Transitional Care in Anorectal Malformation and Hirschsprung's Disease

Infographic · Aug 2024 · 1 min read

In brief

Systematic review identifying key barriers in transitioning ARM and HD patients from pediatric to adult care: patient knowledge gaps, lack of adult surgeon expertise in pediatric conditions, and absence of structured programs. Recommends joint clinics, standardized guidelines, and fostering patient autonomy.

Patients with ARM/HD often lack understanding of their condition, leading to over-reliance on pediatric teams and resistance to adult care.
Adult colorectal surgeons frequently lack training in pediatric colorectal conditions, creating care gaps during transition.
Joint pediatric-adult transition clinics with structured protocols improve continuity of care for ARM and Hirschsprung patients.
Fostering patient autonomy and independence before transition reduces reliance on pediatric surgical teams.
Standardized transition guidelines are needed to benchmark quality of care for pediatric colorectal conditions moving to adult services.

Written by the GCMD Library team from the infographic.

A clinical comparison chart displaying three treatment modalities arranged horizontally. Each section contains anatomical illustrations of the esophagus and lower esophageal sphincter, with color-coded success metrics and complication data presented in graphical format below each approach.

New infographic from the Journal of pediatric Surgery by Dr. Cecilia Gigena

"Transitional Care in Anorectal Malformation and Hirschsprung's Disease: A Systematic Review of Challenges and Solutions"

Authors: Josip Plascevic, Shaneel Shah, Yew-Wei Tan

Full article: https://gcmd.co/3WHxvKX

Background

The literature on transitional care in anorectal malformation (ARM) and Hirschsprung's disease (HD) is diverse and heterogeneous. There is a lack of standards and guidelines specific to transitional care in these conditions. We aim to establish and systematically categorize challenges and solutions related to colorectal transition care.

Methods

Systematic review of qualitative studies from MEDLINE, EMBASE, PubMed and Scopus databases (2008–2022) was conducted to identify the challenges and solutions of healthcare transition specific to ARM and HD. Thematic analyses are reported with reference to patient, healthcare provider and healthcare system.

Results

Sixteen studies from 234 unique articles were included. Fourteen themes related to challenges and solutions, each, are identified. Most challenges identified are patient related. The key challenges pertain to: (1) patient's lack of understanding of their disorder, resulting in over-reliance on the pediatric surgical team and reluctance towards transitioning to adult services; (2) a lack of education and awareness among adult colorectal surgeons in caring for pediatric colorectal conditions and inadequate communication between pediatric and adult teams; and (3) a lack of structured transition program and joint-clinic to meet the needs of the transitioning patients. The key solutions are: (1) fostering young adult patient's autonomy and independence; (2) conducting joint pediatric-adult transition clinics; and (3) ensuring a structured and coordinated transition program is available using a standardized guideline.

Conclusion

A comprehensive framework related to barriers and solutions for pediatric colorectal transition is established to help benchmark care quality of transitional care services.

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