Comparative effectiveness of case-based versus simulation-based communication training: evidence from a quasi-experimental study in oncology nursing education

Abstract

Background

Implementing evidence-based interventions to improve nurse–patient communication is essential for enhancing patient satisfaction and clinical outcomes in oncology. However, robust evidence guiding the selection of effective and feasible communication training models for oncology nurses remains limited. This study aimed to compare the effectiveness of two structured communication training approaches, including case-based training and simulation-based training, in oncology nursing education.

Methods

A quasi-experimental non-randomized controlled trial with a pretest–posttest design was conducted among 258 oncology nurses and 650 cancer patients. Oncology nurses were assigned to one of three groups based on pre-existing clinical shift rotations rather than random allocation: no training (NTG, n = 84), case-based training (CTG, n = 88), or simulation-based training (STG, n = 86). Both intervention groups received structured communication training covering therapeutic communication, needs assessment, instruction delivery, referral practices, and outcome evaluation. The STG used video-based scenarios with standardized patients (20 h), whereas the CTG used written clinical cases (16 h). Outcomes were measured using the Nursing Care Satisfaction Questionnaire, the Health Professionals Communication Skills Scale, and the Occupational Coping Self-Efficacy Scale for Nurses. Data were analyzed using repeated-measures ANOVA with sensitivity analyses.

Results

For patient satisfaction with nursing care, a significant time × group interaction was observed (F(2, 255) = 17.2, p < 0.001, partial η² = 0.12). Both CTG and STG showed significant improvements from pre- to post-intervention (p < 0.001), whereas the NTG showed no significant change (p = 0.81). Similarly, nurses’ communication skills demonstrated a significant interaction effect (F(2, 255) = 19.6, p < 0.001, partial η² = 0.21), with significant improvements in both intervention groups compared with the control group (p < 0.001). For occupational coping self-efficacy, the interaction effect was also significant (F(2, 255) = 15.8, p < 0.001, partial η² = 0.19), indicating increased self-efficacy in both intervention groups (p < 0.001). No statistically significant differences were observed between CTG and STG at post-test for any outcomes.

Conclusion

These findings indicate that case-based and simulation-based communication training may be effective in improving communication-related outcomes in oncology nursing, although conclusions regarding their relative effectiveness should be drawn with caution.

Trial registration

Not applicable.

Introduction

Communication plays a central role in healthcare by facilitating the exchange of essential information and supporting patients’ emotional and psychological needs. In oncology settings, where emotional distress is common, communication also provides much-needed emotional and spiritual support [1]. Some studies have shown that effective nurse–patient communication has been associated with improved adherence to therapy, higher patient satisfaction, and better overall clinical outcomes [1, 2]. Conversely, inadequate communication may lead to inadequate information gathering, emotional neglect, increased clinical errors, and patient dissatisfaction [3–5].

For oncology nurses, therapeutic communication extends beyond the delivery of medical information. It involves responding to patients’ emotional concerns, facilitating shared decision-making, and helping patients and families navigate the uncertainties associated with cancer diagnosis and treatment [6–8]. In this context, communication competence represents a core professional skill that directly influences both patient experience and the quality of care delivered [8].

In addition to communication competence, psychological factors such as occupational coping self-efficacy are also critical for oncology nurses. Oncology care frequently exposes nurses to emotionally demanding interactions, complex treatment decisions, and high patient distress [1]. According to Bandura’s self-efficacy theory, individuals who believe they can effectively manage difficult situations are more likely to maintain performance under stress and demonstrate adaptive coping behaviors [9]. Educational interventions that strengthen communication competence may simultaneously enhance oncology nurses’ coping self-efficacy by increasing confidence in managing difficult patient interactions.

From a healthcare system perspective, patient satisfaction represents another important outcome related to communication practices. Patient satisfaction with nursing care reflects patients’ perceptions of attentiveness, empathy, clarity of information, and responsiveness to concerns during hospitalization. Therefore, evaluating patient satisfaction alongside nurse-level outcomes provides a more comprehensive assessment of the potential clinical impact of communication training interventions [2].

