Abstract
Introduction
Kitasato University Hospital offers a training course for community pharmacists that focus on advanced pharmacy management care in outpatient cancer chemotherapy. The objective of this training program is to facilitate the transition from general to oncology certification for community pharmacists with limited experience in outpatient oncology to support the acquisition of an oncology specialty.
Aim
To evaluate the relationship between the changes in awareness, knowledge, and self-assessment that advanced pharmacy management care traineeship in an outpatient oncology unit for community pharmacists brings to trainees and the duration of training.
Methods
A quantitative text analysis was conducted of the daily training reports of six community pharmacists who had participated previously in the training course and had received in-service training in oncology for at least 30 days. The pre- and post-training results of the knowledge tests and self-assessments of confidence, understanding, and performance were compared. This study was approved by the Research Ethics Committee of Kitasato Institute Hospital in October 2019 (Study No. 19044).
Results
The terms Prescription, Recommendation were extracted from the daily report after the 21st day of oncology in-service training. Furthermore, factors such as knowledge of cancer pharmacotherapy, confidence in patient education regarding the side effects of chemotherapy, and understanding of the work of pharmacists in outpatient cancer chemotherapy significantly increased at the end of the training.
Conclusions
Community pharmacists with limited experience in outpatient oncology could improve their knowledge, understanding, and awareness of outpatient oncology patient care through 30 days of in-service oncology training in a hospital setting. The issues that emerged included training pharmacists to send follow-up documents on the patients’ side effects and medication status as well as developing the literature search environment in community pharmacies.
Keywords
Introduction
In Japan, the Pharmacy Vision for Patients 1 was released in 2015 by the Ministry of Health, Labour, and Welfare. The vision plan promotes the strengthening of family practice and health support functions of community pharmacies and pharmacists for outpatients. In recent years, the role of the Advanced Pharmaceutical Care Management (APCM) function has been to create awareness around a system that can provide specialized pharmacotherapy to cancer patients and other patients using high-risk medicines to mitigate the side effects, support medication adherence, maintain interactions, and address other issues. 1
Several countries have suggested that outpatient clinical pharmacy services can contribute to the medication safety of outpatients with cancer. 2 In Japan, the expansion of outpatient clinical pharmacy services and feedback from community pharmacies has been expected to increase safety and improve Quality-of-Life (QoL) among outpatients with cancer. 3 In August 2021, a certification system was launched for community pharmacies, providing high-quality oncology patient care in collaboration with specialized medical institutions. 4 This collaboration has facilitated the sharing of patient information through documentation across facility boundaries. To utilize this information, it became more important for community pharmacists to improve their knowledge and skills regarding outpatient cancer care. In addition, certified oncology specialty community pharmacies are required by law to employ a full-time community pharmacist with designated oncology specialty pharmacist qualifications.5,6
The qualification of a specialist pharmacist had been assigned mainly to hospital pharmacists in Japan. In recent years, two societies have established new oncology specialist pharmacist systems for community pharmacists. One of the requirements for certification as a specialist community pharmacist in both societies is mandatory oncology training in a hospital setting. However, the duration of hospital training differs between the two types of certification requirements. Each certification course requires a minimum of three to four days per month for five years or 30 days in total within one year. The duration and effectiveness of hospital training for pharmacists are underscored in several reports.7–9 However, most of these reports are on the duration and effectiveness of training in hospital settings for pharmacists working in the future (or currently) in hospitals, such as residency programs and clinical placements for pharmacy students. To the authors’ knowledge, the standard length of hospital training for community pharmacists has not been established, and no report has examined the relationship between the expected training effects and duration of hospital training, particularly for outpatient cancer care.
