Table 2.

Deficiencies found in addressing Six Core Elements of Health Care Transition(TM) and recommendations based upon findings from metasynthesis.

Six Core Elements of Health Care Transition™	Deficiencies Reported by AYA	Recommendations Reported by AYA Ready for Practice Translation
Transition Policy	• Not told far enough in advance about transition • Report unsystematic transfers • Do not know what to expect with transition	• Provide details about process and resources during transition • Talk about transition beginning at early ages • Provide a structured program to encourage preparation
Transition Tracking and Monitoring	• Not discussed by AYA in primary studies	• Not discussed by AYA in the primary studies
Transition Readiness	• Lack knowledge and ability to describe their disease condition, history, and current treatments • Not ready for disease self-management • Do not know when to seek care • Do not feel emotionally ready • Caregivers have trouble letting go of responsibilities	• Provide repetitive education about disease conditions to help AYA become more knowledgeable about their medical conditions and needs • Encourage and support AYA to gradually assume more independence and responsibility as they grow up • Base transition upon individual readiness and not just age • Make AYA active participants in their pending transfer and encourage caregivers to support new roles for AYA
Transition Planning	• Do not know how to identify healthcare providers post-transition • AYA reported not knowing how to navigate insurance or how to obtain appointments with their insurance	• If the healthcare system allows, AYAs should be encouraged to meet and get to know their adult healthcare providers prior to transition. • Encourage active, independent AYA role in clinic appointments earlier • Utilize peers to help provide insight into what to expect • Provide age pertinent information and resources (i.e. information on drugs, alcohol, pregnancy, lifestyle) • Provide information on transition in a creative method (i.e. workshop, shadowing, programming)
Transfer of Care	• Do not know how to identify new providers • Report poor communication between pediatric and adult providers	• Provide assistance in identifying providers • Coordinate care between pediatric and adult providers or offer “joint clinics”
Transfer Complete	• Found adult providers’ expectations were unreasonable • Report having poor experiences with new adult providers and subsequently developing mistrust of the new providers • Reported periods of interruption to care • Reported negative feelings regarding environment or approach with first visits to adult providers settings	• Encourage adult practices to tailor their care towards AYA and their needs • Develop collaborations between pediatric and adult practices to ensure continuity of care • Work with adult providers to reduce inconsistencies in care post-transition • Encourage adult provider to have person-centered communication that is appropriate for youth adults • Maintain pediatric provider role after transition to ensure success