Given these relationships, communication interventions may influence not only oncology nurses’ communication skills but also their perceived ability to cope with demanding clinical situations and the overall experience of patients receiving care.

Communication competence is not merely an inherent personal attribute but a professional competency that can be developed through structured educational interventions. Theoretical frameworks such as Bandura’s Social Learning Theory, Kolb’s Experiential Learning Model, and Watson’s Theory of Human Caring highlight the importance of observation, practice, reflection, and feedback in skill acquisition [10, 11]. These principles underpin interactive pedagogical approaches that actively engage learners in clinical problem-solving.

Two commonly used strategies in healthcare education are case-based learning (CBL) and simulation-based training (SBT) [12]. Case-based learning encourages analytical reasoning through structured discussion of realistic clinical scenarios, whereas simulation-based training allows learners to practice communication behaviors in controlled, experiential environments. Both approaches are widely used in nursing education and have been shown to support the development of clinical and interpersonal skills [12].

Despite the growing use of these educational methods in healthcare education [13–15], most existing studies have examined simulation-based training or case-based learning separately, often among nursing students or in general clinical contexts. Direct empirical comparisons of these two approaches within oncology nursing communication training remain limited. Therefore, the present study aimed to compare the effectiveness of case-based training and simulation-based training in improving three outcomes among oncology nurses: communication skills, occupational coping self-efficacy, and patient satisfaction with nursing care.

Methods

Study design and participants

This study employed a quasi-experimental non-randomized controlled trial with a pretest–posttest design and was conducted between August and November 2024 in the oncology wards of Shanxi Province Cancer Hospital.

Participants included both nurses and patients. Nurses were eligible if they were full-time staff certified in oncology care, actively involved in chemotherapy administration, and willing to participate in both phases of assessment. Patients were eligible if they were aged 18 or older, receiving chemotherapy for the first time within the past five years, not enrolled in any clinical trial, cognitively intact (defined as the ability to understand study information and complete questionnaires independently as judged by the attending nurse), proficient in Chinese, and provided written informed consent.

Oncology nurses were assigned to one of three groups—no training (NTG), case-based training (CTG), or simulation-based training (STG)—based on pre-existing clinical shift rotations within the oncology wards. Because clinical schedules were determined by hospital administration before the study began, random allocation was not feasible. To minimize selection bias, eligibility criteria were rigorously applied across all wards, and recruitment was managed sequentially to prevent self-selection. Recruitment and data collection were conducted by trained research assistants who were not involved in the delivery of the intervention and had no supervisory or evaluative relationship with the participating nurses. This approach was adopted to minimize potential selection and assessment bias.

Sample size estimation was performed for nurse-level outcomes only, using G*Power version 3.1. Based on a repeated-measures ANOVA with a within-between interaction (time × group), assuming three groups and two time points, a medium effect size (f = 0.25), alpha = 0.05, power = 0.80, and a correlation of 0.5 between repeated measures, the required sample size was calculated to be 159. To account for an anticipated attrition rate of 10–15%, the target sample size was increased to 180 oncology nurses. The calculated sample size represented the minimum number of participants required to achieve adequate statistical power. However, all eligible oncology nurses working in the participating wards during the recruitment period were invited to participate in order to maximize statistical precision and reduce the risk of type II error. Recruitment continued until the end of the predefined study period rather than stopping once the minimum sample size was reached. Consequently, the final sample included 258 oncology nurses.

Patients were recruited consecutively under the care of participating oncology nurses during both the pretest and posttest phases. Each patient was linked to the training group of their assigned nurse. Patient-level outcomes (e.g., satisfaction with nursing care) were assessed as dependent variables nested within nurse group assignments and were not used for independent sample size estimation. This nested design allowed for the evaluation of patient-level outcomes as indirect effects of nurse-targeted interventions.

The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Shanxi Province Cancer Hospital (JC2025053). Written informed consent was obtained from all participants.

