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Tomlinson D, Chakkalackal L, Calligan M, Tardif-Theriault C, Kuczynski S, Schechter T, Vettese E, Tomlinson GA, Dupuis LL, Sung L. Symptom documentation and intervention in paediatric cancer care-association with severity: observational study. BMJ Support Palliat Care 2024; 13:e1265-e1271. [PMID: 36854613 DOI: 10.1136/spcare-2022-003874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Primary objectives were to determine the relationship between prevalence of symptom documentation and intervention provision, and increasing severity of bothersome symptoms, as identified by guardians using guardian-reported Symptom Screening in Pediatrics Tool (proxy-SSPedi), which is validated and measures the extent of bothersome symptoms in paediatric patients with cancer. METHODS We included guardians of children 2-7 years of age receiving cancer treatments and seen in hospital daily for 4 consecutive days. Guardians reported proxy-SSPedi at study enrolment and 3 days later. Chart review was performed between the day prior and the day following proxy-SSPedi completion. Symptom documentation and intervention provision were determined by two independent abstractors. RESULTS We enrolled 190 guardians who provided 371 proxy-SSPedi assessments in 190 children. The most common severely bothersome symptoms were 'feeling tired', 'feeling more or less hungry than they usually do' and 'feeling cranky or angry'. Among those with increasing severity of bother, documentation was significantly more common for 12 symptoms while intervention was significantly more common for 7 symptoms. Intervention was not significantly more common with increasing severity of bother due to 'feeling tired', 'feeling more or less hungry than they usually do' and 'feeling cranky or angry'. CONCLUSIONS Symptom documentation was generally more common in patients with severely bothersome symptoms. Intervention was not more common among those with increasing severity of bother due to fatigue, changes in hunger or anger, which were the most common severely bothersome symptoms. Future efforts should focus on facilitating intervention provision to patients with bothersome symptoms.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren Chakkalackal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maryann Calligan
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer, Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Vettese
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Loves R, Green G, Joseph-Frederick Z, Palmert S, Plenert E, Schechter T, Tomlinson D, Vettese E, Zahra S, Zupanec S, Dupuis LL, Sung L. Describing taste changes and their potential impacts on paediatric patients receiving cancer treatments. BMJ Support Palliat Care 2023; 13:e382-e388. [PMID: 34049968 DOI: 10.1136/bmjspcare-2021-002951] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Taste changes are common among paediatric patients receiving cancer treatments although specific descriptions and associations are uncertain. Primary objective was to describe the number of paediatric patients receiving cancer therapies who experienced taste changes, its impact on food intake and enjoyment of eating, and coping strategies. METHODS This was a cross-sectional study that included English-speaking paediatric patients aged 4-18 years with a diagnosis of cancer or haematopoietic stem cell transplantation recipients receiving active treatment. Using a structured interview, we asked participants about their experience with taste changes, impacts and coping strategies. The respondent was the paediatric patient. RESULTS We enrolled 108 patients; median age was 11 years (IQR 8-15). The taste changes reported yesterday or today were food tasting bland (34%), bad (31%), different (27%), bitter (25%), extreme (19%), metallic (15%) or sour (12%). Taste changes were associated with decreased food intake (31%) and decreased enjoyment in eating (25%) yesterday or today. The most common coping strategies were eating food they liked (42%), eating strong-tasting food (39%), drinking liquids (35%), brushing teeth (31%) and sucking on candy (25%). Factors significantly associated with food tasting bad were as follows: older age (p=0.003), shorter time since cancer diagnosis (p=0.027), nausea and vomiting (p=0.008) and mucositis (p=0.009). CONCLUSIONS Among paediatric patients receiving cancer treatments, taste changes were common and were associated with decreased food intake and enjoyment in eating. Common coping strategies were described. Reducing nausea, vomiting and mucositis may improve taste changes.
