The individualized, accompanied transition program “TraiN” for adolescent kidney patients – a local initiative

Paula Collette, Luisa C. Klein, Lisa M. Körner, G. Ernst, S. Brengmann, J. Schäuble, S. Habbig, L. Weber
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Abstract

Abstract Since the transition from pediatric and adolescent to adult care often proceeds unaccompanied and unplanned, young patients with chronic kidney disease may experience health risks and non-adherence after the transfer. The psychosocial team at the Department of Pediatric Nephrology at the University Hospital of Cologne has therefore developed its local transition program “TraiN” for patients with chronic kidney disease aged 13 years and older. It combines structure and flexibility through predefined content modules that can be individually adapted to the patients, offering continuity and sustainability through a transition contact person. In addition, the family members are offered regular psychological consultations. The timing of the transfer is chosen individually depending on the level of psychosocial and medical transition readiness. The aim of “TraiN” is to strengthen the patients’ transition competence and the responsibility for their disease management and to provide them and their families the best possible support during the transition in order to prevent possible health risks. In the near future, a scientific evaluation will be conducted aiming to determine whether “TraiN” can support young people in their independence and self-reliant disease management.
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针对青少年肾脏患者的个性化、伴随的过渡计划“TraiN”——一项当地倡议
摘要由于从儿童和青少年向成人护理的过渡通常是在无人陪伴和无计划的情况下进行的,患有慢性肾脏病的年轻患者在转移后可能会出现健康风险和不依从性。因此,科隆大学医院儿科肾病科的心理社会团队为13岁及以上的慢性肾病患者制定了当地过渡计划“TraiN”。它通过预定义的内容模块将结构和灵活性结合起来,这些模块可以根据患者进行单独调整,通过过渡联系人提供连续性和可持续性。此外,还定期向家庭成员提供心理咨询。转移的时间是根据心理社会和医疗过渡准备程度单独选择的。“TraiN”的目的是加强患者的过渡能力和疾病管理责任,并在过渡期间为他们及其家人提供尽可能好的支持,以防止可能的健康风险。在不久的将来,将进行一项科学评估,旨在确定“TraiN”是否能够支持年轻人的独立性和自力更生的疾病管理。
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