Content area
Aim(s)
This study aims to evaluate the impact of simulation-based learning on improving clinical skills, decision-making, confidence and critical thinking among nurses in the oncology setting compared with traditional teaching methods.
Background
The global oncology nursing workforce, estimated at approximately 28 million nurses, remains insufficient to meet the growing demands of cancer care worldwide. Simulation-based training offers a promising approach to enhancing competencies in clinical skills, decision-making and communication for nurses. However, there is limited research on best practices for simulation in oncology nursing.
Design
A systematic review was conducted guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines.
Methods
The search initially found 135 articles, a total of 15 studies met our inclusion criteria and were included in the review
Data sources
PubMed and CINHAL for articles published in English from 1st January 2004–1 st October 2024.
Results
Our findings demonstrated a significant improvement in pain management knowledge, with mean scores rising from 32.15 in the control group to 50.84 in the simulation group. Communication skills training enhanced truth-telling confidence by a mean difference of 16.86, while tele-health simulation increased competence scores, with a mean improvement to 22.64.
Conclusion
Our findings highlight the effectiveness of simulation in improving knowledge, clinical skills and confidence, supporting its integration into nursing education and professional development programs.
1 Introduction
The global oncology nursing workforce, estimated at approximately 28 million nurses, remains insufficient to meet the growing demands of cancer care worldwide ( European Cancer Organisation, 2023). The global rise in cancer cases projected to increase by more than 75 % by 2050 and has further intensified the demand for oncology nurses, compounding existing workforce shortages. Simulation-based training provides a valuable approach to enhancing nurses' competencies in clinical skills, decision-making and communication ( International Nursing Association for Clinical Simulation and Learning INACSL, 2021). In oncology nursing, simulation technology, including virtual reality and computer-based simulations, offers a safe and controlled environment for skill development. These tools enable nurses to practice real-life scenarios, refine problem-solving abilities and build confidence without compromising patient safety. This type of training helps lower mistakes, improve teamwork and better prepare nurses for the challenges of cancer care, leading to safer and more effective management of patients. Oncology nursing requires a robust combination of knowledge, technical skills and professional attitudes. Knowledge encompasses chemotherapy protocols, symptom management and clinical decision-making. Skills include safe handling of cytotoxic agents, effective communication and emergency response. Attitudes involve empathy, ethical responsibility and a commitment to patient-centred care. Collectively, these competencies form the foundation for safe and effective oncology nursing practice.
Nurses play key roles in cancer care, from prevention to survivorship. Nursing errors in oncology care critically challenge patient safety and treatment efficacy. A study revealed that 67 % of oncology nurses reported direct involvement with at least one error in the preceding six months, with the majority occurring during treatment phases and often related to chemotherapy administration ( Waller et al., 2020). Medication administration errors are frequently attributed to factors such as heavy workloads, insufficient staffing and inadequate training, which are prevalent challenges in oncology nursing ( Alotaibi, 2024). Simulation provides a structured, observable environment for assessing clinical competencies, aligning with modern competency-based frameworks such as the NCLEX Next Generation and AACN’s Essentials, which emphasize validated demonstration of knowledge, judgment and decision-making. As a result, simulation-based education has emerged as a promising strategy to enhance the competencies of healthcare professionals using interactive methods to enhance knowledge, skills and confidence. For this review, simulation refers to any structured learning experience that replicates clinical scenarios using educational technologies or actors. This includes standardized patients, high-fidelity mannequins, 3D models and virtual conferencing platforms. Both in-person and virtual simulation, allowing for the evaluation of multiple modalities across diverse settings. Simulation-based education encompasses both in-person simulations, using lifelike mannequins or trained actors to replicate clinical scenarios and virtual simulations (VS), which employ avatars, animations, or videos to recreate clinical encounters. Recent studies have demonstrated that virtual simulations are effective in enhancing nursing students' knowledge, skills and affective learning outcomes ( Tolarba, 2021; Jeon et al., 2020). Developing a simulation-based intervention involves steps like planning, setting objectives, scenario design, briefing and debriefing ( Li et al., 2020).
A recent scoping review highlighted that simulation-based education has led to improved knowledge, skills and satisfaction among nurses and physicians across the cancer care continuum. However, despite these positive outcomes, there remains a lack of comprehensive research on the effectiveness of simulation in oncology education, emphasising the need for more synthesized literature to guide future practice ( Silva et al., 2023).
Despite these positive indications, there is a lack of comprehensive reviews specifically evaluating the effectiveness of simulation learning in oncology nursing. This gap is critical, as oncology nurses face unique challenges requiring specialized training interventions. However, there is limited research on best practices for simulation in oncology nursing. Therefore, we planned to conduct a systematic review of the impact of simulation-based education on oncology nursing, focusing on its effectiveness in improving knowledge, self-confidence and clinical competence. By synthesizing existing evidence, this systematic review seeks to provide insights into best practices for training oncology nurses and ultimately contribute to enhancing patient care outcomes in this specialized field.
