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Abstract

Background:

There is a growing need for psychosocial oncology and palliative care training among nurses in Cameroon and other low-resource settings, where formal education in these domains remains limited. The Psychosocial Oncology and Palliative Care Training (POPCaT) program was developed to address this gap by providing a blended, contextually relevant training to nurses working in some healthcare settings in Cameroon.

Objective:

To evaluate the implementation, outcomes, and participant experiences of the POPCaT training pilot delivered across six health facilities in Cameroon.

Methods:

This was a pilot evaluation conducted immediately following a 4-day intensive POPCaT training. The course combined didactic lectures, interactive group work, clinical case discussions, role-plays, and a supervised visit to a palliative care unit. Fifty-two nurses purposively selected from six health facilities participated in the training, and 48 voluntarily completed the post-training evaluation. Quantitative data were collected via a structured survey containing closed-ended Likert scale questions assessing course satisfaction, content relevance, learning outcomes, and likelihood of practice implementation. Descriptive statistics were used to summarize responses. Qualitative data were collected through open-ended questions exploring motivations, course experiences, perceived strengths, limitations, and post-course intentions. Thematic analysis was applied to analyze open-text responses.

Results:

Participants were mostly female (83.3%) with a mean age of 38.2 years and varying levels of clinical experience. Most (64.5%) held a nursing diploma, while only 31.3% had prior oncology training. Overall course satisfaction was high, with 77.1% rating the program as “very good” and 93.8% reporting a strong likelihood to implement learning in practice. Participants praised the course content, relevance, interactive methods, and facilitator expertise. Key strengths included clinical exposure, bilingual delivery, and group learning. Areas for improvement included calls for expanded content on breaking bad news, cultural and spiritual care, sexuality, survivorship, and practical service implementation.

Conclusion:

The POPCaT training was positively received, enhanced nurses’ confidence and knowledge, and generated actionable post-course plans across individual, clinical, and institutional levels. Findings support the relevance and scalability of this model for strengthening palliative and psychosocial oncology care in low-resource settings. Future iterations should incorporate suggested enhancements and explore long-term impacts on practice and patient outcomes.

Plain language summary

Development and evaluation of a Psychosocial Oncology and Palliative Care Training program for nurses in Cameroon

In Cameroon and other places with limited resources, nurses often don’t get formal training in caring for cancer patients or those who need palliative care (care focused on improving quality of life for people with serious illnesses). To help with this, a new training program called POPCaT was created. It offers a mix of lectures, group activities, role-playing, and hands-on experience in a palliative care unit. This summary looks at what happened during a pilot version of the training, which was held over four days in six health facilities in Cameroon. A total of 52 nurses took part, and 48 shared feedback afterward. Most of the nurses were women, around 38 years old on average, and had different levels of experience. While many had general nursing diplomas, only a few had previous training in cancer care. The feedback was very positive. Most nurses said the training was very good, Almost all said they were likely to use what they learned in their daily work. They especially liked the practical experience, the interactive sessions, and that the training was given in both English and French. Some participants asked for more training on topics like how to give bad news, cultural and spiritual care, sexuality, and cancer survivorship. In conclusion, the training improved nurses’ confidence and knowledge. It helped them make plans to improve care in their own settings. The program shows promise for use in other low-resource areas, though future versions could be improved by including more topics and tracking long-term effects on patient care.

Keywords

palliative care psychosocial oncology nursing education Cameroon training program evaluation continuing professional development

Introduction

Training healthcare professionals in psychosocial oncology and palliative care is essential to provide comprehensive support for the increasing global population of cancer patients.^1–4 In 2020, approximately 19.3 million new cancer cases were diagnosed worldwide, with 10 million deaths attributed to cancer.⁵ A cancer diagnosis is a significant, life-changing event for both patients and their families. This often triggers complex emotional responses such as shock, denial, and anger.^6–8 Moreover, cancer patients frequently experience physical, spiritual, emotional, and psychosocial issues that negatively impact their quality of life and necessitate palliative and psychosocial care.^4,7,9,10 Studies show that cancer patients who lack access to palliative and psychosocial care suffer increased distress and worse health outcomes compared to those who receive early interventions.^3,11–13

Healthcare experts have identified gaps in addressing the psychosocial and palliative care needs of cancer patients. A major contributing factor to these gaps is healthcare providers’ lack of competence in delivering such care.^1,4,14 Thus, training healthcare providers in this area can improve their ability to meet diverse needs, ranging from basic to advanced, of cancer patients and their families.¹⁵ This education is particularly important for nurses, who work closely with patients and their families, and are well-positioned to screen for distress and provide timely psychosocial and palliative interventions.^16,17 It is even more crucial for nurses in sub-Saharan Africa, where there is a significant shortage of physicians, clinical oncologists, clinical psychologists, and oncology and palliative care nurses.^2,18 In many rural areas of sub-Saharan Africa, nurses are often the only healthcare providers accessible to patients living with cancer, due to financial constraints preventing access to urban cancer centers.^17,18

Nurse education in palliative care is offered at both generalist and specialist levels. This education encompasses various competency areas, including communication, collaboration, clinical skills, ethical and legal issues, and psychosocial and spiritual care.¹⁹ Generalist training, offered at preregistration and continuing professional development levels, prepares nurses to apply an early palliative care approach for patients and families with basic to moderate palliative care needs.^19–23 Specialist training, offered at the post-registration level, prepares nurses to address the moderate to complex palliative care needs of patients and their families and to act as palliative care consultants, educators, researchers, and patient advocates.^20,23

