St. Jude Global offers a wide range of transversal, or cross-regional, initiatives that harness the expertise of St. Jude Global teams to improve standards of care and train practitioners around the world.
In resource-limited settings, hospitalized children with cancer are at high risk for a rapid decline in their condition that can lead to death. A better understanding of these critical illnesses can lead to development of new global standards and improved patient outcomes.
To combat acute clinical deterioration, the St. Jude Global Critical Care Unit has adapted the Pediatric Early Warning System for delivery in resource-limited settings. The Critical Care Unit seeks to educate institutional and regional teams on using this system and monitoring and analyzing the results.
Examples of ongoing initiatives include:
- Implementation of a quality improvement program across Latin America. St. Jude Global implemented a modified pediatric early-warning system at the Unidad Nacional de Oncología Pediátrica in Guatemala City. As a result of that cost-effective intervention, the number of clinical deterioration events fell and use of the pediatric intensive care unit also improved. Positive results from that project are the basis for an ongoing quality improvement initiative in Latin America across more than 30 pediatric oncology units. The goal is to reduce the frequency and severity of clinical deterioration. This will improve patient outcomes—regardless of a hospital’s resource level.
- Creation of a working group to improve critical and supportive care throughout all St. Jude Global regions. Through the early-warning collaboration, a working group emerged to improve the care of hospitalized children with cancer who develop critical illnesses in Latin America. This group is called Grupo Latinoamericano de Estudio sobre Cuidados Intensivos en Oncología Pediátrica (GLECIOP). Plans are underway to expand this initiative across all regions of the St. Jude Global Alliance.
The data needed to guide pediatric cancer control planning at health centers and governments in resource-limited settings is often limited or nonexistent. Policy and decision makers need help to make better decisions using imperfect evidence.
The St. Jude Global Disease Burden and Simulation Unit leverages existing data using statistical models to help inform complex choices. The unit also creates new data through research and implementation initiatives.
These programs will help us:
- Understand the burden of disease associated with childhood cancer
- Implement childhood cancer registries
- Manage the cost effectiveness of childhood cancer interventions
- Prioritize pediatric cancer in resource-limited settings
A health systems approach is necessary to sustain pediatric oncology program development and implementation across all St. Jude Global regions. Health systems-strengthening efforts must expand beyond improvements aimed at clinical services to work not only with clinicians, but also to build a diverse stakeholder base with policy makers, government leaders, civil society, and global health leaders to address needs at the policy and system levels.
To improve health outcomes for children with cancer, the St. Jude Global Health Systems Unit will:
- Support health systems strengthening across national and regional cancer programs. These include developing coordinated national policies and programs that integrate and promote pediatric cancer care, particularly in programs that are newly developing. The unit will also update, implement and evaluate cancer control initiatives on a national and multi-national level. Successful initiatives have been launched in Myanmar and the Philippines, with emerging regional collaborations in Central and South America, and Eurasia.
- Systematically collate, analyze and strengthen national policies pertinent to childhood cancer. The unit has established a comprehensive core bank of more than 800 national policies, including cancer control, noncommunicable diseases and national health plans. These policies will represent every region of the world and all country income levels. An extended core bank will feature monitoring and evaluation reports, action plan assessments, and related documents that highlight plan-to-action and implementation outcomes. The bank has facilitated in-depth comparisons of more than 250 national plans in more than seven languages. These analyses are done via analytic frameworks that examine pediatric oncology inclusion in national policies and implementation plans, alongside broader cancer control priorities across the lifespan, such as equity and palliative care integration.
- Develop and implement tools to assess and support the integration of health systems strengthening childhood cancer control. The unit plans to develop, pilot and refine assessment and opportunity mapping tools aimed at all levels of the health system. Collaborations among individual institutions, national programs and regions will drive evidence-informed decision-making and make sustainable health-system improvements.
- Liaise and collaborate with global and regional stakeholders in noncommunicable diseases and cancer control to embed childhood cancer in global agendas. With regional and global stakeholders, the unit will apply health-system thinking and research to integrate childhood cancer needs, advances and evidence into decision-making platforms. This includes working with national governments and civil society partners as well as with global bodies such as the World Health Organization (WHO). In May 2018, St. Jude was officially designated as a WHO Collaborating Centre for Childhood Cancer.
The Global Infectious Diseases program works to improve the survival rates for children with infectious diseases, especially those with depressed immunity. The program will collaborate with local health care professionals at international sites to raise standards of care and promote evidence-based best practices.
Global Infectious Diseases initiatives help clinicians gain knowledge, access to technology and organizational skills needed to prevent, diagnose, manage and minimize the consequences of infectious diseases in children, particularly those with cancer. The Global Infectious Diseases program creates and administers up-to-date training resources. The program also designs, conducts and implements collaborative research and quality improvement studies.
The Global Infectious Diseases program aims to:
- Improve quality of health care practices through education and training guided by research
- Establish and maintain a network of health care providers working in infection care and prevention. This network will facilitate a continuous exchange of knowledge and expertise in infectious diseases between St. Jude Global and its members.
- Foster and participate in international collaborative research on infectious diseases
Global Infectious Diseases has developed a network model to optimize the care of infections in children with cancer and address the educational needs of their care providers. In 2017, the first such network was established in Latin America, the Prevencionistas e Infectólogos para Cáncer Infantil en América Latina (PRINCIPAL) network. This community establishes and implements strategies for better care and prevention of infections in pediatric oncology units associated with the St. Jude Global Alliance. The network includes 21 institutions in 13 countries, with close to 40 collaborators throughout Mexico, Central and South America and the Caribbean. The goal is to integrate the PRINCIPAL network with all the St. Jude Global regional networks.