2 Methods
We conducted a systematic review following PRISMA guidelines to investigate the impact of simulation training on the skills of oncology nurses.
The findings have been synthesized using the Synthesis without meta-analysis (SWiM) guidelines.
2.1 Protocol and registration
This study has been registered on PROSPERO with ID: CRD42025619999.
2.2 Search strategy and selection process
We systematically searched the databases PubMed and CINHAL for articles published in English from 2004 to 2024. The search strategy included the following terms: ("Oncology") AND ("Nursing" OR "Oncology Nurse" OR "Cancer Nurse" OR "Nurse") AND ("Simulation” OR "Simulated" OR "Simulation Learning" OR "Simulated Patient" OR "Dummy Patient") AND ("Training" OR "Education" OR "Workshop" OR "Course" OR "Learning") AND ("Competency" OR "Competencies” OR "Competence” OR "Skills" OR "Communication" OR "Decision making" OR "Critical thinking" OR "Procedural" OR "Procedures" OR "Safety").
2.3 Eligibility criteria
The review included studies focused on nurses and nursing students in oncology settings. For the inclusion criteria, we considered a range of study designs, including randomized controlled trials (RCTs), case-control studies, cohort studies, cross-sectional studies and other types of observational research.
We excluded studies that did not focus on oncology nurses, were not in English, or were reviews, editorials, case reports and quality improvement projects. The search initially found 135 articles (35 from PubMed, 100 from CINAHL). Using Rayyan software, we identified and removed 18 duplicate studies, resulting in 117 articles for abstract screening. Two reviewers independently screened the abstracts and excluded studies that were not relevant. Conflicts were resolved by consensus with input from a third independent reviewer, which led to a final selection of 24 studies for full-text review. After reviewing the full texts, we excluded studies due to inappropriate study design (N = 5), lack of full-text access (N = 3) and non-English language (N = 1). Finally, a total of 15 studies were included in our review.
2.4 Data extraction and collection
Data extraction was conducted using a Microsoft Excel spreadsheet, with two reviewers independently extracting data to ensure accuracy and reliability. Two reviewers independently screened abstracts in a blinded manner and resolved conflicts through discussion before the full-text review. Then, data were extracted by the primary author and a second reviewer from the full text. The extracted data included study characteristics such as first authors’ last name, publication year, study design and location. Participant information, such as sample size, demographics and gender distribution, were also collected. The reviewed studies included nurses at various stages in career oncology nurses, newly hired oncology nurses, advanced practice nurses and nursing students. Intervention details covered the type of simulation, duration of simulation and settings like simulation labs, hospital units and virtual environments. The primary outcomes measured included such as knowledge, confidence, critical thinking and satisfaction related to oncology nursing practices, whereas secondary variables included were learning satisfaction, self-efficacy and communication strategies. This structured approach ensured a clear review process and a comprehensive understanding of the role of simulation in advancing oncology nursing proficiency.
3 Results
3.1 Study characteristics of included studies
A total of 15 studies were included in the final review (
3.2 Descriptive synthesis for outcomes
A variety of tools were used to measure outcomes across the included studies. Most instruments were self-report scales, such as the Confidence in Communication Scale, NLN Student Satisfaction Scale and the Hospital Anxiety and Depression Scale, all of which have been previously validated with internal consistency scores (e.g., Cronbach’s alpha typically >0.80). Some tools, such as the Creighton Competency Evaluation Instrument (C-CEI) and Extravasation Chemotherapy Management Competency (ECMC), were observational, requiring assessors to rate performance. However, few studies reported inter-rater reliability, which limits the generalizability of observational findings. Where possible, reported reliability measures (e.g., Cronbach’s alpha) were noted in parenthesis in the results. Four primary outcome themes were found across the studies: knowledge, communication skills, confidence and attitude towards cancer care. Knowledge scores showed significant improvement in simulation groups 50.84 (SD 13.45) compared with non-simulated groups 32.15 (SD 12.34), knowledge retention increasing by 16–20 % (p < 0.001). Communication skills were also enhanced, with simulation participants scoring higher 17.72 (SD 3.19) compared with control groups 12.68 (SD 2.34). Self-confidence increased significantly in the simulation group 61.25 (SD 12.1) compared with the control group 38.5 (SD 6.2) with (p = 0.001), demonstrating the effectiveness of simulation in improving perceived competence. Attitudes toward chemotherapy safety, patient engagement and professional accountability improved more in simulation groups, with mean increases ranging between 20 % and 25 % (p < 0.05), indicating a positive shift. Secondary outcomes included satisfaction with learning, emotional response and teamwork. Learning satisfaction was notably higher in the simulation group 153.44 (SD 11.85) compared with the control group 142.9 (SD.22). Emotional engagement and teamwork also showed improvements, with simulation participants demonstrating better collaboration and reduced anxiety in high-pressure oncology scenarios. Overall, simulation-based training in oncology nursing consistently demonstrated superior outcomes compared with traditional learning methods, reinforcing its value in enhancing both clinical competencies and psychosocial preparedness (
4 Discussion
Our systematic review, encompassing 15 studies with a total of 1164 participants, summarises that simulation-based training enhances oncology nurses' knowledge, communication skills, self-confidence and attitudes toward cancer care. The data reveal that simulation interventions lead to improvements in these critical areas, underscoring the value of simulation into nursing education to better prepare nurses for the complexities of oncology practice.
