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TRANSITIONTO ADOLESCENCE
AND BEYOND
Dan Wood Consultant in Adolescent and Reconstructive
UrologyUniversity College London Hospitals
Honorary Consultant UrologistGreat Ormond Street
“An increasing number of chronically ill children are surviving into young adulthood. Achieving a seamless
transfer is becoming one of the greatest challenges facing both children's and
adult services.”
Fiona Smith Adviser in Children's and Young People's
Nursing Royal College of Nursing
DW UCLH
CONSULTATION
Different environment New personnel Information loss Different medical approach Potential for conflicting messages
DW UCLH
CONSULTATION
Building for the rest of your life Regular checks Baseline New team members Watch for problems ?Need for travel???
DW UCLH
CONFIDENTIALITY
Parents in vs. parents out New issues Embarrassment We have to look to build a trust They will grow up
DW UCLH
CHALLENGES
DW UCLH
ChangeChange consentconsent
consultation
consultation
confidentiality
confidentiality
CONSENT
No consent is just me All complex decisions need time …and discussion Important role of our CNS Choices – this can be difficult
DW UCLH
CONSENT
For straight forward procedures – usually no problem
Able to sign for themselves May raise issue from the past Should be a process not an event
DW UCLH
CHALLENGES
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ChangeChange
concordanceconcordance consentconsent
consultation
consultation
confidentiality
confidentiality
CONCORDANCE
With freedom comes responsibility Some have difficulty with this Unsafe? Difficult Usually finite
DW UCLH
CHALLENGES
DW UCLH
ChangeChange
conjugation
conjugation
concordance
concordance
consentconsent
consultation
consultation confidentialit
yconfidentialit
y
CHALLENGES
DW UCLH
ChangeChange
conjugationconjugation
concordance
concordance
consent
consent
consultationconsultation
conflictconflict
confidentiality
confidentiality
OTHER CONCERNS
Future surgery Continence Other diseases Children (1/70 – 1/100) Historical comparison
DW UCLH
OBSTETRICS
Several studies – 45 ladies 49 deliveries May need Caesarian section All likely to need shared care Prolapse is a problem but treatable
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THE LONG-TERM
Regular reviews Good communication with GPs Follow-up bloods Scans Expertise Outcomes - ?database
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