PedROC 2.0: provider confidence in Wilms tumor management in sub-Saharan Africa: making the case for pediatric radiotherapy inclusion during basic medical training

Abstract

BACKGROUND: To investigate the relationship between exposure to pediatric radiotherapy during basic medical training and healthcare provider confidence in managing Wilms tumor within sub-Saharan Africa. METHODS: A cross-sectional study of 370 healthcare providers participating in a second iteration of the Pediatric Radiation Oncology Virtual Course (PedROC) held on the 29th of July 2023 was conducted. Participants were invited to fill an online survey after providing consent with the assurance of anonymity. For the study outcome, we developed a composite confidence score, ranging from 0 to 20, with higher scores reflecting greater self-reported confidence with managing Wilms tumor. The score was derived from participants' self-reported confidence levels in ten critical domains of Wilms tumor management assessed in the survey. The independent variable was any prior pediatric radiotherapy exposure during medical training (coded yes/no). Chi-square, Fisher's Exact test, multivariable linear regression, and ordinal logistic regression were used to analyze associations, adjusting for provider type, previous training, and clinical setting characteristics. Stata v. 18.5 was used for all statistical analyses with significance set at p ≤ 0.05. RESULTS: Of the cohort, 76.86% had no prior pediatric radiotherapy training, and 23.14% did. Confidence levels varied significantly between groups: among those without training, 34.77% reported low or no confidence, 50.54% moderate, and 14.70% high confidence; while those with training reported 7.14%, 50.00%, and 42.86%, low, moderate, and high confidence levels respectively (p < 0.001). In the primary adjusted model, any prior pediatric radiotherapy teaching during training was associated with a significantly higher composite confidence score (coefficient 2.60; 95% CI 1.51-3.69; p < 0.001). Secondary analysis confirmed increased odds of high confidence (OR 1.28; 95% CI 0.69-1.87; p < 0.001). CONCLUSION: Pediatric radiotherapy inclusion in basic medical training was significantly associated with higher provider confidence levels in managing Wilms tumor. These findings support the potential for integrated pediatric radiotherapy training into standard oncology programs in resource-limited settings to enhance provider preparedness and improve pediatric cancer care.