Iranian Nurses' Experiences with Interprofessional Collaboration in Oncology Care: A Qualitative Study

Iranian Nurses' Experiences with Interprofessional Collaboration in Oncology Care: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Iranian Nurses' Experiences with Interprofessional Collaboration in Oncology Care: A Qualitative Study Seyyed Abolfazl Vaghar Seyyedin, Ali Sadeghi-Akbari, Maryam Nakhaei, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4411855/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Interprofessional collaboration is essential for the provision of safe and comprehensive care to patients with complex health needs, particularly in oncology care settings. This qualitative study aimed to explore the experiences of oncology nurses in interprofessional collaboration. Methods This conventional content analysis study involved semi-structured interviews with 14 oncology nurses in Iran. Sampling was purposeful, and data were collected until saturation was achieved. Data were analyzed using the five steps of the Graneheim and Landman method. Trustworthiness was established using the Goba and Lincoln criteria. Results Five categories of interprofessional collaboration emerged from the experiences of oncology nurses: (1) Collaboration in the hands of physicians; (2) Collaboration as a forgotten issue; (3) Vague professional roles; (4) The role of a competent nurse in collaboration; and (5) Complex psychological state of oncology nurses. Conclusions Interprofessional collaboration is a complex, interactive, and communicative process that requires nurses to develop their professional roles and competencies. The nursing profession should take a leadership role in promoting interprofessional collaboration in oncology care. The findings of this study highlight the need to create opportunities for collaboration and to clarify professional roles to ensure that the common goal of providing high-quality care to oncology patients is achieved. Oncology Nurse-physician Neoplasm Interprofessional cooperation Qualitative Content Analysis Background Cancer patients have complex health needs that require the expertise of multiple healthcare professionals (1). Interprofessional collaboration is an approach that facilitates integrated and coherent care and achieves common goals that are difficult to achieve when working alone. Collaborative practice is a dynamic and effective process that includes cooperation, communication, trust, and strong unification to maximize participation and meet the complex needs of patients (2, 3). Effective interprofessional collaboration improves the quality of medical care, increases knowledge, skills, and efficiency, improves patients' conditions, and reduces patients' length of stay at hospitals and treatment costs (4). Collaborative practice is a dynamic and effective process that includes cooperation, communication, trust, and strong unification to maximize participation and meet the complex needs of patients (5). As cancer treatment is complex, interprofessional collaboration is necessary to provide safe and comprehensive care. Interprofessional collaboration focuses on interdependency and shared ability within the team. Accountability to the multiple and complex needs of these patients depends on interprofessional collaboration and teamwork. Parallel and independent performance, individual decision-making, weakness in sharing information, and lack of collective responsibility negatively affect patient safety and outcomes and increase healthcare costs (6). However, no single professional can respond to all the care needs of the patient (4). Advancements in health technology, data analysis, and interprofessional care teams have enabled substantial progress in various cancer treatments. Despite this progress, the intricacy of cancer treatment remains a persistent challenge for patients. The majority of adverse events in care provision stem from inadequate communication and teamwork. Consequently, healthcare teamwork is critical at every stage of the disease course and has a significant impact on the quality of care provided to cancer patients (7). Frontline nurses play a crucial role in helping cancer patients choose the best treatment option. However, traditional societies are facing a paradigm shift in treatment from a paternalistic model (the doctor must decide) to a model of shared decision-making based on patient preferences for more active participation in decision-making (8). In 2013, the National Academy of Medicine, formerly the Institute of Medicine, released a report titled "Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis." This report aimed to enhance the quality of care by promoting trained and coordinated staff alongside an interprofessional team (9). As suggested by Tremblay et al. (2012), a multidisciplinary approach for cancer treatment, particularly for older patients, was recommended. However, there is limited evidence to corroborate the advantages of multidisciplinary collaboration in this area(10). Effective healthcare teamwork is critical at every stage of the disease course and significantly influences the quality of care experienced by cancer patients. Accordingly, numerous researchers have examined various aspects of teamwork and interprofessional collaboration(11). However, in Iran, interprofessional collaboration has not received sufficient attention, and studies indicate insufficient and inadequate communication and collaboration among healthcare professionals(12). Despite the importance of interprofessional collaboration in the care of cancer patients, nurses in different cultural contexts appear to have different experiences with interprofessional collaboration, and qualitative research can reveal these differences. In Iran, interprofessional collaboration has received less attention, and studies suggest limited and inappropriate communication and collaboration between different professions(13–15). Therefore, this study aimed to characterize oncology nurses' experiences with interprofessional collaboration in Iran, as most Iranian studies have focused on the doctor‒nurse relationship, and the concept of interprofessional collaboration is still in its infancy among cancer staff. Method Study Design This study aimed to describe the experiences of oncology nurses in interprofessional collaboration through the use of a qualitative conventional content analysis approach. Qualitative analysis was utilized to provide a detailed exploration of the data, which includes discourse and cultural descriptions and interpretations of social events not attainable using quantitative research alone. Content analysis purposes to achieve new insights into the phenomenon by interpreting both the manifest and latent content. Participants The participants were oncology nurses in the Iranmehr Hospital in Birjand, Iran, and were selected through purposeful sampling to ensure maximum variation in the sample. Data collection The interviews were conducted with nurses who had a minimum of one year of experience in an oncology hospital and who were willing to share their experiences, as presented in Table 1 . The data saturation was reached after 14 interviews, where no new data were extracted to increase the diversity and depth of the results. The interview framework for this study was created after conducting a review of the literature and reflecting on the author's experiences from previous qualitative research. The data were collected through face-to-face interviews. To ensure participant comfort, participants were invited to select a quiet and peaceful environment for the semistructured interview, which usually lasted between 25 and 50 minutes. The purpose of this study was clearly articulated to participants who were all voluntary and had the right to withdraw their participation at any time. The researchers provided assurances regarding the confidentiality of the information obtained from the participants. With the participants' consent, voice recording devices were used. The session began with open-ended questions and progressed to include more probing when necessary, such as requesting clarification or elaboration. Field notes were taken during the interviews, while immediate transcription took place after completion. Data analysis This study aimed to familiarize researchers with nurses' experiences of interprofessional collaboration using Granheim and Lundman's analysis method for conventional content analysis. Initially, researchers immersed themselves in the data and then generated initial concepts before forming subcategories and categories that identified differences and similarities between the codes. Through constant comparison and clustering, common situations were grouped together, and subcategories and categories were