Literature reports a significant positive impact of palliative and psychosocial oncology nursing education on nurses’ competencies and patient outcomes, including improved self-efficacy, communication, symptom management, psychosocial support skills, and patients’ quality of life.^24–27 However, there are limited training opportunities for nurses to enhance their competencies in providing palliative and psychosocial care for cancer patients in sub-Saharan Africa.^2,18,28 This suggests that cancer patients in Africa lack access to comprehensive cancer care, leading to significant suffering. In response to this gap, core competencies for palliative and psychosocial oncology care for nurses in Africa have been developed. Yet, the uptake of palliative and psychosocial oncology training in Africa remains suboptimal.^2,29

Cancer is a significant public health concern in Cameroon.³⁰ In 2022, the number of 5-year prevalent cancer cases in Cameroon was 43,618, in a population of approximately 27.9 million. That year, there were 19,564 new cancer cases and 12,798 cancer-related deaths.³¹ Cancer patients in Cameroon report significant emotional and psychosocial distress and poor quality of life.¹² There are a few cancer centers in the country; thus, cancer patients are often treated in regional hospitals and, in some cases, community clinics.^32–34 In addition, cancer care expenditures in Cameroon are borne by patients and their families, who may pay up to about US$2480 for a full course of chemotherapy and radiotherapy.³³ As a result, individuals from lower socioeconomic backgrounds are often unable to access specialist cancer treatment and instead rely on generalist services at local hospitals or clinics.

Nonetheless, in Cameroon, there is a significant gap in the availability of trained healthcare professionals equipped to address the complex needs of cancer patients and their families. A small number of Cameroonian oncologists face a high patient load.^33,35 Nurses make up the majority of healthcare staff in Cameroon, and many community clinics, especially those in rural areas, are nurse-led.^17,32,35 Therefore, substantial nursing support is essential to achieve effective cancer care outcomes in Cameroon. However, nurses in Cameroon receive little or no education in palliative and psychosocial oncology care. There are no specialization programs for oncology nurses in the country.³² This highlights the urgent need for targeted educational programs to strengthen nurses’ capacity to deliver essential palliative and psychosocial care.

Developing a context-specific training program to address the unique learning needs of Cameroonian nurses is therefore imperative. This paper reports the process of developing, piloting, and evaluating the Psychosocial Oncology and Palliative Care Training (POPCaT) program for nurses in Cameroon. The evaluation presented in this paper aimed to identify the strengths and weaknesses of the training program to inform its revision and facilitate its scale-up.

Development of the POPCaT program

The program development was guided by the six-step approach to curriculum development proposed by Kern et al. (1998).³⁶ This model is widely recognized in health professions education and includes: (i) problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation, and (vi) evaluation and feedback.³⁷ Table 1 outlines how each of these steps was operationalized in the development of the POPCaT program.

Table 1.

POPCaT development steps.

Step of Kern et al.’s approach to program development	Methods used in this study
1. Problem identification and general needs assessment	Integrative literature review^32,34
2. Targeted needs assessment	Three-round Delphi technique
3. Goals and objectives
4. Educational strategies
5. Implementation	Three days of classroom lessons on palliative care and psychosocial oncology, and 1 day of practical experience with cancer patients
6. Evaluation and feedback	Self-administered anonymous survey with open and closed-ended questions

POPCaT: Psychosocial Oncology and Palliative Care Training.

An integrative literature review was conducted to assess the current state of palliative care policy, practice, education, and research in Cameroon. This review aimed to identify existing gaps and inform the development of the program. In addition, the review sought to identify core curricula used globally in the education of nurses in psychosocial oncology and palliative care, with a particular focus on sub-Saharan Africa. Details of the review method and findings have been reported in peer-reviewed publications.^32,34 The review highlighted a significant need for palliative and psychosocial oncology education in Cameroon and identified two major core curricula that could be adapted for use in the country. These included the Psychosocial Care Competencies Framework for Nurses in Africa² and the International Psycho-Oncology Society’s (IPOS) core curriculum.³⁸

To develop the program’s goals, content, and educational strategies, these core curricula, along with a palliative care course developed for preregistration nurse training in Cameroon,^24,39 were reviewed by study team members. This review informed the first draft of the POPCaT program and provided the foundation for establishing its goals and objectives, aimed at addressing the identified gaps in palliative and psychosocial oncology education in Cameroon.

A three-round Delphi technique was employed to review the draft curriculum. The review panel comprised 12 professionals with expertise in palliative care, nursing education, clinical psychology, oncology, and public health from Cameroon (n = 7), the United Kingdom (n = 2), Ghana (n = 1), Indonesia (n = 1), and the United States (n = 1). Panelists were purposively selected from the research team’s professional network. Selection was based on having a prior experience delivering palliative care and psychosocial oncology programs in resource-poor settings, expertise in nursing education and curriculum development, and clinical experience in palliative and psychosocial oncology care. An email explaining the study aims, draft curriculum, and review expectations was sent to all panel members. They provided free-text feedback on all aspects of the program. The curriculum was revised following round-one feedback and circulated for two additional rounds. Comments were submitted to the principal investigator and research coordinator. The experts reviewed objectives, content, session duration, evaluation methods, and future directions. They universally praised the program’s theoretical-practical integration. However, concerns were raised about the brevity of the clinical practice session. Some panelists also contributed additional resources. These insights informed subsequent revisions and facilitated the program pilot. The next section presents the POPCaT program following the GREET checklist.⁴⁰

Description of the POPCaT educational intervention pilot

The POPCaT was piloted as a 32-h course delivered over 4 days, comprising 11 modules plus a clinical practice session. The program aimed to equip practicing nurses to holistically assess and address the palliative and psychosocial needs of cancer patients and their families. It targeted nurses with at least 6 months of experience in oncology, palliative, medical, surgical, or intensive care units, ensuring participants had relevant experience with hospitalized cancer patients.

