Simulation-based interventional training can be used to better prepare primary caregivers for supporting patients with cancer and other chronic diseases.

  • Simulation has been used at Case Western Reserve University to train nurses and doctors in skills like treating cardiac arrest.
  • The simulation intervention occurs in the first week of radiation treatment and focuses on the primary caregiver, not the patient.
  • When the sessions and patient’s treatments are finished, case managers and nurses help prepare for post-treatment survivorship.

The results of a new study suggest the use of a psychoeducational interventional training model can improve education for family caregivers of patients with cancer. The training program uses simulation to enhance skills training.1

“Simulation is a form of experiential learning, and it’s how we train nurses and doctors in some skills,” says Susan Mazanec, PhD, RN, AOCN, FAAN, assistant professor with Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland and nurse scientist at University Hospitals Seidman Cancer Center. “Most often, we use high-fidelity mannequins to [simulate] cardiac arrest, and then the team of nurses and doctors work together to practice their skills in a very safe environment.” Case Western Reserve University uses an entire simulation center, she notes.

Simulation training for caregivers includes these three components:

  • The training takes place during the patient’s radiation treatment. The key point of the intervention is to support and train the caregiver in real time while the patient is undergoing treatment and experiencing problems.
  • Simulation is solely focused on the primary caregiver, not the patient. The patient is not present, and the caregiver could be a family member, neighbor, friend, or someone else. They are whomever the patient identifies as the primary caregiver, Mazanec says.
  • The training occurs during the first week of treatment when the caregiver meets with the nurse interventionist. Two other telemeetings are held during treatment.

In the first sessions with caregivers, nurses present an overview of what patients experience. This is to proactively prepare caregivers for what is to come.

“Each session with caregivers follows the same format, beginning by assessing the stress that the caregiver is feeling and what their immediate needs and concerns are,” Mazanec says. “Then, we provide education about the theme of the session. There is simulation with mannequins and various devices.”

For example, caregivers learn through simulation how to perform a tube feeding for patients with a gastrostomy or tracheostomy tube.

“We will go over with a very structured protocol the basic care of a tube,” Mazanec explains. “We also teach them how to do a skin assessment of the area being treated, and how to do an oral exam to monitor for mucositis.”

Another type of simulation involves roleplay in which case managers or nurses can teach caregivers communication skills.

“Each session has a theme,” Mazanec notes. “The second session’s theme is the caregiver’s experience, including the common issues and concerns of caregivers.”

At the end of the patient’s treatment, nurses and case managers prepare the patient and caregiver for the transition to post-treatment survivorship.


  1. Mazanec SR, Blackstone E, Daly BJ. Building family caregiver skills using a simulation-based intervention for care of patients with cancer: Protocol for a randomized controlled trial. BMC Nurs 2021;20:93.