named before the final results were recorded. This process of data summarization was carried out using MAXQDA 2020 software to manage the data throughout the analysis until data saturation was reached. Rigor Trustworthiness was emphasized as a primary concept of the content analysis methodology, with conformability, credibility, dependability, and transferability being key components of this approach. Guba and Lincoln's criteria were used to enhance rigor and ensure that the study's findings were credible. The interview guide was utilized to strengthen credibility, and nurses were selected with varying positions, education levels, genders, marital statuses, and work experiences. Prolonged engagement and communication with participants aided in establishing the credibility of the data. The researchers provided a detailed explanation of the data analysis stages and the emergence of categories, along with using quotations to enhance dependability. Peer checking and member checking were employed to ensure conformability, and a summary of the interviews was sent to the participants for reconfirmation. Finally, categories were evaluated by experts qualified in qualitative research to enhance transferability, allowing for a comprehensive explanation of the context and characteristics of participants to facilitate comparison and application in other contexts(16–18). Results We interviewed 14 nurses, all of whom had a BS degree in nursing, eight of whom were female and six of whom were male. The mean age of the participants was 31.4±28.64 years, and their work experience in the oncology ward was 4.57±2.53 years. Table 1 shows other information about the participants. Table 1: Characteristics of the participants Participant Age Sex Marital status Position Work experience in oncology P1 34 Female Married supervisior 9 P2 38 Female Married Head nurse 8 P3 33 Male Single nurse 5 P4 36 Female Married nurse 8 P5 25 Male Married nurse 1 P6 28 Male Married nurse 3 P7 27 Female Single nurse 5 P8 31 Female Married nurse 2 P9 29 Female Married nurse 4 P10 30 Male Single nurse 3 P11 35 Male Married nurse 6 P12 38 Female Married nurse 5 P13 23 Female Single nurse 1 P14 31 Male Married nurse 4 Based on the experiences of oncology nurses, we extracted five categories of interprofessional collaboration: 1- Collaboration in the hands of physicians, 2- Collaboration, a forgotten issue, 3- Vague professional roles, 4- The role of competent nurses in collaboration, and 5- Complex psychological state of the oncology nurses (Table 2). Table 2: Main Categories and Subcategories of Nurses' Experiences with Interprofessional Collaboration Categories Subcategories Collaboration in hands of physicians Physician’s dominance diminishes the nurse’s engagement Physicians’ discourageing behaviors toward nurses’ engagement Physicians’ distrust of inexperienced oncology nurses Collaboration depends on the physicians’ willingness Collaboration, a forgotten issue Undefined interprofessional collaboration The role of managers in encouraging nurses to interprofessional collaboration The managers’ lack of efforts to improve interprofessional collaboration Nurse’s professional autonomy Vague professional roles Nurses’ obligation to practice outside their nursing domains Multiple nonspecialized roles of the social worker The need for a psychologist in the oncology ward The role of competent nurse in collaboration Positive effect of nurses’ knowledge and skills on interprofessional collaboration Ability to present competencies Working as a specialist Complex psychological state of the oncology nurses Negative effects of communication with a cancer patient Psychological problems caused by working in the oncology ward Patient’s passive role in developing interprofessional collaboration Category 1: Collaboration in the hands of physicians Nurses in oncology wards often experience the dominance of physicians, who determine the level of interprofessional collaboration. Physicians' lack of trust in oncology nurses with low work experience and discouraging behavior toward nurses can compromise the quality of interprofessional collaboration. There are four subcategories as follows: 1-1 Physician’s Dominance Diminishes the Nurse’s Engagement “Nurses often inform patients about the doctor's decision or their care needs, as doctors have a lot of power. It depends on the doctor's opinion whether you follow the nurse's opinion or not.” (P1) 1-2 Physicians’ discouraging behaviors toward nurses’ engagement “Sometimes we tell doctors the truth, but they do not accept it. On the other hand, the patient's life is in danger, and the doctors do not change their opinions and only want to protect their Prestige.” (P12) 1-3 Physicians’ distrust of inexperienced oncology nurses “Doctors do not trust inexperienced nurses and think they have not required knowledge. Some doctors even avoid visiting patients with those nurses.” (P2) 1-4 Collaboration depends on physicians’ willingness “Some doctors expect us to know everything about the patient. When we suggest a CT scan to the patient, the doctor orders it, but some doctors do whatever they want.” (P12) Category 2: Collaboration, a Forgotten Issue Although interprofessional collaboration in oncology wards is substantial, the study findings showed that there was no specific definition of the concept of collaboration among managers. According to the participants, the managers have forgotten this issue, and they had no planned programmes to strengthen collaboration. Due to the unclear definition of collaboration, nurses are unable to improve interprofessional collaboration. There are four subcategories as follows: 2-1 Undefined interprofessional collaboration “We have little interaction or companionship; doctors very rarely speak to nurses. For example, if a patient has a problem, the doctor warns the nurse to look for it.” (P4) 2-2 Role of managers in encouraging interprofessional collaboration among nurses “I am no longer interested in that. I call the lab; they say the patient's result is fine. I give the patient the drug, and that is it. At first, it was important to me, but then it stopped. It is associated with the behaviors of managers who do not deserve but who have positions. They have neither scientific education nor moral and social perception.” (P6) 2-3 The managers’ lack of effort to improve interprofessional collaboration “In Iran, there is insufficient interaction between nurses and other healthcare professionals because each has their own job. It is not routine to support the patient mentally and physically and to work together interprofessionally for a cancer patient.” (P5) 2-4 Nurses’ professional autonomy “We have no autonomy here. Sometimes we can express our opinions about the changes that have occurred, but often we prefer not to say anything because docters do not notice our recommendations.” (P7) Category 3: Vague Professional Roles Based on nurses’ experiences with interprofessional collaboration, the lack of some professions required for the care and treatment of cancer patients can force nurses to adopt nonprofessional roles, creating role conflicts and disrupting the specialized role of nursing. There are three subcategories as follows: 3-1 Nurses’ obligation to practice outside their nursing domains “We also work as a ward secretary when a patient is admitted; we have to tell them to get their insurance, get different forms, etc., while these activities are outside nurses' responsibilities.” (P9) 3-2 Multiple nonspecialized roles of the social worker “To the best of our knowledge, a social worker guides patients through their economic problems, but here, the social worker deeply communicates with patients and supports them psychologically.” (P14) 3-3 The need for a psychologist in the oncology ward “I think a lot of these patients strongly need a psychologist to talk to them so they do not get frustrated. O ur workload is too much here, so we may not be able to psychologically support many patients.” (P10) Category 4: The Role of Competent Nurses in Collaboration Nurses' experiences with interprofessional collaboration showed that the level of knowledge, skills and confidence of the nurses, as well as specialized work experience in the oncology ward, had a major impact on their collaboration. There are three subcategories in this regard. 