Intervention

The participants of CTG and STG groups received training intervention. To further minimize contamination between groups, training sessions were conducted separately and participants were asked not to share training materials or discuss intervention content with colleagues from other groups until completion of the study.

The intervention consisted of a structured communication skills training program focused on nurse–patient interaction during care provision and discharge planning for cancer patients. The content was rigorously designed based on Bandura’s Social Learning Theory and Kolb’s Experiential Learning Model, both of which emphasize learning through observation, reflection, and active engagement [16, 17]. Also, interventions were also reviewed by a panel of four experts in clinical simulation. The expert panel consisted of two senior oncology nursing educators, one clinical simulation specialist, and one researcher with expertise in nursing education and curriculum development. The training program was first decomposed into discrete instructional components (e.g., needs assessment, information delivery, emotional support, referral communication, and discharge planning). Each component was evaluated by the expert panel for relevance, clarity, and educational appropriateness, which allowed the calculation of the item-level and scale-level CVI. The item-level content validity index (I-CVI) was 0.90, and the scale-level CVI (S-CVI) was 0.85. Based on feedback from the expert panel, minor refinements were made to the training materials, including clarification of scenario wording, alignment of learning objectives, and improvement of instructional sequencing. No substantial structural modifications to the intervention framework were required.

The STG group participated in ten 2-hour sessions (total 20 h) over a 5-week period. Training focused on standardized video scenarios involving a cancer patient and family at discharge. Teaching strategies included lectures, video analysis, group discussion, reflective exercises, and structured feedback. The CTG group received a parallel program using written case scenarios instead of video-based materials. The same instructional content was delivered across eight 2-hour sessions (total 16 h), covering identical themes: needs assessment, instruction delivery, referral planning, and outcome evaluation. Both interventions were delivered by the same two experienced oncology nurse educators to ensure consistency.

Although the STG intervention duration was longer (20 h vs. 16 h), this time difference was strictly allocated to the procedural aspects of simulation (e.g., video deconstruction, technical briefing, and structured debriefing mechanics) rather than additional content delivery. Core educational concepts and learning objectives remained identical between groups. The difference in session frequency solely reflected the necessary pedagogical methodology of simulation versus case-based learning.

Both interventions were delivered by two oncology nurse educators who were not involved in participant recruitment or outcome assessment. Both facilitators held advanced academic qualifications in nursing and had more than seven years of experience in oncology care and communication skills training, including prior experience in simulation-based education.

To ensure intervention fidelity, an independent observer attended all training sessions and used a standardized checklist to monitor adherence to the instructional protocol. In a sample of sessions, dual ratings were conducted to assess consistency; the inter-rater reliability (Cohen’s kappa) was 0.82, indicating substantial agreement. No major deviations from the training protocol were observed. Minor scheduling adjustments due to clinical workflows were managed by rescheduling sessions within the same week, without affecting the instructional sequence. The training programme was not formally piloted prior to implementation in this study.

Assessments

Assessments tools included a sociodemographic questionnaire (for both patients and oncology nurses), the Nursing Care Satisfaction Questionnaire, the Chinese version of the Health Professional Communication Skills Scale, and Chinese version of the Occupational Coping Self-Efficacy Scale for Nurses (OCSE-N).

To assess oncology nurses’ communication skills, the Chinese version of the Health Professionals Communication Skills Scale (HP-CSS) was used. Originally developed by Leal-Costa et al. (2016) and validated in the Chinese context by Zhong et al. in 2023 [18, 19], this 18-item tool covers basic and advanced communication skills, respect for patient rights, and interpersonal skills. Items are rated on a 6-point Likert scale from “strongly disagree” to “strongly agree”, with a total score range of 18 to 108. A higher score reflects stronger communication competence. In this study, the HP-CSS showed acceptable internal consistency (Cronbach’s α = 0.81).

