Emotional Aspects of Transitioning to Adult Care
Although health care checklists have proven effective to ensure high reliability of processes and systems, they do not capture the important emotional aspects of a transition from pediatric to adult care. The pediatric health care team, the patient, and the family typically have a rich and significant history together, so ending these relationships can be challenging for everyone involved.
When I interviewed my own young adult son and daughter for this article, it was this aspect of transitioning that they spoke most about. Though they feel ready to manage appointments, prescriptions, and insurance, their overwhelming preference is to not have to leave the physician and health care team that know them best and have cared for them all of their lives. Many young adult patients share this sentiment. Over years of care, not only has an enormous knowledge base been built that is unique to this patient – but there is also the concept of "being known" and all of the emotional components associated with positive healing relationships.
Within a good framework of therapeutic relationships (McKlindon & Barnsteiner, 1999; McKlindon & Schlucter, 2004), it is important to give attention to and create the opportunity for saying goodbye. It may be helpful to set aside time on the last clinic visit for therapeutic closure for everyone, as well as to share how the patient and family can reconnect if needed and/or how to update the pediatric team about how the young adult is doing.