4-1 Positive effect of nurses’ knowledge and skills on interprofessional collaboration “Our knowledge strongly determines our level of cooperation. We need to know how to behave toward patients. We must provide care for the patient appropriately; our mistakes can reduce the doctor's trust.” (P13) 4-2 Ability to present competencies “There may be nurses who lack knowledge and skills, but because they have great confidence, doctors agree with and account on them. Doctors do not trust skilled nurses who are not confident.” (P11) 4-3 Working as a specialist “Oncology is a specialized ward. I might not be able to give such an opinion in the internal medicine ward, but the treatments here are very different... I almost got something; I recognize if there is an error or an unusual medication protocol.” (P3) Category 5: Complex psychological state of the oncology nurses Due to the constant communication that nurses have with cancer patients who are on the border of death, most nurses have experienced emotional problems and psychological problems related to working in this ward. Constant communication with cancer patients was effective in interprofessional collaboration. 5-1 Negative effects of communication with a cancer patient “Due to frequent referral of patients to this ward, a relationship and friendship develop between them and us. Most patients may not tolerate the side effects of the drug and ultimately die, which is very difficult for us.” (P10) 5-2 Psychological problems caused by working in the oncology ward “It often happened that nurses followed up on patients, for example, what happened to this patient?” Why did he/she not come, maybe something happened to him/her? When they inform that a patient deid, our nurses cry and emotionally damage.” (P4) 5-3 Patients’ passive role in developing interprofessional collaboration “Patients do not comment much on their treatments, and very rarly I have seen that a patient knows her/his course of treatment?” (P2) Discussion The study extracted the "Collaboration in hands of physicians" category. Shared decision-making is identified as a crucial approach to promoting interprofessional collaboration while recognizing the unique roles each profession plays in healthcare delivery. However, imbalanced power dynamics and an emphasis on hierarchies can act as significant barriers to such collaboration. Therefore, assigning appropriate decision-making roles to all team members, without any competition, is essential for true interprofessional collaboration to occur(6, 19). According to Sullivan (1998), collaborative practice in health care is the result of shared behaviors, attitudes, cooperation, decisions and collaboration(5). Banner (1984) also argued that physician‒nurse collaboration was the result of the physician‒nurse's thoughts and perspectives, not the organizational structure. In traditional communication, doctors equate nurses' cooperation with carrying out orders, but nurses are more receptive to cooperation and recognize cooperation as the sharing of information and participation in decision-making by all healthcare professionals(12, 20). Inadequate participation of nurses in decision-making leads to several negative consequences, including a lack of personal value, inferiority, reduced confidence and job satisfaction, frustration, anger, discouragement, and lack of motivation (19). Therefore, empowering team members, regardless of their profession, in decision-making is essential for promoting interprofessional collaboration. The second category identified in this study is "collaboration, a forgotten issue." James (2016) suggested that healthcare team members often receive training in isolated silos, which can hinder the development of essential interpersonal skills required to strengthen teamwork and communication. Healthcare educational systems tend to emphasize professional autonomy and authority, which can lead to independent and parallel practices and prevent effective interprofessional collaboration (6, 7). Vafadar (2018) further argues that systemic factors such as cultural and social norms, as well as gender differences, can also impact interprofessional interactions (6). Interprofessional collaboration is a complex and multilevel process that requires essential principles at both the organizational and personal levels. At the organizational level, nurse leaders can encourage interprofessional collaboration by promoting a shared vision and philosophy and supporting collaboration (21). However, nurses sometimes view organizational leadership as a hindrance to their collaboration because of problems related to structural, philosophical, and organizational resources(22). To promote better teamwork, care services, and a culture of psychological safety, healthcare managers can take up key leadership roles in creating collaborative working environments for all healthcare team members(20, 23). The third category, "Vague professional roles," was identified as a significant barrier to interprofessional collaboration. Moore (2015) explains that role ambiguity can prevent collaboration, with some nurses being less willing to cooperate when they do not fully understand the skills of their oncology nursing colleagues. Specialization in cancer care has led to a greater need for different types of nurses, including oncology nurses (22). The four key principles for designing effective interprofessional collaboration, according to academic associations, include teamwork, values/ethics, roles/responsibilities, and interprofessional communication. One of the crucial principles of interprofessional collaboration is clarity on roles and responsibilities (20). Each profession's awareness of a range of professional roles and responsibilities helps them achieve the desired results effectively. The fourth classification elucidates "The role of competent nurses in collaboration". Stefaniak (1998) suggested that insufficient knowledge and expertise, transfer and modification, and communication voids can impede the cooperative efforts of nurses, leading to a challenge in the process of collaboration(24). In the context of oncology nursing, the display of knowledge and experience can enhance professional recognition, trustworthiness, and mutual respect among nurses. Additionally, mutual respect for diverse opinions, active participation in constructive discussions, and an open-minded approach to collaboration are essential factors that promote interprofessional collaboration (22). Sasahara et al. (2003) conducted a study that revealed that nurses experienced weak interpersonal relationships with their colleagues due to the presence of differing viewpoints, which, in turn, impeded their ability to provide continuous care(25). Moore et al. (2015) stated that nurses participate in collaborative efforts not only for patient care, as their primary objective but also for professional and education-related motives. They utilize opportunities such as professional association gatherings such as the Nurses Association Annual Conference, Clinical Council meetings, or special clinical or organizational projects to foster and uphold healthy relationships among themselves (22). The ultimate category derived from the experiences of the oncology nurses in this study was "The complex psychological states of oncology nurses". Despite the enormous impact of cancer on patients, the quality of care provided by healthcare professionals for cancer patients has been inadequately investigated. Existing studies have highlighted three prominent challenges stemming from the absence of organized care: insufficient diagnostic information about patients, inadequate consideration of the emotional and social challenges faced by patients, and a lack of psychological support for cancer patients and their caregivers(26, 27). The absence of a conducive environment for sharing may deter the transfer of crucial information (6). Morley (2017) emphasized that effective medical decision-making requires active participation from patients and healthcare professionals, where healthcare professionals must assume a supportive role to facilitate effective communication. The nature of doctor‒patient interactions is, therefore, a critical issue for any healthcare team. Through mutual collaboration, the creation of shared values, goals, expectations, and information becomes possible, which enables the development of trust and communication, ultimately resulting in successful adherence to treatment protocols and reduced patient anxiety (5). This category represents one of the unique findings of the present study, as it directly addresses the psychological state of oncology nurses. Limitations and future research In qualitative research, there is a risk of profile bias. Strategies such as the group coding session, constant-comparison analysis, and memo writing were employed to improve reflexivity and minimize bias. It is important to note that this study was conducted solely in an oncology hospital; therefore, caution must be exercised when generalizing the outcomes of this study to other healthcare settings. Future research on this topic would be worthwhile to understand and address potential barriers to collaborative care. This research should involve other