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Stages of change: Strategies to promote use of a Pediatric Early Warning System in resource‐limited pediatric oncology centers

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dc.contributor.authorWoo, Marisa Cristin
dc.contributor.authorFerrara, Gia
dc.contributor.authorPuerto-Torres, Maria
dc.contributor.authorGillipelli, Srinithya R
dc.contributor.authorElish, Paul
dc.contributor.authorMuniz-Talavera, Hilmarie
dc.contributor.authorGonzalez-Ruiz, Alejandra
dc.contributor.authorArmenta, Miriam
dc.contributor.authorBarra, Camila
dc.contributor.authorDiaz-Coronado, Rosdali
dc.contributor.authorHernandez, Cinthia
dc.contributor.authorJuarez, Susana
dc.contributor.authorLoeza, José
dc.contributor.authorMendez, Alejandra
dc.contributor.authorMontalvo, Erika
dc.contributor.authorPeñafiel, Eulalia
dc.contributor.authorPineda, Estuardo
dc.contributor.authorGraetz, Dylan E
dc.contributor.authorKortz, Teresa
dc.contributor.authorAgulnik, Asya
dc.date.accessioned2024-08-15T13:58:17Z
dc.date.available2024-08-15T13:58:17Z
dc.date.issued2023
dc.description.abstractBackground Pediatric Early Warning Systems (PEWS) assist early detection of clinical deterioration in hospitalized children with cancer. Relevant to successful PEWS implementation, the “stages of change” model characterizes stakeholder support for PEWS based on willingness and effort to adopt the new practice. Methods At five resource‐limited pediatric oncology centers in Latin America, semi‐structured interviews were conducted with 71 hospital staff involved in PEWS implementation. Purposive sampling was used to select centers requiring variable time to complete PEWS implementation, with low‐barrier centers (3–4 months) and high‐barrier centers (10–11 months). Interviews were conducted in Spanish, professionally transcribed, and translated into English. Thematic content analysis explored “stage of change” with constant comparative analysis across stakeholder types and study sites. Results Participants identified six interventions (training, incentives, participation, evidence, persuasion, and modeling) and two policies (environmental planning and mandates) as effective strategies used by implementation leaders to promote stakeholder progression through stages of change. Key approaches involved presentation of evidence demonstrating PEWS effectiveness, persuasion and incentives addressing specific stakeholder interests, enthusiastic individuals serving as models for others, and policies enforced by hospital directors facilitating habitual PEWS use. Effective engagement targeted hospital directors during early implementation phases to provide programmatic legitimacy for clinical staff. Conclusion This study identifies strategies to promote adoption and maintained use of PEWS, highlighting the importance of tailoring implementation strategies to the motivations of each stakeholder type. These findings can guide efforts to implement PEWS and other evidence‐based practices that improve childhood cancer outcomes in resource‐limited hospitals. Keywords: behavioral science, clinical cancer research, clinical management, implementation science, pediatric cancer, Pediatric Early Warning Systems, resource‐limited, stages of change, transtheoretical model
dc.identifier.citationWoo MC, Ferrara G, Puerto-Torres M, Gillipelli SR, Elish P, Muniz-Talavera H, Gonzalez-Ruiz A, Armenta M, Barra C, Diaz-Coronado R, Hernandez C, Juarez S, Loeza JJ, Mendez A, Montalvo E, Peñafiel E, Pineda E, Graetz DE, Kortz T, Agulnik A. Stages of change: Strategies to promote use of a Pediatric Early Warning System in resource-limited pediatric oncology centers. Cancer Med. 2023 Jul;12(14):15358-15370. doi: 10.1002/cam4.6087. Epub 2023 Jul 5. PMID: 37403745; PMCID: PMC10417083.
dc.identifier.urihttp://biblioteca.solcaquito.org.ec:9997/handle/123456789/1575
dc.language.isoen
dc.titleStages of change: Strategies to promote use of a Pediatric Early Warning System in resource‐limited pediatric oncology centers
dc.typeArticle
dspace.entity.typePublication
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