Patient-centered interprofessional education in cancer care: a systematic scoping review | BMC Medical Education

The study selection process is illustrated in a PRISMA flow chart (Fig. 1) as suggested by Page et al. [27], including the exact numbers of studies screened and stepwise excluded at every stage of the review process, with the respective reasons for exclusion. The search in scientific databases and registers yielded a total of 5,908 identified records, with 2,520 duplicates removed before the initial screening. The 3,388 records left were screened for titles and abstracts. This initial screening led to 3,353 records being excluded from the review. These publications were either the wrong publication type or of non-educational, non-cancer-specific, non-interprofessional, or non-patient-centered nature. Three of the 35 potentially eligible records could not be retrieved, leading to 32 reports subsequently undergoing full-text screening. During this final screening phase, 25 reports were excluded as some did not focus on postgraduate but on student education, had no focus on cancer care, and thus had the wrong study aim, were the wrong publication type, or did not refer to interprofessional or educational interventions. This final step yielded seven reports from seven different studies for inclusion in the review. Citation searching in the final reports did not result in additional relevant literature, as all potentially eligible references had been included in the initial study identification stage and were excluded later in the screening process. Grey literature was sought online through search engines and personal contacts of the researchers with cancer organizations, yielding 23 online reports that were all assessed for eligibility and excluded due to their non-educational or non-interprofessional nature.

PRISMA flow chart of selection process

Study characteristics

Conducted between 2011 and 2021, all seven studies included in this systematic scoping review were undertaken in the Global North, with most reports stemming from the USA. The overarching aim of all these studies was to enhance interprofessional competencies among healthcare professionals through patient-centered educational interventions.

A common objective among most studies was to improve communication and collaborative skills among healthcare professionals [28,29,30,31,32]. For instance, Starks et al. [32] aimed to enhance advanced patient-centered communication skills and team functioning among palliative care clinicians in the USA, while Papadakos et al. [31] sought to improve healthcare providers’ competence in supporting patients through difficult conversations using a blended simulation-based training program in Canada. Both studies focused on improving interpersonal skills crucial for effective interprofessional practice.

Some studies also share the goal of enhancing interprofessional collaboration through educational interventions. McLeod et al. [29] assessed the impact of a web-based course on interprofessional psychosocial oncology care in Canada, emphasizing the need to foster collaborative attitudes and knowledge among healthcare professionals. Similarly, Blazer et al. [30] evaluated a multimodal course on genetic cancer risk assessment and research collaboration among community-based clinicians in the USA, underscoring the importance of interdisciplinary approaches in oncology care.

Despite these common goals, the studies exhibit differences in subdisciplines and professional populations. For example, Pham et al. [33] in Australia and New Zealand focused on knowledge retention and self-confidence in stereotactic body radiotherapy principles among radiation oncologists, medical physicists, and radiation therapists. This technical focus of treatment application contrasts with the more general communication and collaboration skills targeted by the other studies included in this review. Additionally, Murgu et al. [28] assessed the involvement of an interdisciplinary team in an experiential learning curriculum for non-small cell lung cancer across multiple countries, highlighting a unique curriculum-specific approach.

The methodologies to evaluate outcomes also vary between studies, with most of them solely using quantitative methods to assess knowledge retention, skill acquisition, and self-confidence in their interprofessional collaboration [28, 31, 33, 34]. Aebersold et al. [34] in the USA, for instance, used quantitative methods to develop and pilot a training program for oncology nurses and pharmacists aimed at improving cancer drug safety. In contrast, the smaller number of studies employed mixed methods, integrating qualitative and quantitative data to provide a more comprehensive evaluation of their educational interventions [29, 30, 32].

Sample sizes in the included studies ranged widely, from 24 participants in the study by Starks et al. [32] to 416 participants in the investigation of Murgu et al. [28], reflecting the varied scales of these IPE programs. The professional populations always included a minimum of two types of healthcare providers such as nurses, physicians, pharmacists, social workers, radiation therapists, and medical physicists.

Detailed information on each study can be found in Table 1.

Characteristics of patient-centered IPE curricula

As synthesized from the studies included in this review, the characteristics of patient-centered IPE curricula in cancer care reveal a blend of similarities and differences in their settings, types of interventions, and durations. The interventions were delivered across diverse settings, including community and hospital-based environments [28, 30, 32], web-based platforms [28,29,30,31,32,33,34], and specialized institutions like cancer centers or teaching hospitals [28, 31].