To deliver high-quality childhood cancer care, regional programs must take into account the local context in which care is delivered. What are the resources available to the health care program? How do internal and external factors affect that care?
Simply cataloguing resources and capabilities offers little long-term value for patients, leadership and staff. That’s why St. Jude Global Metrics and Performance Unit has developed a 360-degree modular self-assessment tool.
To help us better understand these issues, the Pediatric Oncology Facility Integrated Local Evaluation Tool (St. Jude PrOFILE) will:
- Reveal how childhood cancer care is delivered globally
- Transform our typical needs-assessment processes into priority-setting mechanisms
- Establish appropriate benchmarks
Eventually, this tool will be used globally through the SJCARES system.
To improve patient care and survival in low- and middle-income countries, the St. Jude Global Nursing Program promotes the implementation of pediatric hematology-oncology nursing standards at St. Jude member sites.
The St. Jude Global Nursing Program works to:
- Train pediatric oncology nurse educators through the Latin American Center for Pediatric Oncology Nursing Education. This center provides a four-week training curriculum for nurse educators working in pediatric oncology resource-limited settings. Trainees come to the center from hospitals in Mexico, Central and South America. Upon returning to their local hospitals, they develop an orientation program for newly hired nurses. They also have regular meetings with St. Jude Global nursing staff. Before this program launched, none of the 19 participating hospitals in Latin America offered formal orientation programs for pediatric oncology nurses. Today, 15 hospitals offer or are developing such programs. St. Jude Global plans to expand this model to other St. Jude Global Alliance regions.
- Implement the pediatric oncology nurse educator role and hospital-based programs
- Support the Latin American Nurse Educator Network. An outcome of the multi-faceted, regional program in Chile is creation of a St. Jude Latin American Nurse Educator Network, which currently includes 23 active members from 17 centers in nine countries and affects more than 1,000 nurses.
- Offer self-paced and instructor-led online training modules through Cure4Kids
- Promote standardized chemotherapy/biotherapy certificate education for nurses in Latin America in partnership with the Association of Pediatric Hematology/Oncology Nurses. St. Jude Global Nursing collaborates with the Association of Pediatric Hematology/Oncology Nurses (APHON) to implement standardized chemo/biotherapy certificate education in Latin America. Through a series of four pilots, APHON courses were conducted with 200 Central American, Mexican and South American nurses. Work continues with APHON to optimize the process, develop a sustainable instructor network in Latin America and eventually take this initiative global.
- Provide nursing quality assessments and recommendations
- Coordinate multi-site quality improvement projects
- Promote baseline nursing standards for pediatric oncology in limited-resource settings through advocacy, dissemination and research as core members of the International Society of Pediatric Oncology (SIOP) Baseline Nursing Standards Taskforce
- Create nursing partnerships and collaborations across St. Jude Global regions
The Neuro-Oncology Unit of St. Jude Global works to improve diagnosis, treatment and research for children with cancers of the brain and spinal cord. Among other projects, leaders of this unit are building certificate-based courses to train clinicians worldwide in the care and treatment of children with these cancers.
Tailoring efforts to local needs and resources, the St. Jude Global Pathology Unit works with partner institutions to enhance clinical diagnostic laboratories and anatomic pathology services in low- and middle-income countries. These services are essential for the accurate diagnosis and treatment of pediatric cancers.
The approach is multi-faceted and comprehensive. The unit provides:
- Focused expertise through consultations based in the St. Jude Department of Pathology
- Ongoing support to develop services through regional educational activities and working groups
- On-site visits, where St. Jude Global faculty perform comprehensive assessment of pathology services and quality, and develop improvement plans
The goals are to establish sustainable local diagnostic expertise and develop regional centers of excellence. These relationships are viewed as long-term partnerships to grow both local and regional capacity. The relationships will also help to instill a culture of quality similar to what is seen at St. Jude and other leading clinical laboratories.
The St. Jude Global Childhood Cancer Analytics Resource and Epidemiological Surveillance System (SJCARES) is an integrated solution to support evidence-based pediatric cancer care decision-making in low- and middle-income countries. This St. Jude-developed suite of toolkits can help institutions and governments continuously identify, target and monitor the vital health metrics that affect patient outcomes.
By using SJCARES, St. Jude Global Alliance sites can optimize the use of valuable resources. This will allow regional hospitals and research groups to collaborate, further improving the quality of childhood cancer care delivered worldwide.
- Evidence-based tools
- Staff training
- Data quality support
- Regular reports
- Integrated data analysis
- Improved population-based registries
- Comparison to peer groups
In April 2018, St. Jude was officially established as the first World Health Organization Collaborating Centre for Childhood Cancer.
St. Jude will support the WHO by:
- Including childhood cancer in national cancer control plans through tools for prioritization, costs and framework for monitoring and evaluation
- Developing tools for health systems innovation diffusion and leadership engagement in childhood cancer management
- Strengthening childhood cancer control and management through technical support, as well as global and regional stakeholder engagement.
Researchers in the Disease Burden and Simulation Unit partner with collaborators at institutions around the world. Starting in 2018, St. Jude faculty joined with colleagues at the Institute for Health Metrics and Evaluation, an independent global health research center at the University of Washington, to quantify the burden of childhood cancer using multiple outcomes measures including mortality, morbidity and other indicators of disease burden. These data are critical for ongoing global pediatric cancer control efforts and will inform initiatives to improve health systems, direct public policy and enhance patient advocacy.