Interprofessional education in cancer care – a scoping review – BMC Medical Education

Characteristics of the studies

A total of 28 studies were identified through database searching, of which one study was identified by reviewing reference lists (Fig. 1). There were fourteen quantitative studies, four reviews, six mixed methods studies and four qualitative studies (Table 1). The articles reported interprofessional educational programmes in United States (n = 15), Canada (n = 7), United Kingdom (n = 3), Denmark (n = 1), Germany (n = 1) and Switzerland (n = 1). Articles were published between 2012 and 2022. Nineteen of the articles were published in the last five years. From the included papers eight focused on describing the need and competences of oncology healthcare professionals [3, 4, 6, 9, 32,33,34,35], three reviewed existing IPE [1, 36, 37] or the development and evaluation (n = 17) of oncology interprofessional training [2, 5, 16, 22, 26, 38,39,40,41,42,43,44,45,46,47,48,49]. The target groups of the IPE included nurses, pharmacists, physicians (medical oncology, surgical oncology, radiation oncology and palliative care), radiographers, technicians and staff with healthcare backgrounds such as psychology, occupational therapy and other support workers (such as social workers, chaplaincy, or administration staff in contact with oncology patients).

Collaborative care in cancer

In oncology, medical, nursing and allied health professionals provide complex care in an interprofessional context [33, 37, 41, 45]. To provide the best treatment and care for people with cancer, healthcare professionals are required to collaborate [1, 37]. According to Head et al. (2022) interprofessional collaborative practice is an essential component of quality healthcare in oncology [42]. Effective interprofessional care was seen as necessary to provide optimal care for patients [16], improve the safety of care delivery [38] and better outcomes of patient care [16, 32, 38].

Terminology

Eight of the papers [3, 6, 26, 32, 34, 35, 37, 44] reported using the concept of IPE or IPL with reference to existing definition in literature. One study used the concept of “Interprofessional clinical training “ [38], one “Interdisciplinary education and training”, and one “Multidisciplinary education and training” [49], however no definition of these concepts were provided [36]. None used the concept of ‘inter-specialty or interspecialty education or training’. Nine of the included papers had some concepts described but did not include clear definitions and eleven had no mention or definition of IPE or IPL. (Appendix Table).

The concept of interprofessional education (IPE) can be seen as a means to improve health system function and delivery of care [34]. In order to achieve positive transformations in healthcare delivery, healthcare professionals (HCPs) must develop skills in interprofessional collaborative practice [42]. The principles of IPE should be embedded into every aspect of programs [36]. IPE would ideally result in greater understanding and improved communication between disciplines and professions [22, 32, 36], improved coordination [32, 36, 39], enhance team-based care management [32] and optimize more culturally affirming care [46]. Desired outcomes from IPE include also articulating one’s professional role as well as those of other professions, mutual respect, trust and willingness to collaborate [5].

Competency domains

In the field of oncology, increasing and building on a set of foundational knowledge, skills, and attitudes within physical, psychological, social/cultural, and spiritual domains, and collaborating with other HCPs, an early learner/novice practitioner will move towards an identity as an expert interprofessional practitioner. A competence framework on the shared set of competencies can bring professionals together, while recognizing the individuality of each profession as possessing distinct and complementary skills [9].

Of the papers describing competence framework development for interprofessional education, one focused on finding consensus on shared interprofessional competences in oncology [9], one on teamwork competences [32], one on integrative oncology [35], one on communication skills [36], one on cultural competence [46], two on paediatric oncology [1, 37], one on palliative care in oncology [42], two on psychosocial training needs in oncology [4, 33] and three papers described the specific needs of radiation oncology professionals [3, 6, 34]. Development of frameworks considered the challenges to effective coordination and the impact on patient and clinical outcomes as essential to optimal, high-quality care [32].

Four of the papers reported development competences for IPE. The development process was informed by guidance from an expert advisory panel with a Delphi study based on a literature review in two of the studies [9, 35]. Both Esplen and colleagues [9] and Wells-Di Gregorio and colleagues [33] started from domains proposed by an expert subgroup, Esplen and colleagues [9] incorporating also focus group interviews. In the Warsi et al. (2022) study the focus group was used to determine intervention objectives [49]. The expert panels all involved oncology professionals, and one [35] included patient and public representatives. All included shared competences divided into the domains of knowledge, skills and attitudes.

Participants

Target groups included in six of ten studies multidisciplinary professionals working in general oncology [16, 38, 39, 45,46,47], four in radiation oncology [2, 22, 26, 44], one in gynaecology-oncology [43], one in paediatrics [48] and four in different departments within the hospital or in primary care [5, 40, 41, 49]. Focus on the programmes varied. Thus, interprofessional collaboration and practice in general was included in the learning goals of the IPE in six papers [3, 6, 9, 25, 35], communication in five papers [9, 16, 26, 35, 39] and teamwork in [2, 3, 22, 26, 39, 46] representing the main areas of interest of IPE in the cancer care setting.