The curriculum was grounded in Kolb’s (1984)⁴¹ Experiential Learning Theory, which describes learning as a cyclical process involving Concrete Experience, Reflective Observation, Abstract Conceptualization, and Active Experimentation. This framework supported diverse learning styles, valued learners’ lived experiences, and encouraged active engagement. POPCaT integrated all four stages as follows:

Concrete experience: Participants engaged with real-world scenarios through case studies and role-plays, providing a foundation for learning.

Reflective observation: Was facilitated through debriefing sessions and structured group discussions, allowing participants to share emotional and professional reflections, fostering critical thinking and perspective-taking.

Abstract conceptualization: Occurred as facilitators guided participants to connect their experiences to key theoretical principles of psychosocial oncology and holistic care, enabling them to refine and deepen their understanding.

Active experimentation: Participants applied newly learned strategies during supervised clinical practice, observed outcomes, and adjusted their approach, reinforcing skills and competence.

Through engagement with the curriculum, participants were expected to develop the knowledge, attitudes, practical skills, and professional confidence required for effective palliative and psychosocial oncology care. These core competencies were outlined in the learning objectives provided in Supplemental File 1.

The course content was organized around the key domains of palliative and psychosocial oncology care, covering:

Conceptual foundations and definitions of palliative care

Principles of pain and symptom management

Effective communication and delivering bad news

Cultural, spiritual, and religious aspects of care

Ethical and legal considerations

Psychosocial support for individuals living with cancer

End-of-life care

Management of loss, grief, and bereavement

The primary instructional resource was the 2016 Facilitator and Participant Palliative Care Toolkit by Lavy and Woodridge (2008)⁴² and Lavy (2009),⁴³ published by Help the Hospice UK and the Worldwide Palliative Care Alliance.⁴⁴ This manual has been widely used for training in resource-limited settings, including Cameroon. Each participant and facilitator received a printed copy in either English or French to accommodate linguistic preferences.

The program employed diverse teaching methods, including problem-based learning, case studies, interactive demonstrations, role-plays, small group discussions, lectures with slides/videos, and supervised clinical practice (Supplemental File 1).

The facilitation team consisted of nurse educators, a public health specialist, a palliative care nurse, a palliative oncologist, a clinical psychologist, and a chaplain (Box 1). All facilitators had more than 3 years of teaching experience, and, with the exception of the public health specialist, had prior experience as participants or facilitators of palliative care and psychosocial care training programs.

Box 1.

Credentials of course facilitators.

1. Nurse Educator and Palliative Care Researcher, RN, PhD 2. Associate Professor of Public Health and Biostatistician, PhD 3. Specialist Palliative Care Nurse, and Head of Palliative Care Unit, MSc 4. Clinical Psychologist, MPhil, PhD Candidate 5. Clinical Oncologist and Palliative Care Physician, MD, Palliative Care Diploma 7. Public Health Epidemiologist, and General Supervisor of Nursing Services, RN, PhD 8. Senior Lecturer of Nursing, RN, PhD 9. Chaplain and Palliative Care Spiritual Care Expert, Palliative Care Diploma10. Nurse Educator and Spiritual Care Expert, RN, PhD11. Clinical Nurse Specialist and Head of Intensive Care Unit, MSc

The pilot was conducted in October 2024 and March 2025. Participants received 32 h of face-to-face training over 4 days, including 11 modules and a clinical practice session. The first 3 days focused on theoretical instruction, with classroom sessions in the hospital conference room lasting 2–3 h within an 8-h daily schedule. On the fourth day, participants provided hands-on care to hospitalized cancer patients under supervision from an expert palliative care nurse, a clinical oncologist, and a clinical psychologist. A concluding debriefing session allowed participants to share clinical insights and discuss strategies for applying their learning in the workplace.

To facilitate comprehension, sessions in the English-speaking region were conducted in English, while those in the French-speaking region were delivered bilingually. Participants could speak in their preferred language, with one facilitator proficient in both English and French providing real-time translation. All participants in the English-speaking region were primarily English speakers, whereas the French-speaking region included both primarily French- and English-speaking participants.

Attendance was recorded by research assistants and the program coordinator at the start of each day and immediately after the lunch break. Attendance was complete for all participants, with only occasional late arrivals during morning sessions. A facilitator served daily as moderator to ensure sessions proceeded as planned, led icebreaker activities, and provided a summary of each day’s key activities. At the end of the program, all participants were awarded a certificate of participation.

POPCaT’s strength lies in the combination of didactic instruction with experiential learning. This model addresses logistical constraints, including the shortage of teaching resources, lack of specialized clinical placements, and the need to maintain high-quality practical learning in Cameroon.

Description of the POPCaT program evaluation

A formal evaluation was undertaken to assess the effectiveness of the POPCaT in addressing oncology and palliative care educational needs of Cameroonian nurses and its feasibility within local contexts.

Materials and methods

Study design

An evaluation design was employed to identify program strengths and areas of improvement. This evaluation was informed by Kirkpatrick’s level one of training program evaluation.⁴⁵ This entailed evaluating participants’ engagement, relevance, and satisfaction with the training program. Data were collected through an end-of-training evaluation survey comprising both closed-ended and open-ended questions. Closed-ended questions were in the form of a Likert scale, and open-ended questions allowed participants to provide free-text information about the program. The study is reported following the SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in Education) guidelines⁴⁶ to ensure clarity and completeness in describing the design, implementation, and evaluation of the training program.

