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McKay V, Chen Y, Prewitt K, Malone S, Puerto-Torres M, Acuña-Aguirre C, Alfonso-Carreras Y, Alvarez-Arellano SY, Andrade-Sarmiento LA, Arce-Cabrera D, Argüello-Vargas D, Barragán-García MDC, Batista-Del-Cid R, Blasco-Arriaga EE, Cach-Castaneda MDC, Ceballo-Batista GI, Chávez-Rios M, Costa ME, Cuencio-Rodriguez ME, Diaz-Coronado R, Fing-Soto EA, García-Sarmiento TDJ, Gómez-García WC, Hernández-González CJ, Jimenez-Antolinez YV, Juarez-Tobias MS, León-López EM, Lopez-Facundo NA, Martínez Soria RA, Miralda-Méndez ST, Montalvo E, Pérez-Alvarado CM, Perez-Fermin CK, Quijano-Lievano ML, Salas-Mendoza B, Sanchez-Fuentes EE, Serrano-Landivar MX, Soto-Chavez V, Tejocote-Romero I, Valle S, Vasquez-Roman EA, Costa JT, Cardenas-Aguirre A, Devidas M, Luke DA, Agulnik A. Connecting Clinical Capacity and Intervention Sustainability in Resource-Variable Pediatric Oncology Centers in Latin America. Glob Implement Res Appl 2024; 4:102-115. [PMID: 38566954 PMCID: PMC10987010 DOI: 10.1007/s43477-023-00106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/10/2023] [Indexed: 04/04/2024]
Abstract
Clinical capacity for sustainability, or the clinical resources needed to sustain an evidence-based practice, represent proximal determinants that contribute to intervention sustainment. We examine the relationship between clinical capacity for sustainability and sustainment of PEWS, an evidence-based intervention to improve outcomes for pediatric oncology patients in resource-variable hospitals. We conducted a cross-sectional survey among Latin American pediatric oncology centers participating in Proyecto Escala de Valoración de Alerta Temprana (EVAT), an improvement collaborative to implement Pediatric Early Warning Systems (PEWS). Hospitals were eligible if they had completed PEWS implementation. Clinicians were eligible to participate if they were involved in PEWS implementation or used PEWS in clinical work. The Spanish language survey consisted of 56 close and open-ended questions about the respondent, hospital, participants' assessment of clinical capacity to sustain PEWS using the clinical sustainability assessment tool (CSAT), and perceptions about PEWS and its use as an intervention. Results were analyzed using a multi-level modeling approach to examine the relationship between individual, hospital, intervention, and clinical capacity determinants to PEWS sustainment. A total of 797 responses from 37 centers in 13 countries were included in the analysis. Eighty-seven percent of participants reported PEWS sustainment. After controlling for individual, hospital, and intervention factors, clinical capacity was significantly associated with PEWS sustainment (OR 3.27, p < .01). Marginal effects from the final model indicate that an increasing capacity score has a positive influence (11% for every additional CSAT point) of predicting PEWS sustainment. PEWS is a sustainable intervention and clinical capacity to sustain PEWS contributes meaningfully to PEWS sustainment.
