Transition to Adulthood Through Coaching and Empowerment in Rheumatology (TRACER): Results of a Feasibility Randomized-Control Trial.

Abstract

Objective: Health care transitions are a time of high needs for youth with chronic rheumatic conditions. Our study aimed to evaluate the feasibility of a multicenter randomized-controlled trial implementing a virtual transition coach intervention (TCI) for youth transitioning from pediatric to adult rheumatology care.

Methods: Youth aged 17 to 18 years with pediatric-onset rheumatic diseases were recruited from McMaster Children's Hospital in Hamilton, and Children's Hospital, London Health Sciences Centre in London, Canada. Participants were randomized to receive a youth transition roadmap (YTR) (standard of care), or YTR plus TCI-eight virtual monthly coaching sessions covering topics from the YTR. Primary outcomes included feasibility criteria, whereas secondary outcomes focused on measures of readiness for transition (Transition-Q), global functioning (PedsQL 4.0), and self-efficacy (PROMIS self-efficacy for managing chronic conditions) at baseline, 8 months, and 11 months. A satisfaction survey was provided to TCI participants upon study completion.

Results: Of 65 patients approached, 31 (48%) consented. Over 95% of TCI sessions were attended, 80% of patients completed 8-month follow-up questionnaires, and missing data were 13%. TCI participants demonstrated slightly larger mean changes across each time point for each instrument compared to controls. TCI participants overwhelmingly endorsed the intervention, with 78% satisfied with the intervention and 89% willing to recommend the intervention to a friend.

Conclusion: Transition coaching is a feasible intervention to support youth transitioning from pediatric to adult rheumatology care. Results from this trial will inform a multicenter trial, investigating the efficacy of a TCI on transition readiness and self-efficacy for managing chronic conditions.