Kitasato University Hospital (KUH) has been offering APCM training in outpatient cancer chemotherapy to community pharmacists since January 2020, before the aforementioned certification system was initiated. 10 The APCM training at KUH was considered equivalent to oncology specialty training in a hospital setting to develop specialist community pharmacists required for certified community pharmacy. 11 We investigated the effectiveness of the oncology APCM training at KUH from multiple perspectives, based on a text analysis of the daily training reports, an objective test, and a questionnaire. Furthermore, the relationship between the changes in awareness, knowledge, and self-assessment through training and the duration of oncology APCM training in a hospital setting for community pharmacists were discussed.
Method
Participants
This study included community pharmacists who participated in APCM training in oncology at KUH. Participants provided written informed consent prior to engaging in the study. Community pharmacists with less than 30 days of in-service oncology training were excluded from the analysis.
Conditions for participation in the training were as follows, at least three years of work experience as a community pharmacist, certified pharmacist in the general field or recognized as having equivalent knowledge and experience, willingness to obtain accreditation as pharmacist of ambulatory cancer chemotherapy from the Japanese Society of Pharmaceutical Oncology and having a recommendation from a superior at the community pharmacy to which each participant belonged.
Study period
The training iterations conducted at KUH from January 2020 to November 2021 were considered in this study. The oncology APCM training iterations were conducted from January 6 to March 19, 2020 (first iteration); September 7 to November 20, 2020 (second iteration); January 4 to March 19, 2021 (third iteration); and September 6 to November 19, 2021 (fourth iteration).
Training objective and program management methods of APCM oncology training at KUH
The objective of this training program is to facilitate the transition from general to oncology certification for community pharmacists with limited experience in outpatient oncology to support the acquisition of an oncology specialty.
The training program was developed independently by a committee within the KUH pharmacy department, including the hospital pharmacy director, oncology pharmacist, ward pharmacist, community pharmacist, and pharmacy faculty, with reference to various training programs for certified pharmacists in Japan.5,6,12 The training content was improved by this committee with minor changes at each iteration (Supplementary Material A). From the third iteration onward, as the details of the oncology pharmacist training program for community pharmacists became clear, 6 the training program was adapted to the 30-day program completed over one year, while retaining the original content.
Survey contents and methods
Co-occurrence network analysis of the daily training report
Throughout the training period, except for the last day, trainees prepared a daily training report with the following items: Summary of the training conducted, Problems experienced during training, and Application of training knowledge to daily community pharmacy services.
Changes in awareness through training were analyzed based on content changes in the Application of training knowledge to daily community pharmacy services section of the daily training report according to the number of days of oncology in-service training. The days of in-service training in oncology comprised APCM training days for operations associated with the outpatient oncology unit, oncological ward pharmacy, and anticancer drug preparation. Text data from the Application of training knowledge to daily community pharmacy services section of the daily training report were separated using 10-day intervals. The days of in-service training in oncology, excluding the days of training absence, were divided into four groups—days 1–10, 11–20, 21–30, and 31 and beyond. A co-occurrence network analysis was conducted using econometric text analysis. The analysis was conducted in Japanese and translated into English.
Pre- and post-training comparisons of knowledge test scores and self-assessment results of confidence, understanding, and level of performance
Changes in the knowledge, confidence, understanding, and performance levels related to oncology were investigated among community pharmacists at the beginning and end of training. On the first and last days of training, participants completed a knowledge test and self-assessment of confidence, understanding, and performance in relation to oncology pharmacotherapy. Thereafter, the results of the changes were compared. Considering that the purpose of this training was to facilitate the initial transition from the general to the oncology area, the required knowledge scoring rate at the end of the training was 80% (40 points). The required confidence score on the 11-point Numerical Rating Scale (NRS) was set to be greater than five, with five points interpreted as the borderline of confidence or lack thereof. In the self-assessment of understanding and practice, levels 3 and higher were interpreted as a state of understanding or practice, respectively.