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Affiliation(s)
- Robyn Loves
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Gloria Green
- Division of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zakia Joseph-Frederick
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Sasha Palmert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Erin Plenert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Serena Zahra
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Sue Zupanec
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Pharmacy, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Guo LL, Calligan M, Vettese E, Cook S, Gagnidze G, Han O, Inoue J, Lemmon J, Li J, Roshdi M, Sadovy B, Wallace S, Sung L. Development and validation of the SickKids Enterprise-wide Data in Azure Repository (SEDAR). Heliyon 2023; 9:e21586. [PMID: 38027579 PMCID: PMC10661187 DOI: 10.1016/j.heliyon.2023.e21586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 09/15/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To describe the processes developed by The Hospital for Sick Children (SickKids) to enable utilization of electronic health record (EHR) data by creating sequentially transformed schemas for use across multiple user types. Methods We used Microsoft Azure as the cloud service provider and named this effort the SickKids Enterprise-wide Data in Azure Repository (SEDAR). Epic Clarity data from on-premises was copied to a virtual network in Microsoft Azure. Three sequential schemas were developed. The Filtered Schema added a filter to retain only SickKids and valid patients. The Curated Schema created a data structure that was easier to navigate and query. Each table contained a logical unit such as patients, hospital encounters or laboratory tests. Data validation of randomly sampled observations in the Curated Schema was performed. The SK-OMOP Schema was designed to facilitate research and machine learning. Two individuals mapped medical elements to standard Observational Medical Outcomes Partnership (OMOP) concepts. Results A copy of Clarity data was transferred to Microsoft Azure and updated each night using log shipping. The Filtered Schema and Curated Schema were implemented as stored procedures and executed each night with incremental updates or full loads. Data validation required up to 16 iterations for each Curated Schema table. OMOP concept mapping achieved at least 80 % coverage for each SK-OMOP table. Conclusions We described our experience in creating three sequential schemas to address different EHR data access requirements. Future work should consider replicating this approach at other institutions to determine whether approaches are generalizable.
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Affiliation(s)
- Lin Lawrence Guo
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Maryann Calligan
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Sadie Cook
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - George Gagnidze
- Information Management Technology, The Hospital for Sick Children, Toronto, Canada
| | - Oscar Han
- Information Management Technology, The Hospital for Sick Children, Toronto, Canada
| | - Jiro Inoue
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Joshua Lemmon
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Johnson Li
- Information Management Technology, The Hospital for Sick Children, Toronto, Canada
| | - Medhat Roshdi
- Information Management Technology, The Hospital for Sick Children, Toronto, Canada
| | - Bohdan Sadovy
- Information Management Technology, The Hospital for Sick Children, Toronto, Canada
| | - Steven Wallace
- Information Management Technology, The Hospital for Sick Children, Toronto, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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Vesely SK, King A, Vettese E, Heller JG, Cuker A, Calhoun C, Stock W, Homer M, Fritz J, Sung L. Influence of participant and reviewer characteristics in application scores for a hematology research training program. Blood Adv 2023; 7:4064-4071. [PMID: 36939221 PMCID: PMC10388723 DOI: 10.1182/bloodadvances.2023009792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023] Open
Abstract
The American Society of Hematology Clinical Research Training Institute (CRTI) is a clinical research training program with a competitive application process. The objectives were to compare application scores based on applicant and reviewer sex and underrepresented minority (URM) status. We included applications to CRTI from 2003 to 2019. The application scores were transformed into a scale from 0 to 100 (100 was the strongest). The factors considered were applicant and reviewer sex and URM status. We evaluated whether there was an interaction between the characteristics and time related to application scores. In total, 713 applicants and 2106 reviews were included. There was no significant difference in scores according to applicant sex. URM applicants had significantly worse scores than non-URM applicants (mean [standard error] 67.9 [1.56] vs 71.4 [0.63]; P = .0355). There were significant interactions between reviewer sex and time (P = .0030) and reviewer URM status and time (P = .0424); thus, results were stratified by time. For the 2 earlier time periods, male reviewers gave significantly worse scores than did female reviewers; this difference did not persist for the most recent time period. The URM reviewers did not give significantly different scores across time periods. URM applicants received significantly lower scores than non-URM applicants. The impact of reviewer sex and URM status changed over time. Although male reviewers gave lower scores in the early periods, this effect did not persist in the late period. Efforts are required to mitigate the impact of applicant URM status on application scores.
