Wearable sensors for fever detection in children with cancer in Kenya: an implementation science study

About This Grant

Candidate: Charles “Nate” Nessle, DO is a US pediatric hematologist oncologist based in Kenya with a clinical research focus on improving fever management in children with cancer. He will gain expertise in implementation science and wearable sensors with the goal to implement wearable sensors into routine clinical practice to advance care delivery, reduce disease burden, and improve the journey for children with cancer in resource-constrained settings in the US negatively impacted by healthcare worker shortages. Career Development Plan: Dr. Nessle received clinical research training through NIH NCI T32 and NIH FIC fellowships. He will gain expertise in: 1) application of pragmatic implementation science 2) principles of choice preference methodologies 3) adaptive use of wearable sensors in low-resourced settings 4) leadership, team science, grantsmanship. He assembled a team of mentors with expertise in oncology, implementation science, and wearable sensors. Through a combination of high-yield didactics, practical experience, and mentorship, Dr. Nessle will be well-positioned to lead implementation initiatives using novel technologies, like wearable sensors, to improve pediatric cancer outcomes in resource-constrained settings in the US. Research Plan: Severe healthcare worker shortages in the US contribute to poor patient outcomes. Fevers and infections are the top preventable causes of treatment related mortality in children with cancer in resource-constrained settings, associated with poor nurse-to-patient ratios (1 nurse to 30 patients) and management delays. Prompt fever management improves patient outcomes, yet this can be challenging and multifactorial in resource-constrained settings; Kenya currently reflects the future US healthcare worker shortages. Shifting the task of fever detection from overburdened nurses to wearable sensors is an innovative solution to increase uptake of effective fever management. Yet to our knowledge, no published studies have evaluated task-sharing and wearable sensors in children with cancer. Dr. Nessle will rigorously evaluate the implementation process of wearable sensors for hospitalized children with cancer in Kenya, which foreshadows healthcare worker shortages in the US; without this understanding, wearable sensor clinical trials in resource-constrained settings in the US will fall short of their potential. First, we will evaluate the implementation barriers and facilitators to pre-implementation outcomes of adoption, appropriateness, and cost through a quantitative survey and stakeholder interviews in internal and external settings to identify a group of mitigating strategies (Aim 1). Then, a choice experiment and a human centered design workshop will evaluate key wearable sensor attributes from the perspectives of children, caregivers and healthcare providers (Aim 2) to inform the selection of a wearable sensor for the pilot study (Aim 3). The group of strategies from Aim 1 will minimize the impact of barriers to support the single-arm wearable sensor pilot study in 30 hospitalized children with acute leukemia, where we will measure feasibility, acceptability, and usability over a 30-day trial period (Aim 3).