# Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in low-resource hospitals

> **NIH NIH R37** · ST. JUDE CHILDREN'S RESEARCH HOSPITAL · 2024 · $877,132

## Abstract

PROJECT SUMMARY/ABSTRACT
Background and Goal. More than 90% of children with cancer live in low-resourced settings, where
survival is only 20%. Sustainable evidence-based (EB) interventions yielding ongoing beneficial
patient outcomes is critical to improve childhood cancer survival. A better understanding of factors
promoting intervention sustainability in these settings is urgently needed. The goal of our project is to
provide an empirical understanding of how clinical capacity, or the resources needed to sustain an
intervention, impacts sustainment of a Pediatric Early Warning System (PEWS), EB interventions that
improves pediatric oncology outcomes in low-resource hospitals by quickly detecting clinical
deterioration in children with cancer, preventing the need for more intense treatment.
Aims and Methods: We will conduct a prospective, longitudinal study of 92 low-resource hospitals
implementing and sustaining PEWS. This work will build on an ongoing St. Jude-Wash U
Implementation Science Collaborative and Proyecto EVAT, a quality improvement collaborative of
Latin American pediatric oncology centers. Aim 1: We will evaluate how clinical capacity for
sustainability changes over time through 5 to 9 prospective measurements of capacity via survey of
clinical staff using PEWS (n=13 per center) during the phases of PEWS adoption, implementation,
and sustainability. Aim 2: We will determine the relationship between capacity and a) PEWS
sustainment and b) clinical deterioration mortality among pediatric oncology patients at centers
sustaining PEWS for 2 to 10 years using chart review and an existing patient outcomes registry. Aim
3: We will develop novel strategies to promote sustainability by gaining a deeper understanding of
perceived challenges to building capacity and PEWS sustainment. In combination with quantitative
outcomes, we will conduct 24 focus groups with hospital staff (doctors, nurses, and administrators)
from hospitals with both high (n=4) and low capacity (n=4). We will then use implementation mapping
to generate theoretically driven, empirically-supported strategies which promote sustainability. All
aims will be informed by an External Advisory Board and the EVAT steering committee.
Innovation and Impact: Few EB sustainability strategies exist for low-resource settings. This study will
advance implementation science by providing a theoretically-driven, foundational understanding of
factors that predict sustainability among a large, diverse cohort of low-resource hospitals. We will
then use this knowledge to develop sustainability strategies that optimize capacity and promote long-
term sustainment of PEWS and improvements in patient outcomes in low-resource settings -
ultimately promoting equity in childhood cancer care globally.

## Key facts

- **NIH application ID:** 10818568
- **Project number:** 5R37CA276215-02
- **Recipient organization:** ST. JUDE CHILDREN'S RESEARCH HOSPITAL
- **Principal Investigator:** Asya Agulnik
- **Activity code:** R37 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $877,132
- **Award type:** 5
- **Project period:** 2023-04-01 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10818568

## Citation

> US National Institutes of Health, RePORTER application 10818568, Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in low-resource hospitals (5R37CA276215-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10818568. Licensed CC0.

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