PROJECT SUMMARY/ABSTRACT Children with cancer in low-resource settings face a survival rate of only 20%. Clinical deterioration, defined as the worsening of patient status that requires clinical teams to recognize and respond in a coordinated fashion, remain a major cause of childhood cancer mortality globally. Interdisciplinary communication is essential to high-quality cancer care, especially during high-acuity events such as clinical deterioration. Despite knowledge that high quality interdisciplinary communication improves patient care and outcomes, we lack an understanding of specific modifiable determinants of communication quality and appropriate, usable, and measurable communication interventions. This is particularly true in low-resource settings. We have previously developed a valid, reliable, multilingual measure of communication quality during clinical deterioration and have conceptualized that communication structure and quality interact to directly impact the quality of childhood cancer care. The goal of this proposal is to develop and test a bundled multilevel intervention that responds to modifiable determinants of interdisciplinary communication quality and structural communication patterns in low-resource pediatric oncology hospitals to improve communication and care delivery. To accomplish this goal, we will engage clinicians and hospitals in low-resource settings. In Aim 1 we will identify the relationship between communication structure and quality in the care of children with cancer. We will conduct a cross-sectional social network analysis from 10 high-quality communication and 10 low-quality communication hospitals as determined by previous work. In Aim 2, we will develop a multilevel intervention to improve communication quality in low-resource hospitals. We will conduct a sequential mixed methods study using quantitative data from Aim 1 supplemented by qualitative interviews with clinicians. Following this, we will engage a global panel of experts in communication and clinical care to conduct implementation mapping, which will develop and prioritize an intervention to address common communication challenges. In Aim 3 we will conduct a cluster randomized control trial to test the feasibility and preliminary effectiveness of this multilevel intervention to improve communication quality in low-resource hospitals. We will test the identified intervention bundle at 8 low-resource hospitals. Our primary outcome will be the change in communication quality score, and we will also assess the feasibility, acceptability, and appropriateness of the intervention among frontline clinicians. When complete, this work will improve interdisciplinary communication and clinical outcomes for children with cancer in hospitals of all resource levels, thus advancing health equity globally.