Congenital Heart Disease and Their Parents With Focus on Disease Knowledge and Transitional Skills

The department of Congenital Heart Disease of the Ghent University Hospital (Belgium) developed a transition program dedicated to adolescents with congenital heart disease (CHD): 'Transition With a Heart´ (TWAH). TWAH was developed based on the Dutch program 'On your own feet´, starting at the age of 12 years and continuing after transfer. The most vital core components include a general and individualized flowchart, adolescent-centred communication, a joined transfer consultation and an appointed transition coordinator. TWAH focuses on promoting disease knowledge, autonomy and skills development of adolescents with CHD. Interventions encompass the use of a communication-paper, autonomously talking to professionals, individualized education and skills development plan. Interventions were selected from the highest sources of scientific evidence currently available including (quasi-) experimental studies, narrative literature reviews and expert opinions.

TWAH is the intervention in the conducted study. Hence, the intervention group are adolescents with CHD and their parents who are participating in TWAH. Adolescents and their parents who are transferred according to standard care (joined transfer consultation only) are identified as the control group and will be examined in the post test phase in order to be able to make comparisons with the intervention group. At baseline (the start of TWAH) participants of the control group already made the transfer to the adult ward.

The investigators consider the following hypothetical scenario:

- TWAH will have a positive influence on disease knowledge and transition experiences of the participants.

Study Overview

• Status: Completed
• Conditions: Transitional Care; Congenital Heart Disease in Adolescence
• Intervention / Treatment: Other: Transition With a Heart (TWAH)

• Study Type: Interventional
• Enrollment (Actual): 81
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Belgium
  • Ghent, Belgium, 9000
    • Ghent University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 25 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Clinical diagnosis of a CHD of great or moderate complexity (6)
• From the age of 12 years or older
• Must be able to complete the questionnaires
• Dutch speaking AND/OR
• Parents having children who are meeting the inclusion criteria above

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Adolescents and their parent of the intervention group; Adolescents and their parent who are participating in TWAH	Other: Transition With a Heart (TWAH); TWAH is a transition program, especially developed for adolescents with CHD and their parents. TWAH is starting at the age of 12 years and continuing after transfer. The most vital core components include a general and individualized flowchart, adolescent-centred communication, a joined transfer consultation and an appointed transition coordinator. TWAH focuses on promoting disease knowledge, autonomy and skills development of adolescents with CHD. Interventions encompass the use of a communication-paper, autonomously talking to professionals, individualized education and skills development plan. Details can be found in De Hosson et al, 2020 (1).
No Intervention: Adolescents and their parent of the control group; Adolescents and their parent who are not participating in TWAH