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Affiliation(s)
- Virginia McKay
- Brown School, Washington University, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kim Prewitt
- Brown School, Washington University, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Sara Malone
- Brown School, Washington University, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
- Division of Population Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria E. Costa
- Hospital del Nino de la Santísima Trinidad, Cordoba, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Clara K. Perez-Fermin
- Hospital Infantil Regional Universitario Dr. Arturo Grullon, Santiago, Dominican Republic
| | | | | | | | | | | | | | - Sergio Valle
- Unidad Nacional de Oncologia Pediatrica (UNOP), Guatemala, Guatemala
| | | | - Juliana Texeira Costa
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Adolfo Cardenas-Aguirre
- 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, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Rajagopal R, Moreira DC, Faughnan L, Wang H, Naqvi S, Krull L, Vasquez L, Diaz-Coronado R, Terao M, Devidas M, Qaddoumi I. An international multicenter survey reveals health care providers' knowledge gap in childhood central nervous system tumors. Eur J Pediatr 2023; 182:557-565. [PMID: 36383283 DOI: 10.1007/s00431-022-04712-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Childhood central nervous system (CNS) tumors have longer delays in diagnosis than do other pediatric malignancies because health care providers (HCPs) lack awareness about clinical presentation of these tumors. To evaluate the knowledge gap among HCPs, we conducted a global cross-sectional survey. The survey consisted of a set of CNS tumor knowledge questions focused on symptoms, signs, and imaging indications. The survey was disseminated to HCPs via email (November 2018-March 2020). Participants had to complete a pre-test survey, attend an education seminar on CNS tumors, and complete a post-test survey. The knowledge gap was evaluated using pre-test and post-test scores. We received 889 pre-test and 392 post-test responses. Most respondents were from Asia (73.1% of pre-test responses; 87.5% of post-test responses). The median pre-test score was 40.0% (range: 13.1-92.9%). A high percentage of correct answers were given in post-test responses (median score: 77.1%, range: 14.9-98.2%). In the pre-test, 18.7% of participants accurately responded that Cushing's triad was a less common symptom, and 15.0% recognized that children aged > 10 years are at risk of late diagnosis. Surprisingly, 21.9% falsely reported that patients with malignancy experienced the longest pre-diagnostic symptom interval, and 54.5% of respondents wrongly selected medulloblastoma as the most common CNS tumor. Overall, pediatricians demonstrated a greater knowledge gap on both surveys than did other specialties. Conclusion: Pre- and post-test surveys revealed significant knowledge gaps in childhood CNS tumors among HCPs. Thus, raising professional awareness on clinical presentations of CNS tumors through educational strategies is important to address this knowledge deficit. What is Known: • Diagnostic delay in childhood central nervous system (CNS) tumors continues to be a significant problem that negatively impacts the quality of life and treatment sequelae. • Lack of medical education on CNS tumors is a contributing factor to this problem. What is New: • Most health care providers do not realize that low-grade tumors are the most common neoplasm in children. • Health care providers fail to recognize that teenagers and adolescents are a vulnerable age group for diagnostic delays, with the longest pre-diagnostic symptom interval.
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Affiliation(s)
- Revathi Rajagopal
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lane Faughnan
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Huiqi Wang
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sameen Naqvi
- Department of Pediatrics, Hematology, and Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Lisa Krull
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Liliana Vasquez
- Centro de Investigación de Medicina de Precision, Universidad de San Martín de Porres, Facultad de Medicina, Lima, Peru.,Unit of Non-Communicable Diseases, Pan American Health Organization, Washington, DC, USA
| | - Rosdali Diaz-Coronado
- Department of Pediatric Oncology, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - Michael Terao
- Office of Student Learning, Georgetown University School of Medicine, Washington, DC, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Mirochnick E, Graetz DE, Ferrara G, Puerto-Torres M, Gillipelli SR, Elish P, Muniz-Talavera H, Gonzalez-Ruiz A, Armenta M, Barra C, Diaz-Coronado R, Hernandez C, Juarez S, Loeza JDJ, Mendez A, Montalvo E, Penafiel E, Pineda E, Agulnik A. Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals. Front Oncol 2022; 12:1018224. [PMID: 36313665 PMCID: PMC9597682 DOI: 10.3389/fonc.2022.1018224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Pediatric Early Warning Systems (PEWS) reduce clinical deterioration, improve interdisciplinary communication, and provide cost savings; however, little is known about how these impacts are achieved or related. This study evaluates the multi-level impacts of PEWS in resource-limited pediatric oncology centers. Methods We conducted 71 semi-structured interviews including physicians (45%), nurses (45%), and administrators (10%) from 5 resource-limited pediatric oncology centers in 4 Latin American countries. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed using a priori and inductively derived codes. Transcripts were independently coded by 2 coders, achieving a kappa of 0.8-0.9. Thematic content analysis explored perceived impacts of PEWS at the level of the patient, clinician, healthcare team, and institution. Results PEWS improved the quality of attention for patients, reducing morbidity and mortality. Clinicians felt more knowledgeable, confident, and empowered providing patient care, resulting in greater job satisfaction. PEWS affected team dynamics by improving interdisciplinary (ward and intensive care unit) and interprofessional (physicians and nurses) relationships and communication. This ultimately led to institutional culture change with emphasis on patient safety, collaboration with other centers, and receipt of institutional awards. Together, these impacts led to hospital-wide support of ongoing PEWS use. Conclusions In resource-limited hospitals, PEWS use results in multi-level positive impacts on patients, clinicians, teams, and institutions, creating a feedback loop that further supports ongoing PEWS use. These findings can guide advocacy for PEWS to various stakeholders, improve PEWS effectiveness, and inform assessment of other interventions to improve childhood cancer outcomes.