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Affiliation(s)
- Sara K. Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Allison King
- Division of Pediatric Hematology/Oncology and Division of Public Health Sciences in Department of Surgery, Washington University School of Medicine Program in Occupational Therapy, St. Louis, MO
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - John G. Heller
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cecelia Calhoun
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Wendy Stock
- Department of Medicine, University of Chicago Comprehensive Cancer Center, Chicago, IL
| | | | - Josel Fritz
- American Society of Hematology, Washington, DC
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
- The Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON
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Vettese E, Sherani F, King AA, Yu L, Aftandilian C, Baggott C, Agarwal V, Nagasubramanian R, Kelly KM, Freyer DR, Orgel E, Bradfield SM, Kyono W, Roth M, Klesges LM, Beauchemin M, Grimes A, Tomlinson G, Dupuis LL, Sung L. Symptom management care pathway adaptation process and specific adaptation decisions. BMC Cancer 2023; 23:350. [PMID: 37069510 PMCID: PMC10108500 DOI: 10.1186/s12885-023-10835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND There is substantial heterogeneity in symptom management provided to pediatric patients with cancer. The primary objective was to describe the adaptation process and specific adaptation decisions related to symptom management care pathways based on clinical practice guidelines. The secondary objective evaluated if institutional factors were associated with adaptation decisions. METHODS Fourteen previously developed symptom management care pathway templates were reviewed by an institutional adaptation team composed of two clinicians at each of 10 institutions. They worked through each statement for all care pathway templates sequentially. The institutional adaptation team made the decision to adopt, adapt or reject each statement, resulting in institution-specific symptom management care pathway drafts. Institutional adaption teams distributed the 14 care pathway drafts to their respective teams; their feedback led to care pathway modifications. RESULTS Initial care pathway adaptation decision making was completed over a median of 4.2 (interquartile range 2.0-5.3) weeks per institution. Across all institutions and among 1350 statements, 551 (40.8%) were adopted, 657 (48.7%) were adapted, 86 (6.4%) were rejected and 56 (4.1%) were no longer applicable because of a previous decision. Most commonly, the reason for rejection was not agreeing with the statement (70/86, 81.4%). Institutional-level factors were not significantly associated with statement rejection. CONCLUSIONS Acceptability of the 14 care pathways was evident by most statements being adopted or adapted. The adaptation process was accomplished over a relatively short timeframe. Future work should focus on evaluation of care pathway compliance and determination of the impact of care pathway-consistent care on patient outcomes. TRIAL REGISTRATION clinicaltrials.gov, NCT04614662. Registered 04/11/2020, https://clinicaltrials.gov/ct2/show/NCT04614662?term=NCT04614662&draw=2&rank=1 .
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Affiliation(s)
- Emily Vettese
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Farha Sherani
- Driscoll Children's Hospital, Cancer and Blood Disorders Center, 3533 S. Alameda Street, Corpus Christi, TX, 78411, US
- Texas A&M University, College Station, TX, US
| | - Allison A King
- Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, US
| | - Lolie Yu
- Louisiana State University Health Sciences Center/Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA
| | | | | | - Vibhuti Agarwal
- Nemours Children's Hospital of The Nemours Foundation, 6535 Nemours Parkway, Orlando, FL, 32827, US
| | | | - Kara M Kelly
- Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St., Buffalo, NY, 14203, US
| | - David R Freyer
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US
| | - Etan Orgel
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US
| | - Scott M Bradfield
- Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, US
| | - Wade Kyono
- Kapi'olani Medical Center for Women & Children, 1319 Punahou Street, Honolulu, Hawai'i, 96826, US
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, US
| | - Lisa M Klesges
- Division of Public Health Sciences, Washington University School of Medicine, 600 So Taylor Ave, St. Louis, MO, 63110, US
| | - Melissa Beauchemin
- Columbia University School of Nursing/Herbert Irving Cancer Center, 560 West 168th Street, New York, NY, 10032, USA
| | - Allison Grimes
- Pediatric Hematology Oncology, University of Texas Health, The Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, US
