Person-centred transition programme to empower adolescents with congenital heart disease in the transition to adulthood: a study protocol for a hybrid randomised controlled trial (STEPSTONES project)

Mariela Acuña Mora, Carina Sparud-Lundin, Ewa-Lena Bratt, Philip Moons, Mariela Acuña Mora, Carina Sparud-Lundin, Ewa-Lena Bratt, Philip Moons

Abstract

Introduction: When a young person grows up, they evolve from an independent child to an empowered adult. If an individual has a chronic condition, this additional burden may hamper adequate development and independence. Transition programmes for young persons with chronic disorders aim to provide the necessary skills for self-management and participation in care. However, strong evidence on the effects of these interventions is lacking. Therefore, as part of the STEPSTONES project (Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditionS), we propose a trial to assess the effectiveness of a structured, person-centred transition programme to empower adolescents with congenital heart disease in the transition to adulthood.

Methods/design: STEPSTONES will use a hybrid experimental design in which a randomised controlled trial is embedded in a longitudinal, observational study. It will be conducted in 4 paediatric cardiology centres in Sweden. 2 centres will be allocated to the randomised controlled trial group, assigning patients randomly to the intervention group (n=63) or the comparison group (n=63). The other 2 centres will form the intervention-naïve control group (n=63). The primary outcome is the level of patient empowerment, as measured by the Gothenburg Young Persons Empowerment Scale (GYPES).

Ethics and dissemination: The study has been approved by the Regional Ethical Board of Gothenburg, Sweden. Findings will be reported following the CONSORT statement and disseminated at international conferences and as published papers in peer-reviewed journals.

Trial registration number: NCT02675361; pre-results.

Keywords: Adolescents; Heart defect; Person centered care; Randomized controlled trial; Transition.

Conflict of interest statement

Competing interestsNone declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Overview of the study design and implementation steps.