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Affiliation(s)
- Emily Mirochnick
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Dylan E. Graetz
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Gia Ferrara
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Srinithya R. Gillipelli
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Paul Elish
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Hilmarie Muniz-Talavera
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alejandra Gonzalez-Ruiz
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Miriam Armenta
- Pediatric Oncology, Hospital General de Tijuana, Tijuana, Mexico
| | - Camila Barra
- Pediatric Oncology, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | | | - Cinthia Hernandez
- Pediatric Oncology, Hospital Infantil Teletón de Oncología, Querétaro, Mexico
| | - Susana Juarez
- Pediatrics, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | - Alejandra Mendez
- Pediatric Critical Care, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Erika Montalvo
- Pediatric Critical Care, Hospital Oncológico Solca Núcleo de Quito, Quito, Ecuador
| | - Eulalia Penafiel
- Pediatric Oncology, Instituto del Cáncer Solca Cuenca, Cuenca, Ecuador
| | - Estuardo Pineda
- Pediatric Oncology, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- *Correspondence: Asya Agulnik,
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Diaz-Coronado R, Reinecke JB, Stanek JR, Finlay JL, Hernandez-Broncano E, Chavez-Paredes S, Miranda-Tunque Y, Heredia-Zelaya A, Casavilca-Zambrano S, Garcia-Corrochano P, Ojeda-Medina L, Orrego-Puelles E, Torres-Malca E, Sernaque-Quintana R, Quispe-Valverde W, Garcia-Leon J, Osorio DS. LINC-23. Factors influencing outcomes of older children with Medulloblastoma over 15 years in Peru, a resource limited setting. Neuro Oncol 2022. [PMCID: PMC9165001 DOI: 10.1093/neuonc/noac079.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. While survival has improved in high-income countries (HIC), the outcomes for patients in low-middle-income countries (LMIC) are unclear. Therefore, we sought to determine the survival of children with Medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 1997 and 2013 in Peru. METHODS: Between 1997-2013, data from 103 children older than three years with Medulloblastoma were analyzed. Fourteen patients were excluded. The patients were split into two distinct cohorts, 1997 – 2008 and 2009 – 2013, corresponding with chemotherapy regimen changes. Event-free (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method, while prognostic factors were determined by univariate analysis (log-rank test). RESULTS: Eighty-nine patients were included; median age was 8.1 years (range: 3-13.9 years). The five-year OS was 62% (95% CI: 53 – 74%) while EFS was 57% (95% CI: 48 – 69%). The variables adversely affecting survival were anaplastic histology [compared to desmoplastic; OS: HR=3.4, p=0.03], metastasis [OS: HR=3.5, p=0.01; EFS: HR=4.3, p=0.004], delay in radiation therapy of 31-60 days [compared to ≤30 days; EFS: HR=2.1, p=0.04], and treatment 2009 – 2013 cohort[OS: HR=2.2, p=0.02; EFS: HR=2.0; p=0.03]. CONCLUSIONS: Outcomes for Medulloblastoma at INEN were low compared with HIC. Anaplastic sub-type, metastasis at diagnosis, delay in radiation therapy, and treatment in the period 2009 - 2013 negatively affected the outcomes in our study. Multidisciplinary teamwork, timely delivery of treatment and partnerships with loco-regional groups and colleagues in HIC is likely beneficial.