| | - George Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M5S 3M2, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Calligan M, Chakkalackal L, Dadzie G, Tardif-Theriault C, Cook S, Vettese E, Soman D, Kuczynski S, Schechter T, Dupuis LL, Sung L. Feasibility of three times weekly symptom screening in pediatric cancer patients. BMC Cancer 2023; 23:4. [PMID: 36597030 PMCID: PMC9809057 DOI: 10.1186/s12885-022-10400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Primary objective was to determine the feasibility of three times weekly symptom reporting by pediatric cancer patients for eight weeks. METHODS We included English-speaking patients 8-18 years of age with cancer. Patients were sent reminders by text or email to complete Symptom Screening in Pediatrics Tool (SSPedi) three times weekly for eight weeks. When patients reported at least one severely bothersome symptom, the symptom report was emailed to the primary healthcare team. Patient-reported outcomes were obtained at baseline, week 4 ± 1 and week 8 ± 1. Symptom documentation, intervention provision for symptoms and unplanned healthcare encounters were determined by chart review at weeks 4 and 8. The primary endpoint was feasibility, defined as at least 75% patients achieving adherence with at least 60% of SSPedi evaluations. We planned to enroll successive cohorts until this threshold was met. RESULTS Two cohorts consisting of 30 patients (cohort 1 (n = 20) and cohort 2 (n = 10)) were required to meet the feasibility threshold. In cohort 1, 11/20 (55%) met the SSPedi completion threshold. Interventions applied after cohort 1 included engaging parents to facilitate pediatric patient self-report, offering mechanisms to remember username and password and highlighting potential benefits of symptom feedback to clinicians. In cohort 2, 9/10 (90%) met the SSPedi completion threshold and thus feasibility was met. Patient-reported outcomes and chart review outcomes were obtained for all participants in cohort 2. CONCLUSIONS Three times weekly symptom reporting by pediatric patients with cancer for eight weeks was feasible. Mechanisms to enhance three times weekly symptom reporting were identified and implemented. Future studies of longitudinal symptom screening can now be planned.
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Affiliation(s)
- Maryann Calligan
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Lauren Chakkalackal
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Grace Dadzie
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Cassandra Tardif-Theriault
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Sadie Cook
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Emily Vettese
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Dilip Soman
- grid.17063.330000 0001 2157 2938Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON M5S 3E6 Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, ON M2K 1S9 Canada
| | - Tal Schechter
- grid.42327.300000 0004 0473 9646Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - L. Lee Dupuis
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacy, The Hospital for Sick Children, and Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Lillian Sung
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada ,grid.42327.300000 0004 0473 9646Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
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Tomlinson D, Dupuis LL, Johnston DL, Kuczynski S, Patel S, Schechter T, Vettese E, Mairs M, Tomlinson GA, Sung L. Reliability and validity of proxy-SSPedi and mini-SSPedi in pediatric patients 2-7 years receiving cancer treatments. BMC Cancer 2022; 22:730. [PMID: 35787263 PMCID: PMC9254487 DOI: 10.1186/s12885-022-09814-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Symptom Screening in Pediatrics Tool (SSPedi) was developed for symptom screening by children 8-18 years. Objectives were to evaluate the reliability and validity of proxy-SSPedi and self-report mini-SSPedi for younger children. Methods This multi-center study enrolled guardians of children 2-7 years receiving cancer treatments (proxy-SSPedi) and their children 4-7 years (mini-SSPedi). The two populations were: (1) More symptomatic group where children were receiving active cancer treatment and were in hospital or clinic for four consecutive days; and (2) Less symptomatic group where children were receiving maintenance therapy for acute lymphoblastic leukemia or had completed cancer therapy. Proxy-SSPedi or mini-SSPedi were completed with measures of mucositis, nausea, pain, quality of life and overall symptoms. Respondents in the more symptomatic group repeated proxy-SSPedi/mini-SSPedi and a global symptom change scale 3 days later. Results There were 402 guardians and 326 children included in the analysis. Test re-test reliability of proxy-SSPedi showed intraclass correlation coefficient (ICC) 0.83 (95% confidence interval (CI) 0.72-0.90). Mean difference in proxy-SSPedi between more and less symptomatic groups was 9.7 (95% CI 8.3-11.1). Proxy-SSPedi was responsive to change and hypothesized relationships between measures were observed. With a priori threshold ≥0.6, inter-rater ICC among all dyads and those 6-7 years were 0.54 (95% CI 0.45-0.62) and 0.62 (95% CI 0.50-0.71) respectively. Among participating children, other hypothesized reliability and validity thresholds were generally met. Conclusions Proxy-SSPedi is reliable, valid and responsive in children 2-7 years old receiving cancer treatments. Mini-SSPedi can be used for children 6-7 years of age. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09814-8.
