Supportive Care in Cancer

, Volume 28, Issue 2, pp 797–808 | Cite as

de Souza interprofessional practice cancer competency framework

  • Mary Jane EsplenEmail author
  • Jonathan Hunter
  • Christine Maheu
  • Zeev Rosberger
  • Jiahui Wong
  • Patti McGillicuddy
  • Scott Secord
  • Susan Blacker
  • Esther Green
  • Brenda Toner
  • Jane Li
  • Kathleen Dobson
Original Article



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.


Oncology 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 information

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.

Supplementary material

520_2019_4823_MOESM1_ESM.docx (165 kb)
ESM 1 (DOCX 165 kb)


  1. 1.
    International Agency for Research on Cancer. All Cancers: World Health Organization; 2018 [cited 2018]. Globocan 2018:[Available from:
  2. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Canadian Partnership Against Cancer. Living with cancer: a report on the patient experience Toronto, Ontario2018. Available from:
  4. 4.
    Katz SJ, Belkora J, Elwyn G (2014) Shared decision making for treatment of cancer: challenges and opportunities. J Oncol Pract 10(3):206–208. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 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. CrossRefPubMedGoogle Scholar
  6. 6.
    Ferrell BR, Winn R (2006) Medical and nursing education and training opportunities to improve survivorship care. J Clin Oncol 24(32):5142–5148. CrossRefPubMedGoogle Scholar
  7. 7.
    Centre for Interprofessional Education. Interprofessional Education Curriculum: University of Toronto; 2018. Available from:
  8. 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. CrossRefPubMedGoogle Scholar
  9. 9.
    Institute of Medicine (2011) The future of nursing: leading change, advancing health. The National Academies PressGoogle Scholar
  10. 10.
    Institute of Medicine (2010) Redesigning continuing education in the health professions. The National Academies PressGoogle Scholar
  11. 11.
    Campbell C, Silver I, Sherbino J, Cate OT, Holmboe ES (2010) Competency-based continuing professional development. Med Teach 32(8):657–662. CrossRefPubMedGoogle Scholar
  12. 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. 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. CrossRefPubMedGoogle Scholar
  14. 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. CrossRefPubMedGoogle Scholar
  15. 15.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Miller GE (1990) The assessment of clinical skills/competence/performance. Acad Med 65(9 Suppl):S63–S67CrossRefGoogle Scholar
  17. 17.
    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. CrossRefPubMedGoogle Scholar
  18. 18.
    Frank JR, Snell L, Sherbino J (2015) CanMEDS 2015 Physician competency framework. Royal College of Physicians and Surgeons of Canada, OttawaGoogle Scholar
  19. 19.
    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):356–373CrossRefGoogle Scholar
  20. 20.
    Jongen C, McCalman J, Bainbridge R (2018) Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res 18(1):232. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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: Scholar
  22. 22.
    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. CrossRefGoogle Scholar
  23. 23.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    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. CrossRefPubMedGoogle Scholar
  26. 26.
    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. CrossRefPubMedGoogle Scholar
  27. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    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. CrossRefPubMedGoogle Scholar
  29. 29.
    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. CrossRefGoogle Scholar
  30. 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 50PubMedGoogle Scholar
  31. 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. 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. 33.
    Mackenzie G, Rennie H, Shearer E. Psychosocial oncology core competencies: BC Cancer; 2018Google Scholar
  34. 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. 35.
    Supportive Cancer Care Victoria. Framework for Professional Competency in the Provision of Supportive Care. Victoria: Supportive Cancer Care Victoria, 2011Google Scholar
  36. 36.
    Raiji P (2007) Competencies of the psycho-oncologist. University at Buffalo, the State University fo, New YorkGoogle Scholar
  37. 37.
    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. CrossRefPubMedGoogle Scholar
  38. 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. 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. CrossRefGoogle Scholar
  40. 40.
    College of Medical Radiation Technologists of Ontario (2018) Standards of practice. College of Medical Radiation Technologists of Ontario, TorontoGoogle Scholar
  41. 41.
    Keeney S, McKenna H, Hasson F (2011) The Delphi technique in nursing and Health Research. Wiley-BlackwellGoogle Scholar
  42. 42.
    Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32(4):1008–1015Google Scholar
  43. 43.
    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):198–205CrossRefGoogle Scholar
  44. 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).

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mary Jane Esplen
    • 1
    • 2
    • 3
    Email author
  • Jonathan Hunter
    • 4
  • Christine Maheu
    • 5
  • Zeev Rosberger
    • 6
    • 7
  • Jiahui Wong
    • 8
  • Patti McGillicuddy
    • 9
  • Scott Secord
    • 10
  • Susan Blacker
    • 11
  • Esther Green
    • 12
  • Brenda Toner
    • 13
  • Jane Li
    • 3
  • Kathleen Dobson
    • 14
  1. 1.Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Princess Margaret Cancer CentreTorontoCanada
  3. Souza InstituteUniversity Health NetworkTorontoCanada
  4. 4.Department of Psychiatry, Faculty of MedicineUniversity of Toronto, Sinai Health SystemTorontoCanada
  5. 5.Ingram School of NursingMcGill UniversityMontréalCanada
  6. 6.Lady Davis Institute for Medical ResearchMontréalCanada
  7. 7.Departments of Psychology, Oncology & PsychiatryMcGill UniversityMontréalCanada
  8. 8.Department of Psychiatry, Faculty of MedicineUniversity of Toronto, de Souza Institute, University Health NetworkTorontoCanada
  9. 9.School of Social WorkUniversity of Toronto, Centre for IPETorontoCanada
  10. 10.Community Addiction and Mental Health Services of Haldimand and Norfolk (CAMHS)TorontoCanada
  11. 11.Cancer and Palliative Program Planning and PerformanceSinai Health SystemTorontoCanada
  12. 12.Nursing and Psychosocial Oncology Cancer Care OntarioTorontoCanada
  13. 13.Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada
  14. 14.University of TorontoTorontoCanada

Personalised recommendations