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Simulation training in non-cancer palliative care for healthcare workers: a systematic review of controlled studies
  1. Joanne Tropea1,2,
  2. Ross Bicknell1,
  3. Debra Nestel3,
  4. Caroline A Brand2,4,
  5. Christina E Johnson5,6,
  6. Sanjoy K Paul2,4,
  7. Brian H Le7,8,
  8. Wen Kwang Lim1,2
  1. 1 Department of Medicine and Aged Care, Melbourne Health, Parkville, Australia
  2. 2 Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
  3. 3 Monash Institute for Health & Clinical Education, Monash University, Clayton, Australia
  4. 4 Melbourne EpiCentre, Melbourne Health, Parkville, Australia
  5. 5 Monash Doctors Education, Monash Health, Clayton, Australia
  6. 6 Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
  7. 7 Department of Palliative Care, Melbourne Health, Parkville, Australia
  8. 8 Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
  1. Correspondence to Joanne Tropea, Department of Medicine and Aged Care, Melbourne Health, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; Joanne.Tropea{at}


Background The need for healthcare workers (HCWs) to have skills and knowledge in non-cancer palliative care has been recognised. Simulation is increasingly being used for palliative care training, offering participants the opportunity to learn in a realistic environment and fully interactive way.

Objective The aim of this systematic review was to summarise and critically appraise controlled studies on simulation training in non-cancer palliative care for HCWs.

Selection Medline, CINAHL, PubMed and Cochrane Library databases were searched using palliative care and simulation terms. Randomised controlled trials (RCTs), non-randomised RCTs and controlled before-and-after (CBA) studies were included. Two reviewers independently screened titles and abstracts and undertook full article review using predefined selection criteria. Studies that met the inclusion criteria had data extracted and risk of bias assessed using the Cochrane Effective Practice and Organisation of Care risk of bias criteria.

Findings Five articles were included: three RCTs and two CBA studies. All studies assessed learners’ palliative care communication skills, most studies evaluated learners’ perception of change in skills and one study assessed impact on patient outcomes and learners’ change in behaviour when applied in practice. There was variation in intervention content, intensity and duration, outcome measures and study design, making it difficult to compare and synthesise results.

Conclusion There is a paucity of evidence to support simulation training to improve non-cancer palliative care. This review highlights the need for more robust research, including multicentre studies that use standardised outcome measures to assess clinician skills, changes in clinical practice and patient-related outcomes.

  • Literature Review
  • Simulation Training

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  • Twitter Debra Nestel @DebraNestel.

  • Contributors JT, WKL, CAB and SKP conceived the systematic review scope. JT led the systematic review, drafted the manuscript and co-ordinated the writing of the review. JT and RB screened title and abstracts and conducted the full-text reviews for the systematic review selection criteria. All authors reviewed the draft manuscripts and contributed to editing and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SKP has acted as a consultant and/or speaker for Novartis, GI Dynamics, Roche, AstraZeneca, Guangzhou Zhongyi Pharmaceutical and Amylin Pharmaceuticals LLC. He has received grants in support of investigator and investigator-initiated clinical studies from Merck, Novo Nordisk, AstraZeneca, Hospira, Amylin Pharmaceuticals, Sanofi-Avensis and Pfizer. All other authors do not have any competing interests to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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