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Graetz DE, Ahmad A, Raza MR, Hameed A, Naheed A, Najmi A, Quanita AT, Munir S, Ahmad S, Ferrara G, Staples C, Rodriguez Galindo C, Ahmer Hamid S, Jeha S, Mack JW. Functions of patient- and family-centered pediatric cancer communication in Pakistan. Front Oncol 2024; 14:1393908. [PMID: 39323999 PMCID: PMC11422343 DOI: 10.3389/fonc.2024.1393908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/08/2024] [Indexed: 09/27/2024] Open
Abstract
Background Communication is an essential aspect of high-quality patient- and family-centered care. A model for pediatric cancer communication developed in the United States defined eight communication functions. The purpose of this study was to explore the relevance of these functions in Pakistan as part of an effort to understand the role of culture in communication. Materials and methods Semi-structured interviews were conducted with 20 clinicians and 18 caregivers of children with cancer at two major cancer centers. Interviews were conducted in Urdu or English and transcribed and translated as necessary. Two independent coders used a priori codes related to the communication model as well as novel codes derived inductively. Thematic analysis focused on operationalization of the functional communication model. Results Clinicians and caregivers in Pakistan discussed the importance of all eight communication functions previously identified including: information exchange, decision-making, managing uncertainty, enabling family self-management, responding to emotions, supporting hope, providing validation, and building relationships. The operationalization of these functions was influenced by Pakistani cultural context. For example, information-exchange included the importance of addressing preconceptions and community myths, while managing uncertainty included strong references to religion and faith-based coping. Essential to all eight functions was trust between the family and the medical team. Discussion These findings support the use of this functional communication model in diverse pediatric oncology settings and emphasize the importance of trust. Culturally sensitive operationalization of these functions could inform the adaptation of tools to measure communication and interventions aimed at supporting the needs of parents of children with cancer.
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Affiliation(s)
- Dylan E. Graetz
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alia Ahmad
- University of Child Health Sciences, Children’s Hospital Lahore, Lahore, Pakistan
| | - Muhammad Rafie Raza
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Ambreen Hameed
- University of Child Health Sciences, Children’s Hospital Lahore, Lahore, Pakistan
| | - Asma Naheed
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Atoofa Najmi
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Afia tul Quanita
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Shabnam Munir
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Safwan Ahmad
- University of Child Health Sciences, Children’s Hospital Lahore, Lahore, Pakistan
| | - Gia Ferrara
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Courtney Staples
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Carlos Rodriguez Galindo
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Syed Ahmer Hamid
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Sima Jeha
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jennifer W. Mack
- Department of Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, United States
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Ghaljeh M, Pezaro S, Mardani-Hamooleh M. Mothers' efforts to overcome difficult twists and turns in living with children with cancer: a phenomenological study. BMC Womens Health 2024; 24:458. [PMID: 39153975 PMCID: PMC11330124 DOI: 10.1186/s12905-024-03295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Child cancer impacts the entire family. However, those who identify as mothers may be most negatively affected due to the societal expectations placed upon them in primary caregiving. This study was conducted with the aim of exploring the lived experiences of mothers of children with cancer and their adaptation to their child's illness. METHODS This study employed a qualitative and hermeneutic approach using Heideggerian phenomenology as a philosophical framework. Our sampling strategy was purposive. Mothers (n = 14) of children diagnosed with cancer participated in face-to-face semi-structured interviews. The seven-steps of critical hermeneutic analysis were used to summarize and interpret findings. RESULTS Analysis revealed that participants' adaptation to their child's illness occurs through comprehensive support and the utilization of empowering beliefs. The theme of comprehensive support included sub-themes of seeking informational support, seeking psychological support, and seeking social support. The theme of utilizing empowering beliefs encompassed sub-themes of resilience against cultural misconceptions and reliance on spiritual beliefs. Furthermore, one constitutive pattern 'mothers' efforts to overcome difficult twists and turns in living with children with cancer' was identified.This related to participants' striving to navigate the twists and turns of life's hardships. CONCLUSIONS Relationships and social context are vital and important features of this phenomena. Employing a team approach to provide comprehensive support to mothers of children with cancer involving physicians, nurses, and psychologists can be supportive in their adaptation to their child's cancer. Additionally, reductions in cultural taboos surrounding cancer could facilitate improved adaptation to childhood cancer for these mothers.
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Affiliation(s)
- Mahnaz Ghaljeh
- Department of Nursing Management, School of Nursing and Midwifery, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sally Pezaro
- School of Nursing, Midwifery and Health, Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
| | - Marjan Mardani-Hamooleh
- Department of Nursing, Nursing and Midwifery Care Research Center, University of Medical Sciences, Vanak Sq., Zafar St, 1996713883, Tehran, Iran.