Occupational coping self-efficacy was measured using the Occupational Coping Self-Efficacy Scale for Nurses (OCSE-N). Developed by Pisanti et al. (2008) [20] and validated for Chinese nurses by Zhai et al. (2021) [21], this 9-items scale addresses coping with workload and interpersonal relationship difficulties. Each item is rated on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Total scores range from 9 to 45, with higher scores indicating higher occupational coping self-efficacy. Prior studies have confirmed the instrument’s reliability in Chinese nursing samples [21, 22]. In this study, the OCSE-N demonstrated high internal consistency (Cronbach’s α = 0.86).

Patient satisfaction was measured using the Nursing Care Satisfaction Questionnaire, developed by the Nursing Care Quality Control Committee of the Houston Health System [23]. The Chinese version of this 20-item scale has demonstrated robust psychometric properties in prior nursing research in China [24]. Items are rated on a 6-point Likert scale (1 = never to 6 = always), with total score ranging from 20 to 120. Higher scores reflect greater satisfaction with nursing care, indicating that patients are more likely to feel that their needs were met in terms of communication, attentiveness, and overall care quality. This scale assesses various dimensions of care, including attentiveness, compassion, professionalism, responsiveness, and follow-up. In this study, the scale demonstrated good internal consistency (Cronbach’s α = 0.83), suggesting that higher scores are meaningfully related to increased perceived care quality, which is a key determinant of patient outcomes. Because inpatient oncology care is delivered by nursing teams across multiple shifts, patient satisfaction scores were conceptualized as reflecting the overall nursing care environment within each clinical unit rather than evaluations of a single nurse.

All assessments were self-administered by participants following standardized instructions to ensure consistency across groups. A trained research assistant was available to provide clarification if needed but did not interfere with the responses. This approach ensured that all participants received the same instructions, promoting uniformity in the data collection process.

To minimize social desirability bias, participants completed the questionnaires individually in a private setting and were assured of confidentiality and anonymity. Additionally, data entry was performed by research assistants blinded to group allocation to prevent assessment bias.

Statistical analysis

Data analysis were performed using IBM SPSS Statistics version 26.0 (IBM Corporation, Armonk, NY, USA). Continuous variables are expressed as means ± standard deviations (SD), and categorical variables as frequencies and percentages. To verify baseline equivalence among the three groups (NTG, CTG, and STG), one-way analysis of variance (ANOVA) was used for continuous variables, and Pearson’s chi-square test was utilized for categorical variables.

To address the potential non-independence of observations due to the hierarchical structure of data (patients nested within nurses), sensitivity analyses employing cluster-robust standard errors were conducted. The results from these adjusted models remained consistent with the primary analyses in both magnitude and statistical significance; therefore, standard General Linear Model (GLM) results are reported.

To evaluate the intervention effects, a 2 (Time: Pre-test, Post-test) × 3 (Group: NTG, CTG, STG) repeated-measures ANOVA was conducted. Although only two measurement points were included (pre-test and post-test), repeated-measures ANOVA was selected because it allows simultaneous evaluation of within-subject changes over time and group × time interaction effects. When the assumption of sphericity was violated (assessed via Mauchly’s test), the Greenhouse–Geisser correction was applied. Normality of distribution and homogeneity of variances were verified using the Shapiro–Wilk test and Levene’s test, respectively. Significant main or interaction effects were followed by Bonferroni-adjusted post hoc pairwise comparisons. Effect sizes were estimated using partial eta-squared (η²). According to conventional benchmarks, partial η² values of 0.01, 0.06, and 0.14 represent small, medium, and large effect sizes respectively. The statistical significance was set at p < 0.05 (two-tailed). Finally, to rule out the potential confounding effect of differences in total training duration (20 h vs. 16 h), a specific sensitivity analysis was performed using Analysis of Covariance (ANCOVA). For each primary outcome, the post-intervention score served as the dependent variable, with the baseline score and “total training hours” entered as covariates.

