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Principal Investigator: Sara Malone
Organization: WASHINGTON UNIVERSITY
Fiscal Year: 2024
Award: $398,207
Funding agency: National Cancer Institute
PROJECT SUMMARY/ABSTRACT
Children with cancer in low-resource settings face a survival rate of only 20%. Clinical
deterioration, defined as the worsening of patient status that requires clinical teams to recognize
and respond in a coordinated fashion, remain a major cause of childhood cancer mortality
globally. Interdisciplinary communication is essential to high-quality cancer care, especially
during high-acuity events such as clinical deterioration. Despite knowledge that high quality
interdisciplinary communication improves patient care and outcomes, we lack an understanding
of specific modifiable determinants of communication quality and appropriate, usable, and
measurable communication interventions. This is particularly true in low-resource settings. We
have previously developed a valid, reliable, multilingual measure of communication quality
during clinical deterioration and have conceptualized that communication structure and quality
interact to directly impact the quality of childhood cancer care. The goal of this proposal is to
develop and test a bundled multilevel intervention that responds to modifiable determinants of
interdisciplinary communication quality and structural communication patterns in low-resource
pediatric oncology hospitals to improve communication and care delivery. To accomplish this
goal, we will engage clinicians and hospitals in low-resource settings. In Aim 1 we will identify
the relationship between communication structure and quality in the care of children with
cancer. We will conduct a cross-sectional social network analysis from 10 high-quality
communication and 10 low-quality communication hospitals as determined by previous work. In Aim
2, we will develop a multilevel intervention to improve communication quality in low-resource
hospitals. We will conduct a sequential mixed methods study using quantitative data from Aim 1
supplemented by qualitative interviews with clinicians. Following this, we will engage a global panel
of experts in communication and clinical care to conduct implementation mapping, which will develop
and prioritize an intervention to address common communication challenges. In Aim 3 we will
conduct a cluster randomized control trial to test the feasibility and preliminary effectiveness of
this multilevel intervention to improve communication quality in low-resource hospitals. We will
test the identified intervention bundle at 8 low-resource hospitals. Our primary outcome will be the
change in communication quality score, and we will also assess the feasibility, acceptability, and
appropriateness of the intervention among frontline clinicians. When complete, this work will
improve interdisciplinary communication and clinical outcomes for children with cancer in
hospitals of all resource levels, thus advancing health equity globally.
Terms: <Address><Cancer Hospital><Cancer Treatment><Child Care><Childhood Cancers><Client satisfaction><Clinical><Communication><Communication challenge><Communication difficulty><Critical Care><Cross-Disciplinary Communication><Data><Decision Making><Deterioration><Effectiveness><Evaluation><Event><Excess Mortality><Face><Goals><Healthcare Delivery><Hospitals><Human Resources><Individual><Interdisciplinary Communication><Intervention><Intervention Strategies><Interview><Knowledge><LMIC><Language><Length of Stay><Linguistic><Linguistics><Low-resource area><Low-resource community><Low-resource environment><Low-resource region><Low-resource setting><Malignant Childhood Neoplasm><Malignant Childhood Tumor><Malignant Neoplasm Therapy><Malignant Neoplasm Treatment><Malignant Pediatric Neoplasm><Malignant Pediatric Tumor><Malignant childhood cancer><Manpower><Maps><Measurable><Measurement><Measures><Medical Errors><Medical Mistakes><Methods><Modernization><Multidisciplinary Communication><Multilingualism><Network Analysis><Number of Days in Hospital><Nurses><Oncology><Oncology Cancer><Outcome><Pathway Analysis><Patient Care><Patient Care Delivery><Patient Satisfaction><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Pattern><Pediatric Oncology><Physicians><Position><Positioning Attribute><Procedures><Professional Role><Provider><Puericulture><Randomized><Randomized, Controlled Trials><Research Methodology><Research Methods><Research Resources><Resource-constrained area><Resource-constrained community><Resource-constrained environment><Resource-constrained region><Resource-constrained setting><Resource-limited area><Resource-limited community><Resource-limited environment><Resource-limited region><Resource-limited setting><Resource-poor area><Resource-poor community><Resource-poor environment><Resource-poor region><Resource-poor setting><Resources><Safety><Saint Jude><Saint Jude Children's Cancer Center><Saint Jude Children's Research Hospital><Science><Social Network><St. Jude><St. Jude Children's Cancer Center><St. Jude Children's Research Hospital><St. Jude Children's Research Hospital Comprehensive Cancer Center><St.Jude Children's Cancer Center><St.Jude Children's Research Hospital><St.Jude Children's Research Hospital Comprehensive Cancer Center><Structure><Survival Rate><System><Testing><Time><Waiting Lists><Work><acceptability and feasibility><anti-cancer therapy><burn-out><burnout><cancer care><cancer death in children><cancer in a child><cancer in children><cancer mortality in children><cancer related death in children><cancer therapy><cancer-directed therapy><care delivery><care for patients><care of patients><caring for patients><child with cancer><childhood cancer death><childhood cancer mortality><childhood malignancy><clinical care><cohort><control trial><faces><facial><feasibility testing><health and care delivery><health care delivery><health delivery systems><health equity><health services delivery><hospital days><hospital length of stay><hospital stay><implementation science><improved><innovate><innovation><innovative><intervention effect><intervention mapping><interventional strategy><low and middle-income countries><multilingual><novel><nurse><patient oriented outcomes><patient safety><pediatric cancer><pediatric malignancy><personnel><pilot test><pressure><primary outcome><psychologic><psychological><randomisation><randomization><randomized control trial><randomly assigned><research and methods><secondary outcome><tool><tumor><usability><waitlist>