References

    1. Kennedy A, Sloman F, Douglass JA, et al. . Young people with chronic illness: the approach to transition. Intern Med J 2007;37:555–60. 10.1111/j.1445-5994.2007.01440.x
    1. Moons P, Bovijn L, Budts W, et al. . Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium. Circulation 2010;122:2264–72. 10.1161/CIRCULATIONAHA.110.946343
    1. Meadows A, Bosco V, Tong E, et al. . Transition and transfer from pediatric to adult care of young adults with complex congenital heart disease. Curr Cardiol Rep 2009;11:291–7. 10.1007/s11886-009-0042-8
    1. American Academy of Pediatrics. A consensus statement on health care transitions for young adults with special health care needs. Pediatrics 2002;110(Pt 2):1304–6.
    1. Warnes CA, Williams RG, Bashore TM, et al. . ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease): developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008;118:E714–833. 10.1161/CIRCULATIONAHA.108.190690
    1. Crowley R, Wolfe I, Lock K, et al. . Improving the transition between paediatric and adult healthcare: a systematic review. Arch Dis Child 2011;96:548–53. 10.1136/adc.2010.202473
    1. Campbell F, Biggs K, Aldiss SK, et al. . Transition of care for adolescents from paediatric services to adult health services. Cochrane Database Syst Rev 2016;4:CD009794 10.1002/14651858.CD009794.pub2
    1. Bravo P, Edwards A, Barr PJ, et al. . Conceptualising patient empowerment: a mixed methods study. BMC Health Serv Res 2015;15:252 10.1186/s12913-015-0907-z
    1. Small N, Bower P, Chew-Graham CA, et al. . Patient empowerment in long-term conditions: development and preliminary testing of a new measure. BMC Health Serv Res 2013;13:263 10.1186/1472-6963-13-263
    1. Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. Patient Educ Couns 2010;79:277–82. 10.1016/j.pec.2009.07.025
    1. Holmström I, Roing M. The relation between patient-centeredness and patient empowerment: a discussion on concepts. Patient Educ Couns 2010;79:167–72. 10.1016/j.pec.2009.08.008
    1. Ekman I, Swedberg K, Taft C, et al. . Person-centered care—ready for prime time. Eur J Cardiovasc Nurs 2011;10:248–51. 10.1016/j.ejcnurse.2011.06.008
    1. Dolk H, Loane M, Garne E, et al. . Congenital heart defects in Europe: prevalence and perinatal mortality, 2000 to 2005. Circulation 2011;123:841–9. 10.1161/CIRCULATIONAHA.110.958405
    1. Marelli AJ, Ionescu-Ittu R, Mackie AS, et al. . Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014;130:749–56. 10.1161/CIRCULATIONAHA.113.008396
    1. Hilderson D, Saidi AS, Van Deyk K, et al. . Attitude toward and current practice of transfer and transition of adolescents with congenital heart disease in the United States of America and Europe. Pediatr Cardiol 2009;30:786–93. 10.1007/s00246-009-9442-1
    1. Mackie AS, Islam S, Magill-Evans J, et al. . Healthcare transition for youth with heart disease: a clinical trial. Heart 2014;100:1113–18. 10.1136/heartjnl-2014-305748
    1. Goossens E, Fieuws S, Van Deyk K, et al. . Effectiveness of structured education on knowledge and health behaviors in patients with congenital heart disease. J Pediatr 2015;166: 1370–6. e1 10.1016/j.jpeds.2015.02.041
    1. Goossens E, Van Deyk K, Zupancic N, et al. . Effectiveness of structured patient education on the knowledge level of adolescents and adults with congenital heart disease. Eur J Cardiovasc Nurs 2014;13:63–70. 10.1177/1474515113479231
    1. Chan AW, Tetzlaff JM, Altman DG, et al. . SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200–7. 10.7326/0003-4819-158-3-201302050-00583
    1. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 1971;43:323–32. 10.1161/01.CIR.43.3.323
    1. Efird J. Blocked randomization with randomly selected block sizes. Int J Environ Res Public Health 2011;8:15–20. 10.3390/ijerph8010015
    1. Warnes CA, Liberthson R, Danielson GK, et al. . Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001;37:1170–5. 10.1016/S0735-1097(01)01272-4
    1. Hilderson D, Westhovens R, Wouters C, et al. . Rationale, design and baseline data of a mixed methods study examining the clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: the DON'T RETARD project. BMJ Open 2013;3:e003591 10.1136/bmjopen-2013-003591
    1. Bartholomew LK, Markham CM, Ruiter R, et al. . Planning health promotion programs: an intervention mapping approach. 4th edn San Francisco: Jossey-Bass, 2016.
    1. Moore GF, Audrey S, Barker M, et al. . Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015;350:h1258 10.1136/bmj.h1258
    1. Dillman D. Mail and other self-administered questionnaires. In: Rossi PH, Wright JD, Anderson AB, eds. Handbook of survey research. New York: Academic Press, 1983:359–77.
    1. Gilleland J, Amaral S, Mee L, et al. . Getting ready to leave: transition readiness in adolescent kidney transplant recipients. J Pediatr Psychol 2012;37:85–96. 10.1093/jpepsy/jsr049
