# Evaluation of task sharing as a workforce optimization strategy in pediatric oncology

## TL;DR

This study evaluates how task sharing is used to address the shortage of pediatric oncologists in Pakistan, showing the roles and responsibilities of task-sharing physicians in cancer care.

## Contribution

The study provides a detailed evaluation of task-sharing models and responsibilities in pediatric oncology in a low- and middle-income country.

## Key findings

- Task-sharing physicians (TSPs) perform a wide range of clinical duties, including chemotherapy orders and procedures like lumbar punctures.
- TSPs can participate in diagnosis and treatment planning under supervision, with varying levels of autonomy across centers.
- TSPs are essential in providing continuous care, including inpatient, outpatient, and emergency coverage in pediatric oncology.

## Abstract

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.