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Development and pilot testing of PROACTIVE: A pediatric onco-critical care capacity and quality assessment tool for
Anita V Arias1, Firas M Sakaan2, Maria Puerto-Torres2
1Division of Critical Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Insights
The PROACTIVE tool effectively assesses pediatric onco-critical care (POCC) capacity in diverse settings. Pilot testing confirmed its feasibility, identifying key challenges like staffing shortages and limited training for improving global POCC services.
Area of Science:
- Pediatric Oncology
- Critical Care Medicine
- Global Health
Background:
- Most children with cancer (nearly 90%) live in low- and middle-income countries.
- These regions face significant hurdles in delivering high-quality pediatric onco-critical care (POCC).
- The PROACTIVE tool was developed to assess POCC quality and capacity, identifying strengths and limitations.
Purpose of the Study:
- To pilot test the PROACTIVE tool for assessing pediatric onco-critical care (POCC) services.
- To develop center-specific reports based on PROACTIVE assessments.
- To identify common challenges in POCC delivery across diverse healthcare settings.
Main Methods:
- Converted 119 indicators into 182 questions across two electronic surveys for intensivists and oncologists.
- Conducted alpha-testing for face validity with four pediatric intensivists.
- Performed beta-testing with 11 diverse centers to assess usability, feasibility, and applicability of PROACTIVE.
Main Results:
- Alpha-testing confirmed face validity; beta-testing demonstrated PROACTIVE's feasibility and usability.
- Twenty-two surveys (99.4% response rate) informed center-specific reports, leading to 200 questions in the final tool.
- Common POCC challenges identified: lack of pediatric intensivists, inadequate monitoring for withdrawal symptoms, insufficient supportive care resources, and limited training for physicians and nurses.
Conclusions:
- PROACTIVE is a feasible and contextually appropriate tool for identifying POCC service challenges.
- The tool is applicable across various resource settings.
- Widespread adoption of PROACTIVE can guide targeted interventions to enhance global POCC services and patient outcomes.
Background:
Nearly 90% children with cancer reside in low- and middle-income countries, which face multiple challenges delivering high-quality pediatric onco-critical care (POCC). We recently identified POCC quality and capacity indicators for PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE), a tool that evaluates strengths and limitations in POCC services. This study describes pilot testing of PROACTIVE, development of center-specific reports, and identification of common POCC challenges.
Methods:
The original 119 consensus-derived PROACTIVE indicators were converted into 182 questions divided between 2 electronic surveys for intensivists and oncologists managing critically ill pediatric cancer patients. Alpha-testing was conducted to confirm face-validity with four pediatric intensivists. Eleven centers representing diverse geographic regions, income levels, and POCC services conducted beta-testing to evaluate usability, feasibility, and applicability of PROACTIVE. Centers' responses were scored and indicators with mean scores ≤75% in availability/performance were classified as common POCC challenges.
Results:
Alpha-testing ensured face-validity and beta-testing demonstrated feasibility and usability of PROACTIVE (October 2020-June 2021). Twenty-two surveys (response rate 99.4%) were used to develop center-specific reports. Adjustments to PROACTIVE were made based on focus group feedback and surveys, resulting in 200 questions. Aggregated data across centers identified common POCC challenges: (1) lack of pediatric intensivists, (2) absence of abstinence and withdrawal symptoms monitoring, (3) shortage of supportive care resources, and (4) limited POCC training for physicians and nurses.
Conclusions:
PROACTIVE is a feasible and contextually appropriate tool to help clinicians and organizations identify challenges in POCC services across a wide range of resource-levels. Widespread use of PROACTIVE can help prioritize and develop tailored interventions to strengthen POCC services and outcomes globally.
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