Knowledge test
The knowledge test comprised 50 true or false questions related to cancer pharmacotherapy (Supplementary Material B). The exam questions were drafted by a pharmacist with experience working in both community and hospital pharmacies. Furthermore, three hospital pharmacists, including an oncology specialist pharmacist, supervised the exam. The questions were consistent on the first and last days of training. However, participants were not notified in advance about the knowledge test on either day of training. The question-and-answer sheets of all participants were collected.
Self-assessment of confidence
Confidence level was self-assessed using the 11-point NRS from 0 (not confident at all) to 10 (very confident) on four questions related to cancer pharmacotherapy monitoring and patient education. The items were as follows: (1) can appropriately validate regimens when administering cancer chemotherapy to patients, (2) can correctly check the withdrawal period of anticancer drugs, (3) can appropriately monitor the side effects caused by cancer chemotherapy, and (4) can provide appropriate information to mitigate the side effects of cancer chemotherapy.
Self-assessment of comprehension
The comprehension survey involved self-assessment using a five-point scale (1 = do not understand at all to 5 = understand very well) in response to four statements related to outpatient cancer treatment, namely, (1) flow from outpatient consultation to hospital admission, (2) flow of outpatient cancer chemotherapy, (3) pharmacist involvement in outpatient cancer chemotherapy, and (4) methods to obtain hospital chemotherapy regimens in community pharmacy.
Self-assessment of performance
The performance level survey was conducted using self-assessment on a five-point scale (1 = not possible at all to 5 = completely possible) for four APCM operational items for pharmacists, namely, (1) checking chemotherapy orders, (2) drug recommendations for anticancer drug side effects, (3) preparing tracing reports, and (4) performing literature searches. A tracing report is a follow-up document sent by the community pharmacist to the attending physician obtaining information from the patient interview. The report may also include a telephone interview regarding the side effects and patient's medication status. While this information is not urgent, it can be a beneficial reference for the physician before the next outpatient visit.
Statistical analysis
KH Coder (Version: 3. Beta.04c) 13 was used for the co-occurrence network analysis of the daily training reports. This analysis was conducted in Japanese. The co-occurrence relations used in the analysis were the top 60, which is the default setting of KH Coder. The recommended range of the number of extracted words for this setting is 60–70. 14 Therefore, in this study, the minimum number of occurrences was set to ensure that the number of extracted words analyzed was close to 60. A list of frequent words was extracted from the daily training reports. Then, a co-occurrence network analysis was performed on the extracted words, and a plot was created using the random walks method. 15 The original contexts of the extracted words listed in the plotted figure were used as a reference for translation into English. For the text analysis, the default part-of-speech settings of KH Coder were used; specifically, functional words such as pronouns, conjunctions, particles, and auxiliary verbs were ignored and excluded from the tabulation and analysis. Additionally, since it was not possible to distinguish between the negative and positive uses of a word in a sentence, the analysis was conducted by referring to the source text to determine the context in which the words were used.
The beginning and end of training comparisons were examined using the Wilcoxon signed-rank test, with p < 0.05 (two-tailed) set as the significance level for all tests. JMP® Pro 16.1.0 for Windows (64-bit) (SAS Institute Inc., Cary, NC, USA) was used for statistical analysis.
Ethical approval
This study was approved by the Research Ethics Committee of Kitasato Institute Hospital in October 2019 (Study No. 19044).
Results
This study comprised eight trainees, with two trainees in each of the four APCM training iterations. However, two trainees in the third iteration with less than 30 days of in-service training in oncology were restricted because of countermeasures for the coronavirus disease 2019 (COVID-19). Therefore, six trainees (three male participants and three female participants) were included in the current analysis. For the six participants’ number of days of in-service training in oncology, there was one participant each for the 32-, 34-, and 35-day in-service training iterations, while three participants received training for 33 days. On the first day of training, a median age of 28.5 (27–40) years and median pharmacist experience of 4.1 (2.8–14.4) years were observed. All participants were certified pharmacists in general practice; one participant had certification in herbal medicine and another in pediatrics.