Setting, participants, and sampling

The study was conducted in six hospitals in the Southwest and Littoral regions of Cameroon. Training sessions were held in October 2024 and March 2025. The study involved 52 nurses purposively selected from the palliative care, oncology, medical, surgical, and intensive care units. A power analysis from a similar study in this setting⁴⁷ indicated that 50 participants would provide 98% power to detect a statistically significant change in palliative care knowledge at a 0.05 significance level. In Cameroon, the nurse-to-population ratio is approximately 1:1,000,³⁵ and most secondary and tertiary hospital units have approximately 10 nurses each. Selecting a minimum of 50 nurses from an estimated total of 220 in the targeted units was considered both statistically adequate and feasible within the study’s logistical constraints. They were selected based on the criterion of having at least 6 months of nursing experience in these units. This criterion aimed to ensure participants had relevant experience in cancer patient care, aligning with the training program’s objectives and educational strategies. Selection was facilitated by the general supervisors of nursing services at each hospital, who oversee continuing professional development initiatives. The program was advertised to targeted participants via a flyer. Interested participants expressed their interest to the General Supervisor of Nursing Services, who selected participants based on administrative considerations. These included eligibility to participate in a continuing professional development program at that time and the feasibility of arranging coverage for the nurses’ shifts during the training period.

Data collection

The method of data collection was a 5-point Likert scale questionnaire asking participants about their experiences of various aspects of the training program. The questionnaire was adapted from other tools in the literature that have been used in training program evaluations. Participants completed the questionnaire at the end of each training day to assess their daily learning experiences and perceptions of the day’s activities. On the last day of the training, a comprehensive survey was administered to evaluate the entire program’s alignment with participants’ expectations and objectives of participating in the training program as well as their perceptions of course design, relationship with facilitators, facilitator support of their learning, impact on their learning and potential impact on their professional practice, plans for transfer of learning to practice, and suggestions for training program improvement. Data regarding participants’ demographic information, practice setting, and previous experience in cancer and palliative care were also collected. To ensure confidential and unbiased feedback, completion of the course evaluation questionnaire was voluntary and did not require personal identifiers. Questionnaires were administered by the study coordinator and research assistants who were not part of the course delivery team, reducing potential influence from course facilitators. Participants were assured that their responses would remain anonymous and would not affect their standing in the program. These measures might have resulted in honest evaluations, thus enhancing the credibility of the findings.

Data analysis

Quantitative survey data were analyzed using descriptive statistics. Frequencies and percentages summarized categorical variables (e.g., gender, institution, education, experience, and oncology training), while continuous variables such as age were described using mean, median, standard deviation, and interquartile range. Participants’ ratings of course experience, design, relevance, facilitator engagement, and likelihood of applying learning in practice were presented as percentages. Analyses were conducted using SPSS version 25.

Qualitative data from open-ended survey responses were analyzed using an inductive thematic analysis approach.⁴⁸ The data were read multiple times to ensure familiarity, then coded for meaningful content and organized into overarching themes, supported by illustrative quotations. Two researchers independently conducted initial coding to develop a preliminary coding framework, which was refined through discussion and applied to the full dataset. Final themes were reviewed and agreed upon collaboratively by the research team to enhance the trustworthiness and rigor of the analysis.

This combined approach enabled a comprehensive understanding of both participants’ overall evaluations and the depth of their experiences.

Results

Sociodemographic distribution of participants

Of the 52 nurses who attended the course, 48 completed the evaluation. Most were female (83.3%) and aged 39–45 years (31.3%). The majority held a nursing diploma (64.5%) and had 1–4 years’ experience with cancer patients (41.7%), while only 31.3% had specialized oncology training (Table 2).

Table 2.

Sociodemographic distribution of study participants.

Characteristics	Category	Frequency (n = 48)	Percentages (%)
Age (years)	Range	33
	Mean	38.23 ± 8.29
	Median	38
	IQR	30, 48
Age group (years)	25–31	13	27.1
	32–38	11	22.9
	39–45	15	31.3
	46–52	6	12.5
	⩾53	3	6.2
	Total	48	100
Gender	Male	8	16.7
	Females	40	83.3
	Total	48	100
Religion	Baptist	11	22.9
	Catholic	8	16.7
	Islam	1	2.1
	Presbyterian	17	35.4
	Others*	11	22.9
	Total	48	100
Hospital of practice	BRH	11	22.9
	CBCHS	7	14.6
	CDCCH	7	14.6
	DGH	11	22.9
	LHD	5	10.4
	LRH	7	14.6
	Total	48	100
Nursing qualification	BSc	15	31.3
	Diploma	31	64.5
	MSc	2	4.2
	Total	48	100
Years working with cancer patients	<1–4 years	20	41.7
	5–9 years	16	33.3
	>10 years	12	25.0
	Total	48	100
Specialty training in oncology	No	33	68.7
	Yes	15	31.3
	Total	48	100
Present unit	Medical	20	41.7
	Surgical	14	29.2
	ICU	4	8.3
	Oncology	8	16.7
	Palliative	2	4.1
	Total	48	100

Apostolic, Church of Christ, Full Gospel, Jehovah Witness, Pentecostal, Protestant Winners Chapel.

Quantitative findings

Participants’ rating of the overall course experience

Most participants rated their overall course experience positively, with 77.1% rating it as “Very Good” and 22.9% as “Good,” reflecting strong satisfaction.

Participants’ perspectives on course design and learning experience

Most participants felt the course met their expectations (75.0%) and learning needs (64.6%), with topics considered relevant (87.5%). Activities and materials were rated positively: clear explanations 81.3%, and useful materials 85.4%. Tutor engagement and feedback were well received: 79.2% and 83.3%, respectively. Overall, 77.1% rated the tutoring experience as “Very Good” (Table 3).

Table 3.

Distribution of participants’ responses on the course design and learning experience.

