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Meta-Analysis
. 2024 Oct 9;10(10):CD014688.
doi: 10.1002/14651858.CD014688.pub2.

Patient navigator programmes for children and adolescents with chronic diseases

Rowena Lalji  1   2   3 , Lee Koh  4 , Anna Francis  1   2   3 , Rabia Khalid  5 , Chandana Guha  5 , David W Johnson  2 , Germaine Wong  6
Affiliations
Meta-Analysis

Patient navigator programmes for children and adolescents with chronic diseases

Rowena Lalji et al. Cochrane Database Syst Rev. .

Abstract

Background: Despite a substantial global improvement in infant and child mortality from communicable diseases since the early 1990s there is now a growing burden of chronic disease in children and adolescents worldwide, mimicking the trend seen in the adult population. Chronic diseases in children and adolescents can affect all aspects of their well-being and function with these burdens and their health-related consequences often carried into adulthood. Up to one third of disability-adjusted life years for children and adolescents globally are a result of chronic disease. This has profound implications for the broader family unit, communities, and health systems in which these children and young people reside. Models of chronic care delivery for children and adolescents with chronic disease have traditionally been adapted from adult models. There is a growing recognition that children and adolescents with chronic diseases have a unique set of healthcare needs. Their needs extend beyond disease education and management appropriate to the developmental stage of the child, to encompass psychological well-being for the entire family and a holistic care approach focusing on the social determinants of health. It is for this reason that patient navigators have been proposed as a potential intervention to help fulfil this critical healthcare gap. Patient navigators are trained medical or non-medical personnel (e.g. lay health workers, community health workers, nurses, or people with lived experience) who provide guidance for the patients (and their primary caregivers) as they move through complex (and often bewildering) medical and social systems. The navigator may deliver education, help to co-ordinate patient care, be an advocate for the patient (and their primary caregivers), or combinations of these. Patient navigators can assist people with a chronic illness (especially those who are vulnerable or from a marginalised population, or both) to better understand their diagnoses, treatment options, and available resources. As there is considerable variation in the purpose, design, and target population of patient navigator programmes, there is a need to systematically review and summarise the existing literature on the effectiveness of navigator programmes in children and young adults with chronic disease.

Objectives: To assess the effectiveness of patient navigator programmes in children and adolescents with chronic diseases.

Search methods: We searched the Cochrane Library and Epistemonikos up to 20 January 2023 for related systematic reviews using search terms relevant to this review. We searched CENTRAL, MEDLINE, Embase, CINAHL EBSCO, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov for primary studies.

Selection criteria: We included randomised controlled trials reporting the effect of patient navigator interventions on children and adolescents (aged 18 years or younger) with any chronic disease in hospital or community settings. Two review authors independently assessed the retrieved titles and abstracts, and where necessary, the full text to identify studies that satisfied the inclusion criteria.

Data collection and analysis: Two review authors extracted data using a standard data extraction form. We used a random-effects model to perform a quantitative synthesis of the data. We used the I² statistic to measure heterogeneity amongst the studies in each analysis. We indicated summary estimates as mean differences (MD), where studies used the same scale, or standardised mean differences (SMD), where studies used different scales, with 95% confidence intervals (CI). We used subgroup and univariate meta-regression to assess reasons for between-study differences. We used the Cochrane RoB 1 tool to assess the methodological quality of the included studies. We used GRADE to assess the certainty of the evidence.

Main results: We included 17 studies (2895 randomised participants). All studies compared patient navigators with standard care. Most studies were at unclear or high risk of bias. Meta-analysis was undertaken only for those studies that had the same duration of patient navigator intervention and follow-up/reporting of outcome measures. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on self-reported quality of life of children with chronic illness (SMD 0.63, 95% CI -0.20 to 1.47; I2 = 96%; 4 studies, 671 participants; very low-certainty evidence); parent proxy-reported quality of life (SMD 0.09, 95% CI -2.21 to 2.40; I2 = 99%; 2 studies, 309 participants; very low-certainty evidence); or parents' or caregivers' quality of life (SMD -1.98, 95% CI -4.13 to 0.17; I2 = 99%; 3 studies, 757 participants; very low-certainty evidence). It is uncertain whether duration of patient navigator intervention accounts for any of the variances in the changes in quality of life. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on the number of hospital admissions (MD -0.05, 95% CI -0.34 to 0.23; I2 = 99%; 2 studies, 381 participants; very low-certainty evidence) and the number of presentations to the emergency department (MD 0.06, 95% CI -0.23 to 0.34; I2 = 98%; 2 studies, 381 participants; very low-certainty evidence). Furthermore, it is unclear whether patient navigator programmes reduce the number of missed school days as data were sparse (2 studies, 301 participants). Four studies (629 participants) reported data on resource use. However, given the variation in units of analysis used, meta-analysis was not possible (very low-certainty evidence). All studies reported cost savings or quality-adjusted life year improvement (or both) in the patient navigation arm. No studies reported on adverse events (specifically, abuse of any type against the navigator, the patient, or their family members).