The results indicate that oncology nurses who participated in simulation training demonstrated higher knowledge levels compared with those in the non-simulation group. These findings align with previous study by Guerrero et al. (2024), found that post-test scores improved from 75.57 (SD 9.32) to 92.22 (SD 5.06) in High-Fidelity Simulation (HFS) and from 72.88 (SD 10.31) to 95.3(SD 4.88) in VS and Alharbi et al. (2024), reported a 48 % increase in Cardiopulmonary Resuscitation (CPR) knowledge scores after simulation training. Our study noted that simulation-based training is an effective educational tool for complex and high-risk procedures like chemotherapy administration. By allowing nurses to practice in a controlled, safe environment, simulation promotes active learning and helps reinforce theoretical knowledge through practical application. Simulation-based training is a powerful tool for enhancing nurses’ knowledge. Studies such as Foronda et al. (2013), reported an increase in knowledge scores among nursing students following virtual simulation training, with mean post-test scores improving from 68 % to 88 % and Cant and Cooper (2017) show that simulation not only reinforces theoretical concepts but also improves the retention of complex clinical procedures. Simulation-based learning led to an average improvement in knowledge retention by 20–25 %. This aligns with the expected competencies in oncology nursing, where knowing how to respond in real-time clinical situations is critical. Furthermore, this improved knowledge base was often accompanied by gains in technical skill performance, suggesting that simulation strengthens the link between cognitive understanding and hands-on capability.
In addition to improving knowledge, simulation training enhanced nurses’ communication skills. Participants in the simulation group demonstrated higher communication scores compared with those in the control group. These findings align with the results of Guerrero et al. (2024), who reported improved communication scores after simulation training in HFS participants from 72.19 (SD 5.37) to 96.04 (SD 4.19) and in vs participants from 72.26 (SD 4.04) to 92.89 (SD 4.04). Effective communication is especially critical in oncology nursing, where clear and accurate information exchange can have an impact on patient safety and treatment adherence. Simulation training provides a structured environment for nurses to practice and refine their communication skills, enabling them to deliver complex clinical information with clarity and confidence. By engaging in realistic patient scenarios, nurses develop the ability to navigate difficult conversations, collaborate effectively with healthcare teams and provide patient-centred care. Jeffries (2012) demonstrated that realistic simulation scenarios allow nursing students to practice clear and effective information exchange, which is crucial in high-risk environments.
While our findings support the idea that simulation fosters confidence, they contrast with those of Yang et al. (2012), who found that student nurses, despite achieving similar accuracy levels in clinical judgments (mean 73.7 % for nursing students vs. 73.5 % for experienced nurses, p = 0.91), reported significantly lower confidence scores (mean confidence: 72.66 for students vs. 80.09 for experienced nurses, p = 0.001). Additionally, students tended to underrate their performance (mean over/under confidence score: –1.05), while experienced nurses overestimated theirs (+6.56, p = 0.01). This reported that nursing students, despite achieving similar accuracy levels to experienced nurses, reported lower confidence. This difference may reflect their stage in the learning process. According to the conscious competence model, simulation may help students move from a stage of unconscious incompetence, where they are unaware of their knowledge gaps to conscious incompetence, where they begin to recognize what they don’t know and become more reflective. This shift is essential in building accurate self-assessment, motivation to improve and ultimately, clinical competence.
Our findings indicate that simulation training improved nurses' attitudes toward chemotherapy administration, showing a positive impact on their confidence and preparedness. These results are similar to D'Cunha et al. (2016), who found that simulation-based teaching improved CPR skill scores among undergraduate medical students. The mean scores increased from 55.69 % before training to 77.33 % after simulation based drills. Additionally, Crannell (n.d.) reported that confidence in chemotherapy administration increased from 36 % to 67 % following simulation exercises. A positive attitude toward chemotherapy administration is crucial for ensuring patient safety and adherence to best practices.
Although attitudes were not explicitly listed among our initial review aims, they closely align with the development of core competencies such as clinical decision-making, critical thinking and confidence. A more positive professional attitude contributes to improved clinical judgment, greater diligence in safety procedures and stronger interpersonal communication especially in high-stress oncology environments. In this way, attitudes serve as an important affective domain that supports cognitive and technical skill development.