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Affiliation(s)
| | - James B Reinecke
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
| | - Joseph R Stanek
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
| | - Jonathan L Finlay
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
| | | | | | | | | | | | | | | | | | | | | | | | - Juan Garcia-Leon
- Instituto Nacional de Enfermedades Neoplasicas , Lima, Lima , Peru
| | - Diana S Osorio
- Nationwide Children's Hospital and The Ohio State University , Columbus, Ohio , USA
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Diaz-Coronado R, Hernández-Broncano E, Casavilca-Zambrano S, Campos-Sanchez D, Maza I, Tello M, Leon E, Cañari H, Custodio J, Ojeda-Medina L, Negreiros T, Cordova O, Mora-Alferez P, Garcia-Leon J, Vasquez L, Moreira D, Qaddoumi I. LINC-21. PROGNOSTIC FACTORS AND SURVIVAL OF LOW-GRADE GLIOMAS IN CHILDREN AND ADOLESCENTS – A MULTICENTER STUDY IN PERU. Neuro Oncol 2022. [PMCID: PMC9165147 DOI: 10.1093/neuonc/noac079.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Low-grade gliomas (LGG) are the most common central nervous system (CNS) tumors in children. Peru is an index country for the Global Initiative for Childhood Cancer (GICC). As part of the Initiative, a multidisciplinary brain tumor team was formed in 2020 that includes five national reference centers: National Institute of Neoplastic Diseases, National Children’s Health Institute-San Borja, National Children’s Health Institute-Breña, Edgardo Rebagliati Martins National Hospital and Guillermo Almenara Irigoyen National Hospital. This multicenter study sought to evaluate the survival and prognostic factors of patients younger than 18 years diagnosed with LGG, an index cancer for the GICC. METHODS: A retrospective study included all patients diagnosed with LGG in the five centers between 2014 and 2018. We analyzed clinical characteristics, histology, and treatment modalities. We used the Kaplan-Meier method for survival. RESULTS: 194 patients were registered; 136 patients were included. M/F ratio was 1.2, mean age 7 years old. The most frequent location was infratentorial (42.2%), supratentorial (34.9%), optic/chiasm/sellar (11%) and brainstem (11.9%). The most frequent histological types were pilocytic astrocytoma (61%), diffuse astrocytoma (10.3%), oligodendroglioma (5.2%), and other low-grade neoplasms (23.5%). Surgery was performed in 109 patients (83.2%). Chemotherapy alone was used in 17 (12.5%), while radiotherapy in 20 (14.7%). Overall survival at 5 years was 82.9% (95% CI 73.3 - 89.4). Age younger than 3 years (p=0.002), diffuse histological type (p=0.04), and location in the brainstem (p=0.001) were factors associated with a worse prognosis. CONCLUSIONS: Within the framework of the GICC, this work is one of the first steps to understand the current context of pediatric CNS tumor care in Peru. Although the reported survival rate is about the GICC goal of 60%, further improvements in care are needed to increase survival to level closer to high-resource setting and decrease long term morbidity.
