Transitioning adolescents to adult nephrology care: a systematic review of the experiences of adolescents, parents, and health professionals

A challenging phase for adolescents with chronic kidney disease (CKD) is the transition from a pediatric to an adult health service. Failure to adequately prepare adolescents for transfer to adult care can lead to a decline in attendance to the adult clinic and an increase in the rate of non-adherence to medical treatment. The aim of this systematic review was to analyze studies exploring the experiences of adolescents, parents, and health professionals regarding the transition process of adolescents with CKD. Six databases were searched from inception to October 2018 for primary research articles. Eleven articles met the inclusion criteria, with only one exploring the parents’ experiences. The results indicated that up to 50% of adolescents did not feel prepared to transfer to adult care at the time of transfer, and the timing was not ideal for some adolescents. Health professionals acknowledged that adolescents and parents felt emotional attachment to the pediatric unit, which led to anxiety about transferring. Once in adult care, adolescents felt out of place among the older patients, overwhelmed by the environment and the lack of attention from health professionals. Initiatives that could support transfer include allowing adolescents to attend pediatric consultation independently and meeting with adult health professionals prior to transfer. This review found that the transition process must be more responsive to adolescents by tailoring the timing of transfer according to their ability to assume self-care responsibility. In addition, there is a need to focus on the parents and their role in the transition process.