The quality certification shows parents that their child is in good hands

There are probably many different ideas about what optimal treatment for childhood cancer should look like. How did you approach achieving an objective assessment?

We followed a multi-stage process. First, we systematically reviewed the scientific literature to see what has been published so far on quality criteria. We found 18 studies. Altogether, they listed around 200 different criteria, which we then consolidated into 90 overarching criteria. In a second step, we developed an online questionnaire and sent it to pediatric oncology representatives from 32 countries whose healthcare systems are comparable to Switzerland's. In this way, we learned that children’s cancer centers in about two-thirds of these countries follow either national or local quality criteria. In the responses, we also came across five additional criteria, which we included in our list. Finally, in a third step, we examined how relevant the various quality criteria are for medical professionals as well as for parents of children with cancer in Switzerland. Having parents with lived experience contribute their practical insights to the project was very important to us—they offered another valuable perspective.

How do the perspectives of professionals and families with lived experience differ?

We oncologists tend to focus on criteria related to treatment. These include, for example, minimizing infection rates in the venous catheters we place for chemotherapy. Or ensuring rapid initiation of antibiotic treatment when a child with a high fever arrives at the hospital. If the fever is caused by a bacterial infection, time is critical because the child’s immune system is weakened by chemotherapy and cannot fight the bacteria, the situation can quickly lead to fatal sepsis.

For parents of children with cancer, other things are often more important. For example, that they do not have to go through the general emergency department when their child’s condition suddenly worsens, but can come directly to the pediatric oncology unit. Our study also showed that many families are very grateful for support provided by psycho-oncological counseling or by the social services team. Social workers can help parents apply for caregiving leave from their employers, for instance. Many parents are also relieved to receive nutritional counseling, which shows them what they themselves can do to positively influence the course of the illness.

Apparently, many parents also value services outside the actual medical treatment.

Yes, we pediatric oncologists provide only a small portion of the overall support. We are part of a large team that supports children with cancer—as well as their siblings and parents. What matters is that we all work together. The quality criteria are intended to help ensure precisely that.

Did you encounter resistance from your colleagues?

No, on the contrary. We received very positive feedback and much recognition for the process we chose. Even before starting this project, we knew that all nine childhood cancer centers in Switzerland perform very well in terms of treatment quality. This is evident in the high survival rates of children with cancer in Switzerland compared with international figures. I think we can all be proud of that. At the same time, we believe it is important to measure quality based on clearly defined and transparent criteria. This helps pediatricians get an accurate picture of the cancer center to which they may refer their young patients. And it also helps families. For many parents, it is reassuring to know that their child is being treated in a hospital that meets high quality standards. Transparent quality data confirms for them that their child is in good hands—and that we are doing everything we can, with combined expertise and commitment, to ensure the child’s well-being.

What happens now that the research is completed?

At the Ostschweizer Kinderspital in St. Gallen, we are launching a pilot project to explore how the quality criteria can be captured in everyday clinical practice without adding extra administrative burden. Our goal is to create a practical tool that integrates seamlessly into our workflows and proves genuinely useful in daily practice.

Project number: HSR-5219-11-2020