Table 1.

Quotations of facilitators of and barriers to transition.

Themes	Stakeholder (n)	Quotations
Facilitators
Preparedness	Patients (7)	“I think the most important is just asking a lot of questions and if you’re uncomfortable with the process making sure that there is someone that you can ask questions to and that someone can answer those questions…”
	Parents (7)	“I think that [transitioning patients] could use some counselling or something [that] could have helped especially in the transition when he was 18/19 trying to cope with this stuff on his own now.”
		“I think [the patient being] mentally prepared. Some kids are totally mentally prepared and making their own appointments and some kids just aren’t.”
	Providers (6)	“How well they have been set up on the other side. A lot of the kids come over from the pediatric GIs and some of the kids seem better set up by the person who set them over.”
Supportive adult care team	Patients (10)	“I think that the [adult] clinic somehow needs to put a little extra attention onto kids or young adults because you do get busy and forget things and you’re stressed out going to school… so I think like a scheduled 3-month call would be nice for a lot of people to remind them like ‘hey we are here if you’re having issues. How are your symptoms? How have they been this last season?’” “[The] new doctor being in the same hospital already made it easier.”
	Parents (4)	“…even just someone at the clinic - maybe the GI clinic has a liaison person and that person’s job is to check up on these kids that are coming out of [pediatric care].” “… give [the transitioning patient] a year to adjust because they are used to an entirely different approach.”
Patient characteristics	Parents (4)	“…a positive attitude and being willing to understand more about the importance of acknowledging symptoms, following up with physician when you have symptoms and respecting the disease I guess is the best way to say it...”
	Providers (9)	“A little bit of less reliance on their parents and taking their own control of their own health, reporting their own symptoms, right?”
		“It depends on their maturity levels as well and whether they’re usually independent at that age and use to undertaking initiative to looking after their own affairs.”
Supportive parents and home environment	Providers (8)	“Parents who are just there to listen and act as a fly on the wall are certainly much easier for the patient overall.”
		“I think if the patient has a stable home environment where they feel confident, where they feel supported, where they have the ability to make some decisions on their own…”
Barriers
Patient factors	Parents (4)	“[Young adults] just aren’t good about advocating for themselves that they are lost in the system a bit or they can potentially get lost.”
	Providers (8)	“I think [transitioning patients] are young and they think they’re invincible and they haven’t really- it’s just a lack of knowledge of their disease and what is involved in maintaining remission and avoiding the progression.” “When there are mental health issues, I think that that can make it quite challenging so anxiety, depression can really make it challenging.”
Hovering parents and family factors	Providers (11)	“A lot of the families that we do see struggle often [because] they have so much other stresses and factors on their plate that it’s hard for them.” “The parents may be overprotective and not interested in supporting youth independence.”
Navigating a new health care system	Patient (11)	“There was a lot of follow up all the time, but then I switched to an infusion clinic and you’re nowhere near a doctor’s office or if you have questions or concerns there is no one to talk to…” “I think a big barrier was it was very intimating. That was the biggest thing. I was just terrified. I didn’t feel super comfortable about the adult setting because it is very strange, I think.”
Travel to clinic	Patient (5)	“…moving cities is really hard and then you’re also really young trying to do things on your own. My parents weren’t involved at all so I was the one transferring different cities and my healthcare and everything like that. You don’t really know how to do that – how to make those phone calls, how to find doctors, how to find referrals is all new.” “I mean the only issues are that I don’t drive so sometimes getting around is a little tough because I also don’t live at home anymore…”
	Provider (4)	“… [transitioning patients] are going into post-secondary education and often they’re moving away to different places and then you have to hand off care to someone else and that again [is] another point they can fall off in terms of follow up from that aspect.”
		“I certainly think if they live further away from a center where their practitioner is – that definitely makes it more difficult.”