Mixed‐methods evaluation of a transition and young adult clinic for kidney transplant recipients

• Published in: Pediatric transplantation 2019-06, Vol.23 (4), p.e13450-n/a
• Main Authors: Michaud, Vanessa, Achille, Marie, Chainey, Fanie, Phan, Véronique, Girardin, Catherine, Clermont, Marie‐José
• Format: Article
• Language: English
• Subjects: adherence; Adolescent; Adult; Blood levels; Humans; Immunosuppressive Agents - blood; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - surgery; kidney transplant; Kidney Transplantation; Kidney transplants; Male; Medical records; Mental disorders; Mixed methods research; mixed‐methods evaluation; outcomes; Patient Compliance; Patients; pediatric; Postoperative Period; psychosocial; Qualitative Research; Quality of Life; Self Report; Social Support; Statistical analysis; Surveys and Questionnaires; Tacrolimus; Tacrolimus - blood; transition; Transition to Adult Care; Treatment Outcome; Young Adult; young adult clinic; Young adults; youth
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.13450

The aims of the present study were to describe the experiences of kidney transplant patients attending a young adult clinic or a regular adult clinic, to explore similarities and differences between the groups, and to conduct an evaluation of the clinical and psychosocial outcomes of the young adult clinic, by comparing these outcomes to those of the regular adult clinic. A mixed‐methods design combining qualitative and quantitative data was used. Empirically validated questionnaires measuring self‐determination theory variables, quality of life, and adherence were distributed to all consenting patients attending the YAC (n = 17) and RAC (n = 16). Semi‐structured interviews were conducted with a subsample of the first (n = 10) and second group (n = 8), and analyzed using thematic analysis. Clinical outcomes were retrieved from medical records. Descriptive, correlational, and comparative analyses were performed. We found clinically significant differences on tacrolimus blood levels variability, self‐reported adherence, and physical quality of life. Small and medium effect sizes were detected. No statistical differences were found. Statistically significant correlations were found between self‐determination theory variables and both physical quality of life and different measures of adherence. Four themes characterized patients’ experiences: resilience; relational needs and the therapeutic alliance; quest for balance; and quest for normalcy. The young adult clinic seems to meet its initial objectives and to make a difference particularly in the early period post‐transition, but over time what matters most for patients is therapeutic alliance. Mental health issues need to be better addressed, and special attention should be paid to youths transplanted in an adult setting.