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Heley K, Vanderpool RC, Vedham V. Global cancer stigma research: a U.S. National Cancer Institute workshop report. J Natl Cancer Inst Monogr 2024; 2024:4-10. [PMID: 38836530 DOI: 10.1093/jncimonographs/lgad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 06/06/2024] Open
Abstract
Stigma is a social process characterized by negative beliefs, attitudes, and stereotypes associated with a specific attribute or characteristic that leads to discrimination and social exclusion. Stigma manifests across the cancer control continuum and remains a key challenge for cancer prevention and control worldwide. In this commentary, we provide an overview of the U.S. National Cancer Institute's (NCI) Global Cancer Stigma Research Workshop, a multi-disciplinary international conference held virtually in September 2022, which focused on the intersection of cancer and stigma. The meeting was unique in its convening of researchers, advocates, clinicians, and non-governmental and governmental organizations, who-as a collective-provided overarching topics, cross-cutting considerations, and future directions for the cancer stigma research community to consider, which we describe herein. In summary, studying cancer stigma comprehensively requires a holistic, adaptive, and multifaceted approach-and should consider interrelated factors and their intersection within diverse cultural and social contexts worldwide. Collectively, there was a call for: an inclusive approach, encouraging researchers and practitioners to identify and measure cancer stigma as a driver for cancer health inequities globally; an expansion of existing research methodology to include diversity of experiences, contexts, and perspectives; and collaborations among diverse stakeholders to develop more effective strategies for reducing stigma and improving cancer outcomes. Such efforts are essential to cultivating effective and equitable approaches to preventing and treating cancer worldwide.
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Affiliation(s)
- Kathryn Heley
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Vidya Vedham
- Center for Global Health, Office of the Director, National Cancer Institute, Rockville, MD, USA
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McKay V, Carothers B, Graetz D, Malone S, Puerto-Torres M, Prewitt K, Cardenas A, Chen Y, Devidas M, Luke DA, Agulnik A. Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in Latin American hospitals: the INSPIRE study protocol. Implement Sci Commun 2023; 4:141. [PMID: 37978404 PMCID: PMC10657009 DOI: 10.1186/s43058-023-00519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND More than 90% of children with cancer live in low-resourced settings, where survival is only 20%. Sustainable evidence-based (EB) interventions yielding ongoing beneficial patient outcomes are critical to improve childhood cancer survival. A better understanding of factors promoting intervention sustainability in these settings is urgently needed. The aim of this study is to provide an empirical understanding of how clinical capacity for sustainability, or the resources needed to sustain an intervention, impacts the sustainment of Pediatric Early Warning System (PEWS), an EB intervention that improves pediatric oncology outcomes in low-resource hospitals by detecting clinical deterioration and preventing the need for more intense treatment. METHODS We will conduct a prospective, longitudinal study of approximately 100 resource-variable hospitals implementing and sustaining PEWS participating in Proyecto EVAT, a quality improvement collaborative of Latin American pediatric oncology centers. Aim 1: We will evaluate how clinical capacity for sustainability changes over time through 5 to 9 prospective measurements of capacity via survey of clinical staff using PEWS (approximately n = 13 per center) during the phases of PEWS adoption, implementation, and sustainability using the Clinical Sustainability Assessment Tool (CSAT). Aim 2: We will determine the relationship between capacity and a) PEWS sustainment and b) clinical deterioration mortality among pediatric oncology patients at centers sustaining PEWS for 2 to 10 years using chart review and an existing patient outcomes registry. Aim 3: We will develop novel strategies to promote sustainability by gaining a deeper understanding of perceived challenges to building capacity and PEWS sustainment. In combination with quantitative outcomes, we will conduct 24 focus groups with staff (doctors, nurses, and administrators) from hospitals with both high (n = 4) and low capacity (n = 4). We will then use implementation mapping to generate theoretically driven, empirically-supported sustainability strategies. DISCUSSION This study will advance implementation science by providing a theoretically driven, foundational understanding of factors that predict sustainability among a large, diverse cohort of hospitals. We will then use this knowledge to develop sustainability evidence-informed strategies that optimize capacity and promote long-term sustainment of PEWS and improvements in patient outcomes, thus promoting equity in childhood cancer care globally.