Integrating patient-centered care into IPE

Patient-centeredness was a core focus in these curricula, with various strategies employed to integrate this principle into the educational interventions. Two studies directly addressed patient-centered communication skills, recognizing their pivotal role in effective cancer care [31, 32]. For instance, Starks et al. [32] dedicated a substantial portion of their curriculum to enhancing patient-centered narrative communication skills, empowering clinicians to engage in meaningful conversations with patients and their families. Similarly, Papadakos et al. [31] focused on improving healthcare providers’ competence in supporting patients through difficult conversations, acknowledging the emotional and psychological impact of cancer on individuals.

Furthermore, the emphasis on interprofessional collaboration in the other studies indirectly refers to patient-centered care [28,29,30, 33, 34]. By fostering effective teamwork and communication among healthcare professionals, these programs facilitate a more coordinated and integrated approach to treatment, ensuring that patients’ diverse needs are met. For example, Aebersold et al. [34] aimed to improve the safety and delivery of cancer drug therapies through interprofessional training, eventually benefiting patient safety and treatment outcomes. McLeod et al. [29] focused on interprofessional psychosocial oncology care, recognizing the importance of addressing the psychological and social well-being of cancer patients alongside their medical treatment.

Learning methods

The integration of experiential and simulation-based learning further reinforces the patient-centered approach in some of the IPE programs [28, 31, 32]. Murgu et al. [28] utilized hands-on simulations and case discussions to enhance interdisciplinary collaboration in the context of non-small cell lung cancer treatment. Papadakos et al. [31] employed standardized patient actors to provide realistic scenarios for practicing difficult conversations, fostering empathy and communication skills essential for patient-centered care. Starks et al. [32] incorporated reflective skill practice with simulated and real patients, allowing participants to apply theoretical knowledge in practical scenarios and gain valuable insights into the patient experience.

The duration of the investigated IPE programs varied significantly, from concise, intensive modules to extended, multi-phase courses. Pham et al. [33] offered a short eLearning program to be completed in a few hours, while the program developed by Blazer et al. [30] spanned a total of 14 months, providing sustained and comprehensive professional development opportunities. The core training of Aebersold et al. [34] lasted nine hours, blending short pre-work with an intensive workshop and Starks et al. [32] extended over nine months with a mix of online and in-person sessions. Overall, this diversity in individual program durations reflects the flexibility in designing patient-centered IPE interventions to meet different educational needs and time constraints of healthcare professionals.

Characteristics of patient-centered IPE evaluation strategies

In terms of the strategies utilized to evaluate the implemented patient-centered IPE curricula across the included studies, a prevalent theme is the use of established evaluation frameworks, such as the models by Kirkpatrick & Kirkpatrick [35] or Moore et al. [36] to assess multiple levels of outcomes. These frameworks typically encompass participant satisfaction, knowledge acquisition, competence, and behavior change, reflecting a comprehensive approach to evaluating educational interventions.

Importance of patients’ and learners’ perspectives

Several included studies went beyond these traditional frameworks to incorporate patient-centered evaluation strategies [31, 32, 34]. Starks et al. [32] included patient feedback in their assessment, recognizing the importance of capturing the patient’s perspective on the effectiveness of their IPE program. Similarly, Papadakos et al. [31] assessed participants’ self-perceived competence in handling difficult conversations, a crucial skill for patient-centered communication. Aebersold et al. [34] also incorporated a patient-centered aspect in their evaluation by assessing participants’ confidence in managing drug therapy care, a critical component of patient safety and well-being. These additional measures highlight a growing recognition of the need to evaluate IPE programs not only from the perspective of healthcare professionals but also from the viewpoint of the patients they serve.

Assessing patient-centered IPE with established frameworks

In their studies, Aebersold et al. [34] and McLeod et al. [29] employed Kirkpatrick’s framework, focusing on participant reactions, learning outcomes, and behavioral changes [35]. Aebersold et al. [34] measured participant satisfaction through a five-point Likert scale and assessed knowledge through pre- and post-course tests, alongside self-confidence surveys. They also evaluated behavior change by following up with participants three months post-workshop to see if practice changes were implemented after course completion. Similarly, McLeod et al. [29] utilized pre- and post-course surveys to measure changes in knowledge, attitudes, and beliefs about interprofessional psychosocial oncology care, supplemented by qualitative feedback on learning outcomes and intended practice changes.

