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Background <p>Pediatric early warning systems (PEWS) are quality improvement interventions that reduce preventable mortality during childhood cancer treatment, but sustaining PEWS implementation remains challenging. Although effective team communication has been linked to improved hospital care delivery, its role in supporting long-term PEWS sustainability is not well understood. This study examined the relationship between team communication quality and PEWS sustainability capacity at resource-diverse hospitals providing childhood cancer care.</p> Methods <p>A cross-sectional survey was conducted among clinicians involved in childhood cancer care and PEWS use at 47 hospitals in Latin America and Spain participating in Proyecto EVAT, a quality improvement collaborative focused on PEWS implementation and sustainability. Team communication quality was assessed using the validated CritCom instrument, and sustainability capacity was measured using the Clinical Sustainability Assessment Tool (CSAT). Associations between communication quality and sustainability capacity were evaluated using Spearman’s correlation and a linear mixed-effects model accounting for hospital-level clustering.</p> Results <p>A total of 1,288 clinicians participated. Communication quality was positively associated with sustainability capacity (Spearman’s ρ = 0.58). In adjusted analyses, each one-unit increase in CritCom score was associated with a 0.50-unit increase in CSAT score (<i>p</i> &lt; 0.001). Physicians and clinicians in PEWS leadership roles reported higher communication quality and sustainability capacity than nurses and non-leadership staff. Respondents working in intensive care and non-clinical settings reported lower sustainability capacity than those working on inpatient wards. Hospital-level characteristics, including funding type and childhood cancer patient volume, were not associated with sustainability capacity.</p> Conclusions <p>Higher-quality team communication independently predicts greater capacity to sustain PEWS across resource-diverse hospitals providing childhood cancer care. Differences by professional role and clinical setting suggest that targeted communication strategies may strengthen the long-term sustainability of evidence-based practices and improve global childhood cancer care outcomes.</p>

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Communication quality shapes the sustainability of pediatric early warning system

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Sara Malone,
  • Luke Zabotka,
  • Rebeca Caires,
  • Veronica Easson,
  • Samantha Hayes,
  • Tessa Concepcion,
  • Miguel Aguilar Barragan,
  • Adolfo Cardenas,
  • Bobbi J. Carothers,
  • Jocelyn Rivera,
  • Ana Berenice Aguilar Román,
  • Andreia Ribeiro Pereira Aguiar de Paula,
  • Carolina Abarzua,
  • Judith Cornejo Barrera,
  • Lupe Nataly Mora Robles,
  • María Sánchez-Martín,
  • Norma Araceli López Facundo,
  • Rosdali Diaz Coronado,
  • Veronica Soto Chavez,
  • Charles Goss,
  • Douglas A. Luke,
  • Dylan E. Graetz,
  • Virginia McKay,
  • Asya Agulnik,
  • Carolina Bravo,
  • Clara Pérez Fermín,
  • Cristal Edén Chacón Chavira,
  • Daniela Arce,
  • Daniela Cobarrubias,
  • Diana Rendon,
  • Diego Figueredo,
  • Eduardo Jorge Baños Rodríguez,
  • Ellioth A. F. Quintana García,
  • Erika Montalvo,
  • Estuardo E. Pineda,
  • Ever Fing,
  • Fiorella Maria Fernandez Berrospi,
  • Gerson Benjamín Morales Quiroa,
  • Gloria Itzel Ceballo Batista,
  • Idalia Lozano,
  • Irene Medina,
  • Isidoro Tejocote Romero,
  • Leticia Andrade,
  • Ligia Rios López,
  • Liz Moctezuma,
  • Marcela Sahonero,
  • Maria do Ceu Diniz Borborema,
  • Maria Susana Sánchez Tobias,
  • Mariadelcarmen Cach,
  • Mariana Dorea,
  • Miriam Armenta Cruz,
  • Octavia Negrin,
  • Priscila Mendes Paiva,
  • Rocio Sanches,
  • Rosario Batista,
  • Rossby Dileni Campos Estrada,
  • Scheybi Teresa Miralda Mendez,
  • Shillel Alvarez,
  • Valentine Jiménez,
  • Valeria García,
  • Yefry Andrés Aragón Joya,
  • Zaira Aguayo

摘要

Background

Pediatric early warning systems (PEWS) are quality improvement interventions that reduce preventable mortality during childhood cancer treatment, but sustaining PEWS implementation remains challenging. Although effective team communication has been linked to improved hospital care delivery, its role in supporting long-term PEWS sustainability is not well understood. This study examined the relationship between team communication quality and PEWS sustainability capacity at resource-diverse hospitals providing childhood cancer care.

Methods

A cross-sectional survey was conducted among clinicians involved in childhood cancer care and PEWS use at 47 hospitals in Latin America and Spain participating in Proyecto EVAT, a quality improvement collaborative focused on PEWS implementation and sustainability. Team communication quality was assessed using the validated CritCom instrument, and sustainability capacity was measured using the Clinical Sustainability Assessment Tool (CSAT). Associations between communication quality and sustainability capacity were evaluated using Spearman’s correlation and a linear mixed-effects model accounting for hospital-level clustering.

Results

A total of 1,288 clinicians participated. Communication quality was positively associated with sustainability capacity (Spearman’s ρ = 0.58). In adjusted analyses, each one-unit increase in CritCom score was associated with a 0.50-unit increase in CSAT score (p < 0.001). Physicians and clinicians in PEWS leadership roles reported higher communication quality and sustainability capacity than nurses and non-leadership staff. Respondents working in intensive care and non-clinical settings reported lower sustainability capacity than those working on inpatient wards. Hospital-level characteristics, including funding type and childhood cancer patient volume, were not associated with sustainability capacity.

Conclusions

Higher-quality team communication independently predicts greater capacity to sustain PEWS across resource-diverse hospitals providing childhood cancer care. Differences by professional role and clinical setting suggest that targeted communication strategies may strengthen the long-term sustainability of evidence-based practices and improve global childhood cancer care outcomes.