Integrating psycho-oncology into medical physical education curricula: A systematic review of simulated patient-based exercise counseling
Abstract
This systematic review investigates the effectiveness of simulation-based education in equipping medical and allied health students with competencies in exercise counseling and psycho-oncological support for individuals with cancer. As holistic cancer care increasingly emphasizes the integration of psychological support and physical activity guidance, medical education must evolve to address these dual demands. A comprehensive literature search across PubMed and the Web of Science Core Collection identified studies published between 2000 and 2025. Following PRISMA guidelines, 20 eligible studies were analyzed. Simulation modalities included standardized patients, high-fidelity mannequins, virtual platforms, and hybrid formats. Findings consistently demonstrate that simulation enhances learners’ communication skills, counseling self-efficacy, empathy, and readiness to navigate emotionally complex scenarios involving oncology patients. Thematic synthesis revealed gains across cognitive, behavioral, and affective learning domains. This is the first systematic review to examine how simulated patient-based exercise counseling can function as an interdisciplinary bridge between physical education and psycho-oncology. The results underscore the pedagogical value of integrating behavior change theory, simulation-based learning, and emotional realism into medical curricula to better prepare future healthcare professionals for the psychosocial and physical complexities of cancer care.
Copyright (c) 2026 Yuqing Gui, Chi Zhang

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021; 71(3): 209–249. doi: 10.3322/caac.21660
2. Bultz BD, Carlson LE. Emotional distress: the sixth vital sign—future directions in cancer care. Psycho-Oncology. 2006; 15(2): 93–95. doi: 10.1002/PON.1022
3. Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. The lancet oncology. 2011; 12(2): 160–174. doi: 10.1016/s1470-2045(11)70002-x
4. Pitman A, Suleman S, Hyde N, et al. Depression and anxiety in patients with cancer. BMJ. 2018: k1415. doi: 10.1136/bmj.k1415
5. Holland J, Weiss T. The New Standard of Quality Cancer Care: Integrating the Psychosocial Aspects in Routine Cancer from Diagnosis Through Survivorship. The Cancer Journal. 2008; 14(6): 425–428. doi: 10.1097/ppo.0b013e31818d8934
6. Rodin G, Mackay JA, Zimmermann C, et al. Clinician-patient communication: a systematic review. Supportive Care in Cancer. 2009; 17(6): 627–644. doi: 10.1007/s00520-009-0601-y
7. Courneya KS, Friedenreich CM. Physical Activity and Cancer Control. Seminars in Oncology Nursing. 2007; 23(4): 242–252. doi: 10.1016/j.soncn.2007.08.002
8. Mishra SI, Scherer RW, Geigle PM, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012. doi: 10.1002/14651858.cd007566.pub2
9. Campbell KL, Winters-Stone K, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Medicine and science in sports and exercise. 2019; 51(11): 2375. doi: 10.1249/MSS.0000000000002116
10. Jones LW, Eves ND, Haykowsky M, et al. Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. The lancet oncology. 2009; 10(6): 598–605. doi: 10.1016/S1470-2045(09)70031-2
11. Patel AV, Friedenreich CM, Moore SC, et al. American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Medicine and science in sports and exercise. 2019; 51(11): 2391. doi: 10.1249/MSS.0000000000002117
12. Berragan L. Simulation: an effective pedagogical approach for nursing? Nurse education today. 2011; 31(7): 660-663. doi:10.1016/j.nedt.2011.01.019
13. Baile WF, Buckman R, Lenzi R, et al. SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oxford University Press; 2000. pp. 302–311.
