Browsing by Author "Kaye, EC"

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    Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries
    (Springer Science and Business Media Deutschland GmbH, 2024) Salek, M; Porter, AS; Maradiege, E; Dolendo, MCJ; Figueredo, D; Geriga, F; Gunasekera, S; Kizyma, R; Nguyen, HTK; Nzamu, I; Raza, MR; Rustamova, K; Sari, NM; Rodriguez-Galindo, C; Graetz, D; Bhakta, N; Kaye, EC; Wise, PH; Hunleth, JM; Friedrich, P; Force, L; Baker, JN
    Purpose: Global childhood cancer survival outcomes correlate with regional contextual factors, yet upfront treatment decision-making for children with advanced or poor prognosis cancer in low- and middle-income countries (LMICs) is not well understood. This study aimed to (1) characterize the landscape of contextual factors that shape physician decision-making at diagnosis for these children in LMICs and (2) describe physician rationales for if/when to offer treatment with non-curative intent, including how they define “poor prognosis” during treatment decision-making. Methods: An international panel of pediatric oncologists practicing in LMICs participated in two focus groups structured for the collaborative generation of factors influencing treatment decision-making, including consideration of non-curative treatment pathways at diagnosis. Thematic analysis of qualitative data was conducted, followed by member checking. Results: Eleven pediatric oncologists participated, representing all global regions defined by the World Health Organization. Participants identified a broad range of factors influencing decision-making across multiple levels, including the individual, hospital, health system, community, and country levels. All participants agreed that treatment with non-curative intent could be offered at diagnosis in certain contexts, and diverse definitions for poor prognosis were described. Conclusions: Upfront treatment decision-making for children with advanced or poor prognosis cancer in LMICs is variable and challenging. Difficulties with decision-making in LMICs may be amplified by inconsistent definitions of poor prognosis and underrepresentation of the factors that influence treatment decision-making within existing decision-making frameworks or childhood cancer treatment guidelines. Future research should explore decision-making approaches, preferences, and challenges in depth from the perspectives of pediatric cancer patients, families, and multidisciplinary clinicians. © The Author(s) 2024.
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    Resilient health care in global pediatric oncology during the COVID-19 pandemic
    (John Wiley and Sons Inc., 2021) Graetz, DE; Sniderman, E; Villegas, CA; Kaye, EC; Ragab, I; Laptsevich, A; Maliti, B; Naidu, G; Huang, H; Gassant, PY; Nunes Silva, L; Arce, D; Montoya Vasquez, J; Arora, RS; Alcasabas, AP; Rusmawatiningtyas, D; Raza, MR; Velasco, P; Kambugu, J; Vinitsky, A; Rodriguez-Galindo, C; Agulnik, A; Moreira DC; COVIMPACT Study Group
    Background: In the face of unprecedented challenges because of coronavirus disease 2019, interdisciplinary pediatric oncology teams have developed strategies to continue providing high-quality cancer care. This study explored factors contributing to health care resilience as perceived by childhood cancer providers in all resource level settings. Methods: This qualitative study consisted of 19 focus groups conducted in 16 countries in 8 languages. Seven factors have been previously defined as important for resilient health care including: 1) in situ practical experience, 2) system design, 3) exposure to diverse views on the patient's situation, 4) protocols and checklists, 5) teamwork, 6) workarounds, and 7) trade-offs. Rapid turn-around analysis focused on these factors. Results: All factors of health care resilience were relevant to groups representing all resource settings. Focus group participants emphasized the importance of teamwork and a flexible and coordinated approach to care. Participants described collaboration within and among institutions, as well as partnerships with governmental, private, and nonprofit organizations. Hierarchies were advantageous to decision-making and information dissemination. Clinicians were inspired by their patients and explained creative trade-offs and workarounds used to maintain high-quality care. Conclusions: Factors previously described as contributing to resilient health care manifested differently in each institution but were described in all resource settings. These insights can guide pediatric oncology teams worldwide as they provide cancer care during the next phases of the pandemic. Understanding these elements of resilience will also help providers respond to inevitable future stressors on health care systems.