Authors' conclusions: There is insufficient evidence at present to support the use of patient navigator programmes for children and adolescents with chronic diseases. The current evidence is based on limited data with very low-certainty evidence. Further studies are likely to significantly change these results.

Trial registration: ClinicalTrials.gov NCT02481986 NCT03989986 NCT02675361 NCT05353998 NCT05639088 NCT05221281 NCT05261477 NCT01834456 NCT03648710 NCT05294042 NCT02928757 NCT03342495 NCT03462511 NCT04711707.

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Conflict of interest statement

RL: associate investigator for NAVKIDS2.

LK: none.

AF: investigator for NAVKIDS2.

RK: investigator for NAVKIDS2.

CG: investigator for NAVKIDS2.

DJ: Cochrane Editor. David, however, was not involved in the editorial process for this systematic review. DJ has received consultancy fees, research grants, speaker's honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care; consultancy fees from AstraZeneca, Bayer and AWAK; speaker's honoraria from Ono, Boehringer Ingelheim, and Lilly; and travel sponsorships from Ono and Amgen. He is a current recipient of an Australian National Health and Medical Research Council Leadership Investigator Grant.

GW: lead investigator for NAVKIDS2.

Update of

  • doi: 10.1002/14651858.CD014688

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    1. NCT01511341. Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases. clinicaltrials.gov/show/NCT01511341 (first received 12 January 2012).
NCT01521247 {published data only}
    1. NCT01521247. Implementation of a pediatric-to-adult asthma transition program. clinicaltrials.gov/show/NCT01521247 (first received 23 January 2012).
NCT01587105 {published data only}
    1. NCT01587105. Improving care for children with complex needs. clinicaltrials.gov/show/NCT01587105 (first received 25 April 2012).
NCT01659294 {published data only}
    1. NCT01659294. Diabetes outcomes and nurse case manager study. clinicaltrials.gov/show/NCT01659294 (first received 12 August 2012).
NCT01792661 {published data only}
    1. NCT01792661. Navigating the challenges of chronic kidney disease. clinicaltrials.gov/show/NCT01792661 (first received 12 February 2013).
NCT01900470 {published data only}
    1. NCT01900470. Effectiveness of patient-centered community health worker support to help patients control chronic disease. clinicaltrials.gov/study/NCT01900470 (first received 11 July 2013).
NCT02114515 {published data only}
    1. NCT02114515. Patient navigator to reduce readmissions. clinicaltrials.gov/study/NCT02114515 (first received 1 April 2014).
NCT02141893 {published data only}
    1. NCT02141893. Effectiveness of a multi-level clinic and family asthma intervention with a randomized control trial. clinicaltrials.gov/show/NCT02141893 (first received 12 May 2014).
NCT02197845 {published data only}
    1. NCT02197845. Enhancing use of hydroxyurea in sickle cell disease using patient navigators. clinicaltrials.gov/study/NCT02197845 (first received 21 July 2014).
NCT02277327 {published data only}
    1. NCT02277327. Trial to reduce hospitalizations in children with medical complexity. clinicaltrials.gov/show/NCT02277327 (first received 24 October 2014).
NCT02331082 {published data only}
    1. NCT02331082. Integrating pediatric care delivery in rural healthcare systems. clinicaltrials.gov/show/NCT02331082 (first received 8 August 2013).
NCT02877823 {published data only}
    1. NCT02877823. Improving cardiometabolic health of youth on antipsychotic medication. clinicaltrials.gov/show/NCT02877823 (first received 7 June 2016).
NCT02944136 {published data only}
    1. NCT02944136. Collaborative care intervention for cancer caregivers. clinicaltrials.gov/show/NCT02944136 (first received 18 October 2016).
NCT02960542 {published data only}
    1. NCT02960542. HELP prevent cancer pilot study. clinicaltrials.gov/study/NCT02960542 (first received 31 October 2016).
NCT03028233 {published data only}
    1. NCT03028233. Healthy kids & families: overcoming social, environmental and family barriers to childhood obesity prevention. clinicaltrials.gov/show/NCT03028233 (first received 10 January 2017).
NCT03066596 {published data only}
    1. NCT03066596. Promoting asthma guidelines and management through technology-based intervention and care coordination. clinicaltrials.gov/show/NCT03066596 (first received 10 January 2017).