Five studies described existing IPE education [6, 36, 37, 42, 46], while two focused on paediatric oncology [1, 37] and one on interdisciplinary education [36]. Three of the studies used literature reviews to identify IPE [1, 37, 49] and one [36] got the information from a survey carried out by oncology physicians from different specialties.

Teaching methods

Teaching methods varied in methods and usefulness and included face-to-face and web-based didactic content such as lectures, workshops, educational sessions, role play and reflections. Three papers concluded that there is a lack of interdisciplinary education in oncology and also highlighted the value of IPE to professionals. (Table 2). Teaching varied in time from a one hour-long discussion group session accompanied by online modules [48] to a year-long course [44]. The mode of delivery also varied including simulated cases and scenarios (n = 5) [2, 16, 22, 26, 40] some specified having standardized patients [2, 16] and others were cases discussed and developed in teams [22, 26, 40] and/or by use of self-reflection [16]. Five of the studies included e-learning modules [5, 16, 38, 41, 48] alone [38, 41] or in combination with face-to-face training [5, 16, 48]; in the case of the other nine, all the training was face-to-face [2, 22, 26, 38, 40, 43,44,45, 47] All but one of the studies were focused on learners. One exception was based on a train-the-trainer model [39].

Evaluation

Of the 18 papers which described the evaluation of IPE programme (Table 3), 11 described also the development process [5, 22, 26, 38,39,40,41, 44, 46, 48, 49].

In the evaluation of education programmes, ten used pre- and post-programme evaluation methods [5, 16, 22, 26, 38, 40, 41, 45, 47, 48], two had mixed methods with observation and surveys [2, 39], one used qualitative evaluation with semi-structured interviews [45] and one compared the professionals participating with participants from other education activities [44]. General feedback surveys with participant satisfaction were the most common programme evaluation surveys developed for the studies.

Studies included samples of between four [44] and 1,138 participants [41]. Three of the studies included three-month follow-ups [38, 43, 48] and three studies, six-month evaluation follow-ups [43, 48, 49] indicating that gained intervention outcomes were sustained in the long term.

The following instruments were used to evaluate the impact of the IPE: (i) Readiness for Interprofessional Learning Scale [3, 22, 26], (ii) UWE Entry Level Interprofessional Questionnaire [22], (iii) Trainee Test of Team Dynamics and Collaborative Behaviours Scale (CBS) [22], (iv) Assessment of Cultural Competence using the Intercultural Development Inventory [40], (v) Frommelt Attitudes Toward Caring of the Dying [40], (vi) Attitudes Toward Health-Care Teams Scale [3], (vii) Attitudes Toward Interdisciplinary Learning Scale [3], (viii) Self-Efficacy for Interprofessional Experiential Learning Scale and End-of-Life Professional Caregiver Survey [1], (ix) Cultural Competency Assessment (CCA), Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS), (x) Interprofessional Socialization and Valuing Scale (ISVS) [46].

Other studies included in the review describe Delphi methods [9] and focus group interviews [4, 6, 9, 33, 39, 45] and instruments developed for the purpose of the study [5, 38, 39, 43].

Participants had positive reactions to the programmes indicating them as a promising strategy in improving cancer care [38]. They reported high levels of satisfaction [26], including improved relations within the team [22], the acquisition of new skills [41] as well as cross-cultural competence [40]. Confidence among the participants also increased [41]. Participants reported that they would highly recommend these programmes to their colleagues [2].

Participants considered that these educational events were valuable. They helped in areas such as consolidating communication, improving dialogue [5], valuing leadership [42, 44] and better understanding of spiritual needs [48]. These programmes also improved understanding of specific issues such as the effects of therapy on patients, the place of palliative care, management of pain and other symptoms and quality of life [47] and also a comprehension of the legal issues surrounding cancer [43].

There was statistically significant improvement in knowledge of teamwork principles [39] developing shared mental models, cross-monitoring situational awareness and effective conflict resolution, agreements about roles and responsibilities [22], and behaviours. Participants valued the opportunity to gain the perspective of other professions, connecting with colleagues from other disciplines practising crisis response in a simulated environment [2], and demonstrating lower levels of concern and anxiety when communicating with other professionals [44]. Some participants incorporated meditation into their daily routine by involving other family members and making it part of a “family routine” [45].

Significant improvement was also noted in increased comfort when discussing survivorship issues with patients. Significant increase in knowledge of survivorship care for five types of cancer, more confidence in ability to explain a Survivorship Care Plan (SCP), and increased comfort in discussing late effects of cancer treatment [47] were all reported. The main challenges were “breaking down the walls and being more comfortable with vulnerability” [45], and in being more open-minded after training [43]. Training increased IPE recognition of participants’ home institutions [42].