Results

In total, 290 oncology nurses initially agreed to participate. After applying inclusion and exclusion criteria, 258 eligible oncology nurses remained and were assigned to the three study groups (NTG: n = 84, CTG: n = 88, STG: n = 86). There were no dropouts during the study period, and all participants completed both pre- and post-intervention assessments. Table 1 presents the baseline characteristics of the oncology nurses. Baseline comparisons revealed no statistically significant differences in demographic or professional characteristics among the three nurse groups, supporting the assumption of initial equivalence (all p > 0.05).

Table 1.

Characteristics of oncology nurses

	Group			p
	NTG (n = 84)	CTG (n = 88)	STG (n = 86)
Age (year), mean ± SD	36.0 ± 2.31	35.87 ± 1.89	35.59 ± 2.09	0.228
Sex (female), n (%)	50 (59.52%)	52 (59.09%)	50 (58.13%)	0.356
Experience (year), mean ± SD	9.02 ± 1.85	9.42 ± 1.64	9.39 ± 1.71	0.108
Weekly working hours (hour), mean ± SD	35.2 ± 3.48	36.33 ± 2.88	35.76 ± 3.11	0.271

NTG = No-training group; CTG= Case-based training group; STG= Simulation-based training group; Continuous variables were compared using one-way ANOVA and categorical variables using chi-square test

Of the 759 cancer patients approached, 650 met the inclusion criteria and provided informed consent. Table 2 summarizes the demographic and clinical characteristics of the patients. No statistically significant differences were observed among the three groups in terms of age, sex, education level, or hospitalization duration (all p > 0.05). The most common primary tumor site was breast cancer in the NTG and STG groups, whereas gastrointestinal (GI) cancer predominated in the CTG group. Palliative treatment intent was the most prevalent across all groups.

Table 2.

Characteristics of patients

Variable		Group			p
		NTG (n = 216)	CTG (n = 218)	STG (n = 216)
Age, mean ± SD		51.45 ± 1.61	51.68 ± 1.49	51.08 ± 1.55	0.347
Sex (male), n (%)		110 (50.92%)	105 (48.16%)	103 (47.68%)	0.128
Education, n (%)	Primary	77 (35.65%)	80 (36.69%)	75 (34.72%)	0.101
	Secondary	80 (37.03%)	76 (34.86%)	82 (37.96%)
	University	59 (27.32%)	62 (28.45%)	59 (27.32%)
Hospitalization (day), mean ± SD		29.8 ± 4.01	30.3 ± 3.91	28.73 ± 4.19	0.293
Primary tumor site, n (%)	Breast	62 (28.7%)	57 (26.14%)	63 (29.16%)	0.115
	GI	60 (27.77%)	63 (28.9%)	59 (27.31%)
	Lung	21 (9.72%)	18 (8.25%)	19 (8.8%)
	Hematologic	28 (12.96%)	28 (12.84%)	29 (13.42%)
	Genitourinary	32 (14.81%)	31 (14.22%)	30 (13.89%)
	Other	13 (6.04%)	21 (9.65%)	16 (7.42%)
Treatment intent, n (%)	Curative	62 (28.7%)	61 (27.98%)	58 (26.85%)	0.202
	Palliative	154 (71.3%)	157 (72.02%)	158 (73.15%)

NTG = No-training group; CTG= Case-based training group; STG= Simulation-based training group; GI= gastrointestinal; Continuous variables were compared using one-way ANOVA and categorical variables using chi-square test.

For Patient Satisfaction with Nursing Care, the repeated-measures ANOVA indicated a significant time × group interaction (F (2, 255) = 17.2, p < 0.001, partial η² = 0.12), suggesting that the trajectory of satisfaction scores differed by training type. Post hoc Bonferroni comparisons showed that both the case-based and simulation-based groups experienced significant improvements from pre- to post-test (p < 0.001), while the no-training group showed no significant change (p = 0.81) (Fig. 1).

Fig. 1.

