The transition of adolescents with chronic gastrointestinal disease from paediatric to adult care
Wednesday, 17 April 2013 06:55
Introduction: The transfer of care of patients with chronic conditions from paediatric to adult services is a time of risk for optimal disease control / adherence to medication / patient satisfaction and quality of life. Appropriate transition services aim to reduce the risk during the transfer of care by educating the patient and their family about the disease and its optimum management and providing a structure of care that reduces the risks discussed above. There are several chronic gastroenterological diseases that require appropriate transition including Inflammatory Bowel Disease, viral and autoimmune liver disease and chronic neuro-gastroenterological conditions.
Aim: To provide an evidence based guideline that documents the risks of poor transition, the benefits of appropriate transition, and assesses the available models of care. The guideline would be used by the entire MDT involved in the care of adolescents with chronic GI disease. Where evidence is not available the guideline will make consensus based recommendations.
Scope: There are currently no clinical guidelines that assess in detail the most appropriate means of transition for adolescents with chronic GI disease. Therefore the scope of this guideline would be to:
- Describe the patient populations
- Document the evidence defining the risks of poor transition
- Document the evidence that appropriate transition improves patient outcome
- Describe the available models
- Assess the evidence supporting use of specific models
- Review the patient perspective of transition
Participants: The guideline committee will have representation from:
- Adult and paediatric gastroenterology
- Adult and paediatric Hepatology
- Adult and paediatric GI surgery
- Adult and paediatric IBD nursing
- Professionals involved in transition in another disease area (eg rheumatology)
- Patient bodies such as Crohn's and Colitis UK
Methodology: The guideline will be produced in accordance with the AGREE document. Working groups will be established to address each sub section (ie IBD / Hepatology). A literature search will be performed; the quality of manuscripts would be assessed according to the SIGN criteria before they were accepted. Statements will be produced and evidence levels will be graded using the Oxford Classification of Evidence Based Medicine.
For the development of the transition guideline relevant questions on each of the topics will be devised by the Chairs and their working parties. The questions will focus on current practice and areas of controversy. In parallel, the working parties will perform a systematic literature search of their topic as above. Statements on each topic will be written by the Chairs, based on answers from their working party, as well as the literature evidence and will be circulated first among their working party and then among all participants.
All working parties will meet to agree the statements. Technically this will be done by projecting the statements and revising them on screen until a consensus was reached. Consensus will be defined as agreement by >80% of participants, termed a Consensus Statement and numbered for convenience in the document. Each recommendation will be graded (RG) according to the Oxford Centre for Evidence Based Medicine, based on the level of evidence.
The final document on each topic will be written by the Chairs in conjunction with their working party. Consensus statements in bold will be followed by comments on the evidence and opinion. Statements are intended to be read in context with qualifying comments and not read in isolation. The final text will be edited for consistency of style.
Dissemination: the guideline will be published in line with the BSG Guidelines Committee Publication Strategy