Items	Strongly agree, n (%)	Agree, n (%)	Disagree, n (%)	Strongly disagree, n (%)
Learning expectations
The course met my expectations	36 (75.0)	10 (20.8)	2 (4.2)	0 (0.0)
The course met my needs	31 (64.6)	15 (31.3)	2 (4.2)	0 (0.0)
The topics covered were relevant to the course	42 (87.5)	6 (12.5)	0 (0.0)	0 (0.0)
Course design
The information was pitched at too low/simple level (use of simple and comprehensible terms)	33 (68.8)	14 (29.2)	0 (0.0)	1 (2.1)
The information was pitched at too high/complex level (use of complex and difficult terms)	3 (6.3)	4 (8.3)	16 (33.3)	25 (52.1)
Perception on activities
The activities were clearly explained	39 (81.3)	9 (18.8)	0 (0.0)	0 (0.0)
The timing of activities was appropriate for the content	27 (56.3)	20 (41.7)	0 (0.0)	1 (2.1)
The sequence of the activities was right	29 (60.4)	18 (37.5)	1 (2.1)	0 (0.0)
The instructions were clear	34 (70.8)	13 (27.1)	1 (2.1)	0 (0.0)
Student/tutor engagement
I was provided with many opportunities to interact with other participants on the course	36 (75.0)	11 (22.9)	0 (0.0)	1 (2.1)
I was provided with many opportunities to interact with the facilitator(s)/tutor(s) of the course	30 (62.5)	15 (31.3)	1 (2.1)	2 (4.2)
Tutor support and teaching
The course material was useful	41 (85.4)	7 (14.6)	0 (0.0)	0 (0.0)
The tutor(s) were engaging	38 (79.2)	10 (20.8)	0 (0.0)	0 (0.0)
The tutor provided helpful feedback	40 (83.3)	8 (16.7)	0 (0.0)	0 (0.0)
Overall tutoring experience	37 (77.1)	11 (22.9)	0 (0.0)	0 (0.0)

Participants’ perspective on the Likelihood to implement learning in practice

Most participants were “very likely” (77.1%) or “likely” (16.7%) to apply the course learning in practice, while a small proportion were “unlikely” (4.2%) or “very unlikely” (2.1%) to do so.

Qualitative findings

Participants’ motivation and course expectations

Participants’ motivations for attending the course were diverse, but quite developed and distinct. Their expressed intentions for participating in this training revealed a shared need to enhance their clinical knowledge and skills in psychosocial oncology and palliative care. They reported wanting “to understand the basics about psycho-oncology and palliative care” (P29), and “to know how to care for patients with palliative care needs and how counselling is done” (P6). They were also eager to learn “more about palliative care, loss, grief, and end of life care” (P2), and “better understand and care for cancer patients using the holistic approach together with their families and those with life limiting conditions” (P5).

Their expectations centered on deepening professional understanding, developing practical caregiving skills, and ultimately providing more compassionate and comprehensive care to cancer patients. Many looked forward to engaging with experts, and some were eager to have real hands-on practice in a palliative care setting. A participant shared that “my expectations were high, I knew I will meet experts, which will improve my skills” (P1). Another said, “I wanted to carry out practicals by working on patients directly” (P4). Some participants stated specific learning expectations such as: “to acquire the skills I will need to help relieve pain during palliative care” (P11), “to acquire knowledge and skills to face the dying patient” (P16), “to gain knowledge/shared experiences” (P22), and “to understand different contexts” (P34).

Participants’ perspective on training program strengths

Generally, participants highly valued some specific course contents, the program structure and educational strategies, the use of bilingualism, and the expertise of facilitators. Some participants reported that they loved the “orderly program of the training” (P7) and the “lectures and demonstrations” (P15), noting that “everything in the course was very interesting” (P23). The value of using both the French and English language during the training was reflected in participants’ responses, with a participant stating that “I most loved the bilingualism for better understanding” (P38). They also found the expertise of the facilitators to be commendable. One participant said: “What I love most was the experience all the facilitators put into the presentations.” Some topics seem to have been of great importance to participants as reflected in the response by P2, who said they found sessions on “management of pain, palliative care, end of life care, loss and grief” especially informative. These seem to have been topics that mostly aligned with their real-life experiences and addressed their day-to-day clinical challenges. This is reflected in comments by P33, who stated that they enjoyed the session on the “management of patients’ pain because that is what we face daily” and P6 who reported “breaking bad news, other symptoms and pain management,” calling it especially relevant “because I meet such clients always in my practice.” In addition, participants highly valued activities that combined experiential learning, reflective practice, and skill-building as well as fostered interaction and critical thinking. Many praised the group work and clinical case discussions: P22 shared that, “I loved it because it helped one to learn from others’ experiences,” and P23 noted that when “we were divided into groups. . .we disagree . . . before coming to agree, by so doing, we learn more.” In addition, P26 emphasized that “the group tasks helped people to network, think out of the box and promoted communication skills since we had an opportunity to present,” and P28 added that “the group presentations . . . I got to understand and gain more knowledge from shared experiences.” Hands-on field experiences, such as the visit to palliative care unit, were impactful, with P8 stating it opened their eyes—“it was my first time. I never knew palliative care units existed.”

Participants’ reported post-course action plans and potential impacts

Participants felt the course would bring meaningful changes in the care of cancer patients at their various hospitals. They described a range of anticipated changes that they saw happening at personal, clinical, and institutional levels. Collectively, the participants’ plans reveal a multi-layered evolution post-course: enhanced communication and empathy at the bedside; stronger clinical skills in pain management, counseling, and palliative care referral; educational outreach and team-centric strategies; and broader advocacy for evidence-based, holistic palliative care.

