Resilient health care in global pediatric oncology during the COVID-19 pandemic


Dylan E. Graetz, St. Jude Children's Research Hospital, Memphis, Tennessee.Follow
Elizabeth Sniderman, St. Jude Children's Research Hospital, Memphis, Tennessee.
Cesar A. Villegas, St. Jude Children's Research Hospital, Memphis, Tennessee.
Erica C. Kaye, St. Jude Children's Research Hospital, Memphis, Tennessee.
Iman Ragab, Hematology-Oncology Unit, Ain Shams University, Children's Hospital, Cairo, Egypt.
Aliaksandra Laptsevich, Belarusian Research Center for Pediatric Oncology Hematology and Immunology, Minsk, Belarus.
Biemba Maliti, Cancer Diseases Hospital, Lusaka, Zambia.
Gita Naidu, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Haiying Huang, Guangzhou Women and Children's Medical Center, Guangzhou, China.
Pascale Y. Gassant, Hospital Saint-Damien, Port-au-Prince, Haiti.Follow
Luciana Nunes Silva, Hospital Martagao Gesteira, Salvador, Brazil.
Daniela Arce, Hospital Pediatrico de Sinaloa, Culiacan, Mexico.
Jacqueline Montoya Vasquez, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru.
Ramandeep Singh Arora, Max Super Specialty Hospital, New Delhi, India.
Ana Patricia Alcasabas, University of the Philippines, Philippine General Hospital, Manila, Philippines.
Desy Rusmawatiningtyas, Sardjito General Hospital, Yogyakarta, Indonesia.
Muhammad Rafie Raza, The Indus Hospital, Karachi, Pakistan.
Pablo Velasco, Pediatric Oncology and Hematology Department, Vall d'Hebron Hospital, Barcelona, Spain.
Joyce Kambugu, Uganda Cancer Institute, Kampala, Uganda.
Anna Vinitsky, St. Jude Children's Research Hospital, Memphis, Tennessee.
Carlos Rodriguez-Galindo, St. Jude Children's Research Hospital, Memphis, Tennessee.
Asya Agulnik, St. Jude Children's Research Hospital, Memphis, Tennessee.Follow
Daniel C. Moreira, St. Jude Children's Research Hospital, Memphis, Tennessee.


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.

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