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Health-care providers' compliance with childhood acute lymphoblastic leukemia protocol in Indonesia
Mei Neni Sitaresmi1, Saskia Mostert, Chad M Gundy
1Department of Growth and Development Pediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia. msitaresmi@yahoo.com
Insights
Health-care providers in Indonesia often misclassify childhood acute lymphoblastic leukemia (ALL) risk, particularly missing key chemotherapy response indicators. Improving risk assessment is crucial for better treatment outcomes in pediatric leukemia patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Protocol non-compliance significantly impacts childhood acute lymphoblastic leukemia (ALL) treatment outcomes.
- Concerns regarding protocol adherence extend to parents, patients, and healthcare providers (HCP).
- This study investigates leukemia risk classification accuracy and HCP attitudes toward protocol compliance in Indonesia.
Purpose of the Study:
- To assess the accuracy of childhood acute lymphoblastic leukemia (ALL) risk classification in medical records.
- To examine healthcare providers' knowledge of ALL risk classification criteria.
- To evaluate healthcare providers' attitudes towards protocol compliance in pediatric leukemia care.
Main Methods:
- A combined retrospective analysis of 164 medical records (MR) for ALL patients.
- A cross-sectional questionnaire study involving 97 healthcare providers (HCP).
- Assessment of ALL risk classification accuracy and HCP knowledge/attitudes regarding protocol adherence.
Main Results:
- 50% of medical records lacked complete high-risk (HR) criteria for ALL.
- 95% of HCP failed to recall all five HR criteria.
- The lymphoblast count on day 8 of chemotherapy was the most frequently missed assessment criterion (35% of MR, 85% of questionnaires).
- Only 14% of HCP verified medication administration with parents.
Conclusions:
- Healthcare providers require enhanced knowledge and assessment skills for childhood ALL risk classification, especially regarding day 8 lymphoblast counts.
- Accurate risk stratification and appropriate treatment are essential for improving cure rates in pediatric leukemia.
- Addressing knowledge gaps in HCP is critical for optimizing childhood ALL management.
Background:
Non-compliance with childhood acute lymphoblastic leukemia (ALL) protocol is an important determinant of poor treatment outcome. Non-compliance with protocol may not only concern parents or patients, but may also concern health-care providers (HCP). Our study examines the accuracy of leukemia risk classification and attitude of HCP toward protocol compliance in Indonesia.
Procedure:
A combined retrospective study of medical records (MR) and a cross-sectional questionnaire study with HCP were conducted. Accurate ALL risk classification in MR was assessed. HCP' knowledge of risk classification and their attitude toward protocol compliance were examined.
Results:
A total of 164 MR patients with ALL were assessed and 97 HCP were interviewed. The protocol criteria for high-risk (HR) were not complete in 82 MR (50%). Of 97 HCP, 95% did not mention all five protocol criteria for HR. Both in the MR as well as in the questionnaires lymphoblast count on day 8 of chemotherapy, as early response to treatment, was the most frequently missed item (missing in 35% of MR and 85% of questionnaires). Only 14% of respondents actually checked with parents whether they administered the prescribed medicines.
Conclusions:
Our study shows that HCP should improve their knowledge and assessment of childhood ALL risk classification, especially lymphoblast count on day 8 of chemotherapy. Proper risk classification and subsequent correct treatment may enable more children to be cured of leukemia.
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