professions and healthcare teams to understand how the findings in this study might also relate to other healthcare contexts. Further research is necessary to validate the results obtained in this study and their applicability on a more comprehensive scale. Conclusion Interprofessional collaboration is a multifaceted, interactive communication process that transpires between colleagues who have undergone professionalization and socialization and who possess shared values and experiences. Our study revealed that enhancing interprofessional collaboration requires a comprehensive definition of this concept across all levels, including education, clinical care, and management practices. Therefore, healthcare providers and management professionals must recognize the importance of collective participation and communication to create an optimal environment for interprofessional collaboration, leading to improved patient outcomes and overall healthcare efficiency. In addition, interprofessional collaboration necessitates the inclination to cooperate among diverse professional groups involved in the care of cancer patients. This can only be accomplished when all professional groups have a clear understanding of their professional roles and are authorized to provide appropriate care and treatment to cancer patients. Nurses, specifically, need to play a more significant role in facilitating interprofessional collaboration by strengthening their professional practice, as well as their caregiving skills for cancer patients. Considering that caring for cancer patients is the shared objective of healthcare teams, it is imperative to establish opportunities for collaboration and foster effective communication among healthcare professionals to optimize patient outcomes. Declarations Ethics approval and consent to participate: Each participant was provided with oral and written information about the study. Participation was voluntary and participants were informed that they could withdraw from the study at any time and that their information would remain confidential. Ethical code was obtained from the Birjand University of Medical Sciences (IR.BUMS.REC.1401.054) to adhere to established ethical standards. Consent for publication: Not applicable. Availability of data and materials: The dataset analyzed during the current study is not publicly available but is available from the corresponding author upon reasonable request. Competing interests: The authors declare no competing interests Funding: No funding was received for this study. Authors' contributions: MN and MB designed the study, and SAVA wrote the research protocol. MB collected data and SAVA, MB and ASA analyzed the data. MB ana ASA wrote the manuscript. MB, ASA and SAVA contributed to the discussions and revisions of the draft and approved the final version. Acknowledgements: We would like to thank the Deputyship for Research and Technology of Birjand University of Medical Sciences, the Student Research Committee, as well as the School of Nursing and Midwifery that paved the way for this study. Finally, we would like to thank all of the participants in this study for allocation of their time and cooperation in carrying out this research. References Bridges D, Davidson RA, Soule Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Medical education online. 2011;16(1):6035 . 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European Journal of Oncology Nursing. 2015;19(5):509-15 . Outten MK. From veterans to nexters: Managing a multigenerational nursing workforce. Nursing Management. 2012;43(4):42-7 . Stefaniak KA. Nurses collaborating with other nurses: When all else fails: University of Kentucky; 1998 . Sasahara T, Miyashita M, Kawa M, Kazuma K. Difficulties encountered by nurses in the care of terminally ill cancer patients in general hospitals in Japan. Palliative Medicine. 2003;17(6):520-6 . Ayanian JZ, Zaslavsky AM, Guadagnoli E, Fuchs CS, Yost KJ, Creech CM, et al. Patients' perceptions of quality of care for colorectal cancer by race, ethnicity, and language. Journal of Clinical Oncology. 2005;23(27):6576-86. Wagner EH, Ludman EJ, Bowles EJA, Penfold R, Reid RJ, Rutter CM, et al. Nurse navigators in early cancer care: a randomized, controlled trial. Journal of clinical oncology. 2014;32(1):12 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 May, 2024 Submission checks completed at journal 15 May, 2024 Editor assigned by journal 15 May, 2024 First submitted to journal 13 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4411855","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":302769505,"identity":"514ee0dd-56d4-4e52-8db5-96bdf82c1ffe","order_by":0,"name":"Seyyed Abolfazl Vaghar Seyyedin","email":"","orcid":"","institution":"Birjand University of Medical Siences","correspondingAuthor":false,"prefix":"","firstName":"Seyyed","middleName":"Abolfazl Vaghar","lastName":"Seyyedin","suffix":""},{"id":302769507,"identity":"72e82d4d-2783-40ce-9f3a-a1cc4b252520","order_by":1,"name":"Ali Sadeghi-Akbari","email":"","orcid":"","institution":"Birjand University of Medical Siences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Sadeghi-Akbari","suffix":""},{"id":302769510,"identity":"753ee863-30f4-4a9a-8391-b8d7f133236e","order_by":2,"name":"Maryam Nakhaei","email":"","orcid":"","institution":"Birjand University of Medical Siences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Nakhaei","suffix":""},{"id":302769511,"identity":"32bb5cc3-2cb8-4b82-87ce-9dfa5db22d74","order_by":3,"name":"Mahnaz Bahrami","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACAwYeECXBwC8BE2ImVovkDBK1ABk3iHWYOfvZYx9+5lhEG9/uMd34g8FOnoGd9wFeLZY9eckze7dJ5G67c8bsNg9DsmEDM7sBfocdyDFm4AVpuZFjdhvokQQGZjYCfjn/xpjxL1DL5hk5Zjd/MNQToeVGjjEzyJYNEjlmN3gYDhPWYjnjjTGzLFDLjDvHym7zGBw3bCOkxZw/x5jx7ba63P7Zzdtu/qiolufnP4ZfC7o7GRgI2DEKRsEoGAWjgBgAAMxqPTFusAxHAAAAAElFTkSuQmCC","orcid":"","institution":"Birjand University of Medical Siences","correspondingAuthor":true,"prefix":"","firstName":"Mahnaz","middleName":"","lastName":"Bahrami","suffix":""}],"badges":[],"createdAt":"2024-05-13 08:42:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4411855/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4411855/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57079246,"identity":"c3fb0413-f08f-4cfa-a1d2-b6b6c8f8f413","added_by":"auto","created_at":"2024-05-24 10:07:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":775925,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4411855/v1/c303f85e-c9b9-4ce0-acf7-64c897874938.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Iranian Nurses' Experiences with Interprofessional Collaboration in Oncology Care: A Qualitative Study","fulltext":[{"header":"Background","content":"\u003cp\u003eCancer patients have complex health needs that require the expertise of multiple healthcare professionals (1). Interprofessional collaboration is an approach that facilitates integrated and coherent care and achieves common goals that are difficult to achieve when working alone. Collaborative practice is a dynamic and effective process that includes cooperation, communication, trust, and strong unification to maximize participation and meet the complex needs of patients (2, 3). Effective interprofessional collaboration improves the quality of medical care, increases knowledge, skills, and efficiency, improves patients' conditions, and reduces patients' length of stay at hospitals and treatment costs (4).\u003c/p\u003e \u003cp\u003eCollaborative practice is a dynamic and effective process that includes cooperation, communication, trust, and strong unification to maximize participation and meet the complex needs of patients (5). As cancer treatment is complex, interprofessional collaboration is necessary to provide safe and comprehensive care. Interprofessional collaboration focuses on interdependency and shared ability within the team. Accountability to the multiple and complex needs of these patients depends on interprofessional collaboration and teamwork. Parallel and independent performance, individual decision-making, weakness in sharing information, and lack of collective responsibility negatively affect patient safety and outcomes and increase healthcare costs (6). However, no single professional can respond to all the care needs of the patient (4).\u003c/p\u003e \u003cp\u003eAdvancements in health technology, data analysis, and interprofessional care teams have enabled substantial progress in various cancer treatments. Despite this progress, the intricacy of cancer treatment remains a persistent challenge for patients. The majority of adverse events in care provision stem from inadequate communication and teamwork. Consequently, healthcare teamwork is critical at every stage of the disease course and has a significant impact on the quality of care provided to cancer patients (7).