    1. Rönning H, Arestedt K, Erik Nielsen N, et al. . Development and psychometric evaluation of the knowledge scale for adults with congenitally malformed hearts. J Cardiovasc Nurs 2013;28:228–37. 10.1097/JCN.0b013e3182498785
    1. Yang HL, Chen YC, Wang JK, et al. . Measuring knowledge of patients with congenital heart disease and their parents: validity of the ‘Leuven Knowledge Questionnaire for Congenital Heart Disease’. Eur J Cardiovasc Nurs 2012;11:77–84. 10.1177/1474515111429662
    1. Goossens E, Luyckx K, Mommen N, et al. . Health risk behaviors in adolescents and emerging adults with congenital heart disease: psychometric properties of the Health Behavior Scale-Congenital Heart Disease. Eur J Cardiovasc Nurs 2013;12:544–57. 10.1177/1474515113475934
    1. Varni JW, Burwinkle TM, Seid M, et al. . The PedsQL* 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 2003;3:329–41. 10.1367/1539-4409(2003)003<0329:TPAAPP>;2
    1. Petersen S, Hagglof B, Stenlund H, et al. . Psychometric properties of the Swedish PedsQL, pediatric quality of life inventory 4.0 generic core scales. Acta Paediatr 2009;98:1504–12. 10.1111/j.1651-2227.2009.01360.x
    1. Bratt E-L, Luyckx K, Goossens E, et al. . Patient-reported health in young people with congenital heart disease transitioning to adulthood. J Adolesc Health 2015;57:658–65. 10.1016/j.jadohealth.2015.07.021
    1. Sand P, Kljajić M, Sunnegårdh J. The reliability of the pediatric quality of life inventory 3.0 Cardiac Module for Swedish children with congenital heart defects. Nordic Psychol 2013;65:210–23. 10.1080/19012276.2013.824204
    1. Dyer MT, Goldsmith KA, Sharples LS, et al. . A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes 2010;8:1–12. 10.1186/1477-7525-8-13
    1. Moons P, Van Deyk K, De Bleser L, et al. . Quality of life and health status in adults with congenital heart disease: a direct comparison with healthy counterparts. Eur J Cardiovasc Prev Rehabil 2006;13:407–13. 10.1097/00149831-200606000-00017
    1. Luyckx K, Missotten L, Goossens E, et al. . Individual and contextual determinants of quality of life in adolescents with congenital heart disease. J Adolesc Health 2012;51:122–8. 10.1016/j.jadohealth.2011.11.007
    1. Apers S, Moons P, Goossens E, et al. . Sense of coherence and perceived physical health explain the better quality of life in adolescents with congenital heart disease. Eur J Cardiovasc Nurs 2013;12:475–83. 10.1177/1474515113477955
    1. EuroQoL Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208. 10.1016/0168-8510(90)90421-9
    1. Moons P, Marquet K, Budts W, et al. . Validity, reliability and responsiveness of the “Schedule for the Evaluation of Individual Quality of Life—Direct Weighting” (SEIQoL-DW) in congenital heart disease. Health Qual Life Outcomes 2004;2:1–8. 10.1186/1477-7525-2-27
    1. Apers S, Kovacs AH, Luyckx K, et al. . Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease—International Study (APPROACH-IS): rationale, design, and methods. Int J Cardiol 2015;179:334–42. 10.1016/j.ijcard.2014.11.084
    1. Hilderson D, Moons P, Van der Elst K, et al. . The clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: results of the DON'T RETARD project. Rheumatology (Oxford) 2016;55:133–42. 10.1093/rheumatology/kev284
    1. World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310:2191–4. 10.1001/jama.2013.281053
    1. Moher D, Hopewell S, Schulz KF, et al. . CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c869 10.1136/bmj.c869
    1. Bourbonniere MC, Russell DJ, Goldsmith CH. Authorship issues: one research center's experience with developing author guidelines. Am J Occup Ther 2006;60:111–17. 10.5014/ajot.60.1.111
    1. Whellan DJ, Ellis SJ, Kraus WE, et al. . Method for establishing authorship in a multicenter clinical trial. Ann Intern Med 2009;151:414–20. 10.7326/0003-4819-151-6-200909150-00006
    1. Asp A, Bratt EL, Bramhagen AC. Transfer to adult care—experiences of young adults with congenital heart disease. J Pediatr Nurs 2015;30:e3–10. 10.1016/j.pedn.2015.05.025
    1. Burstrom A, Ojmyr-Joelsson M, Bratt EL, et al. . Adolescents with congenital heart disease and their parents: needs before transfer to adult care. J Cardiovasc Nurs 2016;31:399–404. 10.1097/JCN.0000000000000288
    1. Craig P, Dieppe P, Macintyre S, et al. . Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655 10.1136/bmj.a1655
    1. Erlen JA, Tamres LK, Reynolds N, et al. . Assessing usual care in clinical trials. West J Nurs Res 2015;37:288–98. 10.1177/0193945914526001
    1. Sable C, Foster E, Uzark K, et al. . Best practices in managing transition to adulthood for adolescents with congenital heart disease: the transition process and medical and psychosocial issues: a scientific statement from the American Heart Association. Circulation 2011;123:1454–85. 10.1161/CIR.0b013e3182107c56

Source: PubMed

3
Tilaa