Development and pilot testing of <scp>PROACTIVE</scp>: A pediatric <scp>onco‐critical</scp> care capacity and quality assessment tool for <scp>resource‐limited</scp> settings

Arias, A.; Sakaan, Firas; Puerto-Torres, Maria; Zebin, Zebin Al; Bhattacharyya, Parthasarathi; Cardenas, Adolfo; Gunasekera, Sanjeeva; Kambugu, Joyce; Киргизов, К. И.; Libes, Jaime; Martínez, Angélica; Matinyan, Nune V.; Mendez, A Ruiz; Middlekauff, Janet; Nielsen, Katie R.; Pappas, Andrew; Ren, Hong; Sharara‐Chami, Rana; Torres, Silvio; McArthur, Jennifer; Agulnik, Asya

doi:10.1002/cam4.5395

Cited by 12 publications

(14 citation statements)

References 48 publications

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“…This Research Topic represents a new field in pediatric critical care-pediatric onco-critical care (POCC)-focused on improving care and outcomes for critically ill children with cancer and blood disorders. Over the past few years, multiple collaborative groups have developed POCC educational curricula (23), consensus research priorities (24), and quality and capacity indicators (25,26). This Research Topic describing 30 articles on the critical complications in pediatric oncology and HCT marks the future of this growing field.…”

Section: The Future Of Our Fieldmentioning

confidence: 99%

“…The future of POCC must intentionally address health equity in this field through research that specifically focuses on improving care and outcomes for critically ill children with cancer and blood disorders in resourcelimited settings. This includes addressing therapeutic, resource, and implementation challenges that may be unique to POCC in these settings (26,31,32). This targeted focus is urgently needed to reduce global in childhood cancer outcomes.…”

Section: The Future Of Our Fieldmentioning

confidence: 99%

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Editorial: Critical complications in pediatric oncology and hematopoietic cell transplant – how far we have come and how much further we must go

Agulnik

Mahadeo²,

Steiner³

et al. 2023

Front. Oncol.

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Editorial on the Research TopicCritical complications in pediatric oncology and hematopoietic cell transplant History of pediatric onco-critical careThe evolving experience and expertise in caring for critically ill pediatric oncology, hematopoietic cell transplant (HCT), and cellular therapies (CT) patients is a very recent effort. This topic, however, carries behind it tremendous energy and enthusiasm as evidenced by the numerous quality submissions to this Research Topic, "Critical Complications in Pediatric Oncology and Hematopoietic Cell Transplantation".Pediatric HCT was first successfully performed by the Robert A. Good team in 1968 to treat a non-malignant disorder (X-linked severe combined immune deficiency) (1) followed by expanded indications to bone marrow malignancies and failure (2-4). In this era, pediatric critical care was also early in its infancy but was available to patients with sepsis/septic shock, hemorrhage, and respiratory insufficiency/failure. Pediatric renal replacement therapies were limited, tunneled central venous access was in development, and non-invasive positive pressure was still decades away. Initial hematopoietic growth factors, anti-viral agents, and infection prophylaxis were undergoing study in clinical trials.Mortality in this early era in both adult and pediatric oncology and HCT patients with septic shock and/or acute respiratory failure was dismal, with mortality rates exceeding 80% (5-9). Indeed, one published series from this early period stated: "Intensive respiratory care is effective for patients with readily reversible causes of respiratory failure, but is generally futile for patients with progressive interstitial pneumonia" and "We also recommend providing bone-marrow transplant patients with realistic prognostic estimates … before transfer to the intensive care unit … This approach may reduce the amount of futile care" (10).

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Section: The Future Of Our Fieldmentioning

confidence: 99%

Section: The Future Of Our Fieldmentioning

confidence: 99%

Editorial: Critical complications in pediatric oncology and hematopoietic cell transplant – how far we have come and how much further we must go

Agulnik

Mahadeo²,

Steiner³

et al. 2023

Front. Oncol.

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“…This consensus-derived tool contains 200 questions divided in two surveys designed to be completed by at least two providers, one intensivist and one oncologist, managing critically ill PHO patients and it evaluates POCC services across eight domains and 22 subdomains 7,8 (Table S1). Other team members (e.g., nurses) support completion of the surveys by providing additional insight to the answers being collected by the primary providers.…”

Section: Proactivementioning

confidence: 99%

“…Service Capacity, (v) Service Integration, (vi) Supportive Services, (vii) Medication and Equipment, and (viii) Outcomes. 7,8 To date, 28 hospitals across 19 countries have used PROACTIVE. 9 The King Hussein Cancer Center (KHCC) in Jordan completed PROAC-TIVE in 2021 and 2022, providing a unique opportunity to compare results over time.…”

Section: Introductionmentioning

confidence: 99%

Improving quality of pediatric onco‐critical care: A 2‐year experience using PROACTIVE at a cancer center in Jordan

Abutineh,

Zebin,

Obeidat

et al. 2023

Pediatric Blood & Cancer

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PROACTIVE (PediatRic Oncology cApaCity Assessment Tool for IntensiVe CarE) is a consensus‐derived tool that evaluates pediatric onco‐critical care (POCC) services and identifies gaps amenable to improvement. King Hussein Cancer Center (KHCC), an oncology hospital in Jordan, completed PROACTIVE in 2021 and 2022. We evaluated PROACTIVE's ability to identify gaps and improve POCC services at KHCC by analyzing score changes and interviewing site leaders to understand mechanisms of improvement. Results identified three types of outcomes: direct (e.g., improved multidisciplinary communication), indirect (e.g., guidelines implementation), and other outcomes unrelated to PROACTIVE (e.g., funding mechanisms). PROACTIVE can assist institutions strengthen and monitor POCC services over time.

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“…Multidisciplinary guidelines to manage pediatric sepsis, 30 , 31 treating fever and neutropenia, 32 preventing central line infections and other complications of therapy 33 , 34 are vital to improving care. Recent work has identified global hospital indicators to assess the quality and capacity of pediatric onco-critical care services; 35 , 36 using such assessments can aid hospitals to identify opportunities to improve patient care and outcomes. A greater systems-level focus on these modifiable factors will improve global survival for children with cancer who develop sepsis and critical illness.…”

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confidence: 99%

Development and pilot testing of PROACTIVE: A pediatric onco‐critical care capacity and quality assessment tool for resource‐limited settings

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 12 publications

References 48 publications

Editorial: Critical complications in pediatric oncology and hematopoietic cell transplant – how far we have come and how much further we must go

Editorial: Critical complications in pediatric oncology and hematopoietic cell transplant – how far we have come and how much further we must go

Improving quality of pediatric onco‐critical care: A 2‐year experience using PROACTIVE at a cancer center in Jordan

Management of septic shock in children with cancer—Common challenges and research priorities

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