NCT03077425 {published data only}
    1. NCT03077425. Obesity and caries in young south Asian children: a common risk factor approach. clinicaltrials.gov/show/NCT03077425 (first received 2 March 2017).
NCT03092063 {published data only}
    1. NCT03092063. Using multifamily groups to improve self-management of type 2 diabetes. clinicaltrials.gov/show/NCT03092063 (first received 10 March 2017).
NCT03106727 {published data only}
    1. NCT03106727. Evaluating the impact of a community health worker program in Neno, Malawi. clinicaltrials.gov/show/NCT03106727 (first received 3 April 2017).
NCT03176576 {published data only}
    1. NCT03176576. Patient navigation in the adolescent and young adult (AYA) cancer population. clinicaltrials.gov/show/NCT03176576 (first received 2 June 2017).
NCT03178773 {published data only}
    1. NCT03178773. Text-MED + FANS full trial. clinicaltrials.gov/show/NCT03178773 (first received 5 June 2017).
NCT03196024 {published data only}
    1. NCT03196024. Corazon de la Familia (Heart of the Family). clinicaltrials.gov/show/NCT03196024 (first received 20 June 2017).
NCT03317977 {published data only}
    1. NCT03317977. Translating an efficacious illness management intervention for youth with asthma. clinicaltrials.gov/show/NCT03317977 (first received 18 October 2017).
NCT03699748 {published data only}
    1. NCT03699748. Lay health worker engage, educate, and encourage patients to share. clinicaltrials.gov/study/NCT03699748 (first received 5 October 2018).
NCT03800459 {published data only}
    1. NCT03800459. Effect of a family empowerment program on coping, problem solving in parents, and quality of life in children with cystic fibrosis. clinicaltrials.gov/show/NCT03800459 (first received 28 December 2018).
NCT03989986 {published data only}
    1. NCT03989986. iPeer2Peer program for youth with sickle cell disease. clinicaltrials.gov/show/NCT03989986 (first received 17 June 2019).
NCT03995953 {published data only}
    1. NCT03995953. Integrated care delivery of HIV prevention and treatment in AGYW in Zambia. clinicaltrials.gov/show/NCT03995953 (first received 21 June 2019).
NCT04115813 {published data only}
    1. NCT04115813. Project YES! Youth engaging for success. clinicaltrials.gov/show/NCT04115813 (first received 2 October 2019).
NCT04388592 {published data only}
    1. NCT04388592. The effect of nurse practitioner (NP-led) care on mood, anxiety and health related quality of life in people with multiple sclerosis – a randomized trial. clinicaltrials.gov/show/NCT04388592 (first received 11 May 2020).
NCT04414553 {published data only}
    1. NCT04414553. Community active and healthy families. clinicaltrials.gov/study/NCT04414553 (first received 20 May 2020).
NCT04761016 {published data only}
    1. NCT04761016. The integrated population (I-POP) health trial. clinicaltrials.gov/study/NCT04761016 (first received 28 January 2021).
NCT04790604 {published data only}
    1. NCT04790604. ENCOMPASS: expansion study A, RCT. clinicaltrials.gov/show/NCT04790604 (first received 13 January 2021).
NCT04790617 {published data only}
    1. NCT04790617. ENCOMPASS: expansion study B, RCT. clinicaltrials.gov/show/NCT04790617 (first received 13 January 2021).
NCT04791267 {published data only}
    1. NCT04791267. ENCOMPASS: expansion study C, RCT. clinicaltrials.gov/show/NCT04791267 (first received 5 May 2021).
NCT05292365 {published data only}
    1. NCT05292365. Respiratory exacerbation plans for action and care transitions for children with severe CP. clinicaltrials.gov/study/NCT05292365 (first received 14 March 2022).
NCT05455216 {published data only}
    1. NCT05455216. Peer caregiver navigation for family caregivers in oncology. ichgcp.net/clinical-trials-registry/NCT05455216 (first received 1 July 2022).
Overbury 2021 {published data only}
    1. Overbury RS, Huynh K, Bohnsack J, Frech T, Hersh A. A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes. Pediatric Rheumatology Online Journal 2021;19(1):164. - PMC - PubMed
Pape 2022 {published data only}
    1. Pape L, Kreuzer M, Großhenig A, Prüfe J, Group S. Health care transition of adolescents after kidney transplantation in Germany and Austria – the randomized controlled transnephro trial. American Journal of Transplantation 2022;22:694-5.