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Affiliation(s)
- Virginia McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Bobbi Carothers
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Dylan Graetz
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sara Malone
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Population Health Science, Washington University in St. Louis School of Medicine, St Louis, MO, United States
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kim Prewitt
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Adolfo Cardenas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Douglas A Luke
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, USA
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Wiphatphumiprates PP, Graetz DE, Ferrara G, Puerto‐Torres M, Gillipelli SR, Elish P, Muniz‐Talavera H, Gonzalez‐Ruiz A, Armenta M, Barra C, Carpio Z, Hernandez C, Juarez S, de Jesus Loeza J, Mendez A, Montalvo E, Penafiel E, Pineda E, McKay V, Agulnik A. The COVID-19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource-limited hospitals. Cancer Med 2023; 12:11878-11888. [PMID: 37022012 PMCID: PMC10242859 DOI: 10.1002/cam4.5876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic impacted healthcare delivery worldwide, including pediatric cancer care, with a disproportionate effect in resource-limited settings. This study evaluates its impact on existing quality improvement (QI) programs. METHODS We conducted 71 semi-structured interviews of key stakeholders at five resource-limited pediatric oncology centers participating in a collaborative to implement Pediatric Early Warning System (PEWS). Interviews were conducted virtually using a structured interview guide, recorded, transcribed, and translated into English. Two coders developed a codebook of a priori and inductive codes and independently coded all transcripts, achieving a kappa of 0.8-0.9. Thematic analysis explored the impact of the pandemic on PEWS. RESULTS All hospitals reported limitations in material resources, reduction in staffing, and impacts on patient care due to the pandemic. However, the impact on PEWS varied across centers. Identified factors that promoted or limited ongoing PEWS use included the availability of material resources needed for PEWS, staff turnover, PEWS training for staff, and the willingness of staff and hospital leaders to prioritize PEWS. Consequently, some hospitals were able to sustain PEWS; others halted or reduced PEWS use to prioritize other work. Similarly, the pandemic delayed plans at all hospitals to expand PEWS to other units. Several participants were hopeful for future expansion of PEWS post-pandemic. CONCLUSION The COVID-19 pandemic created challenges for sustainability and scale of PEWS, an ongoing QI program, in these resource-limited pediatric oncology centers. Several factors mitigated these challenges and promoted ongoing PEWS use. These results can guide strategies to sustain effective QI interventions during future health crises.
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Affiliation(s)
| | - Dylan E. Graetz
- Global Pediatric Medicine at St. Jude Children's Research HospitalTennesseeMemphisUSA
| | - Gia Ferrara
- Global Pediatric Medicine at St. Jude Children's Research HospitalTennesseeMemphisUSA
| | - Maria Puerto‐Torres
- Global Pediatric Medicine at St. Jude Children's Research HospitalTennesseeMemphisUSA
| | | | - Paul Elish
- Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | | | | | - Miriam Armenta
- Pediatric OncologyHospital General de TijuanaTijuanaMexico
| | - Camila Barra
- Pediatric OncologyHospital Dr. Luis Calvo MackennaSantiagoChile
| | - Zulma Carpio
- Pediatric OncologyInstituto Nacional de Enfermedades NeoplásicasLimaPeru
| | - Cinthia Hernandez
- Pediatric OncologyHospital Infantil Teletón de OncologíaQuerétaroMexico
| | - Susana Juarez
- PediatricsHospital Central Dr. Ignacio Morones PrietoSan Luis PotosíMexico
| | | | - Alejandra Mendez
- Pediatric Critical CareUnidad Nacional de Oncología PediátricaGuatemala CityGuatemala
| | - Erika Montalvo
- Pediatric Critical CareHospital Oncológico Solca Núcleo de QuitoQuitoEcuador
| | - Eulalia Penafiel
- Pediatric OncologyInstituto del Cáncer SOLCA CuencaCuencaEcuador
| | - Estuardo Pineda
- Pediatric OncologyHospital Nacional de Niños Benjamín BloomSan SalvadorEl Salvador
| | - Virginia McKay
- Bloom School of MedicineWashington UniversitySt. LouisMissouriUSA
| | - Asya Agulnik
- Global Pediatric Medicine at St. Jude Children's Research HospitalTennesseeMemphisUSA
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Williams AH, Rivas S, Fuentes L, Cáceres‐Serrano A, Ferrara G, Reeves T, Antillon‐Klussmann F, Rodriguez‐Galindo C, Mack JW, Graetz DE. Understanding hope at diagnosis: A study among Guatemalan parents of children with cancer. Cancer Med 2023; 12:9966-9975. [PMID: 36846975 PMCID: PMC10166945 DOI: 10.1002/cam4.5725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/05/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In high-income countries, hope facilitates parental coping and builds the clinical relationship between families of children with cancer and their clinicians. However, the manifestation of hope in low- and middle-income countries (LMICs) remains poorly understood. Our study explores Guatemalan parents' experiences with hope during the pediatric oncology diagnostic process and aims to identify discrete actions clinicians take to support hope. METHODS This qualitative study utilized audio-recordings of the diagnostic process and an additional semi-structured interview for 20 families of children with cancer at Unidad Nacional de Oncología Pediátrica in Guatemala. Spanish audio-recordings were translated into English, transcribed, and coded using a priori and novel codes. Thematic content analysis using constant comparative methods explored parents' hopes and concerns. RESULTS At diagnosis, Guatemalan parents expressed both hopes and concerns related to the entire cancer continuum. Throughout the diagnostic process, hope grew as concerns were alleviated. Clinicians supported hope by creating a supportive environment, providing information, affirming religious beliefs, and empowering parents. These strategies helped parents shift their focus from fear and uncertainty toward hope for their child's future. Parents expressed that establishing hope improved mood, promoted acceptance, and enabled them to care for themselves and their children. CONCLUSION These results confirm the relevance of supporting hope in pediatric oncology settings in LMICs and suggest that culture informs hope-related needs. Supporting hope is critical across cultures and can be integrated into clinical conversation using the four processes identified by our results.