Clinically, many reported increased confidence and a renewed commitment to patient-centered care. As one participant shared, “I feel more confident in taking care of patients with cancer” (P27), while another said they will “be more patient, listen and communicate” (P46). A stronger orientation toward holistic care was evident, with participants expressing intentions to treat patients “more holistically, treating them uniquely and with a lot of empathy” (P22) and to “always put myself in their shoes so as to care for them well” (P7).

Motivation to extend learning beyond individual practice was also prominent. One participant planned to “let my staff and others know more about palliative care” and “do more research about palliative care” (P23), reflecting institutional education and professional growth. Others intended to “do presentations during our meetings” (P2) and “create a workshop to impart the knowledge to others” (P5), signaling commitment to knowledge-sharing.

Teamwork and multidisciplinary collaboration emerged as key themes in post-course plans. Participants described intentions “to engage in teamwork with colleagues to give holistic care” (P6), “always work as a team” (P48), and improve “teamwork in the management of my patient” (P42), indicating a potential shift toward integrated care models.

Finally, institutional advocacy and raising community awareness about palliative care were also evident as potential action plans post-course. P22 emphasized passing knowledge not only to colleagues but to the “community,” while P34 expressed a vision to embed “more evidence-based practice . . . holistic care” into routine workflows. Such commitments signal a potential transformative impact, from changing individual habits to influencing organizational culture and policies.

Participants’ perspective on training program’s limitations and areas for enhancement

Participants identified some areas where the course could be improved. Some raised concerns about engagement and course structure: P27 expressed a desire for more icebreakers, stating they did not like the fact that there were “Limited ice breaks,” P28 did not like “the persistent reminder on holistic care,” P46 said “time” was an issue, P43 said the topic on “Death” was the least enjoyed, and P45 reported that it was “beyond my role as a nurse.”

Some participants expressed a desire for expanded training, especially around emotionally sensitive topics. Support was requested for “breaking bad news and follow-up after death” (P1) and enhancing “communication” (P23). Cultural and spiritual competencies were also highlighted, with participants emphasizing “spiritual, cultural and religious aspects in palliative care” (P2) and the influence of “cultural norms” on care (P14). Further training was also sought in “managing other symptoms as disease progresses” (P12), “evaluation of psychogenic pain” (P40), and “ethical and legal implementation of palliative care” (P42).

Participants also showed interest in topics not covered during the training. A highly solicited area was “sexuality in palliative care among couples with terminal illness” (P34), “sexuality in patients with palliative care needs” (P36), and survivorship care for patients who are “cancer-free and have gone back to normal day-to-day life” (P11).

Practical guidance on service delivery was another priority. Participants asked for content on the “organisation of a palliative care team” (P47) and “how to go about home-based palliative care” (P33). The heavy workload of oncology nurses was also noted “management of oncology services, the heavy task of the nurse” (P46). Finally, the importance of sustainability was emphasized with calls for “follow-up of proper implementation of knowledge in the various health facilities” (P22).

Discussion

This study reports the development, pilot implementation, and evaluation of the POPCaT program, delivered to 52 Cameroonian nurses across six facilities in the Southwest and Littoral regions. Spanning four consecutive days, the curriculum combined classroom teaching with supervised clinical practice. Post-training assessments indicated high levels of participant satisfaction with the training program and strong intentions to apply the acquired knowledge in clinical practice. The use of a blended instructional approach—including interactive lectures and group activities, role-plays, and clinical exposure—was particularly valued for fostering engagement, conceptual understanding, and practical skill acquisition. Notably, post-course action plans revealed many potential personal, clinical, and institutional-level changes to improve palliative and psychosocial care for cancer patients in various study sites. To enhance future training programs, participants recommended more interactive icebreakers, greater clinical exposure, and expanded content on breaking bad news, spiritual and cultural care, sexuality, survivorship, and guidance on palliative care service development and implementation.

The POPCaT training attracted a predominantly mid-career cohort of nurses with varied clinical roles and levels of experience in cancer and palliative care. This heterogeneity reflects the existing gaps in specialized nursing education in palliative and psychosocial oncology within Cameroon and across much of Africa.^32,34,49 While most participants lacked formal oncology training, they demonstrated strong intrinsic motivation to improve their competence in psychosocial oncology and palliative care. This supports the appropriateness of the program for both novices and experienced nurses, including those without prior specialized training. Assessing baseline knowledge and educational goals is essential when evaluating and planning future adaptations or scale-up. Accordingly, the course’s alignment with generalist palliative care principles,^19,21 core curriculum recommendations,^2,29,38 and regional contextual factors^24,28,39 was crucial for its relevance. Participants articulated clear motivations to develop competencies in psychosocial oncology, counseling, communication, and pain management—motivations that mirror global nursing literature highlighting nurses’ central role in palliative care and their desire for continued education in this area.^49–51

Overall course satisfaction was uniformly high—with no negative responses—and participants described the training as well-structured, engaging, and practically relevant. This reception aligns with prior research on the benefits of palliative and psychosocial oncology training in day-to-day nursing practice^2,52 and in addressing clinical challenges in cancer care.⁵³ Given the rising cancer burden in low- and middle-income countries,⁵ nurses increasingly encounter complex care scenarios, therefore requiring targeted capacity-building to improve patient and family outcomes.^2,18,49,54

A key strength that emerged from both quantitative and qualitative data was the opportunity for interactive learning activities and facilitator expertise. The literature underscores the importance of peer interaction through group work, clinical case discussions, and reflective dialogue, alongside expert support from tutors, in enhancing engagement, knowledge retention, and skill development.^55,56 In this study, structured discussions and consensus-building activities were reported to have a positive impact on critical thinking, which is critical for clinical effectiveness. Moreover, the use of diverse teaching methods seems to have further accommodated different learning styles, reinforcing the value of learner-centered strategies in palliative oncology nursing education.^53,57