Changes in Nursing Care Satisfaction Scores from Pre- to Post-Intervention across Groups; NTG: no-training group, CTG: case-based training group, STG: simulation-based training group. *: statistically significant difference compared to pre-intervention; †: statistically significant difference compared to the NTG

Additionally, post-test comparisons revealed that both intervention groups had significantly higher satisfaction scores than the no-training group (p < 0.001 for both), but there was no significant difference between the CTG and STG (p = 0.43).

Regarding Nurses’ Communication Skills, a significant time × group interaction was similarly observed (F(2, 255) = 19.6, p < 0.001, partial η² = 0.21). Post hoc comparisons demonstrated significant gains in both intervention groups compared to baseline (p < 0.001), with no meaningful change in the NTG (p = 0.201). At post-test, both CTG and STG scored significantly higher than NTG (p < 0.001 for both), with no statistically significant difference between the two intervention groups (p = 0.341) (Fig. 2). Sensitivity analyses adjusting for clustering by nurse confirmed these results.

Fig. 2.

Changes in nurse communication skills from pre- to post-intervention across Groups; NTG: no-training group, CTG: case-based training group, STG: simulation-based training group. *: statistically significant difference compared to pre-intervention; †: statistically significant difference compared to the NTG

For Occupational Coping Self-Efficacy, the interaction was also significant (F(2, 255) = 15.8, p < 0.001, partial η² = 0.19). Both CTG and STG showed enhanced self-efficacy from pre- to post-intervention (p < 0.001), whereas the NTG showed no significant improvement (p = 0.119) (Fig. 3). Consistent with other outcomes, no significant differences were found between CTG and STG at post-test (p = 0.281).

Fig. 3.

The occupational coping self-efficacy of nurses before and after intervention across Groups; NTG: no-training group, CTG: case-based training group, STG: simulation-based training group. *: statistically significant difference compared to pre-intervention; †: statistically significant difference compared to the NTG

Finally, the sensitivity analysis using ANCOVA revealed that total training duration (entered as a covariate) was not a significant predictor for any of the primary outcomes (p > 0.05), confirming that the observed improvements were likely attributable to the training content rather than the difference in contact hours.

Discussion

The present study examined the effectiveness of two structured communication training approaches—case-based learning and simulation-based training—in oncology nursing education. The findings of this study suggest that participation in case-based training intervention or simulation-based training intervention was associated with improvements in oncology nurses’ communication skills and occupational coping self-efficacy, as well as higher levels of patient satisfaction with nursing care. Importantly, the sensitivity analyses adjusting for differences in total training duration confirmed the robustness of these findings, indicating that the observed improvements were not attributable to differences in contact hours. Furthermore, no statistically significant differences were observed between the two intervention formats across the measured outcomes. Furthermore, no statistically significant differences were observed between the two intervention formats across the measured outcomes.

These findings are consistent with previous studies showing that structured communication training can enhance both interpersonal competence and professional confidence among healthcare providers [25–30]. Oncology care frequently requires nurses to engage in emotionally complex interactions with patients and families, including discussions about treatment expectations, symptom management, and supportive care needs. Educational interventions that incorporate reflection, feedback, and active engagement may therefore support oncology nurses in managing these interactions more effectively.

The improvement observed in oncology nurses’ communication skills in both intervention groups aligns with the principles of experiential learning. Both case-based learning and simulation-based training are grounded in experiential educational frameworks, emphasizing active engagement with realistic clinical scenarios rather than passive knowledge acquisition. These approaches reflect the principles of Kolb’s experiential learning model [31], which highlights the importance of concrete experience, reflective observation, and guided feedback in professional skill development. Previous studies have similarly reported that active learning strategies, including role-play, unfolding case studies, and simulation-based exercises, can significantly enhance communication competence and critical thinking among nursing professionals [32, 33].

Another important finding of this study was the improvement in occupational coping self-efficacy among oncology nurses who participated in either training format. According to Bandura’s self-efficacy theory [9], individuals develop confidence in managing challenging situations through mastery experiences, observational learning, and constructive feedback. The training activities implemented in this study—including scenario analysis, structured discussion, and guided reflection—provided opportunities for oncology nurses to rehearse communication strategies and receive feedback from instructors and peers. These experiences may have contributed to increased confidence in handling demanding clinical interactions. Previous studies have also shown that higher communication competencies are associated with improved professional resilience and reduced risk of occupational stress and burnout among nurses [34–36].

