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Published on: June 20, 2020
Feasibility and Concurrent Validity of the Family-Assisted Severe Illness Therapy Tool Compared With Pediatric Early
Jane Namusisi1,2, Steven Kikonyogo2, Babra Atuheire1
1Uganda Cancer Institute, Kampala, Uganda.
Insights
Caregivers can use the Family-Assisted Severe Illness Therapy (FASTER) tool to effectively screen children with cancer for clinical deterioration, showing high feasibility and acceptability in resource-limited settings.
Area of Science:
- Pediatric Oncology
- Global Health
- Clinical Assessment Tools
Background:
- Children with cancer in low- and middle-income countries experience high preventable mortality due to delayed recognition of clinical deterioration.
- Existing Pediatric Early Warning Systems (PEWS) require frequent clinician assessments, which are challenging in resource-constrained environments.
- The Family-Assisted Severe Illness Therapy (FASTER) tool offers an alternative by training caregivers to perform bedside assessments.
Purpose of the Study:
- To evaluate the concurrent validity, feasibility, and acceptability of caregiver-administered FASTER scores compared to clinician-administered PEWS scores.
- To assess FASTER as a screening approach for pediatric oncology inpatients in a low-resource setting.
Main Methods:
- A prospective, concurrent validity study involving 50 caregiver-patient pairs at the Uganda Cancer Institute.
- Caregivers recorded FASTER scores every 6 hours for 48 hours post-training; a study nurse independently recorded PEWS scores every 8 hours.
- Analysis included Spearman correlation, kappa agreement, diagnostic performance metrics (sensitivity, specificity, AUROC), adherence monitoring, and exit interviews.
Main Results:
- FASTER scores showed moderate to strong correlation with PEWS scores (ρ = 0.65, P < .001), but poor categorical agreement (κ = 0.07).
- FASTER demonstrated high sensitivity (96.7%) and modest specificity (47.5%) for detecting PEWS-defined deterioration (PEWS ≥3), with an AUROC of 0.89.
- Caregiver adherence was high (98.3%), and acceptability was strong (100% useful, 78% easy/very easy), though lower education correlated with increased difficulty.
Conclusions:
- The FASTER tool exhibits concurrent validity with PEWS and demonstrates high feasibility and acceptability among caregivers in a resource-limited pediatric oncology setting.
- Further research is needed to establish the predictive validity of FASTER and its impact on clinical outcomes.
Purpose:
Children with cancer in low- and middle-income countries face high preventable in-hospital mortality, often because of delayed recognition of clinical deterioration. Pediatric Early Warning Systems (PEWS) enable early detection but require frequent clinician assessments that are difficult to sustain in resource-constrained settings. The Family-Assisted Severe Illness Therapy (FASTER) tool trains caregivers to perform simple bedside assessments as an alternative screening approach. We evaluated the concurrent validity, feasibility, and acceptability of caregiver-recorded FASTER scores versus clinician-recorded PEWS scores among pediatric oncology inpatients at the Uganda Cancer Institute.
Methods:
In this prospective, concurrent validity study, 50 caregiver-patient pairs were enrolled. After structured training, caregivers performed FASTER assessments every 6 hours over 48 hours while a study nurse independently recorded PEWS scores every 8 hours, yielding 321 concurrent paired observations for analysis. Concurrent validity was assessed using Spearman correlation and kappa agreement statistics. Diagnostic performance for PEWS-defined deterioration (PEWS ≥3) was evaluated using sensitivity, specificity, predictive values, and AUROC. Feasibility and acceptability were assessed through adherence monitoring and structured exit interviews.
Results:
FASTER scores correlated moderately to strongly with PEWS scores (ρ = 0.65 [95% CI, 0.58 to 0.71]; P < .001), although categorical agreement was poor (unweighted κ = 0.07). For PEWS-defined deterioration, FASTER showed high sensitivity (96.7%) and modest specificity (47.5%); AUROC was 0.89 (95% CI, 0.84 to 0.94), reflecting yellow-threshold discrimination given only two PEWS-red events. The positive predictive value was 29.7%, and the negative predictive value was 98.4%. Caregiver adherence was high (98.3%), and acceptability was strong (100% useful, 78% easy/very easy), although lower education predicted greater difficulty (P = .014).
Conclusion:
FASTER demonstrated concurrent validity with PEWS and high feasibility and acceptability; its predictive validity and impact on clinical outcomes require further study.