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Paeds Vivasneurology-neurodisability-and-neuromuscular

Paeds Vivas · neurology-neurodisability-and-neuromuscular

Transition and advance care planning in neurodisability: Viva

Branching clinical structured oral on transition and advance care planning in young people with neurodisability, covering the distinction between transition and transfer, the Got Transition Six Core Elements with the age milestones of twelve fourteen eighteen and twenty-one, the transition readiness tools and the named coordinator, the dangerous transition gap, paediatric advance care planning across the four domains of goals of care ceiling of treatment resuscitation decisions and preferred place of care, and the integration of palliative care with disease-modifying treatment across the trajectory.

branching clinical structured oral3 min readVerification in progress

Target exams

RACP DWERACP DCEMRCPCH Clinical
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Target exams

RACP DWERACP DCEMRCPCH Clinical
Prompt
A seventeen-year-old young woman with severe cerebral palsy, a gastrostomy, and nocturnal non-invasive ventilation is months from leaving paediatric services. Her mother has always coordinated her care and answers every question, the young woman has never met the adult team, and no transition plan is documented. The examiner asks what transition means and how it differs from transfer, how you would assess her readiness and build the plan, what structural elements you would put in place, why this boundary is dangerous, and how you would approach the parallel advance care planning conversation for a child with a life-limiting neurodisability.

Branch 1: What transition means, and how it differs from transfer

A strong candidate opens by defining health care transition as a purposeful, planned, multi-year process of moving a young person from child-centred to adult-centred care, and then separates it from transfer, the single administrative event of moving clinical responsibility. The word that matters is process, because a service that discharges the young woman with a letter and no plan has completed the transfer and failed the transition. The candidate anchors the practice to the Got Transition Six Core Elements of policy, tracking, readiness, planning, transfer, and completion, and to the age milestones of twelve, fourteen, eighteen, and twenty-one. [1]

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References7ShowHide
  1. [1]White PH, Cooley WC Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics, 2018.PMID 30348754
  2. [2]Fair C, Cuttance J, Sharma N, et al International and Interdisciplinary Identification of Health Care Transition Outcomes. JAMA Pediatr, 2016.PMID 26619178
  3. [3]Okumura MJ, Kuo DZ, Ware AN, et al Improving Health Care Transitions for Children and Youth With Special Health Care Needs. Acad Pediatr, 2022.PMID 35248248
  4. [4]Myers LL, Nerminathan A, Fitzgerald DA, et al Transition to adult care for young people with cerebral palsy. Paediatr Respir Rev, 2020.PMID 31987717
  5. [7]Brunetta J, Fahner J, Legemaat M, et al Age-Appropriate Advance Care Planning in Children Diagnosed with a Life-Limiting Condition: A Systematic Review. Children (Basel), 2022.PMID 35740767
  6. [8]Bennett HE, Duke S, Richardson A Paediatric advance care planning in life-limiting conditions: scoping review of parent experiences. BMJ Support Palliat Care, 2023.PMID 37201934
  7. [11]Liben S, Papadatou D, Wolfe J Paediatric palliative care: challenges and emerging ideas. Lancet, 2008.PMID 17707080
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