Developmental surveillance and screening practices in a pediatric oncology clinic: Initial progress of a quality improvement study.

Abstract

Pediatric cancer patients' oncology teams regularly take on a primary care role, but due to the urgent nature of cancer treatment, developmental screenings may be deprioritized. This leaves patients at risk of developmental diagnoses and referrals being delayed. Clarify the current developmental surveillance and screening practices of one pediatric oncology team. Researchers reviewed charts for patients (n=66) seen at a pediatric oncology clinic in a suburban academic medical center to determine engagement in developmental screening (including functioning around related areas such as speech, neurocognition, etc.) and referrals for care in these areas. Developmental histories were collected from all patients through admission history and physical examination (H&P), but there was no routinized follow-up. Physicians did not conduct regular developmental screening per American Academy of Pediatrics guidelines for any patients but identified n=3 patients with needs while the psychology team routinely surveilled all patients seen during this time (n=41) and identified n=18 patients as having delays. Physicians did not routinely screen for development needs beyond H&P and were inconsistent in developmental follow-up/referrals. Integrated psychologists were key in generating referrals for developmental-based care. However, many oncology patients were not seen by psychologists quickly or at all, creating a significant gap in care during a crucial developmental period. The case is made for further routinization of ongoing developmental screening in pediatric oncology care.