The total duration of in-service training, including noncancer training, was 52 days for the first and second iterations and 35 days for the fourth iteration. Table 1 provides an overview of the APCM oncology training at KUH. In the first and second iterations, the APCM training program occurred over 11 weeks and comprised eight weeks of APCM work in the outpatient chemotherapy unit (including up to one week of anticancer drug preparation work), two weeks of pharmacist services in hospital wards (one week each in cancer and noncancer wards), and one week of central pharmacy services in the hospital pharmacy department. Other activities included an exercise in literature search methods, consisting of a lecture on literature search methods and an actual search, and observation of human immunodeficiency virus (HIV) treatment and the work of medical social workers. The trainees also participated in multidisciplinary hospital conferences based on their requests. The duration and content of the training for the fourth iteration was restricted by COVID-19. The training for ward pharmacy operations was reduced to one day in the cancer ward, and the training in central pharmacy services was canceled, the survey on the first day of training was conducted via the Internet. However, more than 30 days of in-service training in oncology were secured.
Overview of the Advanced Pharmaceutical Care Management oncology training at Kitasato University Hospital.
ACPM: Advanced Pharmaceutical Care Management; DI: drug information; HIV: human immunodeficiency virus.
Quantitative text analysis for daily training reports
During the quantitative text analysis, 339 sentences/11,475 words for days 1–10; 341 sentences/11,882 words for days 11–20; 310 sentences/11,071 words for days 21–30; and 68 sentences/2544 words (all Japanese-based) for days 31 and beyond were extracted from the Application of training knowledge to daily community pharmacy services section of the daily report. Co-occurrence network analysis was performed using the 62 words that appeared at least 10 times on days 1–10, 61 words that appeared at least 11 times on days 11–20, 59 words that appeared at least 12 times on days 21–30, and 54 words that appeared at least four times on days 31 and beyond. The 60 most relevant co-occurrence relationships among the extracted words were plotted (Figure 1). Consequently, “Community-pharmacy, Anticancer-drug, Patient, Education, and Learning” appeared on days 1–10. Furthermore, “Anticancer-drug, Chemotherapy, Side-effect, Understanding, and Necessary” were observed for days 11–20. Moreover, “Prescription, Recommendation” and “Nail, Care” were found for days 21–30, with similar contents on days 31 and beyond, including “Prescription, Consider, Physicians, Recommendation,” “Person, Attitude, Facial-expression, Anxious,” and “Telephone, Follow-up.” Notably, Patient, Side-effect, Education, Community-pharmacy, Confirm and “Send, Information” were common except after the 31st day. On days 31 and beyond, the co-occurrence of “Side-effect” with “Anxious, Follow-up” and that of “Information” with “Service, In-case-of” were observed.
Co-occurrence network analysis for the description of the application of training knowledge to daily community pharmacy services in the daily training report.
Pre- and post-training comparisons of knowledge test scores and self-assessment results of confidence, understanding, and level of performance
Table 2 shows the pre- and post-training comparisons of knowledge test scores and self-assessment results of confidence, understanding, and level of performance. A significant increase was observed in knowledge test scores, confidence in providing patient education on countermeasures for cancer chemotherapy side effects, understanding of the flow of outpatient cancer chemotherapy, and understanding of the pharmacist's involvement in outpatient cancer chemotherapy at the end of the training. Furthermore, the median self-rated confidence, understanding, and performance levels increased after the training for all questions. The 11-point confidence score for cancer chemotherapy monitoring and patient education increased from the median score of ≤3 to ≥5. The median score for understanding of outpatient cancer treatment was initially ≤2 (do not understand well) for all questions, but after the training, the median score was ≥3 (understand). The scores for the flow of outpatient cancer chemotherapy and the pharmacist's involvement in it were particularly high. Regarding the performance level of the four APCM operational items, the median score after the training was ≥3 (possible), but none of the items reached 4 (smoothly possible). The median score for tracing report preparation was 3 at the beginning of the training and 3.5 after the training, showing little change.
