Transition from paediatric to adult-orientated care for adolescents with cystic fibrosis

Abstract

Adolescence is a time of major physical and psychological change. Young teenagers need to become comfortable with their developing sexuality, to begin moving towards independence with a greater reliance on peer group acceptance, to face the future and to make important decisions about their education, career and goals. Difficulties inherent in all of these steps to adult life are magnified by chronic ill health. It is harder for adolescent patients to break family ties, harder to feel accepted by their peer group, harder to plan realistically for the future. It must be the overriding aim of the professional health carers to encourage these patients to confront the problems of adolescence and to help them maintain their physical and emotional stability throughout this challenging period. Parents also must be supported, and encouraged gradually to devolve to their child responsibilities for decision making and for taking prescribed medication. A planned and sensitive transition from a paediatric to an adult health-care system will aid a successful evolution to an independent adult life. The paediatric hospital environment is not best equipped to deal with the problems of adolescence. Just as parents must allow their child to move on, so the paediatric caring team must loosen its ties with the patient and allow transfer to the adult team. There are several ways of effecting this transfer of care. None of them is proven to be better than any other, but the transfer should always be planned, smooth, efficient and expected by the patient. Ideally, all patients should have the opportunity to transfer to a properly equipped and properly staffed adult cystic fibrosis centre where they can continue to receive the highest standards of care from an experienced multidisciplinary team.