Abstract
BackgroundChildhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation.MethodThe PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when training (strategy I) is combined with implementation expanded resources (strategy II). There are three aims: (1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; (2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster-randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost-effective use of resources consistent with family risk (institution); (3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit.DiscussionUse of the PAT across children’s cancer programs nationally can achieve the assessment standard and inform equitable delivery of psychosocial care matched to family need for all patients.Trial RegistrationClinicalTrials.gov, NCT04446728, registered 23 June 2020
Highlights
Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health
Few programs offer such care in an efficient, comprehensive, consistent manner [5, 6], highlighting critical gaps in care that can magnify health disparities. This study addresses this critical gap in the delivery of care to our diverse population of children with cancer and their families by evaluating two approaches to implementing an evidence-based, parent report screener of family psychosocial risk in English and Spanish—the Psychosocial Assessment Tool (PAT) [7, 8]
Overview of the study The aim of this mixed methods research is to implement universal, systematic family psychosocial risk screening with the PAT in English and Spanish to assure that all families of children newly diagnosed with cancer at the participating cancer centers are screened
Summary
Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The diagnosis and treatment of pediatric cancer affects and is affected by multiple levels of the social ecology, including patient and caregiver physical and psychosocial health. The standards outline evidence-based care for all patients and families to improve health, increase access to care, and reduce health disparities by decreasing distress, addressing risks, and improving quality of life. In qualitative interviews with multidisciplinary healthcare providers regarding the implementation of screening, the overarching theme was that screening all families is important because it facilitates clinical care and partnerships that can improve outcomes especially for those at risk for disparities. Few programs offer such care in an efficient, comprehensive, consistent manner [5, 6], highlighting critical gaps in care that can magnify health disparities
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