In contrast, Blazer et al. [30] and Murgu et al. [28] followed the outcome levels outlined by Moore et al. [36], which include participation (level 1), satisfaction (level 2), declarative knowledge (level 3 A) and procedural knowledge (level 3B), competence (level 4), and performance (level 5). Blazer et al. [30] adapted this framework by conducting extensive data collection, including knowledge tests (levels 3 A and 3B), professional self-efficacy surveys (level 4), case-based skills scenarios (level 4), practice and professional development surveys (level 5), as well as continuous activity tracking (level 5). This modified approach allowed for a detailed assessment of the intervention’s impact on knowledge, skills, and interprofessional practice over time. Murgu et al. [28] similarly used a combination of pre-post-tests, program evaluations, and long-term surveys to measure knowledge and skill improvement, participant competency, and changes in clinical practice, using multiple-choice questions and faculty evaluations to gather data on learner outcomes.

Confidence and skill evaluation

Confidence evaluation was a key component in the studies by Pham et al. [33] and Papadakos et al. [31]. Pham et al. [33] assessed knowledge retention and confidence through pre- and post-module tests, with a follow-up knowledge test four weeks later to gauge long-term retention. Healthcare professionals’ confidence to apply knowledge into their own clinical practice was measured on a self-assessment Likert scale before and after each module. On the other hand, Papadakos et al. [31] focused on communication skills, using a needs assessment survey and competency ratings to evaluate self-efficacy, task value, and goal orientation before and after their intervention. This approach provided insights into the participants’ perceived competence and their intention to apply the learned interprofessional skills in practice.

Lastly, Starks et al. [32] evaluated domains such as narrative and patient-centered communication, interprofessional team practice, and team skills. Their evaluation process included online surveys on content relevance and quality, open-ended comments on skill practice, self-assessment questionnaires on skill mastery, and learning self-efficacy questions. Participants also provided specific examples of how they applied learned skills in clinical practice, offering qualitative insights into the practical impact of the training.

Impact of patient-centered IPE curricula

Across the included studies, common themes regarding the IPE programs’ effectiveness revolve around notable improvements in knowledge, confidence, and practical skills among healthcare professionals—outcomes reflecting the effectiveness of patient-centered IPE interventions in fostering interprofessional collaboration and enhancing clinical competencies.

Enhanced knowledge

Participants in most of the included studies demonstrated marked increases in knowledge, particularly in areas outside their primary expertise and with improvements often retained over the long term [28, 30, 32,33,34]. For example, Aebersold et al. [34] reported substantial knowledge gains alongside high overall program satisfaction, while Pham et al. [33] showed an average test score improvement of 14% maintained weeks after completing the modules, underscoring the effectiveness of these curricula in enhancing participants’ understanding of cancer-specific topics, especially in areas outside of their occupational scope.

Enhanced confidence

Another common outcome is the general increase in confidence among participants. Several studies reported significant boosts in self-confidence and self-efficacy related to clinical tasks and interprofessional communication [31, 33, 34]. In this regard, Aebersold et al. [34] observed significant increases in confidence to meet program objectives, and Papadakos et al. [31] found a notable rise in participants’ self-perceived competence in handling difficult conversations with patients. This increase in confidence is crucial for translating knowledge into effective patient-centered practice, as it encourages healthcare professionals to apply new (interprofessional) skills in their clinical settings.

Practice and policy changes

Implementing IPE curricula also led to concrete changes in clinical practice and policies. Aebersold et al. [34] found that 60% of participants reported making at least one clinical practice or institutional policy change three months post-workshop, suggesting that patient-centered IPE can catalyze broader improvements in cancer care delivery. Similarly, Blazer et al. [30] observed significant enhancements in genetic cancer risk assessment services and increased patient participation in research studies after concluding their program. These changes indicate that patient-centered IPE programs can have a lasting impact, extending beyond individual skills to influence organizational practices and patient involvement in their own care.

Adaptability of patient-centered IPE to diverse settings

While the included studies share many similarities in their positive outcomes, some differences exist in their key areas and the extent of their impacts. For instance, McLeod et al. [29] highlighted the role of web-based learning in improving attitudes and beliefs about interprofessional psychosocial oncology care, suggesting that the mode of delivery can effectively broaden participants’ perspectives and foster collaboration between healthcare providers. In contrast, Murgu et al. [28] emphasized the impact of experiential learning through the GAIN 3.0 program, which significantly improved interdisciplinary communication and team-based approaches to patient care. This indicates that different educational approaches influence specific outcomes, with variations in the competencies targeted by different curricula. Also, while Starks et al. [32] focused on enhancing narrative communication skills, interprofessional team practice, and systems integration in palliative care, Papadakos et al. [31] concentrated on improving communication techniques for handling difficult conversations. These differences reflect the beneficial nature of patient-centered IPE interventions that can be tailored to address specific educational needs within different subfields of cancer care.