Nurses who feel more confident and comfortable administering chemotherapy are more likely to act with accuracy and accountability. This confidence, reinforced through repeated exposure and structured reflection, supports sustained improvements in both performance and mindset. Our findings, along with those of McGaghie et al. (2014), highlight that simulation promotes not only technical competence but also a broader professional identity marked by engagement, ethical practice and commitment to quality care values that are central to oncology nursing.
4.1 Strengths and limitations
There are several strengths in our systematic review. It followed a well-recognized approach, with registration in PROSPERO. This is the first systematic review analyzing the role of simulation in oncology nursing. This review provides insights into how simulation can enhance and improve the quality of nursing education, ultimately resulting in improved patient care.
However, there are some limitations. A meta-analysis was unfeasible because of the different outcomes measured across the studies, making it inappropriate to combine the results. There was considerable variation in the simulation interventions, such as the duration and design, which made comparisons between studies challenging. Additionally, the review only included studies in English, which may introduce a language bias. Most outcome measures in this review relied on self-report tools, with limited use of observational measures and no consistent reporting of inter-rater reliability. While the included studies measured a broad range of outcomes, the majority aligned with our aims (clinical skills, decision-making, confidence and critical thinking), though some addressed secondary areas like satisfaction and attitudes. The inclusion of both nurses and nursing students introduced variability, which was managed through a clear conceptual definition of "nurse," but may limit generalizability. Lastly, there were limited studies on oncology nursing simulations, which restricts the sample size and findings in that area.
4.2 Future research
Future research in simulation-based education for oncology nursing should address several key areas to enhance its effectiveness and long-term impact. First, longitudinal studies are needed to assess the sustainability of the knowledge and skills gained through simulation, particularly regarding the retention of knowledge and clinical competence beyond short-term outcomes. These studies could provide a clearer understanding of the long-term benefits of simulation-based training, especially in critical areas such as chemotherapy administration. Additionally, the variation in simulation interventions across studies highlights the need for standardized protocols. Future research should focus on determining the optimal duration, frequency and type of simulation (e.g., HFS, VS or role-playing) to ensure consistency and maximize educational outcomes. One promising approach is the integration of Artificial Intelligence (AI) into simulation-based education. AI can enhance decision-making and critical thinking by creating adaptive clinical scenarios and delivering personalized feedback. These features directly support the development of core competencies in oncology nursing, aligning with the review’s focus on improving clinical skills, judgment and learner confidence ( Nawaz et al., 2025). Future research should also explore simulation based oncology education in diverse international contexts, particularly in low and middle-income countries, to understand how cultural, systemic and resource differences have an impact on implementation and outcomes beyond the U.S.-based studies.
Moreover, comparative studies between different simulation modalities would help identify which methods are most effective for improving knowledge retention, self-confidence and clinical competencies in oncology nursing. While simulation has shown positive results in controlled environments, research should also investigate these skills to real-world clinical practice. Understanding how simulation training influences nurses' ability to apply learned skills in patient care would be valuable for assessing its practical impact on patient safety and treatment outcomes.
5 Conclusion
In conclusion, this systematic review demonstrates the promising role of simulation-based education in enhancing oncology nursing competencies, including knowledge, communication skills, self-confidence and attitudes toward chemotherapy administration. The findings show that simulation learning improves the proficiency of oncology nurses compared with traditional learning methods. Student nurses and oncology nurses, who participated in simulation-based training experienced higher levels of knowledge retention, enhanced communication and greater confidence in their ability to handle complex oncology care scenarios. Furthermore, simulation training positively influenced nurses' attitudes toward chemotherapy administration contributing to safer and more effective patient care.
Author contributions
FU, AJ and FN collaborated on the study protocol. FU completed the search strategy, reviewed by AJ and FN. FU and AJ handled screening and data extraction, supervised by MR and FN. FU and MB drafted the manuscript, with input from RK, AJ and VB. All authors approved the final manuscript.
CRediT authorship contribution statement
Meisya Rosamystica: Writing – review & editing, Methodology. Mitansh Bansal: Writing – original draft. Ayesha Jalal: Methodology. Usman Firdous: Writing – review & editing, Writing – original draft, Methodology, Investigation, Conceptualization. Rahul Kashyap: Writing – review & editing, Validation, Supervision. Nawaz Faisal: Writing – review & editing, Supervision. Zara Arshad: Project administration, Methodology, Investigation, Data curation, Conceptualization. Vikas Bansal: Writing – review & editing, Validation, Supervision.
Consent for publication
Not Applicable.