Another important highlight of this training program was the high intention of participants to apply learning, with 93.8% of participants stating they were “very likely” or “likely” to use course content in their practice. Plans to influence team dynamics, lead palliative and psychosocial oncology educational initiatives, and champion holistic care suggest shifts in mindset consistent with course goals and core competencies.⁵⁸ This readiness to translate knowledge reflects increased confidence, which is a known facilitator of successful learning transfer.⁵⁹ Through its intentional use of peer and facilitator interactions, this training program seems to have contributed to nurturing potential leadership and ownership of care improvements.^2,19,34,38 While longer-term outcomes are pending evaluation, early results underscore POPCaT’s potential to advance psychosocial oncology and palliative care throughout participating institutions. However, structural barriers such as limited institutional support and heavy workloads may constrain the application of new skills.^24,39

The clinical practice component was especially valued by most participants, with a few reporting it as their first exposure to a palliative care unit. Clinical learning plays a critical role in bridging theory and practice,^53,60 and this positive feedback supports integrating experiential components into oncology and palliative nursing education.⁶¹ By reinforcing confidence and competence, experiential modules address essential educational gaps and prepare nurses for effective real-world care.^59,60

This evaluation highlights both the strengths of the training and the limitations of using written open-ended survey responses. Participants’ requests for additional instruction on emotionally sensitive topics such as breaking bad news, end-of-life care, and cultural or spiritual aspects of palliative care point to challenges in applying course content, with some perceiving certain elements as beyond their nursing role. A few participants also expressed resistance to repeated emphasis on holistic care, suggesting underlying tensions possibly related to attitudes toward palliative care, professional identity, clinical experience, or organizational culture, which may affect engagement with training material. In Cameroon, although nurses are not formally restricted from providing palliative care, the absence of a national policy and unclear role definitions can create uncertainty about their responsibilities in delivering this type of care.³² Traditionally, nursing roles in many Cameroonian hospitals emphasize medical and task-oriented care, which may lead some participants to perceive holistic or psychosocial interventions as “beyond their role.” Institutional norms may also limit autonomy, and nurses with limited prior exposure may feel unprepared to adopt holistic approaches or perceive them as outside the traditional nursing scope.⁶² Professional identity and entrenched organizational expectations can further influence acceptance of new care models.⁶³ Future curriculum iterations could address these constraints directly, offering strategies to integrate holistic approaches that align with both learner perspectives and the realities of the practice environment. Insights from group discussions and consensus exercises suggest that peer interaction and collaborative learning may have helped participants work through difficulties, reconcile differing viewpoints, and strengthen critical thinking.⁶⁴ Although the survey format limited deeper exploration, these findings suggest that interactive activities can facilitate the integration of new knowledge and the navigation of complex palliative care situations.⁶⁵ Future studies employing interviews or focus groups could provide a richer understanding of how nurses address contradictions, manage uncertainties, and translate training into clinical practice, offering a more detailed view of professional growth in psychosocial oncology and palliative care.

Challenges, implications, and global relevance

While overall feedback on the POPCaT program was positive, several areas for improvement were identified, providing guidance for future refinement and scale-up. The findings offer a strong foundation for enhancing the program’s effectiveness, sustainability, and broader applicability. Recommended enhancements include the following:

First, program content can be expanded and deepened by incorporating dedicated modules on survivorship and sexuality in palliative care, drawing on the IPOS core curriculum.³⁸ Training on sensitive topics such as breaking bad news, cultural and spiritual care, and ethical-legal considerations could be strengthened through multiple case studies, role-play, return demonstrations, and structured experience sharing. Second, program duration and pacing should be reassessed to optimize learning and engagement. Adjustments may include allowing sufficient time for icebreakers, implementing spaced delivery over several weeks, and tailoring schedules to available resources, thereby reducing cognitive load and enhancing participant engagement. Third, practical and experiential learning opportunities could be reinforced through the use of simulations, standardized patient scenarios, and expanded site visits, including virtual tours of palliative care units. These approaches provide hands-on experience and reinforce applied skills. Fourth, institutional integration can be facilitated by empowering participants as peer educators and local champions. This may involve providing facilitation toolkits, presentation materials, and guidance on online resources, including practical implementation guides for palliative care team setup and service delivery. Finally, ongoing support and follow-up are essential to consolidate learning. Development of refresher workshops, mentorship schemes, and virtual learning communities can reinforce skills, sustain engagement, and promote long-term program impact.

Beyond its national context, the POPCaT model also offers a scalable framework for strengthening nursing education and palliative care capacity in low-resource settings globally. Its blended, competency-based curriculum—integrating didactic, experiential, and reflective learning—aligns with international standards, including the WHO Public Health Strategy for Palliative Care Integration⁶⁰ and multiple global frameworks for oncology and palliative care nursing education.^61–63 This pilot study demonstrates the feasibility of empowering frontline nurses as change agents and educators within multidisciplinary cancer care and highlights strategies that could inform regional training hubs, south–south collaborations, and international mentorship initiatives. These elements are particularly relevant for countries with similar health system constraints, where nurse-led educational interventions may accelerate palliative care integration and improve quality of life for patients and families.

Given the widespread challenges in low- and middle-income countries—such as workforce shortages, limited oncology curricula, and high patient burdens,^2,47,64—POPCaT represents a contextually adaptable model with relevance not only for the Cameroonian health system but also for global stakeholders seeking sustainable approaches to integrate palliative care into oncology services and strengthen nursing leadership in resource-constrained settings.