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Affiliation(s)
- Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Department of Pharmacy, The Hospital for Sick Children555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 3M2, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Serina Patel
- Division of Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Mark Mairs
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada. .,Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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Dupuis LL, Grimes A, Vettese E, Klesges LM, Sung L. Barriers to symptom management care pathway implementation in pediatric Cancer. BMC Health Serv Res 2021; 21:1068. [PMID: 34627259 PMCID: PMC8500815 DOI: 10.1186/s12913-021-07047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Objectives were to describe barriers to pediatric cancer symptom management care pathway implementation and the impact of the COVID-19 pandemic on clinical research evaluating their implementation. METHODS We included 25 pediatric oncology hospitals in the United States that supported a grant submission to perform a cluster randomized trial in which the intervention encompassed care pathways for symptom management. A survey was distributed to site principal investigators prior to randomization to measure contextual elements related to care pathway implementation. Questions included the inner setting measures of the Consolidated Framework for Implementation Research (CFIR), study-specific potential barriers and the impact of the COVID-19 pandemic on clinical research. The Wilcoxon rank sum test was used to compare characteristics of institutions that agreed that their department supported the implementation of symptom management care pathways vs. institutions that did not agree. RESULTS Of the 25 sites, one withdrew because of resource constraints and one did not respond, leaving 23 institutions. Among the seven CFIR constructs, the least supported was implementation climate; 57% agreed there was support, 39% agreed there was recognition and 39% agreed there was prioritization for symptom management care pathway implementation at their institution. Most common barriers were lack of person-time to create care pathways and champion their use (35%), lack of interest from physicians (30%) and lack of information technology resources (26%). Most sites reported no negative impact of the COVID-19 pandemic across research activities. Sites with fewer pediatric cancer patients were more likely to agree that staff are supported to implement symptom management care pathways (P = 0.003). CONCLUSIONS The most commonly reported barriers to implementation were lack of support, recognition and prioritization. The COVID-19 pandemic may not be a major barrier to clinical research activities in pediatric oncology.
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Affiliation(s)
- L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 3M2, Canada
| | - Allison Grimes
- Pediatric Hematology Oncology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Lisa M Klesges
- Division of Public Health Sciences, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO, 63108, USA
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada. .,Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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9
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Dupuis LL, Grimes A, Vettese E, Klesges LM, Sung L. Readiness to Implement Symptom Management Care Pathways in Pediatric Cancer. Res Sq 2020. [PMID: 33398260 PMCID: PMC7781319 DOI: 10.21203/rs.3.rs-136225/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: To describe barriers to pediatric cancer symptom management care pathway implementation and the impact of the COVID-19 pandemic on clinical research evaluating their implementation. Methods: We included 25 pediatric oncology hospitals in the United States that supported a grant submission to perform a cluster randomized trial in which the intervention encompassed care pathways for symptom management. A survey was distributed to site principal investigators to measure contextual elements related to care pathway implementation. Questions included the inner setting measures of the Consolidated Framework for Implementation Research (CFIR), study-specific potential barriers and the impact of the COVID-19 pandemic on clinical research. The Wilcoxon rank sum test was used to compare characteristics of institutions that agreed that their department supported the implementation of symptom management care pathways vs. institutions that did not agree. Results: Of the 25 sites, one withdrew because of resource constraints and one did not respond, leaving 23 institutions. Among the seven CFIR constructs, the least supported was implementation climate; 57% agreed there was support, 39% agreed there was recognition and 39% agreed there was prioritization for symptom management care pathway implementation at their institution. Most common barriers were lack of person-time to create care pathways and champion their use (35%), lack of interest from physicians (30%) and lack of information technology resources (26%). Most sites reported no negative impact of the COVID-19 pandemic across research activities. Sites with fewer pediatric cancer patients were more likely to agree that staff are supported to implement symptom management care pathways (P=0.003). Conclusions: The most commonly reported barriers to implementation were lack of support, recognition and prioritization. The COVID-19 pandemic was not a major barrier to clinical research activities in pediatric oncology. Clinical Trial Registration: NCT04614662.