Ethical approval
This study was conducted in accordance with ethical guidelines. Ethical approval was not required as this study is a systematic review.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
This abstract was presented at the 1st Dubai Health Cancer Research Symposium that took place in January 2025 in Dubai, United Arab Emirates.
Table 1
| Author and year | Location of study | Design | Duration (mins) | Gender | Types of Nurses |
Sample
N = Total Nurses I= Intervention group C= Control group D= Dropouts |
Simulation Design | Types of Technology | Simulation duration (mins) | Simulation Setting |
Types of
Simulation |
Scales |
| ( Kang et al., 2022) | China | Quasi-experimental | 30 | M= 4
F= 46 |
Newly hired
oncology nurses |
N = 118
I = 50 C = 59 D = 9 |
Hands On | Simulated Patients (SP) | 70 | Cancer Hospital | Active patients (AP) | Knowledge
questionnaires California Critical Thinking Disposition Inventory Learning satisfaction scale |
| ( Sharour, 2019) | Jordan | Quasi-experimental | 90 | M= 20
F= 50 |
Fourth year
undergraduate nursing students in oncology emergencies education |
N = 70
I= 35 C= 35 D= 0 |
High Fidelity
Simulation (HFS) |
High Fidelity
Mannequins |
20 | Simulation Lab | AP | Knowledge questionnaire
using Mosby’s oncology nursing advisor: A comprehensive Guide to clinical practice Self-confidence scale- Students’ satisfaction scale- National League for Nursing (NLN) Self-efficacy-Schwarzer & Jerusalem |
| ( Alkhalaf and Wazqar, 2022) | Saudi Arabia | Quasi-experimental study | 182 | Not Applicable (NA) | Oncology nurses | N = 68
I= 34 C= 34 D= NA |
Hands
on |
Standard training; textbooks, lectures pre-test in skills lab post-test with cancer patient in cancer unit | 45 | Clinical simulation centre, day unit of teaching hospital | AP | Extravasation chemotherapy management competency (ECMC) |
| ( Bagley, 2018) | USA | Pre/ Post
test design |
120 | M= 2
F= 54 |
Med Surg Nurses | N = 88
I= 16 C= 41 D= 20 |
Hands on | Hospital beds,
IV poles, IV pumps, PPE and computers Simulation content |
240 | Hospital lab
at Duke Raleigh |
SP | Team STEPPS Teamwork
perception questionnaire Satisfaction with simulation experience scale (SSES) |
| ( Coyle et al., 2015) | USA | Pre/ Post
test design |
731 | NA | Oncology Nurses | N = 247
I= 247 C=NA D=NA |
Hands
on |
SP | 90 | NA | SP | 5 item Likert scale |
| ( Page et al., 2016) | USA | Pre/ Post
test design |
120 | NA | NA | N = 25
I= 25 C=NA D=NA |
Hands on | Simulated central line care mode | NA | Adult inpatient haemato-oncology unit | AP | 13 Multiple Choice Questionnaire (MCQ) |
| ( Jang et al., 2019) | Korea | Non-equivalent control group pre-test-post-test design | 23 | M= 3
F= 51 |
Oncology Nurses | N = 54
I= 25 C= 29 D= NA |
Hands on | SP | 360 | NA | AP | 33 item MCQ and 12-item Course Satisfaction Evaluation tool |
| ( Wu et al., 2023) | Taiwan | Pre/ Post study | 637 | NA | Oncology and
Non-Oncology Nurses |
N = 159
I= 159 C= 0 D= 55 |
Hands on | Interactive visual
training course and 3D simulation models of IV ports |
NA | Simulation Lab | Simulated
environment, no active patients |
Three questionnaires for
key knowledge, cognitive attitude, and contextual behavioural attitude |
| ( Burrell et al., 2023a) | USA | Pilot study | 49 | M= 1
F= 13 |
Senior
baccalaureate nursing students |
N = 14
I= 14 C= NA D= 0 |
Hands on
Telehealth with standardized patients via Zoom |
Standardize
patients - Zoom video conferencing |
20 | Virtual zoom | AP | Likert style
questionnaire Nursing Assessment of Simulated Clinical Decision-Making scale (NASC- CDM) |
| ( Chen et al., 2021) | Taiwan | Pilot study | 579 | NA | Advanced
Practice Nurse including nurse practitioners and case managers |
N = 61
I= 28 C= 33 D= NA |
Hands on | SP
Actors trained for role play |
360 | NA | AP | Truth Telling
Questionnaire Confidence in communication scale Hospital Anxiety depression scale Distress Thermometer |
| ( Burrell et al., 2021) | USA | Pilot study (Longitudinal, one group, mixed method convergent) | 49 | M= 2
F= 61 |
Oncology Nurses | N = 63
I= 63 C= NA D= 0 |
Hands on | SP | 20 | Simulation Centre | AP | 24 item Likert scale, Creighton competency evaluation (C-CEI) |
| ( Deluche et al., 2023) | France | Feasibility study | 121 | M= 21
