de Souza interprofessional practice cancer competency framework
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.
KeywordsOncology Interprofessional practice Competencies and standards Educational framework Quality of care
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The authors have full control of all primary data and agree to allow the journal to review their data if requested.
- 1.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
- 2.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 CrossRefGoogle Scholar
- 3.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
- 5.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 CrossRefGoogle Scholar
- 7.Centre for Interprofessional Education. Interprofessional Education Curriculum: University of Toronto; 2018. Available from: https://ipe.utoronto.ca/interprofessional-education-curriculum
- 8.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 CrossRefGoogle Scholar
- 9.Institute of Medicine (2011) The future of nursing: leading change, advancing health. The National Academies PressGoogle Scholar
- 10.Institute of Medicine (2010) Redesigning continuing education in the health professions. The National Academies PressGoogle Scholar
- 12.Bachelor M (2015) Professional development of continuing higher education unit leaders: a need for a competency-based approach. J Contin High Educ 63:12Google Scholar
- 13.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 CrossRefGoogle Scholar
- 14.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 CrossRefGoogle Scholar
- 18.Frank JR, Snell L, Sherbino J (2015) CanMEDS 2015 Physician competency framework. Royal College of Physicians and Surgeons of Canada, OttawaGoogle Scholar
- 21.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.
- 27.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 CrossRefGoogle Scholar
- 30.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 50Google Scholar
- 31.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, 2007Google Scholar
- 32.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, TorontoGoogle Scholar
- 33.Mackenzie G, Rennie H, Shearer E. Psychosocial oncology core competencies: BC Cancer; 2018Google Scholar
- 34.Aranda S, Yates P (2009) A national professional development framework for cancer nursing. The National Cancer Nursing Education Project (EdCaN), Cancer Australia, CanberraGoogle Scholar
- 35.Supportive Cancer Care Victoria. Framework for Professional Competency in the Provision of Supportive Care. Victoria: Supportive Cancer Care Victoria, 2011Google Scholar
- 36.Raiji P (2007) Competencies of the psycho-oncologist. University at Buffalo, the State University fo, New YorkGoogle Scholar
- 38.Canadian Association of Nurses in Oncology. Practice standards and competencies for the specialized oncology nurse Canadian Association of Nurses in oncology, 2006Google Scholar
- 39.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 CrossRefGoogle Scholar
- 40.College of Medical Radiation Technologists of Ontario (2018) Standards of practice. College of Medical Radiation Technologists of Ontario, TorontoGoogle Scholar
- 41.Keeney S, McKenna H, Hasson F (2011) The Delphi technique in nursing and Health Research. Wiley-BlackwellGoogle Scholar
- 42.Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32(4):1008–1015Google Scholar
- 44.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