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in disease-related knowledge of adolescents of the intervention group (paired test)	Total knowledge score assesed by the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD): and consists of 27 multiple choice questions for girls and 25 items for boys (Philip Moons et al., 2001). The total knowledge score consists of a ratio of the sum of correct answers to the total number of questions resulting in a 0-100 scale, where a higher score reflects a better disease-related knowledge.	At baseline (first transition outpatient visit around 14y) and through study completion, an average of 1 year from the transfer consultation
Comparison between disease-related knowledge scores of adolescents of the intervention group and adolescents of the control group	Total knowledge score assesed by the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD): and consists of 27 multiple choice questions for girls and 25 items for boys (Philip Moons et al., 2001). The total knowledge score consists of a ratio of the sum of correct answers to the total number of questions resulting in a 0-100 scale, where a higher score reflects a better disease-related knowledge.	Through study completion, an average of 1 year from the transfer consultation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in health-related quality of life of adolescents of the intervention group (paired test)	Level of health-related quality of life of adolescents assesed by the Pediatric Quality of Life inventory (PEDSQoL) adolescent version: cardiac and general module. Adolescents were asked to indicate the degree to which they experienced problems with these respective items over the past month using a five-point Likert scale (from 0=never to 4=always). For calculating the total score, the answers were reversed and computed to the domain and total scores on a 0-100 scale, where a higher score reflects a higher perceived QoL.	At baseline (first transition outpatient visit around 14y) and through study completion, an average of 1 year from the transfer consultation
Comparison between levels of health-related quality of life of adolescents of the intervention group and adolescents of the control group	Level of health-related quality of life of adolescents assesed by the Pediatric Quality of Life inventory (PEDSQoL) adolescent version: cardiac and general module. Adolescents were asked to indicate the degree to which they experienced problems with these respective items over the past month using a five-point Likert scale (from 0=never to 4=always). For calculating the total score, the answers were reversed and computed to the domain and total scores on a 0-100 scale, where a higher score reflects a higher perceived QoL.	Through study completion, an average of 1 year from the transfer consultation
Comparison of transfer experiences between adolescents of the intervention group and the adolescents of the control group	Assesed with the On Your Own Feet Tranfer Experience Scale and consists of two subscales: 1) perceived alignment and collaboration between pediatric and adult care and 2) experienced preparation for transfer, including readiness. The items could be rated on a five-point Likert scale (from 1= strongly disagree to 5=strongly agree). The theoretical scores range from 11 to 55 for the first subscale and 7 to 35 for the second. A higher score reflects a higher level of satisfaction with the transitional process. In addition, the overall satisfaction of the transfer could be indicated using a using visual analogue scale (from 1 if completely unsatisfied to 10 if completely satisfied), as well as confidence in the pediatric cardiologist and the adult cardiologist (from 1= no confidence to 10=complete confidence)	Through study completion, an average of 1 year from the transfer consultation
Comparison of transfer experiences between parents in the intervention group and control group	Assesed with the On Your Own Feet Tranfer Experience Scale and consists of two subscales: 1) perceived alignment and collaboration between pediatric and adult care and 2) experienced preparation for transfer, including readiness. The items could be rated on a five-point Likert scale (from 1= strongly disagree to 5=strongly agree). The theoretical scores range from 11 to 55 for the first subscale and 7 to 35 for the second. A higher score reflects a higher level of satisfaction with the transitional process. In addition, the overall satisfaction of the transfer could be indicated using a using visual analogue scale (from 1 if completely unsatisfied to 10 if completely satisfied), as well as confidence in the pediatric cardiologist and the adult cardiologist (from 1= no confidence to 10=complete confidence)	Through study completion, an average of 1 year from the transfer consultation

Collaborators and Investigators

• Sponsor: University Hospital, Ghent
• Collaborators: Universiteit Antwerpen

Publications and helpful links

General Publications

• Warnes CA, Liberthson R, Danielson GK, Dore A, Harris L, Hoffman JI, Somerville J, Williams RG, Webb GD. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol. 2001 Apr;37(5):1170-5. doi: 10.1016/s0735-1097(01)01272-4. No abstract available.
• van Staa A, Sattoe JN. Young adults' experiences and satisfaction with the transfer of care. J Adolesc Health. 2014 Dec;55(6):796-803. doi: 10.1016/j.jadohealth.2014.06.008. Epub 2014 Aug 19.
• de Hosson M, De Backer J, De Wolf D, De Groote K, Demulier L, Mels S, Vandekerckhove K, Goossens E. Development of a transition program for adolescents with congenital heart disease. Eur J Pediatr. 2020 Feb;179(2):339-348. doi: 10.1007/s00431-019-03515-4. Epub 2019 Nov 22.
• Moons P, De Volder E, Budts W, De Geest S, Elen J, Waeytens K, Gewillig M. What do adult patients with congenital heart disease know about their disease, treatment, and prevention of complications? A call for structured patient education. Heart. 2001 Jul;86(1):74-80. doi: 10.1136/heart.86.1.74.

Helpful Links

• Reference no. 3
• Reference no. 4

Study record dates

Study Major Dates

• Study Start (Actual): November 5, 2015
• Primary Completion (Actual): December 1, 2021
• Study Completion (Actual): December 1, 2022

Study Registration Dates

• First Submitted: October 16, 2020
• First Submitted That Met QC Criteria: July 26, 2022
• First Posted (Actual): July 29, 2022

Study Record Updates

• Last Update Posted (Estimate): January 30, 2023
• Last Update Submitted That Met QC Criteria: January 27, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: Transitional care
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Congenital Abnormalities; Cardiovascular Abnormalities; Heart Diseases; Heart Defects, Congenital
• Other Study ID Numbers: 2015-1037

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No