Assessing clinician communication in pediatric oncology care

Project Dates: 2023-2024

Over 70% of medical errors are due to communication failures. Ineffective clinician communication leads to suboptimal treatment outcomes, including increased cost, resource utilization, and patient morbidity and mortality. Team communication, sometimes described as a communication network, is an important determinant of communication quality and, thus, essential for delivering evidence-based care. Team communication is particularly challenging during moments of high stress, such as clinical deterioration events, or when caring for complex patients, such as those with cancer. Children with cancer frequently experience clinical deterioration, with up to 40% requiring critical care during their treatment. Deterioration events in these patients are often fatal and represent a significant cause of treatment-related mortality, particularly in low-resource settings with limited resources to manage critical illness. Managing acute deterioration in hospitalized patients is complex, involving multiple medical personnel from different teams, all converging to care for one patient. As a result, excellent communication during such events, across disciplines (ward, intensive care unit (ICU)) and professions (nurse, physician), is crucial to deliver high-quality patient care. Improving communication is, therefore, a priority to improve hospital outcomes for children with cancer, particularly in low-resource settings. There is limited data, however, on how communication network structure leads to better patient care in these settings.

Project Goals:

• Describe communication structures between oncology and critical care teams in two low-resource hospitals in Mexico. The study will do this through SNA among clinical staff at each hospital. The study will assess the communication patterns and hierarchy that exists between individuals within the networks (e.g. role, unit). Refine equity-focused appointment reminder system to enhance dissemination and implementation.
• Co-design a bilingual dashboard to disseminate findings to hospital clinicians. This will facilitate interpretation of, interaction with, and active use of site-specific data regarding communication and network analysis findings. The dashboard will empower clinician interpretation and application of results from SNA.
• Examine clinicians’ preferences and priorities regarding participation in SNA studies and dissemination of findings through the interactive dashboard. The study will do this through semi-structured interviews.

Implications for Research and Practice:

This study leverages comprehensive systems science methodology to inform implementation science in cancer, and is innovative in three ways: First, the use of SNA in low-resource settings. SNA has been used to understand communication networks in a variety of high-resource settings. The need for SNA in resource-limited settings has been identified, but not completed due to barriers in understanding how to feasibly and rigorously apply the methodology. This study will thoughtfully and appropriately use SNA in low-resource settings, bringing a new understanding of communication structures. Second, focus on communication within clinical teams. While there has been some theoretical development and empirical work beginning to understand clinician communication, this area of study is novel. There is still very little known about how clinicians communicate with each other in a variety of settings. Third, a Dashboard for rapid dissemination to clinicians, promoting clinical benefit. This study prioritizes the development of a pragmatic dashboard that is accessible by all clinicians within the study setting. Historically, there has been a lack of targeted dissemination of research findings to participants in low-resource settings.

Project Contact:  Sara Malone

Project Team: Douglas A Luke, Asya Agulnik, Jocelyn Rivera