As the demand in cancer care continues to increase, health systems require a workforce of highly educated specialists and generalists to provide continuity of care across settings.
Led by de Souza Institute in Canada, an interdisciplinary working group was formed to develop a competency framework with relevance across regulated health professionals involved in cancer care.
The working group was presented with results from a scoping review of national and international guidelines, standards, and competencies in oncology, as well as data from needs assessments on continuing education opportunities and oncology topics most relevant to clinicians. Fifty-one professionals from, e.g., family medicine, pharmacy, social work, psychology, occupational therapy, and nursing participated in seven focus groups. An additional 32 nurses participated in a nursing-specific needs assessment survey. Using modified Delphi technique, working group members conducted three iterative rounds to review data and built consensus on competency items in relation to three levels of expertise, from early learner/novice practitioner, advancing practitioner, to expert practitioner.
A final consensus was reached for the selection of competencies that reflect optimal cancer care mapped into three levels of expertise, as well as knowledge, skills, and attitudes expected of each level. Examples for the competency for early learner/novice practitioner include the following: Have awareness of common ethical issues in cancer care (knowledge); demonstrate ability to discuss, educate, and counsel patients and their support persons(s) regarding preferences (skills); and appreciate the impact of culture, the sensitivity, and diversity of attitudes in relation to cancer (attitude). Expert practitioner examples include: recognition of need for, and ability to advocate for challenges involving equity and access in order to improve health outcomes (skill) and awareness of workplace complexities, such as provider roles, team functioning, and organizational environments affecting patient-practitioner relationships (attitude).
The de Souza Interprofessional practice cancer competency framework provides a set of shared competencies and a novice to expert pathway for clinicians across disciplines and supports a more standardized learning and comprehensive approach in organizing professional development towards a coordinated, high quality, and person-centered care.
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International Agency for Research on Cancer. All Cancers: World Health Organization; 2018 [cited 2018]. Globocan 2018:[Available from: http://gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf
Dizon DS, Krilov L, Cohen E, Gangadhar T, Ganz PA, Hensing TA, Hunger S, Krishnamurthi SS, Lassman AB, Markham MJ, Mayer E, Neuss M, Pal SK, Richardson LC, Schilsky R, Schwartz GK, Spriggs DR, Villalona-Calero MA, Villani G, Masters G (2016) Clinical Cancer advances 2016: annual report on Progress against Cancer from the American Society of Clinical Oncology. J Clin Oncol 34(9):987–1011. https://doi.org/10.1200/JCO.2015.65.8427
Canadian Partnership Against Cancer. Living with cancer: a report on the patient experience Toronto, Ontario2018. Available from: http://www.systemperformance.ca/report/living-with-cancer-patient-experience/?utm_source=referral&utm_medium=corp-press-release&utm_campaign=patience-experience
Katz SJ, Belkora J, Elwyn G (2014) Shared decision making for treatment of cancer: challenges and opportunities. J Oncol Pract 10(3):206–208. https://doi.org/10.1200/JOP.2014.001434
Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 376(9756):1923–1958. https://doi.org/10.1016/S0140-6736(10)61854-5
Ferrell BR, Winn R (2006) Medical and nursing education and training opportunities to improve survivorship care. J Clin Oncol 24(32):5142–5148. https://doi.org/10.1200/jco.2006.06.0970
Centre for Interprofessional Education. Interprofessional Education Curriculum: University of Toronto; 2018. Available from: https://ipe.utoronto.ca/interprofessional-education-curriculum