Parker 2008 {published data only}
    1. Parker EA, Israel BA, Robins TG, Mentz G, Xihong Lin, Brakefield-Caldwell W, et al. Evaluation of Community Action Against Asthma: a community health worker intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. Health Education & Behavior 2008;35(3):376-95. - PMC - PubMed
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Raphael 2013 {published data only}
    1. Raphael JL, Rueda A, Lion KC, Giordano TP. The role of lay health workers in pediatric chronic disease: a systematic review. Academic Pediatrics 2013;13(5):408-20. [DOI: 10.1016/j.acap.2013.04.015] - DOI - PMC - PubMed
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    1. Robertson J. Stress point interventions for parents of children in hospital with chronic conditions reduced stress and improved child and family functioning [commentary on Burke SO, Handley-Derry MH, Costello EA, et al Stress-point intervention for parents of repeated]. Evidence Based Nursing 1998;1(3):79.
Saarijarvi 2021 {published data only}
    1. Saarijarvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Mechanisms of impact and experiences of a person-centred transition programme for adolescents with CHD: the Stepstones project. BMC Health Services Research 2021;21(1):573. - PMC - PubMed
Saarijarvi 2022 {published data only}
    1. Saarijarvi M, Bratt EL, Moons P, Wallin L, Gyllensten H. Cost-effectiveness of a transition program for adolescents with congenital heart disease: the stepstones project. Cardiology in the Young 2022;32:S274-5. - PMC - PubMed
Sequeira 2015 {published data only}
    1. Sequeira PA, Pyatak EA, Weigensberg MJ, Vigen CP, Wood JR, Ruelas V, et al. Let's empower and prepare (LEAP): evaluation of a structured transition program for young adults with type 1 diabetes. Diabetes Care 2015;38(8):1412-9. - PMC - PubMed
Sparring 2018 {published data only}
    1. Sparring V, Tschank J, Handler K, Mansoory E, Konzett-Smoliner S, Lindgren P. Social and economic impact of a case management approach for people with rare and complex conditions in Salaj, Romania. International Journal of Integrated Care 2018;18:1-3.
Steinbeck 2012 {published data only}
    1. Steinbeck KS, Harvey V, Shrewsbury VA, Donaghue K, Woodhead H. 132 outcomes for adolescents with type 1 diabetes mellitus participating in a comprehensive program to aid transition from pediatric to adult care: a pilot randomized controlled trial. Journal of Adolescent Health 2012;50(2):S77.
Sullivan‐Bolyai 2010 {published data only}
    1. Sullivan-Bolyai S, Bova C, Leung K, Trudeau A, Lee M, Gruppuso P. Social Support to Empower Parents (STEP): an Intervention for parents of young children newly diagnosed with type 1 diabetes. Diabetes Educator 2010;36(1):88-97. - PubMed
    1. Sullivan-Bolyai S, Grey M, Deatrick J, Gruppuso P, Giraitis P, Tamborlane W. Helping other mothers effectively work at raising young children with type 1 diabetes. Diabetes Educator 2004;30(3):476-84. - PubMed
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    1. Takaro TK, Krieger JW, Song L. Effect of environmental interventions to reduce exposure to asthma triggers in homes of low-income children in Seattle. Journal of Exposure Analysis and Environmental Epidemiology 2004;14(Suppl 1):S133-43. - PubMed
Thomsen 2022 {published data only}
    1. Thomsen EL, Boisen KA, Hanghoj S, Hansson H, Grabow Scheelhardt HV, Christensen ST, et al. A comprehensive transfer program from pediatrics to adult care for parents of adolescents with chronic illness (ParTNerSTEPs): study protocol for a randomized controlled trial. Trials 2022;23(1):1034. - PMC - PubMed
Tschank 2018 {published data only}
    1. Tschank J, Handler K, Konzett-Smoliner S. Measuring the effects of a case management approach on the quality of life of rare and complex disease patients in Salaj, Romania: a pilot randomised control trial of efficacy. Orphanet Journal of Rare Diseases 2018;13:P38. [DOI: 10.1186/s13023-018-0895-2] - DOI
Yang 2022 {published data only}
    1. Yang J, Lin L, Gao Y, Wang W, Yuan L. Interventions and strategies to improve social support for caregivers of children with chronic diseases: an umbrella review. Frontiers in Psychiatry 2022;13:973012. - PMC - PubMed
Yun 2015 {published data only}
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References to studies awaiting assessment

