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Development and Pilot Testing of PrOFILE-ST: A Pediatric Surgical Oncology Capacity and Quality Assessment Tool for
Fernanda Kelly Marques de Souza1, Simone de Campos Vieira Abib1, Rodrigo Chaves Ribeiro2
1Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil.
Insights
The Pediatric Oncology Facility Integrated Local Evaluation Surgical Tool (PrOFILE-ST) assesses pediatric cancer surgery capacity globally. It identifies disparities and guides quality improvements, especially in low-resource settings.
Area of Science:
- Global Health
- Pediatric Surgical Oncology
- Health Services Research
Background:
- Childhood cancer incidence is rising, particularly in low- and middle-income countries (LMICs).
- High mortality rates in LMICs are linked to inadequate pediatric surgical care access.
- The International Society of Pediatric Surgical Oncology (IPSO) and St. Jude Children's Research Hospital developed PrOFILE-ST to evaluate surgical capacity in resource-limited settings.
Purpose of the Study:
- To develop and validate a tool for assessing pediatric oncology surgical capacity and quality.
- To identify disparities in surgical care between different income settings.
- To guide quality improvement initiatives in pediatric cancer surgery.
Main Methods:
- PrOFILE-ST was developed through construction, content validation, and pilot testing over three years.
- Refinement involved expert feedback and biweekly team meetings.
- Pilot testing at six institutions across five countries (Sudan, Zambia, Peru, Mexico, Brazil) collected quantitative and qualitative data.
Main Results:
- The final PrOFILE-ST tool comprises 12 modules and 273 questions.
- Significant differences in surgical capacity were observed between upper-middle-income countries (UMICs) and LMICs/LICs.
- UMICs showed better infrastructure, while LMICs/LICs demonstrated strengths in reporting and timeliness.
Conclusions:
- PrOFILE-ST effectively assesses pediatric oncology surgery across diverse settings.
- The tool highlights specific areas for improvement, including fellowships and standardized reporting.
- PrOFILE-ST can inform quality improvement efforts to reduce global childhood cancer outcome disparities.
Background:
The global incidence of childhood cancer is rising, with nearly 90% of cases occurring in low- and middle-income countries (LMICs), where mortality remains high due to limited access to quality pediatric surgical care. To address this, the International Society of Pediatric Surgical Oncology (IPSO) and St. Jude Children's Research Hospital developed the Pediatric Oncology Facility Integrated Local Evaluation Surgical Tool (PrOFILE-ST) to assess surgical capacity and quality in resource-limited settings.
Methods:
PrOFILE-ST was developed in three stages: construction, content validation, and pilot testing. The tool was refined over three years through biweekly team meetings and expert feedback. Pilot testing took place at six institutions across five countries (Sudan, Zambia, Peru, Mexico, Brazil), collecting both quantitative and qualitative data on surgical practices. Data was analyzed using descriptive statistics, producing reports to guide quality improvement.
Results:
The final tool consists of 12 modules and 273 questions. Pilot testing revealed differences in surgical capacity between upper-middle-income countries (UMICs) and lower middle/low-income countries (LMICs/LICs). UMICs had better infrastructure, while LMICs/LICs excelled in surgical reporting and timeliness. Improvement priorities included the development of pediatric surgical oncology fellowships, standardization of operative reporting, systematic morbidity and mortality analysis, and establishment of real-time multidisciplinary team discussions.
Conclusions:
PrOFILE-ST is an effective tool for assessing pediatric oncology surgery across diverse settings, highlighting strengths and areas for improvement. It can guide quality improvement efforts to address global disparities in childhood cancer outcomes.