The improvement observed in patient satisfaction with nursing care may also be associated with enhanced communication practices among trained nurses. Effective communication is a central component of patient-centered care and has been consistently linked to higher patient satisfaction, improved trust in healthcare providers, and stronger therapeutic relationships [37, 38]. In oncology settings in particular, patients often value clear information, emotional support, and respectful interactions with healthcare providers. However, these findings should be interpreted cautiously. Because inpatient oncology care is typically delivered by nursing teams across multiple shifts, patient satisfaction scores likely reflect perceptions of the overall communication environment within the clinical unit, rather than evaluations of individual nurses.

Importantly, no statistically significant differences were observed between the two intervention formats across the measured outcomes. However, this finding should be interpreted with caution, as the absence of statistically significant differences does not necessarily indicate equivalence. The present study was not designed as a non-inferiority or equivalence trial. Simulation-based training is often considered a highly effective educational strategy due to its immersive and interactive nature, yet it frequently requires specialized equipment, trained facilitators, and dedicated training facilities [39]. In contrast, case-based learning can be implemented with considerably fewer institutional resources [40].

From a practical perspective, both training approaches were associated with improvements in key outcomes. While simulation-based training is often considered resource-intensive, case-based learning may represent a feasible and resource-sensitive alternative in certain contexts. However, given the study design, these findings should not be interpreted as evidence that the two approaches are equivalent in effectiveness. Few studies have examined these approaches simultaneously among practicing oncology nurses while also evaluating both professional outcomes (communication skills and coping self-efficacy) and patient-related outcomes. By addressing this gap, the findings provide evidence that may assist educators and healthcare administrators in selecting communication training strategies that balance educational effectiveness with resource availability.

Several limitations should be considered when interpreting the findings. First, the study employed a non-randomized controlled design, and although baseline characteristics were comparable across groups, the possibility of residual selection bias cannot be entirely excluded. Second, although cluster-robust standard errors were used to partially account for the hierarchical structure of the data, full multilevel modeling was not implemented, which may have allowed for a more comprehensive examination of variability at both the oncology nurse and patient levels. Third, because the same instructors delivered both training formats, potential instructor effects cannot be completely ruled out. Fourth, although efforts were made to minimize contamination between groups, informal sharing of training content among colleagues working within the same institution cannot be entirely excluded. Additionally, the study was not designed to formally test non-inferiority or equivalence between the two intervention approaches, which limits the ability to draw definitive conclusions regarding their comparative effectiveness. Finally, the study was conducted in a single clinical center, which may limit the generalizability of the findings to other healthcare settings.

Future research should consider randomized study designs, objective observational measures of communication performance, and longer follow-up periods to evaluate the sustainability of training effects. Additionally, examining how organizational factors, such as leadership support, team communication culture, and professional autonomy, influence the transfer of communication training into clinical practice may further improve understanding of how educational interventions affect patient care outcomes.

Conclusion

Based on the findings of this study, both case-based and simulation-based communication training were associated with improvements in oncology nurses’ communication skills, occupational coping self-efficacy, and patient satisfaction with nursing care. Although no statistically significant differences were detected between the two intervention groups, these findings should be interpreted with caution, as the study was not designed to establish equivalence between the approaches. These results suggest that both training strategies may be beneficial in enhancing communication-related outcomes in oncology nursing. In practice, the selection of training methods should consider institutional resources, learner needs, and contextual factors to ensure effective implementation.

Author contributions

FG designed the study, analyzed the data, and wrote the original draft. JC designed the study, supervised the project and reviewed the final manuscript. All authors read and approved the final manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Shanxi Province Cancer Hospital (Reference: JC2025053). Written informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.