Potter R, Eriksen JG, Beavis AW, Coffey M, Verfaillie C, Leer JW et al (2012) Competencies in radiation oncology: a new approach for education and training of professionals for radiotherapy and oncology in Europe. Radiother Oncol 103(1):1–4. https://doi.org/10.1016/j.radonc.2012.03.006
Institute of Medicine (2011) The future of nursing: leading change, advancing health. The National Academies Press
Institute of Medicine (2010) Redesigning continuing education in the health professions. The National Academies Press
Campbell C, Silver I, Sherbino J, Cate OT, Holmboe ES (2010) Competency-based continuing professional development. Med Teach 32(8):657–662. https://doi.org/10.3109/0142159X.2010.500708
Bachelor M (2015) Professional development of continuing higher education unit leaders: a need for a competency-based approach. J Contin High Educ 63:12
Lockyer J, Bursey F, Richardson D, Frank JR, Snell L, Campbell C, on behalf of the ICBME Collaborators (2017) Competency-based medical education and continuing professional development: a conceptualization for change. Med Teach 39(6):617–622. https://doi.org/10.1080/0142159X.2017.1315064
Cicutto L, Gleason M, Haas-Howard C, Jenkins-Nygren L, Labonde S, Patrick K (2017) Competency-based framework and continuing education for preparing a skilled school health workforce for asthma care: the Colorado experience. J Sch Nurs 33(4):277–284. https://doi.org/10.1177/1059840516675931
Gruppen LD, Mangrulkar RS, Kolars JC (2012) The promise of competency-based education in the health professions for improving global health. Hum Resour Health 10:43. https://doi.org/10.1186/1478-4491-10-43
Miller GE (1990) The assessment of clinical skills/competence/performance. Acad Med 65(9 Suppl):S63–S67
Carrington C, Weir J, Smith P (2011) The development of a competency framework for pharmacists providing cancer services. J Oncol Pharm Pract 17(3):168–178. https://doi.org/10.1177/1078155210365582
Frank JR, Snell L, Sherbino J (2015) CanMEDS 2015 Physician competency framework. Royal College of Physicians and Surgeons of Canada, Ottawa
Beach MC, Price EG, Gary TL, Robinson KA, Gozu A, Palacio A, Smarth C, Jenckes MW, Feuerstein C, Bass EB, Powe NR, Cooper LA (2005) Cultural competence: a systematic review of health care provider educational interventions. Med Care 43(4):356–373
Jongen C, McCalman J, Bainbridge R (2018) Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res 18(1):232. https://doi.org/10.1186/s12913-018-3001-5
Lie DA, Lee-Rey E, Gomez A, Bereknyei S, Braddock CH, 3rd. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Intern Med 2011;26(3):317–325. doi: https://doi.org/10.1007/s11606-010-1529-0.
Goldman J, Kitto S, Reeves S (2018) Examining the implementation of collaborative competencies in a critical care setting: key challenges for enacting competency-based education. J Interprofessional Care 32(4):407–415. https://doi.org/10.1080/13561820.2017.1401987
Young T, Rohwer A, Volmink J, Clarke M (2014) What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 9(1):e86706. https://doi.org/10.1371/journal.pone.0086706
Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z et al (2012) Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 12:80. https://doi.org/10.1186/1471-2458-12-80
McLeod D, Esplen MJ, Wong J, Hack TF, Fillion L, Howell D, Fitch M, Dufresne J (2018) Enhancing clinical practice in the management of distress: the therapeutic practices for distress management (TPDM) project. Psychooncology. 27(9):2289–2295. https://doi.org/10.1002/pon.4831
Morcke AM, Dornan T, Eika B (2013) Outcome (competency) based education: an exploration of its origins, theoretical basis, and empirical evidence. Adv Health Sci Educ Theory Pract 18(4):851–863. https://doi.org/10.1007/s10459-012-9405-9
Carney PA, Palmer RT, Fuqua Miller M, Thayer EK, Estroff SE, Litzelman DK, Biagioli FE, Teal CR, Lambros A, Hatt WJ, Satterfield JM (2016) Tools to assess behavioral and social science competencies in medical education: a systematic review. Acad Med 91(5):730–742. https://doi.org/10.1097/ACM.0000000000001090
