Advances in pediatric cancer treatment have led to significant improvements in survival rates, where 5-year survival now exceeds 85%. Despite improved survival, children and adolescents who survive cancer often face significant short- and long-term psychosocial and physical late effects. Children undergoing cancer treatment often experience prolonged school absence, which disrupts their academic development and impedes critical socio-emotional growth during formative school years, with lasting consequences into adulthood. Together, these challenges underscore the need for targeted interventions that support educational continuity, promote school activity, and foster psychosocial well-being.
The SchoolCare Intervention aims to reduce school absence experienced by children diagnosed with cancer during their treatment trajectory. The intervention introduces school navigation support in combination with the use of telepresence robots (TPRs) and a teleteaching program. TPRs enable the children to attend school remotely, when they are not able to attend physically. The study is designed to investigate the effectiveness of the intervention throughout a period of eight months for school-aged children (i.e., 5-17 years) who are diagnosed with cancer. The investigators hypothesize that telepresence robots will increase school attendance among children and adolescents diagnosed with cancer, representing our primary outcome (H1). Additionally, the investigators explore secondary outcomes by hypothesizing that the intervention will improve the social well-being of these children and adolescents (H2) and enhance their academic level (H3). By focusing on both school attendance and broader psychosocial and academic effects, this study will provide a comprehensive evaluation of the telepresence robot intervention and its potential to support educational continuity and well-being for children with cancer.
None
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Parallel
Telepresence robot
DeviceChildren in arm A will receive a telepresence robot (either AV1 or BEAM). The children are able to attend their schooling environment through telepresence robots operated via an App installed on a provided study-tablet. Each participant is provided an tablet. AV1 is a compact unit designed to sit on the student's desk in the classroom. It enables real-time, one-way video transmission with zoom functionality combined with two-way audio communication, and allows the user to remotely adjust the robot's orientation, including full rotation and vertical head movement. The second device, BEAM, is a larger, mobile robot positioned on the classroom floor, capable of moving independently within the room at a controlled speed of up to 5 km/h. It offers real-time two-way audio and video interaction via an integrated 10-inch screen with zoom functionality.
School Navigator
Other interventionAs part of the SchoolCare intervention, the investigators will hire two professionals with formal education and experience within the school system into roles of school navigators. The primary purpose of the school navigators is to ensure continuous education and to maintain a connection to the schooling environment for children and adolescents diagnosed with cancer. To achieve this, the school navigator will (1) establish contact with the school (teachers and principal) along with the child's first hospital discharge; (2) verify the existence of a learning plan, and if absent, assist the school principal in developing and monitoring an appropriate plan for the child; (3) facilitate ongoing communication with parents through monthly calls throughout the eight-month intervention period; (4) organize a transition meeting at the end of the intervention; and (5) identify barriers and facilitators encountered throughout the intervention period.
Teleteaching and technical support
Other interventionThe school navigator will facilitate a teleteaching program consisting of three components: (1) introduce the robot to parents, school teachers, school principals, and classmates, (2) conduct a teleteaching class where classmates will get hands-on experience with the robot, and (3) provide technical support during the intervention.
School Attendance
School attendance is measured as the percentage of days attended out of the total number of possible school days. School navigators are instructed to assess school attendance at regular monthly intervals. At each time-point, the school navigator will ask about school attendance during the previous week (at the school of origin, hospital school, or teacher-led homeschooling). If a scheduled monthly assessment coincides with periods when the child is on holiday or hospitalized, the assessment will be conducted during one of the adjacent school weeks (i.e., the week before or the week after). This adjustment applies only if the child misses more than two school days during the assessment week. Holidays and periods of hospitalization are considered legitimate absences and will be accounted for in the calculation of the total number of possible school days. To be included in the analysis, a minimum registration of 25 possible schooldays is required per child.
Social Well-Being
Children's social well-being will be assessed using the Danish version of the Strengths and Difficulties Questionnaire (SDQ). The Strengths and Difficulties Questionnaire (SDQ) is a validated tool used to assess social, emotional, and behavioral functioning in children and adolescents. The questionnaire consists of 25 items rated on a three-point scale ranging from "not true" to "certainly true." Responses are grouped into five domains: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Reporting and scoring will be performed according to the official SDQ guidelines.
Academic Level
Children's academic level will be assessed using a 5-point \[1; 5\] Likert-scale capturing self-reported overall academic performance as well as subject-specific performance in Danish and mathematics. To enhance the validity of the assessment, children's self-reports will be triangulated with corresponding evaluations provided by parents and teachers, allowing for a more comprehensive estimation of the child's academic level. A high value indicates a high academic level, and vice versa.
School Well-Being
School well-being will be measured with questions about school environment, classmates, and teachers (e.g., "Are you \[the participants\] happy to go to your school?"; "Are you \[the participants\] happy with your class?"; "Do you \[the participants\] feel lonely at school?"; "I \[the participants\] feel that I belong at my school"). The questions all have outcomes within a 5-point Likert scale \[1; 5\], with total agreement of the statement and total disagreement at each end of the scale.
Self Efficacy
Academic self-efficacy. To support the assessment of academic level, children's self-efficacy will be measured using items adapted from the Health Behaviour in School-Aged Children (HBSC) international questionnaire (HBSC International Network, 2023). Two items will be used (i.e., "How often can you \[the participants\] find a solution to problems in class if you try hard enough?"; "How often can you \[the participants\] succeed at what you set out to do in class?"). Responses will be recorded according to the HBSC Likert-scale guidelines.
Robot-use
Datalogs from the telepresence robots will be collected to capture patterns of use, including log-on attempts, session duration, connection failures, and interaction behaviors. This provides insight into how children engage with the technology in real-world school settings. These results will be analyzed exploratory.
Qualitative evaluation of the interventions
Following the intervention, semi-structured interviews will be conducted with a subset of children diagnosed with cancer, their parents, teachers, and school navigators. The interviews will explore experiences related to school attendance, social well-being, academic level, telepresence robot use, school navigation, and classroom contexts, providing in-depth insights to complement the quantitative outcomes. Participant observation will be conducted to explore how the classroom environment and interactions are shaped by the presence of a telepresence robot. The investigators will conduct observations in the classroom settings at the actual schools the children attend.
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Rigshospitalet, Denmark
Lead sponsor
Aarhus University Hospital
Collaborator
Aalborg University Hospital
Collaborator
