Evaluation of Task Sharing as a Workforce Optimization Strategy in Pediatric Oncology

Saman K. Hashmi ^1* Muhammad Rafie Raza ² Muhammad Shamvil Ashraf ² Ghulam Qadir ^2,3,4 Uzma Imam ⁵ Zehra Fadoo ⁶ Alia Ahmad ⁷ Haleema Saeed ⁸ Tariq Ghafoor ⁹ Nuzhat Yasmeen ¹⁰ Zulfiqar A Rana ¹¹ Muhammad Haroon Hamid ¹² Mohammad Fahim ur Rehman ¹³ Ameer Malik ¹⁴ Rabia Iqbal ¹⁵ Juverya Syed ¹⁶ Sundus Hashmani ¹⁷ Wasfa Farooq ² Carlos Rodriguez-Galindo ¹ Sima Jeha ¹ Asim F. Belgaumi ⁶ Daniel C. Moreira ¹

• ¹ St. Jude Children's Research Hospital, Memphis, United States
• ² Indus Hospital & Health Network, Karachi, Pakistan
• ³ Indus Hospital & Health Network, Badin, Pakistan
• ⁴ Sheikh Zayed Hospital/Indus Hospital & Health Network, Quetta, Pakistan
• ⁵ Children Cancer Centre of Child Aid Association, National Institute of Child Health, Karachi, Pakistan
• ⁶ Aga Khan University Medical College, Karachi, Pakistan
• ⁷ Children’s Hospital and University of Child Health Sciences, Lahore, Pakistan
• ⁸ Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab, Pakistan
• ⁹ Combined Military Hospital, Rawalpindi, Punjab, Pakistan
• ¹⁰ Pakistan Institute of Medical Sciences (PIMS), Islamabad, Islamabad, Pakistan
• ¹¹ Children’s Hospital and Institute of Child Health, Multan, Pakistan
• ¹² King Edward Medical University, Lahore, Punjab, Pakistan
• ¹³ Children's Hospital and Institute of Child Health, Faisalabad, Pakistan
• ¹⁴ Bahawal Victoria Hospital, Bahawalpur, Punjab, Pakistan
• ¹⁵ Lahore General Hospital, Lahore, Punjab, Pakistan
• ¹⁶ Mother and Child Hospital, Nawabshah, Pakistan
• ¹⁷ Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Punjab, Pakistan

Task sharing is a pragmatic response to the growing shortage of pediatric oncologists globally, especially in low-and middle-income countries (LMICs). However, there have been limited evaluations of how task sharing has been implemented. In this study, we sought to determine the roles and responsibilities of task-sharing physicians (TSPs) in one LMIC, Pakistan. A multicenter cross-sectional study was conducted across 16 hospitals with secondary-to quaternary-level pediatric oncology facilities. An online survey was used to determine task-sharing models, the responsibilities of TSPs, and the level of supervision. Pediatric oncologists were present at 13 of the 16 centers, with a median of 2 pediatric oncologists per center. We found that TSPs included tiers of medical officers/general physicians and pediatricians. They provided inpatient, outpatient, overnight and emergency room coverage. TSPs could participate in defining cancer diagnosis and risk-stratification (n = 9; 56%), selecting initial chemotherapy plans for patients with newly diagnosed cancer (n = 6; 38%) and modifying chemotherapy on the basis of toxicities (n = 6; 38%) under supervision of a pediatric oncologist. In addition, TSPs could write intravenous chemotherapy orders (n = 10; 63%) and prescribe oral chemotherapy (n = 10; 63%). Furthermore, they could independently perform procedures, such as lumbar punctures (n = 15; 94%), intrathecal chemotherapy administration (n = 11; 69%), and bone marrow aspirates and biopsies (n = 11; 69%). TSPs are critical in the pediatric oncology workforce with responsibilities across the pediatric cancer care continuum.