Comparisons between the beginning and end of training about knowledge test scores, self-assessment results of confidence, understanding, and performance level.
Wilcoxon signed-rank test.
p < 0.05.
Table 3 compares the fourth iteration (which was affected by training restrictions due to the COVID-19 pandemic) with the first and second iterations (which were not affected) for each score at the end of the training. Due to the small sample size, no statistical analysis was performed. The medians of the knowledge score, self-assessment of confidence and practice, and understanding of outpatient chemotherapy flow were lower in the fourth iteration, when restricted training due to COVID-19 was implemented, than in the first and second iterations, when COVID-19 had little influence.
Knowledge test scores, self-assessment results of confidence, comprehension, and performance level at the end of the training; comparison of unrestricted training (first and second iterations) and restricted training (fourth iteration; due to COVID-19).
COVID-19: coronavirus disease 2019.
Discussion
This study suggests that 30 days of in-service training in an outpatient oncology unit for community pharmacists in the early stages of their career as oncology specialists can improve their knowledge, understanding, and awareness of outpatient oncology care. The daily training reports analysis revealed that community pharmacists who attended the oncology APCM training at KUH became aware of providing pharmacological recommendations and QoL improvement in their daily work in community pharmacy. This study observed increased test scores for cancer pharmacotherapy, confidence in patient education regarding countermeasures to mitigate adverse drug reactions and understanding of pharmacist work in outpatient cancer chemotherapy at the end of training. These findings suggest that in-service oncology training for community pharmacists can improve the quality of APCM in the community and promote collaboration between specialty hospitals and community pharmacies. The issues noted in our training program could be addressed using strategies (determined based on the study results) including enhancing training to improve tracing reports skills and developing a literature search environment in community pharmacies.
The changes in the content of the daily reports listed in Application of training knowledge to daily community pharmacy services underscore the gradual understanding of interpersonal work particularly in terms of patient education on the side effects of anticancer drugs, understanding the characteristics of the treatment and the side effects of each anticancer drug, pharmacological recommendations, QoL improvement, responding to patients’ feelings, and telephone follow-up. The multidisciplinary collaboration through pharmacological recommendations was an issue for training programs in the first iteration at KUH. 11 In contrast, words such as Prescription, Recommendation, and Nail, Care were extracted from the daily reports after the 21st day of this study. The following modifications in the second and subsequent training iterations could be the reason why these words were extracted. The program was reviewed after the completion of the first iteration to increase opportunities for pharmacological proposals to physicians and nurses. Specifically, training hours were changed to be based on the working hours of physicians and nurses, rather than the working hours of pharmacists. It was inferred that allowing more time for collaboration with physicians and nurses is one of the important factors contributing to improved pharmacological recommendation skills and patient QoL in oncology in-service training.
In all training periods except after the 31st day, Send, Information was obtained from the daily reports. The co-occurrence of Send, Information was not observed after the 31st day because Send was not included in the 54 words that appeared at least four times in the analysis. The text data of the daily reports after the 31st day were only available for a total of 14 days. In contrast, other periods had text data for a total of 60 days each, making comparisons difficult. However, patient education, telephone follow-up, response to patients’ concerns, treatment of electrolyte disorders, prescription review, and suggestions were extracted. Therefore, it was suggested that the 30-day in-service training in oncology at a hospital could contribute to improving community pharmacists’ APCM capability in the field of oncology. Long and consecutive days of training are burdensome for both hospital and community pharmacies; it is thus important to set an appropriate training period for the expected training effects. This study suggests that at least 30 days of in-service training in oncology are required to fulfill pharmacological recommendations and gain the ability to adhere to good practices aimed at improving QoL. However, the APCM training in this study is a continuous training program. Thus, future research is needed to determine the effectiveness and duration of training when training is conducted once a week for the equivalent of 30 days.