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10
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Sung L, Corbin C, Steinberg E, Vettese E, Campigotto A, Lecce L, Tomlinson GA, Shah N. Development and utility assessment of a machine learning bloodstream infection classifier in pediatric patients receiving cancer treatments. BMC Cancer 2020; 20:1103. [PMID: 33187484 PMCID: PMC7666525 DOI: 10.1186/s12885-020-07618-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Objectives were to build a machine learning algorithm to identify bloodstream infection (BSI) among pediatric patients with cancer and hematopoietic stem cell transplantation (HSCT) recipients, and to compare this approach with presence of neutropenia to identify BSI. Methods We included patients 0–18 years of age at cancer diagnosis or HSCT between January 2009 and November 2018. Eligible blood cultures were those with no previous blood culture (regardless of result) within 7 days. The primary outcome was BSI. Four machine learning algorithms were used: elastic net, support vector machine and two implementations of gradient boosting machine (GBM and XGBoost). Model training and evaluation were performed using temporally disjoint training (60%), validation (20%) and test (20%) sets. The best model was compared to neutropenia alone in the test set. Results Of 11,183 eligible blood cultures, 624 (5.6%) were positive. The best model in the validation set was GBM, which achieved an area-under-the-receiver-operator-curve (AUROC) of 0.74 in the test set. Among the 2236 in the test set, the number of false positives and specificity of GBM vs. neutropenia were 508 vs. 592 and 0.76 vs. 0.72 respectively. Among 139 test set BSIs, six (4.3%) non-neutropenic patients were identified by GBM. All received antibiotics prior to culture result availability. Conclusions We developed a machine learning algorithm to classify BSI. GBM achieved an AUROC of 0.74 and identified 4.3% additional true cases in the test set. The machine learning algorithm did not perform substantially better than using presence of neutropenia alone to predict BSI. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07618-2.
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Affiliation(s)
- Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada.
| | - Conor Corbin
- Biomedical Informatics Research, Stanford University, Palo Alto, USA
| | - Ethan Steinberg
- Biomedical Informatics Research, Stanford University, Palo Alto, USA
| | - Emily Vettese
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
| | - Aaron Campigotto
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Loreto Lecce
- Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
| | | | - Nigam Shah
- Biomedical Informatics Research, Stanford University, Palo Alto, USA
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Watling CZ, McCarthy C, Theodorakidis A, Cook S, Vettese E, Schechter T, Abubeker H, Dupuis LL, Sung L. Development of the SPARK family member web pages to improve symptom management for pediatric patients receiving cancer treatments. BMC Cancer 2020; 20:923. [PMID: 32977751 PMCID: PMC7519510 DOI: 10.1186/s12885-020-07433-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK) is a web-based application that facilitates symptom screening and access to supportive care clinical practice guidelines (CPGs) for children and adolescents receiving cancer treatments. Objective was to develop SPARK family member web pages for pediatric patient family members accessing: (1) proxy symptom screening and symptom reports, and (2) care recommendations for symptom management based on CPGs. Methods SPARK family member web pages were developed and included access to symptom screening and care recommendations sections. Care recommendations for fatigue and mucositis were created. These were iteratively refined based upon cognitive interviews with English-speaking family members ≥16 years of age until less than two participants incorrectly understood sections as adjudicated by two independent raters. Results A total of 100 family members were enrolled who evaluated the SPARK family member web pages (n = 40), fatigue care recommendation (n = 30) and mucositis prevention care recommendation (n = 30). Among the last 10 participants, none said that the SPARK family member web pages were hard or very hard to use, one incorrectly understood one web page, none said either care recommendation was hard to understand and none were incorrect in their understanding of the care recommendations. Conclusions We successfully developed SPARK web pages for use by family members of pediatric patients receiving cancer treatments. We also developed a process for translating CPG recommendations designed for healthcare professionals to lay language. The utility of SPARK family member web pages after clinical implementation could be a focus for future research.