F= 25 |
Oncology and digestive surgery | N = 46
I= 46 C= NA D= NA |
Hands on | Affect-tag
wristbands |
10 | Simulation Centre | AP | Likert scale for subjective
skills assessment; Affect-tag parameters for emotional and cognitive reactions |
| ( Burrell et al., 2023b) | USA | Longitudinal, one group, mixed method convergent | 49 | M= 3
F= 22 |
Oncology Nurses | N = 25
I= 25 C= NA D= NA |
Hands on | SP | 20 | NA | AP | C-CEI Creighton competency evaluation, 11 ITEM Likert scale researcher developed |
| ( Canivet et al., 2014) | Belgium | Randomised Control Trail | 90 | M= 9
F= 91 |
Oncology
Nurses |
N = 115
I= 48 C= 52 D= 15 |
Hands on | SP | 20 | NA | AP | Pain management
Communication Coding system |
| ( Mrad et al., 2024) | Canada | Feasibility study | 30 | M= NA
F= 11 |
Oncology Gynaecological Nurses | N = 11
I= NA C= NA D= NA |
Hands on | SP | 120 | Online Via Zoom | AP | Permission, Limited Information, Specific Suggestions and Intensive Therapy (PLISSIT) tool |
Table 2
| Author and year | Objective | Primary Outcome (Intervention vs Control Group) |
Mean (SD)
(Intervention vs Control) |
Secondary Outcome (Intervention vs Control Group) |
Mean (SD)
(Intervention vs Control) |
Major findings |
| ( Kang et al., 2022) | To evaluate the effectiveness of palliative care simulations with standardized patients in improving the knowledge, skill performance, and critical thinking of newly hired oncology nurses. | Knowledge of pain
Management |
50.8 ± 13.45
vs 32.15 ± 12.34 |
Total score of critical thinking | 243.92 ± 24.54
vs 213.88 ± 17.45 |
After intervention, the simulation group was significantly greater in knowledge of pain management, and knowledge of special scenario communication. The critical-thinking score was also significantly greater in the simulation group (P < 0.001). The simulation group had higher satisfaction (P < 0.001). |
| Knowledge of special
scenario communication |
61.08 ± 18.63
vs 39.66 ± 19.65 |
Total score of
learning satisfaction |
15344.±11.85
vs 142.9 ± 14.22 | |||
| ( Sharour, 2019) | To assess the effectiveness of High-Fidelity Simulation on satisfaction, self-confidence and self-efficacy and knowledge of undergraduate students in oncology care. | Knowledge | 13.95 ± 3.35 vs 6.25 ± 2.65 | NA | NA | HFS in nursing increased student knowledge, self-confidence, satisfaction, and self- efficacy in managing septic shock and infusion reaction as common oncology emergencies. |
| Self-Confidence | 61.25 ± 12.1 vs 38.5 ± 6.2 | NA | NA | |||
| Satisfaction | 42.25 ± 4.25 vs 28.5 ± 3.15 | NA | NA | |||
| Self-Efficacy | 35.5 ± 3.25 vs 24.25 ± 2.85 | NA | NA | |||
| Alkhalaf and Wazqar (2022) | To investigate the effects of high-fidelity simulation (HFS) on nursing student's competency in managing chemotherapy extravasation and their ability to transfer skills to clinical settings. | Extravasation of chemotherapy management | Pre-Test= 9.72 vs 7.67
Post-Test 1 = 17.91 vs 17.47 Post-Test 2 = 19.53 vs 18.38 |
NA | NA | Students trained with HFS showed higher competency scores than those trained traditionally, though the differences were not statistically significant. Both methods were effective in teaching skills, but HFS showed slight improvement in skill transfer. |
| Bagley (2018) | To implement and evaluate the "Oncology Intensives Initiative" (ONCii) to enhance knowledge, attitudes, self-efficacy, and teamwork among medical-surgical nurses caring for cancer patients. | Attitudes
toward Chemo administration (negative) |
Pre-Test = 18.75 vs 19.73 ± 3.38
Post-Test= 19.19 vs 20.41 ± 4.25 |
Interdisciplinary teamwork | Pre-Test= 100.25 ± 12.12 vs 102.02 ± 12.08
Post-Test= 102.56 ± 14.48 vs 102.21 ± 14.05 |
The initiative reduced nurses' worries, improved positive attitudes toward chemotherapy administration, and increased self-efficacy, particularly among those participating in both didactic and simulation sessions. Challenges included resource demands and low simulation participation. |
| Attitudes
toward CA (positive) |
Pre-Test = 19.5 vs 19.39 ± 5.09
Post-Test= 24.63 vs 22.29 ± 4.04 |
Self-efficacy | Pre-Test= 24.62 ± 3.24 vs 24.9 ± 3.97
Post-Test= 26.56 ± 3.25 vs 25.04 ± 4.83 | |||
| Worries | Pre-Test=