\u003c/p\u003e \u003cp\u003eFrontline nurses play a crucial role in helping cancer patients choose the best treatment option. However, traditional societies are facing a paradigm shift in treatment from a paternalistic model (the doctor must decide) to a model of shared decision-making based on patient preferences for more active participation in decision-making (8).\u003c/p\u003e \u003cp\u003eIn 2013, the National Academy of Medicine, formerly the Institute of Medicine, released a report titled \"Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.\" This report aimed to enhance the quality of care by promoting trained and coordinated staff alongside an interprofessional team (9). As suggested by Tremblay et al. (2012), a multidisciplinary approach for cancer treatment, particularly for older patients, was recommended. However, there is limited evidence to corroborate the advantages of multidisciplinary collaboration in this area(10).\u003c/p\u003e \u003cp\u003eEffective healthcare teamwork is critical at every stage of the disease course and significantly influences the quality of care experienced by cancer patients. Accordingly, numerous researchers have examined various aspects of teamwork and interprofessional collaboration(11). However, in Iran, interprofessional collaboration has not received sufficient attention, and studies indicate insufficient and inadequate communication and collaboration among healthcare professionals(12).\u003c/p\u003e \u003cp\u003eDespite the importance of interprofessional collaboration in the care of cancer patients, nurses in different cultural contexts appear to have different experiences with interprofessional collaboration, and qualitative research can reveal these differences. In Iran, interprofessional collaboration has received less attention, and studies suggest limited and inappropriate communication and collaboration between different professions(13\u0026ndash;15). Therefore, this study aimed to characterize oncology nurses' experiences with interprofessional collaboration in Iran, as most Iranian studies have focused on the doctor‒nurse relationship, and the concept of interprofessional collaboration is still in its infancy among cancer staff.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study aimed to describe the experiences of oncology nurses in interprofessional collaboration through the use of a qualitative conventional content analysis approach. Qualitative analysis was utilized to provide a detailed exploration of the data, which includes discourse and cultural descriptions and interpretations of social events not attainable using quantitative research alone. Content analysis purposes to achieve new insights into the phenomenon by interpreting both the manifest and latent content.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe participants were oncology nurses in the Iranmehr Hospital in Birjand, Iran, and were selected through purposeful sampling to ensure maximum variation in the sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe interviews were conducted with nurses who had a minimum of one year of experience in an oncology hospital and who were willing to share their experiences, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The data saturation was reached after 14 interviews, where no new data were extracted to increase the diversity and depth of the results.\u003c/p\u003e \u003cp\u003eThe interview framework for this study was created after conducting a review of the literature and reflecting on the author's experiences from previous qualitative research. The data were collected through face-to-face interviews. To ensure participant comfort, participants were invited to select a quiet and peaceful environment for the semistructured interview, which usually lasted between 25 and 50 minutes. The purpose of this study was clearly articulated to participants who were all voluntary and had the right to withdraw their participation at any time. The researchers provided assurances regarding the confidentiality of the information obtained from the participants. With the participants' consent, voice recording devices were used. The session began with open-ended questions and progressed to include more probing when necessary, such as requesting clarification or elaboration. Field notes were taken during the interviews, while immediate transcription took place after completion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThis study aimed to familiarize researchers with nurses' experiences of interprofessional collaboration using Granheim and Lundman's analysis method for conventional content analysis. Initially, researchers immersed themselves in the data and then generated initial concepts before forming subcategories and categories that identified differences and similarities between the codes. Through constant comparison and clustering, common situations were grouped together, and subcategories and categories were named before the final results were recorded. This process of data summarization was carried out using MAXQDA 2020 software to manage the data throughout the analysis until data saturation was reached.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eRigor\u003c/h2\u003e \u003cp\u003eTrustworthiness was emphasized as a primary concept of the content analysis methodology, with conformability, credibility, dependability, and transferability being key components of this approach. Guba and Lincoln's criteria were used to enhance rigor and ensure that the study's findings were credible. The interview guide was utilized to strengthen credibility, and nurses were selected with varying positions, education levels, genders, marital statuses, and work experiences. Prolonged engagement and communication with participants aided in establishing the credibility of the data. The researchers provided a detailed explanation of the data analysis stages and the emergence of categories, along with using quotations to enhance dependability. Peer checking and member checking were employed to ensure conformability, and a summary of the interviews was sent to the participants for reconfirmation. Finally, categories were evaluated by experts qualified in qualitative research to enhance transferability, allowing for a comprehensive explanation of the context and characteristics of participants to facilitate comparison and application in other contexts(16\u0026ndash;18).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe interviewed 14 nurses, all of whom had a BS degree in nursing, eight of whom were female and six of whom were male. The mean age of the participants was 31.4\u0026plusmn;28.64 years, and their work experience in the oncology ward was 4.57\u0026plusmn;2.53 years. Table 1 shows other information about the participants.\u003c/p\u003e\n\u003cp\u003eTable 1: Characteristics of the participants\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePosition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork experience in oncology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003esupervisior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eHead nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.48611111111111%\" valign=\"top\"\u003e\n \u003cp\u003eP14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.895833333333334%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.194444444444445%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003enurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4375%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eBased on the experiences of oncology nurses, we extracted five categories of interprofessional collaboration: 1- Collaboration in the hands of physicians, 2- Collaboration, a forgotten\u0026nbsp;issue,\u0026nbsp;3-\u0026nbsp;Vague professional roles, 4-\u0026nbsp;The role of competent nurses in collaboration, and 5- Complex psychological state of the oncology nurses (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Main Categories and Subcategories of Nurses\u0026apos; Experiences with Interprofessional Collaboration\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.53605015673981%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.46394984326019%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubcategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.53605015673981%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCollaboration in hands of physicians\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.46394984326019%\" valign=\"top\"\u003e\n \u003cp\u003ePhysician\u0026rsquo;s dominance diminishes the nurse\u0026rsquo;s engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ePhysicians\u0026rsquo; discourageing behaviors toward