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Affiliation(s)
- Cody Z Watling
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - Clodagh McCarthy
- Canadian Cancer Society, 55 St Clair St W., Toronto, Ontario, Canada
| | - Alexandra Theodorakidis
- AboutKidsHealth, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
| | - Sadie Cook
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - Tal Schechter
- Department of Pediatrics, Division of Haematology/Oncology, The Hospital of Sick Children and Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada
| | - Hanan Abubeker
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Research Institute and Department of Pharmacy, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada
| | - Lillian Sung
- Department of Pediatrics, Division of Haematology/Oncology, The Hospital of Sick Children and Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada. .,Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
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Tomlinson D, Sung L, Vettese E, Murphy S, Plenert E. Mindfulness-Based Interventions for Symptom Management in Children and Adolescents With Cancer: A Systematic Review. J Pediatr Oncol Nurs 2020; 37:423-430. [DOI: 10.1177/1043454220944126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Psychological interventions have shown benefit in reducing symptoms in children and adolescents with cancer. More recently, mindfulness-based interventions (MBIs) have been shown to be a promising approach to symptom intervention in adolescents with chronic illnesses. In this systematic review, we aimed to describe MBIs or focused-breathing interventions that have been used to treat symptoms in children receiving cancer therapy. A systematic review was conducted using MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO from inception to September 2019. We identified relevant articles in which MBIs or focused-breathing interventions were the primary interventions delivered to improve symptoms in children or adolescents with cancer. Six studies met the inclusion criteria. MBIs included controlled breathing and belly breathing. Intervention effects were found to be beneficial with regard to symptoms that included procedural pain, distress, and quality of life. The interventions were generally well accepted and beneficial. All studies suffered limitations because of methodological flaws, including the lack of randomization, and small sample sizes. Despite the small numbers of studies and participants, MBIs delivered to children with cancer may have beneficial effects on certain symptoms. Implications for future research include interventions tailored to the specific symptom burden. Studies must aim to increase sample sizes as well as to include individuals at high risk for severe symptoms.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Sceiences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lillian Sung
- Child Health Evaluative Sceiences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Vettese
- Child Health Evaluative Sceiences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelley Murphy
- Department of Curriculum, Teaching and Learning, University of Toronto, Toronto, Ontario, Canada
| | - Erin Plenert
- Child Health Evaluative Sceiences, The Hospital for Sick Children, Toronto, Ontario, Canada
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13
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Loves R, Plenert E, Tomlinson V, Palmert S, Green G, Schechter T, Tomlinson D, Vettese E, Zupanec S, Dupuis LL, Sung L. Changes in hunger among pediatric patients with cancer and hematopoietic stem cell transplantation recipients. Support Care Cancer 2020; 28:5795-5801. [PMID: 32219569 DOI: 10.1007/s00520-020-05425-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Change in hunger is a common and bothersome symptom among pediatric patients receiving cancer treatments. Objectives were to describe how children and adolescents receiving cancer treatments experience changes in hunger, factors associated with both increases and decreases in hunger, and coping strategies used by these patients. METHODS We enrolled children and adolescents 4-18 years of age with cancer or hematopoietic stem cell transplantation (HSCT) recipients who were actively receiving treatment or who had completed therapy. Using a single, qualitative, semi-structured interview, we asked participants about the experience of increases or decreases in hunger, including characteristics of the change and identified coping strategies. RESULTS There were 50 children enrolled; 25 (50%) were 4-10 years of age and 33 (66%) were boys. Most often, patients associated an increase in hunger with corticosteroid administration, while other treatments, accompanying symptoms, inactivity, and the hospital environment were associated with a decrease in hunger. Many reported that no coping strategies were successful. For those who did report successful strategies to manage an increase in hunger, these included sleep and having food available. Strategies used to manage a decrease in hunger included anti-emetic medications, increased caloric intake, varied food choices, encouragement to eat, scheduling or tracking of meals, and physical activity. CONCLUSIONS Both increases and decreases in hunger were commonly described. Some coping strategies were reported to be successful. Further research should identify and test interventions to manage changes in hunger in pediatric cancer patients.
