Feasibility and Concurrent Validity of the Family-Assisted Severe Illness Therapy Tool Compared With Pediatric Early Warning Systems in Pediatric Oncology.
In a prospective study of 50 caregiver-patient pairs at the Uganda Cancer Institute, caregiver-recorded FASTER scores were highly feasible and sensitive for concurrent PEWS-defined deterioration, but had poor categorical agreement, modest specificity, and no demonstrated effect on clinical outcomes.
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In a prospective study of 50 caregiver-patient pairs at the Uganda Cancer Institute, caregiver-recorded FASTER scores were highly feasible and sensitive for concurrent PEWS-defined deterioration, but had poor categorical agreement, modest specificity, and no demonstrated effect on clinical outcomes.
Research significance
The evidence supports FASTER as a feasible caregiver-assisted screening approach with a high negative predictive value relative to concurrent PEWS; it remains an inference, requiring prospective validation, that integrating FASTER into escalation pathways could accelerate recognition of deterioration and reduce preventable mortality in resource-constrained pediatric oncology units.
Source abstract
PURPOSE: Children with cancer in low- and middle-income countries face high preventable in-hospital mortality, often because of delayed recognition of clinical deterioration. Pediatric Early Warning Systems (PEWS) enable early detection but require frequent clinician assessments that are difficult to sustain in resource-constrained settings. The Family-Assisted Severe Illness Therapy (FASTER) tool trains caregivers to perform simple bedside assessments as an alternative screening approach. We evaluated the concurrent validity, feasibility, and acceptability of caregiver-recorded FASTER scores versus clinician-recorded PEWS scores among pediatric oncology inpatients at the Uganda Cancer Institute. METHODS: In this prospective, concurrent validity study, 50 caregiver-patient pairs were enrolled. After structured training, caregivers performed FASTER assessments every 6 hours over 48 hours while a study nurse independently recorded PEWS scores every 8 hours, yielding 321 concurrent paired observations for analysis. Concurrent validity was assessed using Spearman correlation and kappa agreement statistics. Diagnostic performance for PEWS-defined deterioration (PEWS ≥3) was evaluated using sensitivity, specificity, predictive values, and AUROC. Feasibility and acceptability were assessed through adherence monitoring and structured exit interviews. RESULTS: FASTER scores correlated moderately to strongly with PEWS scores (ρ = 0.65 [95% CI, 0.58 to 0.71]; P < .001), although categorical agreement was poor (unweighted κ = 0.07). For PEWS-defined deterioration, FASTER showed high sensitivity (96.7%) and modest specificity (47.5%); AUROC was 0.89 (95% CI, 0.84 to 0.94), reflecting yellow-threshold discrimination given only two PEWS-red events. The positive predictive value was 29.7%, and the negative predictive value was 98.4%. Caregiver adherence was high (98.3%), and acceptability was strong (100% useful, 78% easy/very easy), although lower education predicted greater difficulty (P = .014). CONCLUSION: FASTER demonstrated concurrent validity with PEWS and high feasibility and acceptability; its predictive validity and impact on clinical outcomes require further study.