35.69 ± 10.65 vs 31.71 ± 11.53 Post- Test= 29.25 ± 10.37 vs 27.66 ± 11.97 | |||||
| ( Coyle et al., 2015) | To adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants’ confidence in using the communication skills learned and their satisfaction with the module | Communication skill, self-confidence rating | Pre-Test = 3.09 ± 1.03 vs NA
Post-Test= 4.07 ± 0.69 vs NA |
NA | NA | Nurses’ confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90 %–98 % of the time. Nurses’ CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions. |
| ( Page et al., 2016) | To evaluate the impact of a simulation-based educational intervention on improving nurses' knowledge and skills in central line care and reducing central line-associated bloodstream infections (CLABSIs) in an oncology unit. | Reduce CLABSIs in the oncology unit
Pertest Average Score: 74.3 % Post-test Average Score: 91.2 % 16.9 % improvement |
- | NA | NA | The intervention improved nursing competence by 16.9 % and reduced the CLABSI rate from 5.86 to 3.43 per 1000 line-days. With additional audits, the rate further decreased to 1.42, demonstrating the program's effectiveness in enhancing infection control practices. |
| ( Jang et al., 2019) | To evaluate the effectiveness of a standardized patient-based oncology nursing simulation program in improving nursing students' knowledge, performance ability, and educational satisfaction compared to case-based learning. | Knowledge and Nursing Performance | Pre-Test= 21.08 ± 1.41 vs 20.38 ± 2.14
Post-Test= 24.44 ± 2.0 vs 23.76 ± 1.86 |
Satisfaction | 4.71 ± 0.3 vs 4.37 ± 0.37 | The simulation program significantly enhanced nursing performance ability and satisfaction compared to case-based learning, while both methods improved knowledge. Simulation-based training proved more effective for oncology nursing education. |
| Cancer Pain
Management |
Pre-Test= 16.68 ± 2.95 vs 16.31 ± 4.59
Post-Test= 24.36 ± 2.40 vs 21.48 ± 3.20 |
NA | NA | |||
| Safety management
in chemotherapy |
Pre-Test= 21.20 ± 4.08 vs 22.31 ± 4.75
Post-Test= 36.72 ± 5.38 vs 26.03 ± 5.48 |
NA | NA | |||
| Side effects
management in chemotherapy |
Pre-Test= 24.76 ± 3.74 vs 23.51 ± 4.67
Post-Test= 36.52 ± 2.83 vs 27.20 ± 4.97 |
NA | NA | |||
| Management
of emergency situations |
Pre-Test= 14.76 ± 3.83 vs 14.41 ± 4.17
Post-Test= 25.16 ± 2.99 vs 20.41 ± 2.51 |
NA | NA | |||
| ( Wu et al., 2023) | To evaluate the efficacy of the education course through interactive visual training course and three-dimensional (3-D) simulator for participants and verified questionnaires as tool | Knowledge scores
K3- Ideal irrigation orientation |
- | Cognitive and
behavioural attitude C2- Orientation of non coring needle |
Pre-Test= 2.68 ± 1.10 vs NA
Post-Test= 3.19 ± 0.87 vs NA |
The interactive visual training course, including maintenance lectures and practice with a 3-D simulator, improved consensus among the nursing staff and increased the willingness of oncology nurses to perform the proposed port irrigation procedure |
| B4- Confidence to
perform ideal port irrigation |
Pre-Test= 2.92 ± 0.87 vs NA
Post-Test= 3.27 ± 0.51 | |||||
| ( Burrell et al., 2023a) | Competence | Pre-Test= NA
Post-Test= 22.64 ± 2.50 |
NA | NA | ||
| Confidence | Pre-Test= NA vs NA
Post-Test= NA vs NA |
NA |
NA | |||
| ( Chen et al., 2021) | To test the
effectiveness of the Advanced Practice Nurses (APN) share CST |
Truth telling
confidence and perception |
Mean Difference
17.72 vs 16.86 |
Emotional status and
satisfaction with truth-telling |
Mean difference
1.65 vs NA |
APNs in the EG had more confidence (p < 0.05) and better perceptions of cancer truth-telling (p < 0.01) than APNs in the CG at both T1 and T2. No group differences were found in patients' or their caregivers' satisfaction with truth telling, emotional distress, and anxiety (p > 0.05). In addition, patients in the EG had higher depression than patients in the CG (p > 0.01) |
| Patient's
Depression scores |
Mean difference
1.65 vs NA | |||||
| ( Burrell et al., 2021) | To evaluate the effects of standardized patient simulation on nursing students' knowledge, confidence, and competence in oncology evidence-based symptom management (EBSM), and to assess perceptions and satisfaction with this learning method. | Self-perceived competence | Timepoint (T)1: 2.82 ± 0.62 vs NA