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Affiliation(s)
- Robyn Loves
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Erin Plenert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Vivian Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Sasha Palmert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Gloria Green
- Division of Clinical Dietetics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Sue Zupanec
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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14
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Vettese E, Cook S, Soman D, Kuczynski S, Spiegler B, Davis H, Duong N, Schechter T, Dupuis LL, Sung L. Longitudinal evaluation of Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK), a symptom screening and management application. BMC Cancer 2019; 19:458. [PMID: 31096957 PMCID: PMC6521508 DOI: 10.1186/s12885-019-5662-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
Background Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK) is a web application focused on improving symptom control. It enables pediatric cancer and hematopoietic stem cell transplant (HSCT) patients to self-report and track symptoms, and allows healthcare professionals to access guidelines for symptom management. Objective was to determine the feasibility of longitudinal collection of symptom data. Methods In this longitudinal, single-armed feasibility study, respondents were children 8–18 years of age with cancer or pediatric HSCT recipients. Participants completed symptom reporting daily for 5 days. Cognitive interviews were conducted on day 5. Quantitative evaluation included SPARK ease of use and understandability of SPARK reports. Qualitative feedback on facilitators and barriers to daily symptom screening was solicited. Feasibility was defined as ≥75% of participants completing symptom screening on at least 60% of on-study days during the five-day study. Results Among the 30 children enrolled, the median number of days SSPedi was completed at least once was 5 (range 3 to 5). Overall, 28/29 (96.6%) thought completing symptom screening using SPARK was easy or very easy. All participants understood SPARK symptom reports. Severe symptoms was the most common barrier to daily reporting while an alarm reminder system was the most commonly identified facilitator. Conclusions Daily completion of symptom screening using SPARK over 5 days was feasible in children aged 8 to 18 years with cancer and pediatric HSCT recipients. SPARK is now appropriate for use in randomized trials to evaluate the effect of symptom screening and symptom feedback.
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Affiliation(s)
- Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Sadie Cook
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Dilip Soman
- Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON, M5S 3E6, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, ON, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Hailey Davis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Nathan Duong
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - L Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Cook S, Vettese E, Soman D, Hyslop S, Kuczynski S, Spiegler B, Davis H, Duong N, Ou Wai S, Golabek R, Golabek P, Antoszek-Rallo A, Schechter T, Lee Dupuis L, Sung L. Initial development of Supportive care Assessment, Prioritization and Recommendations for Kids (SPARK), a symptom screening and management application. BMC Med Inform Decis Mak 2019; 19:9. [PMID: 30630480 PMCID: PMC6327501 DOI: 10.1186/s12911-018-0715-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
Background We developed Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK), a web-based application designed to facilitate symptom screening by children receiving cancer treatments and access to supportive care clinical practice guidelines primarily by healthcare providers. The objective was to describe the initial development and evaluation of SPARK from the perspective of children. Implementation Development and evaluation occurred in three phases: (1) low fidelity focused on functionality, (2) design focused on “look and feel” and (3) high fidelity confirmed functionality and design. Cognitive interviews were conducted with children receiving cancer treatments 8–18 years of age. Evaluation occurred after every five interviews and changes were guided by a Review Panel. Quantitative evaluation included SPARK ease of use and understandability of SPARK reports. Results The number of children included by phase were: low fidelity (n = 30), design (n = 30) and high fidelity (n = 30). Across phases, the median age was 13.2 (range 8.5 to 18.4) years. During low-fidelity and design phases, iterative refinements to SPARK improved website navigation, usability and likability from the perspective of children and established symptom report design. Among the last 10 children enrolled to high-fidelity testing, all (100%) understood how to complete symptom screening, access reports and interpret reports. Among these 10 respondents, all (100%) found SPARK easy to use and 9 (90%) found SPARK reports were easy to understand. Conclusions SPARK is a web-based application which is usable and understandable, and it is now appropriate to use for research. Future efforts will focus on clinical implementation of SPARK.
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Affiliation(s)
- Sadie Cook
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Dilip Soman
- Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, Ontario, M5S 3E6, Canada
| | - Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Hailey Davis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Nathan Duong
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Stacee Ou Wai
- Translucent Computing, 1 Yonge Street, Toronto, Ontario, M5E 1E5, Canada
| | - Robert Golabek
- Translucent Computing, 1 Yonge Street, Toronto, Ontario, M5E 1E5, Canada
| | - Patryk Golabek
- Translucent Computing, 1 Yonge Street, Toronto, Ontario, M5E 1E5, Canada
| | - Adam Antoszek-Rallo
- Catalyst Workshop Inc, 192 Spadina Avenue, Suite 108, Toronto, Ontario, M5T 2C2, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - L Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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Hyslop S, Sung L, Stein E, Dupuis L, Spiegler B, Vettese E, Tomlinson D. Identifying symptoms using the drawings of 4–7 year olds with cancer. Eur J Oncol Nurs 2018; 36:56-61. [DOI: 10.1016/j.ejon.2018.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/25/2018] [Accepted: 08/17/2018] [Indexed: 11/27/2022]
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