Impact of asynchronous online cancer education for nurses on practice outcomes: A systematic review using the kirkpatrick evaluation model.

[BACKGROUND] Continuing education is critical for oncology nurses to enable the delivery of safe, efficient, specialist care based on current evidence-based guidelines. Accessing training opportunities can be challenging in the face of work and staffing pressures. Asynchronous online education can circumvent this barrier but despite growth in popularity, evidence of its effectiveness on practice outcomes is weak.

[AIM] To evaluate and synthesise evidence for the impact of asynchronous online cancer education for nurses on practice outcomes.

[METHODS] A systematic approach was used to identify primary studies in the following databases: CINAHL, MEDLINE, APA, PsychInfo, ERIC, EMBASE, PubMed and Web of Science. Critical appraisal was guided by the Medical Education Research Quality Instrument (MERSQI) and Effective Public Health Practice Project (EPHPP) tools for quantitative studies, and the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies. The Kirkpatrick Four Level Model of training evaluation and a modified effect direct plot were used to facilitate synthesis of the evidence.

[FINDINGS] Thirty studies of varying research design were included in the review. Vast heterogeneity was apparent in research designs, participants, intervention design and duration, and outcome measures. Due to this heterogeneity, it was difficult to establish that one design of education was more effective than another. Patient outcomes were not measured in any of the thirty studies reviewed. Behavioural change was objectively measured in two (7 %) studies, evaluating screening rates and pain assessments, and self-reported in eleven (37 %) studies regarding changes such as adapting to patients' language needs, cytotoxic drug handling, and discussing reproductive health. At least one educational outcome (nurses' knowledge, skills, attitudes, beliefs, confidence or self-efficacy) was measured in all thirty papers, however, improvements in these did not necessarily translate to evidence of changing practice outcomes. The overall quality of evidence was weak, particularly with respect to research design and validity of outcome measures.

[CONCLUSION] The need for more rigorous research in this field continues as there were limited evidence available to evaluate the direct impact of online cancer education on practice outcomes. Practice outcome evaluation could be enhanced by using measurements that are less subject to bias.