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In the search for alternative ways to connect with their pediatric transplant patients, clinicians at BC Children’s Hospital piloted a novel project whereby they completed weekly check-ins with their patients via text. The results, published in Pediatric Transplant earlier this year, show how the approach can enhance the health care experience for this population.  

Kathryn Armstrong is a clinician at BC Children’s Hospital who helped co-lead the pilot study. Armstrong says that she and her colleagues were concerned about their patients’ transitions from pediatric to adult care, whereby within five years of transitioning, up to 10% of transplants were rejected by the recipient’s immune system. As well, many of the clinicians felt they were communicating more so with the children’s parents than the children, and wondered whether more direct communication with their patients could improve adherence to therapy, quality of life, and the health care experience. 

“So we ran a little focus group with some pediatric patients,” explains Armstrong. “We agreed on text messaging as a way they would feel comfortable communicating with us. With text, they felt they may be brave enough to ask questions they were still not ready to ask us in person in clinic visits.”

Armstrong’s team then connected with a Vancouver-based company called WelTel Inc., which provides platforms to support health care communications. Through a WelTel platform, clinicians texted their pediatric patients every Monday with an open-ended question: How are you?

Study participants were children and teens between the age of 12 and 19 who had received a kidney, liver or heart transplant. Any patients who had concerns, questions or needed additional care in some way could then communicate these issues to their clinician in an open, bi-directional manner at any time between 9 am and 5 pm, Monday to Friday. 

The study results show that this intervention did not significantly improve adherence to therapy – but as Armstrong notes, this was because adherence to therapy was already fairly high at the beginning of the study. Study participants did, however, report significant improvements in their health care experience. 

“It opened up the communications for the patients themselves to take ownership of their care,” says Armstrong, noting that patients reported positive feedback about the method of communication. “They felt more heard, empowered and engaged after it. By improving our communication with our patients, we improved the quality of care we could provide for them.”

Armstrong says this pilot study also helped her feel more connected with her patients. “Personally, my favourite aspect was really getting to know my patients,” she says, noting she felt more informed about her patients’ lives and well-being by the time in-person visits took place. 

Moving forward, Armstrong and her colleagues will continue to explore how texting can enhance the health care experience for youth living with a transplant. They have been piloting a virtual exercise program through the WelTel platform, whereby pediatric participants can complete an exercise program at home and communicate with their health care providers via text about the program. As well, the team has received funding for an additional pilot study to explore how virtual reality may improve physical activity in the same transplant population. 

Publication: A text messaging intervention and quality of life in adolescents with solid organ transplants