Development and pilot testing of PROACTIVE: A pediatric onco‐critical care capacity and quality assessment tool for resource‐limited settings

• Published in: Cancer medicine (Malden, MA) Vol. 12; no. 5; pp. 6270 - 6282
• Main Authors: Arias, Anita V., Sakaan, Firas M., Puerto‐Torres, Maria, Al Zebin, Zebin, Bhattacharyya, Parthasarathi, Cardenas, Adolfo, Gunasekera, Sanjeeva, Kambugu, Joyce, Kirgizov, Kirill, Libes, Jaime, Martinez, Angelica, Matinyan, Nune V., Mendez, Alejandra, Middlekauff, Janet, Nielsen, Katie R., Pappas, Andrew, Ren, Hong, Sharara‐Chami, Rana, Torres, Silvio F., McArthur, Jennifer, Agulnik, Asya
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2023; John Wiley and Sons Inc; Wiley
• Subjects: Cancer; Child; Children & youth; Critical Care; critical care medicine; Data analysis; global health; GNI; Gross National Income; health quality of care; Humans; Intensive care; Neoplasms - diagnosis; Neoplasms - therapy; Oncology; pediatric cancer; Pediatrics; Quality control; Quality improvement; Quality of Health Care; Resource-Limited Settings; Surveys; Surveys and Questionnaires; Teams; Usability; United States > US; global health; health quality of care; critical care medicine; quality improvement; pediatric cancer
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.5395

Background Nearly 90% children with cancer reside in low‐ and middle‐income countries, which face multiple challenges delivering high‐quality pediatric onco‐critical care (POCC). We recently identified POCC quality and capacity indicators for PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE), a tool that evaluates strengths and limitations in POCC services. This study describes pilot testing of PROACTIVE, development of center‐specific reports, and identification of common POCC challenges. Methods The original 119 consensus‐derived PROACTIVE indicators were converted into 182 questions divided between 2 electronic surveys for intensivists and oncologists managing critically ill pediatric cancer patients. Alpha‐testing was conducted to confirm face‐validity with four pediatric intensivists. Eleven centers representing diverse geographic regions, income levels, and POCC services conducted beta‐testing to evaluate usability, feasibility, and applicability of PROACTIVE. Centers' responses were scored and indicators with mean scores ≤75% in availability/performance were classified as common POCC challenges. Results Alpha‐testing ensured face‐validity and beta‐testing demonstrated feasibility and usability of PROACTIVE (October 2020–June 2021). Twenty‐two surveys (response rate 99.4%) were used to develop center‐specific reports. Adjustments to PROACTIVE were made based on focus group feedback and surveys, resulting in 200 questions. Aggregated data across centers identified common POCC challenges: (1) lack of pediatric intensivists, (2) absence of abstinence and withdrawal symptoms monitoring, (3) shortage of supportive care resources, and (4) limited POCC training for physicians and nurses. Conclusions PROACTIVE is a feasible and contextually appropriate tool to help clinicians and organizations identify challenges in POCC services across a wide range of resource‐levels. Widespread use of PROACTIVE can help prioritize and develop tailored interventions to strengthen POCC services and outcomes globally. We described the development and pilot testing of PROACTIVE, a tool to assess pediatric onco‐critical care services in hospitals across a wide range of resource‐levels. Collected data was used to create center‐specific reports and identify common challenges, which included lack of adequate pediatric intensivists, training programs, and supportive care resources.