Barriers to transition from pediatric to adult care: a systematic review
Abstract
Objective: Transition research in each disease group is developing in its own "silo." A comprehensive review of barriers to transition within and across chronic illness groups is needed to facilitate information sharing and larger-scale efforts to overcome barriers and improve patient care. This study systematically reviews and identifies the barriers to transition from pediatric to adult care across pediatric illness populations. Methods: Medline, CINAHL, PsychINFO, Social Services Abstracts, Web of Science, and the Cochrane library databases were searched. Peer-reviewed English articles presenting original data on barriers to transition to adult care, focused on a specific pediatric chronic illness population, and conducted in the United States were included. Study design, population, and barriers were extracted. Barriers were categorized according to the Socioecological Model of Adolescent/Young Adult Readiness to Transition. Articles were evaluated for study quality. Results: Fifty-seven articles were included. The most common barriers to transition fell within the "Relationships" domain (e.g., difficulties letting go of long-standing relationships with pediatric providers) followed by "Access/Insurance" (e.g., difficulty accessing/finding qualified practitioners, insurance issues), and "Beliefs/Expectations" (e.g., negative beliefs about adult care). Barriers related to "Knowledge" (e.g., limited patient/caregiver knowledge about medication/illness and the transition process) and "Skills/Efficacy" (e.g., lack of self-management skills) were also common. While relationship barriers were commonly reported by all, some barriers varied by transfer status (pre- vs. posttransfer). Conclusions: Each chronic illness group experiences illness-specific challenges but certain barriers transcend chronic illness populations. Suggestions to overcome these barriers are provided.
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In a systematic review, the most important barriers to successful transition across chronic illness groups were in the relationship domain, access to adult services, knowledge, and insurance issues.
“In a systematic review, the most important barriers to successful transition across chronic illness groups were in the “relationship domain” (eg, difficulties in letting go of long-standing relationships with pediatric providers), “access to adult services,” “knowledge” (regarding medication/illness), and “insurance issues”.548”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [548]
Transitioning care to an adult TS team may not be feasible in many centers and regions due to lack of access to specialists who have knowledge and training in TS care and/or inadequate funding to support streamlined transition processes and resources.
“Transitioning care to an adult TS team may not be feasible in many centers and regions due to lack of access to specialists who have knowledge and training in TS care and/or inadequate funding to support streamlined transition processes and resources.532,548,550,552”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [548]
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- Authors
- Gray, W. N., Schaefer, M. R., Resmini-Rawlinson, A., & Wagoner, S. T.
- Affiliations
- Auburn University (US)
- University of Florida
- Corresponding author
- Gray, Wendy N
- Venue
- Journal of Pediatric Psychology
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-11-28
- Volume
- 43
- Issue
- 5
- Pages
- 488-502
- ISSN
- 0146-8693 (ISSN-L)
- 1465-735X
- OpenAlex
- W2770360041
- Cited by
- 326
- References
- 90
- Citations by year
- 2026: 37 · 2025: 56 · 2024: 51 · 2023: 35 · 2022: 52 · 2021: 31 · 2020: 21 · 2019: 26 · 2018: 16
- FWCI
- 3.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Crohn's and Colitis Foundation (285083)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- care transitions, transition to adult care, barriers to transition, chronic disease, socio-ecological model, patient-provider relationship, health insurance access, self-management skills, caregiver knowledge
- MeSH terms
- Adolescent, Adult, Chronic Disease, Humans, Young Adult, Transition to Adult Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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