nurses\u0026rsquo; engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ePhysicians\u0026rsquo; distrust of inexperienced oncology nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eCollaboration depends on the physicians\u0026rsquo; willingness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.53605015673981%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCollaboration, a forgotten issue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.46394984326019%\" valign=\"top\"\u003e\n \u003cp\u003eUndefined interprofessional collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe role of managers in encouraging nurses to interprofessional collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe managers\u0026rsquo; lack of efforts to improve interprofessional collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eNurse\u0026rsquo;s professional autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.53605015673981%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVague professional roles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.46394984326019%\" valign=\"top\"\u003e\n \u003cp\u003eNurses\u0026rsquo; obligation to practice outside their nursing domains\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eMultiple nonspecialized roles of the social worker\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe need for a psychologist in the oncology ward\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.53605015673981%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe role of competent nurse in collaboration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.46394984326019%\" valign=\"top\"\u003e\n \u003cp\u003ePositive effect of nurses\u0026rsquo; knowledge and skills on interprofessional collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eAbility to present competencies\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eWorking as a specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.53605015673981%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplex psychological state of the oncology nurses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.46394984326019%\" valign=\"top\"\u003e\n \u003cp\u003eNegative effects of communication with a cancer patient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ePsychological problems caused by working in the oncology ward\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003ePatient\u0026rsquo;s passive role in developing interprofessional collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCategory 1: Collaboration in the hands of physicians\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNurses in oncology wards often experience the dominance of physicians, who determine the level of interprofessional collaboration. Physicians\u0026apos; lack of trust in oncology nurses with low work experience and discouraging behavior toward nurses can compromise the quality of interprofessional collaboration. There are four subcategories as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1-1 Physician\u0026rsquo;s Dominance Diminishes the Nurse\u0026rsquo;s Engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Nurses often inform patients about the doctor\u0026apos;s decision or their care needs, as doctors have a lot of power. It depends on the doctor\u0026apos;s opinion whether you follow the nurse\u0026apos;s opinion or not.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1-2 Physicians\u0026rsquo; discouraging behaviors toward nurses\u0026rsquo; engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes we tell doctors the truth, but they do not accept it. On the other hand, the patient\u0026apos;s life is in danger, and\u0026nbsp;\u003c/em\u003ethe doctors do not change their opinions\u003cem\u003e\u0026nbsp;and only want to protect their Prestige.\u0026rdquo; (P12)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1-3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePhysicians\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edistrust of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einexperienced\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;oncology nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Doctors do not trust inexperienced nurses and think they have not required knowledge.\u003c/em\u003e \u003cem\u003eSome doctors even avoid visiting patients with those nurses.\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1-4 Collaboration depends on physicians\u0026rsquo; willingness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Some doctors expect us to know everything about the patient. When we suggest a CT scan to the patient, the doctor orders it, but some doctors do whatever they want.\u0026rdquo; (P12)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCategory 2: Collaboration, a Forgotten Issue\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough interprofessional collaboration in oncology wards is\u0026nbsp;substantial, the study findings showed that there was no specific definition of the concept of collaboration among managers. According to the participants, the managers have forgotten this issue, and they had no planned programmes to strengthen collaboration. Due to the unclear definition of collaboration, nurses are unable to\u0026nbsp;improve\u0026nbsp;interprofessional collaboration. There are four subcategories as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-1 Undefined interprofessional collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have little interaction or companionship; doctors very rarely speak to nurses. For example, if a patient has a problem, the doctor warns the nurse to look for it.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-2 Role of managers in encouraging interprofessional collaboration among nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I am no longer interested in that. I call the lab; they say the patient\u0026apos;s result is fine. I give the patient the drug, and that is it. At first, it was important to me, but then it stopped.\u0026nbsp;\u003c/em\u003e\u003cem\u003eIt is associated with the behaviors of managers who do not deserve but who have positions. They have neither scientific education nor moral and social perception.\u0026rdquo; (P6)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-3 The managers\u0026rsquo; lack of effort to improve interprofessional collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In Iran, there is insufficient interaction between nurses and other healthcare professionals because each has their own job. It is not routine to support the patient mentally and physically and to work together interprofessionally for a cancer patient.\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-4 Nurses\u0026rsquo; professional autonomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have no autonomy here. Sometimes we can express our opinions about the changes that have occurred, but often we prefer not to say anything because docters do not notice our recommendations.\u0026rdquo; (P7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCategory 3: Vague Professional Roles\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on nurses\u0026rsquo; experiences with interprofessional collaboration, the lack of some professions required for the care and treatment of cancer patients can force nurses to adopt nonprofessional roles, creating role conflicts and disrupting the specialized role of nursing. There are three subcategories as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-1 Nurses\u0026rsquo; obligation to practice outside their nursing domains\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We also work as a ward secretary when a patient is admitted; we have to tell them to get their insurance, get different forms, etc., while these activities are outside nurses\u0026apos; responsibilities.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-2 Multiple nonspecialized roles of the social worker\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;To the best of our knowledge, a social worker guides patients through their economic problems, but here, the social worker deeply communicates with patients and supports them psychologically.\u0026rdquo; (P14)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-3 The need for a psychologist in the oncology ward\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think a lot of these patients\u003c/em\u003e \u003cem\u003estrongly need a psychologist to talk to them so they do not get frustrated. O\u003c/em\u003eur workload is too much here, so\u0026nbsp;\u003cem\u003ewe may not be able to psychologically support many patients.