The pharmacists’ specialty must be assigned for a community pharmacy to be certified as practicing oncology APCM in collaboration with a specialized medical institution related to all aspects of cancer pharmacotherapy. These aspects include knowledge of chemotherapy of anticancer drugs and drugs used in supportive care. 4 Scores on knowledge tests related to cancer pharmacotherapy increased significantly after the training, suggesting that the oncology APCM training conducted at KUH could contribute to improved expertise.
Self-rated confidence level in patient education regarding mitigative countermeasures against the side effects of cancer pharmacotherapy also significantly increased, with the median scores more than doubling. The results can be interpreted as a contribution to the quality of pharmacological management associated with the side effects of medications used in supportive care. Furthermore, the level of understanding of the flow of outpatient cancer chemotherapy in hospitals and the involvement of pharmacists significantly deepened, changing from “do not understand well” to “understand well” after attending the training. Although there were significant differences in the changes before and after the training, the median at the end of the fourth iteration, which was restricted by COVID-19, tended to be lower than that in the unrestricted iterations. It cannot be ruled out that the lack of experience in ward pharmacy work and anticancer drug preparation work and central pharmacy services in the hospital may have negatively affected the confidence and understanding levels, respectively. These results predict that in-service training of community pharmacists at the hospital will promote community collaboration in outpatient cancer chemotherapy between the hospital and community pharmacies.
With regard to performance level scores, no significant differences were found, even though all self-assessments increased after the training. The median self-assessment scores at the end of the training were ≥3 (possible) for all questions. Since the purpose of this training program was to support the initial phase of community pharmacists who wish to specialize in oncology, the evaluation of “possible” can be interpreted as having generally achieved the goal. However, this study did not define each of the self-assessment scores. Establishing these definitions and presenting them to trainees would help improve the achievement of training outcomes. The differences between the beginning and end of the training were particularly small in tracing reports and the literature search. Tracing reports are not written by hospital pharmacists, as this is a task unique to community pharmacists. Thus, there was likely a limited opportunity to implement practice during the training. One possible improvement to the program would be to add a training component to instruct and review the methods of writing information required by specialty hospitals based on the actual tracing reports sent by community pharmacies. In contrast, regarding the practice of literature search, there were opportunities to practice literature search during the training, and the exercise lecture was conducted. In Japan, community pharmacists have been reported to be less adept to reading clinical trial articles or have less access to them in contrast to hospital pharmacists. 16 Thus, a slight difficulty was experienced with regard to practicing the literature search in community pharmacies as the trainees did during their training. The APCM accreditation criteria for community pharmacies do not include provisions for access to the latest literature. However, this study finds it important to create environments and practices that facilitate access to literature in community pharmacies.
This study focused on the relationship between the changes in awareness, knowledge, self-assessment, and duration of hospital training for oncology community pharmacists. All training iterations in this study were conducted under the influence of the COVID-19 pandemic. At the beginning of the global pandemic, Japan implemented strict movement restrictions nationwide, resulting in a relatively small impact on hospital care during the first and second training periods compared to other countries. However, the third and fourth iterations were significantly affected by measures such as restricted access to hospitals and the suspension of medical care. Therefore, it is necessary to consider the impact of COVID-19 restrictions on training when evaluating the results. The median scores, other than for understanding at the end of training, tended to be lower in the fourth iteration than in the first and second iterations. In addition, some of the confidence levels and all of the practice levels did not reach the training goals. Apart from the fourth iteration, which was shortened due to COVID-19, training was conducted on non-oncological APCM and community collaboration, such as training in non-oncological wards, training in the central pharmacy service, observing HIV outpatient clinics and conferences, and training with medical social workers. The extent to which these training iterations affected the results of the current study is unknown. The possibility of bias due to differences in individual skills should be considered. However, additional trainings outside of the outpatient oncology unit may have increased community pharmacists’ confidence and practice level by increasing experience with hospital staff. The longer total training period may have also increased opportunities for self-learning, which may have contributed to increased expertise and retention.
