A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services.
Paul, Moli O'Hara, Lesley Tah, Priya Street, Cathy Maras, Athanasios Ouakil, Diane Purper Santosh, Paramala Signorini, Giulia Singh, Swaran Preet Tuomainen, Helena
Paul, Moli
O'Hara, Lesley
Tah, Priya
Street, Cathy
Maras, Athanasios
Ouakil, Diane Purper
Santosh, Paramala
Signorini, Giulia
Singh, Swaran Preet
Tuomainen, Helena
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Affiliation
University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Stratford Healthcare; Saint John of God Research Foundation clg; Yulius Academie, Netherlands; Hôpital Saint Eloi; King’s College London; Saint John of God Clinical Research Center, Italy; Lucena Clinic Rathgar, Dublin; University College Dublin; Our Lady’s Children Hospital Crumlin, Dublin
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Publication date
2018-07-18
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Abstract
Background
Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative.
Methods
A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced.
Results
Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence.
Conclusions
There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area.
Citation
Paul, M., O’Hara, L., Tah, P. et al. A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services. BMC Med Ethics 19, 73 (2018). https://doi.org/10.1186/s12910-018-0276-3
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Article