Thomas A, Saroyan A, Dauphinee WD (2011) Evidence-based practice: a review of theoretical assumptions and effectiveness of teaching and assessment interventions in health professions. Adv Health Sci Educ Theory Pract. 16(2):253–276. https://doi.org/10.1007/s10459-010-9251-6
Ferrell BR, Twaddle ML, Melnick A, Meier DE (2018) National Consensus Project Clinical Practice Guidelines for quality palliative care guidelines, 4th edition. J Palliat Med 21:1684–1689. https://doi.org/10.1089/jpm.2018.0431
Smith AP, Lichtveld MY, Miner KR, Tyus SL, Gase LN (2009) A competency-based approach to expanding the cancer care workforce: proof of concept. Medsurg Nurs 18(1):38–49 quiz 50
Committee on psychosocial services to Cancer patients/families in a community setting. Cancer Care for the Whole Patient: meeting psychosocial health needs. Concensus report. Institute of Medicine, 2007
Howell D, Keshavarz H, Esplen MJ, Hack T, Hamel M, Howes J et al (2015) Pan-Canadian practice guideline: screening, assessment and management of psychosocial distress, depression and anxiety in adults with cancer. Canadian Association of Psychosocial Oncology and Canadian Partnership Against Cancer, Toronto
Mackenzie G, Rennie H, Shearer E. Psychosocial oncology core competencies: BC Cancer; 2018
Aranda S, Yates P (2009) A national professional development framework for cancer nursing. The National Cancer Nursing Education Project (EdCaN), Cancer Australia, Canberra
Supportive Cancer Care Victoria. Framework for Professional Competency in the Provision of Supportive Care. Victoria: Supportive Cancer Care Victoria, 2011
Raiji P (2007) Competencies of the psycho-oncologist. University at Buffalo, the State University fo, New York
Zebrack B, Walsh K, Burg MA, Maramaldi P, Lim JW (2008) Oncology social worker competencies and implications for education and training. Soc Work Health Care 47(4):355–375. https://doi.org/10.1080/00981380802173954
Canadian Association of Nurses in Oncology. Practice standards and competencies for the specialized oncology nurse Canadian Association of Nurses in oncology, 2006
Jenkins J, Blitzer M, Boehm K, Feetham S, Gettig E, Johnson A, Lapham EV, Patenaude AF, Reynolds PP, Guttmacher AE (2001) Recommendations of core competencies in genetics essential for all health professionals. Genet Med 3:155–159. https://doi.org/10.1097/00125817-200103000-00011
College of Medical Radiation Technologists of Ontario (2018) Standards of practice. College of Medical Radiation Technologists of Ontario, Toronto
Keeney S, McKenna H, Hasson F (2011) The Delphi technique in nursing and Health Research. Wiley-Blackwell
Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32(4):1008–1015
Green B, Jones M, Hughes D, Williams A (1999) Applying the Delphi technique in a study of GPs' information requirements. Health Social Care Community 7(3):198–205
Esplen MJ, Wong J, Green E, Richards J, Li J (2018) Building a high quality oncology nursing workforce through lifelong learning: the De Souza model. Int J Nurs Educ Scholarsh 15(1). https://doi.org/10.1515/ijnes-2016-0079
We would like to acknowledge contributions by all external experts and stakeholders who reviewed the framework; and to physicians in the working group Dr. Pamela Catton, Dr. Kim Miller, and Dr. Caroline Gerin-Lajoie.
Funding was provided by the Ontario Ministry of Health and Long term Care.
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Relevance: The manuscript describes an interprofessional practice cancer competency framework that supports person-centered oncology care across disciplines. It is therefore relevant to policy and/or programs.
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Esplen, M.J., Hunter, J., Maheu, C. et al. de Souza interprofessional practice cancer competency framework. Support Care Cancer 28, 797–808 (2020). https://doi.org/10.1007/s00520-019-04823-z
- Interprofessional practice
- Competencies and standards
- Educational framework
- Quality of care