Background: Despite the growing emphasis on high-quality HCT, there remains a paucity of evidence to guide inpatient providers in transitioning adolescents to adult medical care. An inter-professional team at our institution created a video incorporating Self-Determination Theory (SDT) concepts as the educational construct emphasizing key elements of HCT. The objectives were to determine the effect of viewing an HCT educational video on the perception of knowledge, attitudes, and participation in pediatric to adult-oriented HCT planning among hospitalized AYA.
Methods: We randomly assigned hospitalized patients aged 15-25 years during 11/2013-10/2015 admitted to a children’s hospital to control (standard of care) and intervention group (viewing the educational HCT video). Exclusion criteria were acute psychosis, intellectual disability, non–English speaking, and patients in the ICU. Primary outcomes were change in perception of knowledge, attitudes and participation in HCT planning. Patients filled out a survey at enrollment (T1), prior to hospital discharge (T2), and one month after discharge (T3). Intermediate outcomes were autonomous and controlled motivation, and perceived competence using validated SDT scales. Differences in mean scores were done between groups for perception of knowledge, attitudes and participation in HCT planning using t tests. Repeated measures ANOVA was used to evaluate change in perception of knowledge in groups over three time points. Hierarchical regression analyses were used to evaluate perceived competence as a mediator of change in perception of knowledge from T1 to T3.
Results: 148 patients were randomized and 135 patients (68/67 control and intervention respectively) completed survey one, 46/43 for survey two, 41/35 for survey three. Baseline demographic characteristics were similar between groups. The intervention group reported more knowledge about HCT after watching the video (87% (40) vs. 54%(23); p < 0.01), but no differences in attitudes and participation in HCT planning. Linear regression model revealed that older patients across groups had higher participation in transition planning during their hospitalization (p=0.04). Repeated measures ANOVA exhibited a significant increase in perception of knowledge for intervention vs group control over three time points (p=0.03). Hierarchical regression analyses indicated that change in perception of knowledge from T1 to T3 was mediated by perceived competence at T2 (p=0.016).
Conclusions: An educational video in hospitalized AYA improved knowledge about HCT, which was mediated by reported competence, supporting the use of the SDT behavioral model for interventions in AYA during HCT.