Dr. Kathryn Armstrong, a pediatric cardiologist at BC Children’s Hospital, works with children and youth along the entire continuum of transplant. These patients present unique challenges, and Dr. Armstrong believes health care professionals and medicine must adapt to meet the needs of this distinct population.
She was the recipient of the Transplant Research Foundation 2018 Venture Grant competition for her project that looks at innovative ways to use technology to support and engage adolescent patients in their post-transplant care. As part of her project, "Lets Talk Teenage Transplant": Using Text Messaging to Engage with Adolescent Solid Organ Transplant Patients, teenaged patients will communicate with their health care team via weekly text message check-ins. The goal is for this communication to lead to enhanced quality of life, better adherence to medication, and greater compliance with treatment.
Tell us about your connection to transplantation
In the early part of my pediatric training in Ireland, I worked with patients who had end-stage liver disease and required liver transplants. This gave me my first insight into the complex medical needs of solid organ transplant patients, and the important role of the interdisciplinary team in their care.
During my training in pediatric cardiology in Canada, I developed a keen interest in heart failure and transplant. I think this was in part fuelled by my early exposure to transplant patients and my natural progression towards the complicated medical needs of patients suffering from end stage heart failure. It was exciting to be training at BC Children's Hospital when it became a heart transplant centre and to have the opportunity to finish my training in this field at the Hospital for Sick Children in Toronto.
What do you find so compelling about pediatric transplant medicine?
Transplant offers young patients the possibility of a life-saving treatment that may allow them to have a normal quality of life and to grow up doing the things that their peers are doing.
Transplant patients have unique needs as infants and children, who grow into adolescents who have their own challenges. Being part of their care as they transition and grow, teaching them about their heart and how to manage their medical needs, while supporting them to be normal teenagers is a very rewarding (and sometimes challenging!) part of the job.
It is gratifying to watch patients successfully graduate from our paediatric services to those in the adult world and knowing that they will have the opportunity to go on to university or get married.
What unique challenges exist for pediatric and adolescent transplant patients?
Paediatric patients often receive their heart transplant in infancy—they therefore never really know how sick they were. They rely completely on their parents to advocate for them and ensure they receive their medications on time, and to attend their various medical appointments.
How we educate children and then adolescents, is vital to their overall wellbeing and to help them maintain a sense of normalcy.
I think an important part of our job is to support and educate parents about how to look after their babies and children following transplant, but also introduce the idea early that we hope to grow these children into independent adults who will achieve their full potential.
What role do you think technology can play in addressing the needs of these patients?
Technology is a primary communication tool in today's culture, particularly among adolescents. Incorporating this tool into care delivery empowers young patients. It gives them the opportunity to ask questions and reach out to people in their care team outside the clinic setting. We want our adolescent patients to achieve a sense of normalcy, develop their own identity, achieve peer acceptance and develop autonomy all while telling them to take medicine twice a day for life and come to regular hospital appointments!
We think that by improving our communication and engagement with adolescent patients we may help them achieve all that they want to do while ensuring greater adherence to their medications, medical appointments and required investigations.
How do you see technology playing a greater role in the future of transplant medicine?
We have to embrace technology to keep up with teenage patients. We surveyed a group of our teenage patients with congenital heart disease and those who have had a heart transplant and they told us that they want to be able to have a way to communicate with us and that text messaging is their preferred method.
Our goal in the solid organ transplant clinic in BC Children's Hospital is to lead the way in embracing technology, such as text messaging, to improve engagement with our teenage patients. Our goal is to educate and empower them about their solid organ transplant. Dreaming big – we would like to roll this out across Canada for all teenage organ transplant patients.
Tell us about one of your best transplant related memories.
I will never forget the privilege of being in the operating room the first time I ever watched a heart transplant procedure. I think that all of the patients and the families that we get to look after are unique and we learn something from them as well.
A real highlight for me was being involved in the care of my first heart transplant patient since coming back to BC Children's Hospital. Being part of that patient's recovery, challenges and successes has been very rewarding.
Anything else you would like to add?
I'd like to thank Dr. Sanjiv Gandhi and Dr. Derek Human for their hard work in setting up the Heart Transplant program in BC—without them, our ongoing excellent care for these patients would not be possible. Dr. Tom Blydt Hansen is a great mentor and he continues to lead our Solid Organ Transplant Program in BC, with the help of our amazing interdisciplinary team. It's a privilege to work with such a great group.
Finally, as we continue to do research in this field none of this would be possible without the continuing support of organizations such as the Transplant Research Foundation of BC.
Kathryn Armstrong along with Dr. Tom Blydt Hansen and Lori Lothian, TRF Chair, at Celebrate Transplant Research event this past fall.
The Transplant Research Foundation of BC (TRFBC) is dedicated to funding peer-reviewed organ donation and transplantation research. Since 2009, TRF has given out over $285,000 in research funding to BC-based scientists, which has been leveraged into over $10 million in external funding from agencies such as Canadian Institutes of Health Research, Genome Canada and Canadian Donation and Transplantation Research Program.