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCategory 4: The Role of Competent Nurses in Collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNurses\u0026apos; experiences with interprofessional collaboration showed that the level of knowledge, skills and confidence of the nurses, as well as specialized work experience in the oncology ward, had a major impact on their collaboration. There are three subcategories in this regard.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4-1 Positive effect of nurses\u0026rsquo; knowledge and skills on interprofessional collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Our knowledge strongly determines our level of cooperation. We need to know how to behave toward patients. We must provide care for the patient appropriately; our mistakes can reduce the doctor\u0026apos;s trust.\u0026rdquo; (P13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4-2 Ability to present\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;competencies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There may be nurses who lack knowledge and skills, but because they have great confidence, doctors agree with and account on them. Doctors do not trust skilled nurses who are not confident.\u0026rdquo; (P11)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4-3 Working as a specialist\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;Oncology is a specialized ward. I might not be able to give such an opinion in the internal medicine ward, but the treatments here are very different... I almost got something; I recognize if there is an error or an unusual medication protocol.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCategory 5: Complex psychological state of the oncology nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the constant communication that nurses have with cancer patients who are on the border of death, most nurses have experienced emotional problems and psychological problems related to working in this ward. Constant communication with cancer patients was effective in interprofessional collaboration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5-1 Negative effects of communication with a cancer patient\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Due to frequent referral of patients to this ward, a relationship and friendship develop between them and us. Most patients may not tolerate the side effects of the drug and ultimately die, which is very difficult for us.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5-2 Psychological problems caused by working in the oncology ward\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It often happened that nurses followed up on patients, for example, what happened to this patient?\u0026rdquo; Why did he/she not come, maybe something happened to him/her? When they inform that a patient deid, our nurses cry and emotionally damage.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5-3 Patients\u0026rsquo; passive role in developing interprofessional collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Patients do not comment much on their treatments, and very rarly I have seen that a patient knows her/his course of treatment?\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study extracted the \"Collaboration in hands of physicians\" category. Shared decision-making is identified as a crucial approach to promoting interprofessional collaboration while recognizing the unique roles each profession plays in healthcare delivery. However, imbalanced power dynamics and an emphasis on hierarchies can act as significant barriers to such collaboration. Therefore, assigning appropriate decision-making roles to all team members, without any competition, is essential for true interprofessional collaboration to occur(6, 19). According to Sullivan (1998), collaborative practice in health care is the result of shared behaviors, attitudes, cooperation, decisions and collaboration(5). Banner (1984) also argued that physician‒nurse collaboration was the result of the physician‒nurse's thoughts and perspectives, not the organizational structure. In traditional communication, doctors equate nurses' cooperation with carrying out orders, but nurses are more receptive to cooperation and recognize cooperation as the sharing of information and participation in decision-making by all healthcare professionals(12, 20). Inadequate participation of nurses in decision-making leads to several negative consequences, including a lack of personal value, inferiority, reduced confidence and job satisfaction, frustration, anger, discouragement, and lack of motivation (19). Therefore, empowering team members, regardless of their profession, in decision-making is essential for promoting interprofessional collaboration.\u003c/p\u003e \u003cp\u003eThe second category identified in this study is \"collaboration, a forgotten issue.\" James (2016) suggested that healthcare team members often receive training in isolated silos, which can hinder the development of essential interpersonal skills required to strengthen teamwork and communication. Healthcare educational systems tend to emphasize professional autonomy and authority, which can lead to independent and parallel practices and prevent effective interprofessional collaboration (6, 7). Vafadar (2018) further argues that systemic factors such as cultural and social norms, as well as gender differences, can also impact interprofessional interactions (6).\u003c/p\u003e \u003cp\u003eInterprofessional collaboration is a complex and multilevel process that requires essential principles at both the organizational and personal levels. At the organizational level, nurse leaders can encourage interprofessional collaboration by promoting a shared vision and philosophy and supporting collaboration (21). However, nurses sometimes view organizational leadership as a hindrance to their collaboration because of problems related to structural, philosophical, and organizational resources(22). To promote better teamwork, care services, and a culture of psychological safety, healthcare managers can take up key leadership roles in creating collaborative working environments for all healthcare team members(20, 23).\u003c/p\u003e \u003cp\u003eThe third category, \"Vague professional roles,\" was identified as a significant barrier to interprofessional collaboration. Moore (2015) explains that role ambiguity can prevent collaboration, with some nurses being less willing to cooperate when they do not fully understand the skills of their oncology nursing colleagues. Specialization in cancer care has led to a greater need for different types of nurses, including oncology nurses (22). The four key principles for designing effective interprofessional collaboration, according to academic associations, include teamwork, values/ethics, roles/responsibilities, and interprofessional communication. One of the crucial principles of interprofessional collaboration is clarity on roles and responsibilities (20). Each profession's awareness of a range of professional roles and responsibilities helps them achieve the desired results effectively.\u003c/p\u003e \u003cp\u003eThe fourth classification elucidates \"The role of competent nurses in collaboration\". Stefaniak (1998) suggested that insufficient knowledge and expertise, transfer and modification, and communication voids can impede the cooperative efforts of nurses, leading to a challenge in the process of collaboration(24). In the context of oncology nursing, the display of knowledge and experience can enhance professional recognition, trustworthiness, and mutual respect among nurses. Additionally, mutual respect for diverse opinions, active participation in constructive discussions, and an open-minded approach to collaboration are essential factors that promote interprofessional collaboration (22).\u003c/p\u003e \u003cp\u003eSasahara et al. (2003) conducted a study that revealed that nurses experienced weak interpersonal relationships with their colleagues due to the presence of differing viewpoints, which, in turn, impeded their ability to provide continuous care(25). Moore et al. (2015) stated that nurses participate in collaborative efforts not only for patient care, as their primary objective but also for professional and education-related motives. They utilize opportunities such as professional association gatherings such as the Nurses Association Annual Conference, Clinical Council meetings, or special clinical or organizational projects to foster and uphold healthy relationships among themselves (22).