The median pharmacist experience of the participants in this analysis was 4.1 years, which is less than the five years of work experience required for a pharmacist specialist. In the context of sufficient experience, the level of knowledge, confidence, understanding, and performance at the start of training may be higher among the participants, making it difficult to obtain the comparative results of this study. Several significant differences were found in the statistical analysis; the results may reflect biases in individual values and abilities, because of the limited number of participants (i.e., six).
The text analysis only included the Application of training knowledge to daily community pharmacy services section of the daily report, which is directly related to the training outcomes and did not consider the relevance of the other sections. Extracting only one section of the daily report, which is a series of statements, runs the risk of misinterpreting the context. Accordingly, qualitative methods could have been considered in the interpretation of training effectiveness. However, there was a risk that interventions conducted using qualitative methods during the training period could affect the trainees’ awareness, confidence, and other evaluation indicators. To minimize the impact of such interventions during the training period, the current study chose the method of text analysis of daily reports after the training was completed. In other ways, the choice of the exit interview method might have reduced the disruption of the trainees’ awareness. In addition, specific information on the recommended training period and the changes for community pharmacists in training in the hospital setting remain unclear. This study highlights the outcomes of in-service oncology training for community pharmacists in the early stages of oncology care from multiple perspectives through text analysis of daily reports, knowledge tests, and self-assessments; continued reporting on the educational effects of hospital training on community pharmacists is expected in the future, including qualitative methods.
Conclusion
Community pharmacists with limited experience in outpatient oncology could improve their knowledge, understanding, and awareness of outpatient oncology patient care through 30 days of in-service oncology training in a hospital setting.
Supplemental Material
sj-docx-2-opp-10.1177_10781552231200427 - Supplemental material for Investigating effective methods of clinical pharmacy training on oncology for community pharmacists: An observational study
Supplemental material, sj-docx-2-opp-10.1177_10781552231200427 for Investigating effective methods of clinical pharmacy training on oncology for community pharmacists: An observational study by Takahiro Fukawa, Junichi Mohri, Hiroshi Inano, Koichiro Atsuda and Katsuya Otori in Journal of Oncology Pharmacy Practice
Supplemental Material
sj-docx-3-opp-10.1177_10781552231200427 - Supplemental material for Investigating effective methods of clinical pharmacy training on oncology for community pharmacists: An observational study
Supplemental material, sj-docx-3-opp-10.1177_10781552231200427 for Investigating effective methods of clinical pharmacy training on oncology for community pharmacists: An observational study by Takahiro Fukawa, Junichi Mohri, Hiroshi Inano, Koichiro Atsuda and Katsuya Otori in Journal of Oncology Pharmacy Practice
Footnotes
Acknowledgments
Authors’ note
This study was conducted in collaboration with Kitasato University and KUH, and the authors had complete access to the study data. The retention of the original study data for five years after the end of the study period is stipulated, during which time the authors will continue to have full access to the study data. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy reasons.
Authors’ contribution
TF and KA and KO, designed the study; TF and HI, collected the data; TF and JM, performed the analysis and interpreted the results; TF and JM, drafted the manuscript. All authors reviewed and approved the final version of the manuscript.
Declaration of conflicting interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Takahiro Fukawa, Koichiro Atsuda and Katsuya Otori received research funds for an endowed chair from the Medical System Network Co. Ltd. Medical System Network Co. Ltd was not involved in this study in any way except for funding of an endowed chair. However, the community pharmacies where the trainees were employed include affiliates of Medical Systems Network Co. Ltd.
Ethics statement
All study participants provided informed consent, and the study design was approved by the appropriate ethics review board. This study was approved by the Research Ethics Committee of Kitasato University Kitasato Institute Hospital in October 2019 (Study No. 19044).
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental material
Supplemental material for this article is available online.
References
Supplementary Material
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