title: Barriers and Facilitators of Transition from Pediatric to Adult Long-Term Follow-Up Care in Childhood Cancer Survivors.
abstract: OBJECTIVE
  Despite the risk for late effects in adult survivors of cancer in childhood or adolescence, many survivors fail to transition from pediatric to adult long-term follow-up (LTFU) care. The purpose of this study was to identify the barriers and facilitators of transition from pediatric to adult LTFU care.
  
  
  METHODS
  In this qualitative study, 38 Canadian survivors of cancer in childhood or adolescence, currently aged 15-26 years, were interviewed using semi-structured, open-ended questions. Participants belonged to one of four groups: pre-transition (n=10), successful transition (n=11), failed to transition (n=7), and transitioned to an adult center but then dropped out of adult care (n=10). A constructivist grounded theory approach was used to analyze the interview data. This approach consisted of coding transcripts line by line to develop categories and using constant comparison to examine relationships within and across codes and categories. Interviewing continued until saturation was reached.
  
  
  RESULTS
  Three interrelated themes were identified that affected the transition process: micro-level patient factors (e.g., due diligence, anxiety), meso-level support factors (e.g., family, friends), and macro-level system factors (e.g., appointments, communication, healthcare providers). Factors could act as facilitators to transition (e.g., family support), barriers to transition (e.g., difficulty booking appointments), or as both a barrier and a facilitator (e.g., anxiety).
  
  
  CONCLUSIONS
  This study illustrates the interaction between multiple factors that facilitate and/or prevent transition from pediatric to adult LTFU cancer care. A number of recommendations are presented to address potential macro-level system barriers to successful transition.
authors.affiliation: 1 St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto, Ontario, Canada .
authors.forename: Zahava R S
authors.initials: ZR
authors.lastname: Rosenberg-Yunger
authors.affiliation: 2 Department of Pediatrics, McMaster University , Hamilton, Ontario, Canada .
authors.forename: Anne F
authors.initials: AF
authors.lastname: Klassen
authors.affiliation: 3 Cancer Survivorship Program, Princess Margaret Cancer Centre , Toronto, Ontario, Canada .
authors.forename: Leila
authors.initials: L
authors.lastname: Amin
authors.affiliation: 4 Ben Gurion University of the Negev , Department of Public Health, Beer-Sheva, Israel .
authors.forename: Leeat
authors.initials: L
authors.lastname: Granek
authors.affiliation: 5 Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital and Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Norma M
authors.initials: NM
authors.lastname: D'Agostino
authors.affiliation: 6 Child Health Evaluative Sciences, The Hospital for Sick Children, Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Boydell
authors.affiliation: 7 The Hospital for Sick Children , Division of Haematology/Oncology, Toronto, Ontario, Canada .
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
authors.affiliation: 2 Department of Pediatrics, McMaster University , Hamilton, Ontario, Canada .
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Barr
authors.affiliation: 7 The Hospital for Sick Children , Division of Haematology/Oncology, Toronto, Ontario, Canada .
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
keywords: long-term follow-up care; qualitative research; social support; survivorship; transition in care