ACTRN12622001459718 {published data only}12622001459718
    1. ACTRN12622001459718. Equity pathways in integrated care in cerebral palsy (EPIC-CP): a pilot clinical trial of social prescribing for children and young people with cerebral palsy and their parents/caregivers. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384867 (first received 27 October 2022).
Goyal 2022 {published data only}CTRI/2020/10/028379
    1. Goyal A, Peerzada A, Sarteau AC, Praveen PA, Kalaivani M, Tandon N. A multi-center pediatric to adult care transition intervention program to improve clinic visit adherence and clinical outcomes among adolescents and emerging adults with type 1 diabetes mellitus [PATHWAY]: protocol for a randomized controlled trial. Contemporary Clinical Trials 2022;119:106830. [DOI: 10.1016/j.cct.2022.106830] - DOI - PubMed
NCT05353998 {published data only}
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NCT05639088 {published data only}
    1. NCT05639088. Improving transition care for adolescents and young adults with type 1 diabetes (SHIFT2). clinicaltrials.gov/study/NCT05639088 (first received 28 November 2022). [CLINICAL TRIALS NUMBER: NCT05639088]
Willems 2021 {published data only}
    1. Willems J, Farin-Glattacker E, Langer T. Evaluation of a case management to support families with children diagnosed with spinal muscular atrophy – protocol of a controlled mixed-methods study. Frontiers in Pediatrics 2021;9:614512. - PMC - PubMed