14. Hancock K, Clayton JM, Parker SM, et al. Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliative medicine. 2007; 21(6): 507–517. doi: 10.1177/02692163070808
15. Usman FM, Jalal A, Bansal M, et al. The role of simulation in oncology nursing: A systematic review. Nurse Education in Practice. 2025; 87: 104466. doi: 10.1016/j.nepr.2025.104466
16. Brennan AM, D’Urzo KA, Fenuta AM, et al. Integrating exercise counseling into the medical school curriculum: a workshop-based approach using behavior change techniques. American Journal of Lifestyle Medicine. 2021; 15(1): 84–107. doi: 10.1177/1559827617722754
17. Buffart LM, Kalter J, Sweegers MG, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer treatment reviews. 2017; 52: 91–104. doi: 10.1016/j.ctrv.2016.11.010
18. Geng L, Duan Y, Li X, et al. Comparative efficacy of mind‐body exercise for depression in breast cancer survivors: A systematic review and network meta‐analysis. Worldviews on Evidence‐Based Nursing. 2023; 20(6): 593–609. doi: 10.1111/wvn.12669
19. Ajzen I. The theory of planned behavior. Organizational behavior and human decision processes. 1991; 50(2): 179–211. doi: 10.1016/0749-5978(91)90020-T
20. Bandura A. Social cognitive theory: An agentic perspective. Annual review of psychology. 2001; 52(1): 1–26. doi: 10.1146/annurev.psych.52.1.1
21. Coyle N, Manna R, Shen MJ, et al. Discussing death, dying, and end-of-life goals of care: a communication skills training module for oncology nurses. Clinical journal of oncology nursing. 2015; 19(6): 697. doi: 10.1188/15.CJON.697-702
22. Stan DL, Collins NM, Olsen MM, et al. The evolution of mindfulness‐based physical interventions in breast cancer survivors. Evidence‐based Complementary and Alternative Medicine. 2012; 2012(1): 758641. doi: 10.1155/2012/758641
23. Ross JG, Burrell SA. Standardized patient simulation to facilitate learning in evidence-based oncology symptom management. Journal of Nursing Education. 2018; 57(4): 250–253. doi: 10.3928/01484834-20180322-12
24. Takemura N, Cheung DST, Fong DYT, et al. Tai Chi and aerobic exercise on cancer-related dyspnea in advanced lung cancer patients: a randomized clinical trial. Journal of pain and symptom management. 2024; 68(2): 171–179. doi: 10.1016/j.jpainsymman.2024.04.025
25. Bower JE, Greendale G, Crosswell AD, et al. Yoga reduces inflammatory signaling in fatigued breast cancer survivors: a randomized controlled trial. Psychoneuroendocrinology. 2014; 43: 20–29. doi: 10.1016/j.psyneuen.2014.01.019
26. Chen SH, Chen SY, Yang SC, et al. Effectiveness of communication skill training on cancer truth‐telling for advanced practice nurses in Taiwan: A pilot study. Psycho‐Oncology. 2021;30(5):765–772. doi:10.1002/pon.5629
27. Kang D, Zhang L, Jin S, Wang Y, et al. Effectiveness of palliative care simulation in newly hired oncology nurses’ training. Asia-Pacific Journal of Oncology Nursing. 2022; 9(3): 167–173. doi: 10.1016/j.apjon.2021.11.004
28. Sharour LA. Implementing simulation in oncology emergencies education: A quasi-experimental design. Technology and Health Care. 2019; 27(2): 223–232. doi: 10.3233/THC-181543
29. Peoples AR, Garland SN, Pigeon WR, et al. Cognitive behavioral therapy for insomnia reduces depression in cancer survivors. Journal of Clinical Sleep Medicine. 2019; 15(1): 129–137. doi: 10.5664/jcsm.7586
30. Ebbert DW, Connors H. Standardized patient experiences: evaluation of clinical performance and nurse practitioner student satisfaction. Nursing Education Perspectives. 2004; 25(1): 12–15.
31. Silva A, Galica J, Woo K, et al. The use of simulation-based education in cancer care: A scoping review protocol. International Journal of Healthcare Simulation. 2022; 1(2): 37–41. doi: 10.54531/auxj4316
32. Giuliani M, Gillan C, Wong O, et al. Evaluation of high-fidelity simulation training in radiation oncology using an outcomes logic model. Radiation Oncology. 2014; 9(1): 189. doi: 10.1186/1748-717X-9-189
33. Burrell SA, Ross JG, Byrne C, et al. The effects of a simulation-based experience with standardized participants on learning and clinical decision-making related to nursing management of oncologic emergencies. Journal of Cancer Education. 2023; 38(3): 870–877. doi: 10.1007/s13187-022-02199-z
34. Al Wachami N, Chahboune M, Youlyouz-Marfak I, et al. Improving the quality of care and patient safety in oncology, the contribution of simulation-based training: A scoping review. International Journal of Nursing Sciences. 2024; 11(2): 187–196. doi: 10.1016/j.ijnss.2024.03.005
35. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; n71. doi: 10.1136/bmj.n71
36. Campbell M, McKenzie JE, Sowden A, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020; l6890. doi: 10.1136/bmj.l6890
37. Michie S, Richardson M, Johnston M, et al. The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions. Annals of Behavioral Medicine. 2013; 46(1): 81–95. doi: 10.1007/s12160-013-9486-6
