# 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 · $256,620

## Abstract

Project Summary
Background and Goal: Nearly 90% children with cancer live in low- and middle-income countries, where survival
is as low as 20%. Children undergoing cancer treatment frequently develop critical illness, however, low-resource
hospitals face multiple challenges delivering high-quality pediatric onco-critical care (POCC), including limited
material and human resources. Additionally, hospitals in these settings face challenges implementing and
sustaining evidence-based interventions that improve outcomes for children undergoing cancer treatment.
Pediatric Early Warning Systems (PEWS) are evidence-based interventions that aid in early identification of
critical illness in children with cancer, resulting in improved survival. Although sustaining interventions like PEWS
is essential for ongoing impact on childhood cancer outcomes, little is known about how resource limitations
impact their ongoing use and sustainability. The goal of the proposed diversity supplement is to investigate how
POCC resources impact PEWS sustainability in resource-limited hospitals.
Aims and Methods: We will conduct an observational cross-sectional study of 36 resource-limited centers
participating in Proyecto EVAT, a collaborative of hospitals in Latin America implementing and sustaining PEWS,
and evaluate how POCC resources affect PEWS sustainability. We will measure POCC resources through
PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe care), a consensus derived tool to
assess the quality and capacity for POCC in resource-limited hospitals. During Aim 1: We will identify common
gaps in POCC resources among Proyecto EVAT centers and their perceived impact on PEWS sustainability.
During Aim 2: We will evaluate the relationship between POCC resources, clinical capacity for sustainability,
ongoing PEWS use, and patient outcomes.
Innovation and Impact: Determinants of sustainability for evidence-based interventions, including the role of
resources, are poorly understood. This study will advance the field of implementation science by enhancing our
understanding of how resources promote ongoing use of intervention like PEWS in low-resource settings by
leveraging a new measure (PROACTIVE). This work will contribute to the overall aim of the parent award
(R37CA276215-01, MPIs: Agulnik/McKay) to identify determinants of PEWS sustainability in these low-resource
hospitals and inform development of sustainability strategies suitable to a hospital’s resources. Findings from
this study will also assist hospitals to advocate for resources that promote sustainability of interventions that
outcomes for children with cancer in low-resource settings.

## Key facts

- **NIH application ID:** 10940288
- **Project number:** 3R37CA276215-02S1
- **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:** $256,620
- **Award type:** 3
- **Project period:** 2023-04-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10940288

## Citation

> US National Institutes of Health, RePORTER application 10940288, Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in low-resource hospitals (3R37CA276215-02S1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10940288. Licensed CC0.

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