Conclusion

The POPCaT training program was found to be contextually relevant and positively received by Cameroonian nurses working with cancer and palliative care patients. Participants reported high satisfaction, increased confidence, and strong intentions to translate learning into practice. Key program strengths included its combination of both classroom and practical sessions, use of interactive educational strategies, and facilitator expertise. However, important areas for enhancement were also identified, including expanded coverage of communication and breaking bad news, sexuality, survivorship, and practical implementation strategies. These findings offer a solid foundation for refining and scaling POPCaT and affirm the value of practical, contextually tailored training to advance palliative oncology care in low-resource settings.

Limitations

This evaluation is based on cross-sectional, self-reported data collected at course completion, which may not fully reflect long-term behavioral changes. While the integration of quantitative and qualitative evaluation, high participant engagement, and consistency in feedback across sites support the reliability and credibility of the findings, future work should include longitudinal follow-up and patient-level outcomes to more robustly assess program effectiveness. In addition, using interviews or focus groups could allow for a deeper exploration of participants’ experiences, including tensions, contradictions, and challenges in applying training principles in practice. The study was also limited to two regions in Cameroon, which may restrict generalizability; nevertheless, the lessons identified and context-aware adaptations may be transferable to settings with similar resource constraints.

Supplemental Material

sj-docx-1-pcr-10.1177_26323524251409345 – Supplemental material for Development and pilot evaluation of a Psychosocial Oncology and Palliative Care Training program for nurses in Cameroon

Supplemental material, sj-docx-1-pcr-10.1177_26323524251409345 for Development and pilot evaluation of a Psychosocial Oncology and Palliative Care Training program for nurses in Cameroon by Nahyeni Bassah, Nicholas Tendongfor, Bachi-Ayukokang Ebob-Anya, Malika Esembeson, Vivian Ayamba Eta, Ndzi Eric Ngah, Salisu Ango Abdul-Rahim, Bih Vanessa Tita, Asu Carine Ndum, Sango Rita Afanyini, Che Joseph Ngwa, Anne Marthe Maison Mayeh and Loveline Ngem Mboh in Palliative Care and Social Practice

Supplemental Material

sj-docx-2-pcr-10.1177_26323524251409345 – Supplemental material for Development and pilot evaluation of a Psychosocial Oncology and Palliative Care Training program for nurses in Cameroon

Supplemental material, sj-docx-2-pcr-10.1177_26323524251409345 for Development and pilot evaluation of a Psychosocial Oncology and Palliative Care Training program for nurses in Cameroon by Nahyeni Bassah, Nicholas Tendongfor, Bachi-Ayukokang Ebob-Anya, Malika Esembeson, Vivian Ayamba Eta, Ndzi Eric Ngah, Salisu Ango Abdul-Rahim, Bih Vanessa Tita, Asu Carine Ndum, Sango Rita Afanyini, Che Joseph Ngwa, Anne Marthe Maison Mayeh and Loveline Ngem Mboh in Palliative Care and Social Practice

Footnotes

The authors gratefully acknowledge all study participants,the participating hospital sites,and the POPCaT training program development team for their valuable contributions.

ORCID iDs

Nahyeni Bassah

Nicholas Tendongfor

Bachi-Ayukokang Ebob-Anya

Malika Esembeson

Vivian Ayamba Eta

Ndzi Eric Ngah

Salisu Ango Abdul-Rahim

Bih Vanessa Tita

Asu Carine Ndum

Sango Rita Afanyini

Joseph Ngwa

Anne Marthe Maison Mayeh

Loveline Ngem Mboh

Ethical considerations

Ethical approval for this study was obtained from the Institutional Review Board of the Faculty of Health Sciences,University of Buea (Ref: 2023/2165-10/UB/SG/IRB/FHS). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki,ensuring the rights,safety,and well-being of all participants were protected throughout the research process.

Consent to participate

Informed consent was obtained from all participants prior to their inclusion in the study. Participant confidentiality was strictly maintained throughout,and all data presented are fully anonymized.

Author contributions

Nahyeni Bassah: Conceptualization;Data curation;Formal analysis;Funding acquisition;Investigation;Methodology;Project administration;Resources;Supervision;Validation;Visualization;Writing – original draft;Writing – review & editing.

Nicholas Tendongfor: Conceptualization;Data curation;Formal analysis;Funding acquisition;Investigation;Methodology;Project administration;Resources;Supervision;Validation;Visualization;Writing – review & editing.

Bachi-Ayukokang Ebob-Anya: Conceptualization;Data curation;Formal analysis;Funding acquisition;Investigation;Methodology;Project administration;Resources;Supervision;Validation;Visualization;Writing – review & editing.

Malika Esembeson: Funding acquisition;Investigation;Methodology;Writing – review & editing.

Vivian Ayamba Eta: Funding acquisition;Investigation;Methodology;Writing – review & editing.

Ndzi Eric Ngah: Funding acquisition;Investigation;Methodology;Writing – review & editing.

Salisu Ango Abdul-Rahim: Funding acquisition;Investigation;Methodology;Writing – review & editing.

Bih Vanessa Tita: Data curation;Formal analysis;Investigation;Writing – review & editing.

Asu Carine Ndum: Data curation;Formal analysis;Investigation;Writing – review & editing.

Sango Rita Afanyini: Data curation;Formal analysis;Investigation;Writing – review & editing.

Che Joseph Ngwa: Investigation;Writing – review & editing.

Anne Marthe Maison Mayeh: Investigation;Writing – review & editing.

Loveline Ngem Mboh: Investigation;Writing – review & editing.

Funding

The authors disclosed receipt of the following financial support for the research,authorship,and/or publication of this article: This work was supported with grant funding from Pfizer Global Medical Grants (76387581).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Data availability statement

To protect the privacy of study participants,the original data are not publicly available. However,the data supporting the findings of this study and additional materials are available from the first author upon reasonable request.

Supplemental material

Supplemental material for this article is available online.

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