T2: 3.94 ± 0.53 vs NA T3: 4.54 ± 0.43 vs NA |
NA |
NA | Standardized patient simulation significantly improved knowledge, confidence, and competence over time, with high levels of satisfaction reported by students. Key themes included realism, knowledge application, and the unique focus of the training on oncology symptom management |
| Confidence | T1: 2.77 ± 0.63 vs NA
T2: 3.81 ± 0.51 vs NA T3: 4.40 ± 0.5 vs NA |
NA | NA | |||
| Knowledge %score | T1: 58.2 ± 0.19 vs NA
T2: 69.05 ± 0.17 vs NA T3: 79.1 ± 0.14 vs NA |
NA | NA | |||
| ( Deluche et al., 2023) | To assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news. | EP (emotional power)
T0: First session T1: Second session |
T0 = 38.7 ± 20.7 vs NA
T1 = 33.8 ± 6.6 vs NA |
Subjective skills assessment
Time to First Emotional Peak (TEP): |
NA | The study demonstrated that HFS reduced stress (lower emotional power, p < 0.001), improved students’ responsiveness to external stimuli (higher emotional density, p = 0.005), and maintained cognitive focus. It was found to effectively enhance communication skills while managing emotional impacts during difficult conversations. |
| ED
(emotional density) |
T0 = 12.40 ± 29.4 vs NA
T1 = 19.02 ± 19.04 vs NA |
NA | NA | |||
| CL
(cognitive load) |
T0 = 29.4 ± 19.7 vs NA
T1 = 19.04 ± 9.4 vs NA |
NA | NA | |||
| ( Burrell et al., 2023b) | To determine the effects of simulation-based experiences with standardized participants on prelicensure nursing students' confidence, competence, anxiety, clinical decision-making, satisfaction, and self-confidence in managing oncologic emergencies. | Self-perceived confidence
T1: pre seminar, T2: pre simulation with SP, T3: post simulation with SP |
T1: 27.56 ± 10 vs NA
T2: 39.36 ± 8.89 vs NA T3: 45.61 ± 7.23 vs NA |
Anxiety | T1: 85.16 ± 23.23 vs NA
T2: 73.44 ± 17.04 vs NA T3: 61.2 ± 20.09 vs NA |
Simulation- based education, significantly increased students' confidence and self-perceived competence while decreasing anxiety related to clinical decision-making. Students expressed positive perceptions of realism and highlighted critical thinking and professional practice benefits. |
| Competence | T1: 29.48 ± 9.85 vs NA
T2: 39.84 ± 6.31 vs NA T3: 46.64 ± 5.58 vs NA |
Self Confidence | T1: 104.26 ± 25.13 vs NA
T2: 121.76 ± 15.37 vs NA T3: 132.72 ± 16.83 vs NA | |||
| ( Canivet et al., 2014) | To investigate the impact of a general communication skills training program designed for oncology nurses on specific cancer pain management communication. | Communication strategies | 1st step
T1: 3.6 ± 2.7 vs 2.9 ± 2.9 T2: 4.3 ± 3.6 vs 2.9 ± 3.2 |
NA | NA | The general communication skills training program improved only a few of the communication strategies needed for optimal cancer pain management in nursing. General communication skills training programs should be consolidated using specific modules focusing on communication skills related to cancer pain management. |
| Communication strategies | 2nd step
T1 = 1.6 ± 1.5 vs 2.2 ± 2.3 T2 = 4.0 ± 1.9 vs 2.2 ± 2.3 |
NA | NA | |||
| Communication strategies | 3rd step
T1 = 2.4 ± 2.3 vs 1.8 ± 1.8 T2 = 1.9 ± 1.3 vs 1.7 ± 2.1 |
NA | NA | |||
| Communication strategies | 4th step
T1 = 4.3 ± 2.9 vs 3.9 ± 3.3 T2 = 3.1 ± 2.5 vs 3.3 ± 2.4 |
NA | NA | |||
| Communication strategies | 5th step
T1 = 5.7 ± 3.4 vs 5.0 ± 3.8 T2 = 3.8 ± 2.9 vs 5.0 ± 3.7 |
NA | NA | |||
| ( Mrad et al., 2024) | To document the learning experience, impacts, and feasibility of an online simulation activity held between oncology nurses and a simulated participant on communication regarding the sexual health of gynaecologic cancer patients. | Communication skills | - | NA | NA | The study found that an online training helped nurses talk better about sexual health with women who have gynaecologic cancer. Nurses learned more, felt more confident, and were more willing to discuss sexual health problems. The training was easy to set up and use, but some nurses had trouble working in groups and faced technical issues. Overall, the training was useful, but more research is needed to make it even better. |
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