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Affiliation(s)
| | | | | | | | - Ivan Maza
- Hospital Nacional Edgardo Rebagliati Martins , Lima, Lima , Peru
| | - Mariela Tello
- Instituto de Salud del Niño- San Borja , Lima, Lima , Peru
| | - Esmeralda Leon
- Hospital Nacional Guillermo Almenara Irigoyen , Lima, Lima , Peru
| | - Hernan Cañari
- Instituto Nacional del Niño-Breña , Lima, Lima , Peru
| | - Javier Custodio
- Hospital Nacional Edgardo Rebagliati Martins , Lima, Lima , Peru
| | | | | | - Olga Cordova
- Hospital Nacional Edgardo Rebagliati Martins , Lima, Lima , Peru
| | | | - Juan Garcia-Leon
- Instituto Nacional de Enfermedades Neoplasicas , Lima, Lima , Peru
| | - Liliana Vasquez
- Organizacion Mundial de la Salud , Columbia, Washington , USA
| | - Daniel Moreira
- St. Jude Children’s Research Hospital , Memphis, Tennessee , USA
| | - Ibrahim Qaddoumi
- St. Jude Children’s Research Hospital , Memphis, Tennessee , USA
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Agulnik A, Schmidt-Grimminger G, Ferrara G, Puerto-Torres M, Gillipelli SR, Elish P, Muniz-Talavera H, Gonzalez-Ruiz A, Armenta M, Barra C, Diaz-Coronado R, Hernandez C, Juarez S, Loeza JDJ, Mendez A, Montalvo E, Penafiel E, Pineda E, Graetz DE, McKay V. Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America. Front Health Serv 2022; 2:1004805. [PMID: 36925775 PMCID: PMC10012640 DOI: 10.3389/frhs.2022.1004805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022]
Abstract
Background Sustainability, or continued use of evidence-based interventions for long-term patient benefit, is the least studied aspect of implementation science. In this study, we evaluate sustainability of a Pediatric Early Warning System (PEWS), an evidence-based intervention to improve early identification of clinical deterioration in hospitalized children, in low-resource settings using the Clinical Capacity for Sustainability Framework (CCS). Methods We conducted a secondary analysis of a qualitative study to identify barriers and enablers to PEWS implementation. Semi-structured interviews with PEWS implementation leaders and hospital directors at 5 Latin American pediatric oncology centers sustaining PEWS were conducted virtually in Spanish from June to August 2020. Interviews were recorded, professionally transcribed, and translated into English. Exploratory thematic content analysis yielded staff perceptions on PEWS sustainability. Coded segments were analyzed to identify participant perception about the current state and importance of sustaining PEWS, as well as sustainability successes and challenges. Identified sustainability determinants were mapped to the CCS to evaluate its applicability. Results We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefits. Identified sustainability determinants included supportive leadership encouraging ongoing interest in PEWS, beneficial patient outcomes enhancing perceived value of PEWS, integrating PEWS into the routine of patient care, ongoing staff turnover creating training challenges, adequate material resources to promote PEWS use, and the COVID-19 pandemic. While most identified factors mapped to the CCS, COVID-19 emerged as an additional external sustainability challenge. Together, these challenges resulted in multiple impacts on PEWS sustainment, ranging from a small reduction in PEWS quality to complete disruption of PEWS use and subsequent loss of benefits to patients. Participants described several innovative strategies to address identified challenges and promote PEWS sustainability. Conclusion This study describes clinician perspectives on sustainable implementation of evidence-based interventions in low-resource settings, including sustainability determinants and potential sustainability strategies. Identified factors mapped well to the CCS, however, external factors, such as the COVID pandemic, may additionally impact sustainability. This work highlights an urgent need for theoretically-driven, empirically-informed strategies to support sustainable implementation of evidence-based interventions in settings of all resource-levels.
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Affiliation(s)
- Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Gia Ferrara
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Paul Elish
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Hilmarie Muniz-Talavera
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Alejandra Gonzalez-Ruiz
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Miriam Armenta
- Pediatric Oncology, Hospital General de Tijuana, Tijuana, Mexico
| | - Camila Barra
- Pediatric Oncology, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | | | - Cinthia Hernandez
- Pediatric Oncology, Hospital Infantil Teletón de Oncología, Querétaro, Mexico
| | - Susana Juarez
- Pediatrics, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | - Alejandra Mendez
- Pediatric Critical Care, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Erika Montalvo
- Pediatric Critical Care, Hospital Oncológico Solca Núcleo de Quito, Quito, Ecuador
| | - Eulalia Penafiel
- Pediatric Oncology, Instituto del Cáncer SOLCA Cuenca, Cuenca, Ecuador
| | - Estuardo Pineda
- Pediatric Oncology, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Dylan E Graetz
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Virginia McKay
- Brown School, Washington University, St. Louis, MO, United States
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