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Affiliation(s)
| | - Silvia Rivas
- Unidad Nacional de Oncología PediátricaGuatemala CityGuatemala
| | - Lucia Fuentes
- Unidad Nacional de Oncología PediátricaGuatemala CityGuatemala
| | | | - Gia Ferrara
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Tegan Reeves
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Federico Antillon‐Klussmann
- Unidad Nacional de Oncología PediátricaGuatemala CityGuatemala
- Francisco Marroquin University School of MedicineGuatemala CityGuatemala
| | | | - Jennifer W. Mack
- Dana Farber Cancer Institute/Boston Children's HospitalBostonMassachusettsUSA
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7
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Graetz DE, Rivas SE, Fuentes AL, Caceres-Serrano A, Antillon-Klussmann F, Rodriguez-Galindo C, Mack JW. Development and Adaptation of a Patient-Centered Communication Survey for Parents of Children With Cancer in Guatemala. JCO Glob Oncol 2022; 8:e2200124. [PMID: 36179269 PMCID: PMC9812448 DOI: 10.1200/go.22.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Surveys to assess patient and family experiences of pediatric cancer care have been primarily developed and validated in high-income Western settings with English-speaking participants. However, 90% of children with cancer live in low- and middle-income countries. We sought to develop a survey focused on pediatric cancer communication for use in a low-literacy population in Guatemala, including adaptation of many previously validated items. METHODS A multidisciplinary team developed a quantitative survey on the basis of a theoretical model of important components and influences on pediatric cancer communication. The original survey included established items previously used in high-income settings and novel questions designed for this study. The survey was translated into Spanish and pilot tested with parents of children receiving treatment at Unidad Nacional de Oncologia Pediatrica in Guatemala City, Guatemala, from April-June 2019. Cognitive interviews were used during pilot testing, and the survey was iteratively revised throughout this process. RESULTS Early in testing, Guatemalan parents tended to choose answers at the extreme ends of response categories and socially desirable responses. Ultimately, a visual aid was developed to accompany three-item Likert scale response options. This allowed for successful administration of the survey instrument, resulting in moderate variation of response options and similar proportions to those generated when the original five-item responses were used in parent populations from the United States. CONCLUSION Appropriately adapted surveys are necessary to understand patient-centered communication among pediatric oncology populations in low- and middle-income countries. Eventual validation of such tools will enable cross-cultural studies and comparative analysis of results.
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Affiliation(s)
- Dylan E. Graetz
- St Jude Children's Research Hospital, Memphis, TN,Dylan E. Graetz, MD, MPH, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mailstop 721, Memphis, TN 38105-3678; Twitter: @DylanGraetzMD; e-mail:
| | | | | | | | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala,Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | | | - Jennifer W. Mack
- Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA
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Graetz DE, Caceres-Serrano A, Radhakrishnan V, Salaverria CE, Kambugu JB, Sisk BA. A proposed global framework for pediatric cancer communication research. Cancer 2022; 128:1888-1893. [PMID: 35201609 PMCID: PMC9303244 DOI: 10.1002/cncr.34160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
The authors introduce a functional communication framework that can be used for global pediatric cancer research.
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Affiliation(s)
- Dylan E Graetz
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.,Solid Tumor Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ana Caceres-Serrano
- Department of Psychology, Unidad Nacional Oncologia Pediatrica, Guatemala City, Guatemala
| | | | - Carmen E Salaverria
- Department of Psychology, Fundacion Ayudame a Vivir, San Salvador, El Salvador
| | - Joyce B Kambugu
- Department of Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Bryan A Sisk
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St. Louis, Missouri.,Bioethics Research Center, Department of Medicine, Washington University, St. Louis, Missouri
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