References to ongoing studies

Bollegala 2022 {published data only}
    1. Bollegala N, Barwick M, Fu N, Griffiths AM, Keefer L, Ahola Kohut S, et al. Multimodal intervention to improve the transition of patients with inflammatory bowel disease from pediatric to adult care: protocol for a randomized controlled trial. BMC Gastroenterology 2022;22:251. [DOI: 10.1186/s12876-022-02307-9] - DOI - PMC - PubMed
    1. NCT05221281. Implementing a multimodal RCT intervention to improve the transition of patients with Crohn's disease from pediatric to adult care. clinicaltrials.gov/study/NCT05221281 (first received 10 January 2022). [CLINICALTRIALS.GOV: NCT05221281]
Bryant‐Stephens 2021 {published data only}
    1. Bryant-Stephens T, Williams Y, Kanagasundaram J, Apter A, Kenyon CC, Shultz J. The West Philadelphia asthma care implementation study. Contemporary Clinical Trials Communications 2021;24:100864. - PMC - PubMed
Jimenez 2021 {published data only}
    1. Jimenez N, Fuentes M, Virtue A, Alonso-Gonzalez L, Lopez E, Zhou C, et al. Feasibility and acceptability of a telephone-based intervention for Hispanic children to promote treatment adherence after traumatic brain injury: a pilot study. Journal of Head Trauma Rehabilitation 2021;36(4):274-81. [DOI: 10.1097/HTR.0000000000000658] - DOI - PMC - PubMed
Lipman 2019 {published data only}
    1. Lipman TH, Smith JA, Hawkes CP. Community health workers and the care of children with type 1 diabetes. Journal of Pediatric Nursing 2019;49:111-2. [DOI: 10.1016/j.pedn.2019.08.014] - DOI - PubMed
NCT01834456 {published data only}
    1. NCT01834456. Comprehensive care of children with medical complexity. clinicaltrials.gov/study/NCT01834456 (first received 21 December 2012). [CLINICAL TRIALS NUMBER: NCT01834456]
NCT03648710 {published data only}
    1. NCT03648710. Community health workers and mhealth for sickle cell disease care. clinicaltrials.gov/study/NCT03648710 (first received 24 August 2018). [CLINICAL TRIALS NUMBER: NCT03648710]
NCT04238949 {published data only}
    1. NCT04238949. Community health workers in pediatric patients with newly diagnosed type 1 diabetes. clinicaltrials.gov/study/NCT04238949 (first received 21 January 2020).
NCT05294042 {published data only}
    1. NCT05294042. Patient navigators for children's community mental health services in high poverty urban communities. clinicaltrials.gov/study/NCT05294042 (first received 2 February 2022).
Orkin 2019 {published data only}
    1. Orkin J, Chan CY, Fayed N, Lin JL, Major N, Lim A, et al. Complex care for kids Ontario: protocol for a mixed-methods randomised controlled trial of a population-level care coordination initiative for children with medical complexity. BMJ Open 2019;9:e028121. [DOI: 10.1136/ bmjopen-2018-028121] - PMC - PubMed
Samuel 2019 {published data only}
    1. NCT03342495. Evaluating innovations in transition from pediatric to adult care – the Transition Navigator trial. clinicaltrials.gov/study/NCT03342495 (first received 3 November 2017). [CLINICALTRIALS.GOV: NCT03342495]
    1. Samuel S, Dimitropoulos G, Schraeder K, Klarenbach S, Nettel-Aguirre A, Guilcher G, et al. Pragmatic trial evaluating the effectiveness of a patient navigator to decrease emergency room utilisation in transition age youth with chronic conditions: the Transition Navigator Trial protocol. BMJ Open 2019;9(12):e034309. [DOI: 10.1136/bmjopen-2019-034309] - DOI - PMC - PubMed
Smaldone 2019 {published data only}
    1. Smaldone A, Manwani D, Aygun B, Smith-Whitley K, Jia H, Bruzzese J-M, et al. HABIT efficacy and sustainability trial, a multi-center randomized controlled trial to improve hydroxyurea adherence in youth with sickle cell disease: a study protocol. BMC Pediatrics 2019;19:354. [DOI: 10.1186/s12887-019-1746-6] - DOI - PMC - PubMed
van Zwieten 2019 {published data only}ACTRN12618001152213
    1. Guha C, Khalid R, Zweiten A, Francis A, Hawley CM, Jaure A, et al. Baseline characteristics of participants in the NAVKIDS2 trial: a patient navigator program in children with chronic kidney disease. Pediatric Nephrology (Berlin, Germany) 2023;38(5):1577-90. [DOI: 10.1007/s00467-022-05772-2] - DOI - PMC - PubMed
    1. Zwieten A, Caldwell P, Howard K, Tong A, Craig JC, Alexander S, et al. NAV-KIDS2 trial: protocol for a multi-centre, staggered randomised controlled trial of a patient navigator intervention in children with chronic kidney disease. BMC Nephrology 2019;20:134. [ACTRN: 12618001152213] [DOI: 10.1186/s12882-019-1325-y] - DOI - PMC - PubMed
    1. Zwieten A, Ryan EG, Caldwell P, Howard K, Tong A, Craig JC, et al. NAVKIDS2 trial: a multi-centre, waitlisted randomised controlled trial of a patient navigator intervention in children with chronic kidney disease – statistical analysis plan and update to the protocol. Trials 2022;23:824. - PMC - PubMed
Wahi 2022 {published data only}
    1. Wahi G, Marjerrison S, Gutierrez C, Krasevich K, Morrison KM, Thabane L. Screening and addressing social needs of children and families enrolled in a pediatric weight management program: a protocol for a pilot randomized controlled trial. Pilot and Feasibility Studies 2022;8:129. - PMC - PubMed

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