\u003c/p\u003e \u003cp\u003eThe ultimate category derived from the experiences of the oncology nurses in this study was \"The complex psychological states of oncology nurses\". Despite the enormous impact of cancer on patients, the quality of care provided by healthcare professionals for cancer patients has been inadequately investigated. Existing studies have highlighted three prominent challenges stemming from the absence of organized care: insufficient diagnostic information about patients, inadequate consideration of the emotional and social challenges faced by patients, and a lack of psychological support for cancer patients and their caregivers(26, 27). The absence of a conducive environment for sharing may deter the transfer of crucial information (6). Morley (2017) emphasized that effective medical decision-making requires active participation from patients and healthcare professionals, where healthcare professionals must assume a supportive role to facilitate effective communication. The nature of doctor‒patient interactions is, therefore, a critical issue for any healthcare team. Through mutual collaboration, the creation of shared values, goals, expectations, and information becomes possible, which enables the development of trust and communication, ultimately resulting in successful adherence to treatment protocols and reduced patient anxiety (5). This category represents one of the unique findings of the present study, as it directly addresses the psychological state of oncology nurses.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and future research\u003c/h2\u003e \u003cp\u003eIn qualitative research, there is a risk of profile bias. Strategies such as the group coding session, constant-comparison analysis, and memo writing were employed to improve reflexivity and minimize bias. It is important to note that this study was conducted solely in an oncology hospital; therefore, caution must be exercised when generalizing the outcomes of this study to other healthcare settings. Future research on this topic would be worthwhile to understand and address potential barriers to collaborative care. This research should involve other professions and healthcare teams to understand how the findings in this study might also relate to other healthcare contexts. Further research is necessary to validate the results obtained in this study and their applicability on a more comprehensive scale.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eInterprofessional collaboration is a multifaceted, interactive communication process that transpires between colleagues who have undergone professionalization and socialization and who possess shared values and experiences. Our study revealed that enhancing interprofessional collaboration requires a comprehensive definition of this concept across all levels, including education, clinical care, and management practices. Therefore, healthcare providers and management professionals must recognize the importance of collective participation and communication to create an optimal environment for interprofessional collaboration, leading to improved patient outcomes and overall healthcare efficiency.\u003c/p\u003e \u003cp\u003eIn addition, interprofessional collaboration necessitates the inclination to cooperate among diverse professional groups involved in the care of cancer patients. This can only be accomplished when all professional groups have a clear understanding of their professional roles and are authorized to provide appropriate care and treatment to cancer patients. Nurses, specifically, need to play a more significant role in facilitating interprofessional collaboration by strengthening their professional practice, as well as their caregiving skills for cancer patients. Considering that caring for cancer patients is the shared objective of healthcare teams, it is imperative to establish opportunities for collaboration and foster effective communication among healthcare professionals to optimize patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEach participant was provided with oral and written information about the study. Participation was voluntary and participants were informed that they could withdraw from the study at any time and that their information would remain confidential. Ethical code was obtained from the Birjand University of Medical Sciences (IR.BUMS.REC.1401.054) to adhere to established ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The dataset analyzed during the current study is not publicly available but is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e MN and MB designed the study, and SAVA wrote the research protocol. MB collected data and SAVA, MB and ASA analyzed the data. MB ana ASA wrote the manuscript. MB, ASA and SAVA contributed to the discussions and revisions of the draft and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to thank the Deputyship for Research and Technology of Birjand University of Medical Sciences, the Student Research Committee, as well as the School of Nursing and Midwifery that paved the way for this study. Finally, we would like to thank all of the participants in this study for allocation of their time and cooperation in carrying out this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eBridges D, Davidson RA, Soule Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. 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Nurses collaborating with other nurses: When all else fails: University of Kentucky; 1998\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eSasahara T, Miyashita M, Kawa M, Kazuma K. Difficulties encountered by nurses in the care of terminally ill cancer patients in general hospitals in Japan. Palliative Medicine. 2003;17(6):520-6\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eAyanian JZ, Zaslavsky AM, Guadagnoli E, Fuchs CS, Yost KJ, Creech CM, et al. Patients\u0026apos; perceptions of quality of care for colorectal cancer by race, ethnicity, and language. Journal of Clinical Oncology. 2005;23(27):6576-86.\u003c/li\u003e\n\u003cli\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eWagner EH, Ludman EJ, Bowles EJA, Penfold R, Reid RJ, Rutter CM, et al. Nurse navigators in early cancer care: a randomized, controlled trial. Journal of clinical oncology. 2014;32(1):12\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003cem\u003e\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oncology, Nurse-physician, Neoplasm, Interprofessional cooperation, Qualitative, Content Analysis","lastPublishedDoi":"10.21203/rs.3.rs-4411855/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4411855/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eInterprofessional collaboration is essential for the provision of safe and comprehensive care to patients with complex health needs, particularly in oncology care settings. This qualitative study aimed to explore the experiences of oncology nurses in interprofessional collaboration.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis conventional content analysis study involved semi-structured interviews with 14 oncology nurses in Iran. Sampling was purposeful, and data were collected until saturation was achieved. Data were analyzed using the five steps of the Graneheim and Landman method. Trustworthiness was established using the Goba and Lincoln criteria.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive categories of interprofessional collaboration emerged from the experiences of oncology nurses: (1) Collaboration in the hands of physicians; (2) Collaboration as a forgotten issue; (3) Vague professional roles; (4) The role of a competent nurse in collaboration; and (5) Complex psychological state of oncology nurses.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eInterprofessional collaboration is a complex, interactive, and communicative process that requires nurses to develop their professional roles and competencies. The nursing profession should take a leadership role in promoting interprofessional collaboration in oncology care. The findings of this study highlight the need to create opportunities for collaboration and to clarify professional roles to ensure that the common goal of providing high-quality care to oncology patients is achieved.\u003c/p\u003e","manuscriptTitle":"Iranian Nurses' Experiences with Interprofessional Collaboration in Oncology Care: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-24 09:59:52","doi":"10.21203/rs.3.rs-4411855/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-15T11:27:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-15T08:09:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-15T08:09:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-05-13T08:41:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"241e6171-2346-4f41-8f33-1407454dad1d","owner":[],"postedDate":"May 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-22T05:21:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-24 09:59:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4411855","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4411855","identity":"rs-4411855","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}