Mapping Evidence in Teaching Palliative Care in Undergraduate Curriculum of Healthcare Professionals Qualification: A Systematic Scoping Review Protocol

Mapping Evidence in Teaching Palliative Care in Undergraduate Curriculum of Healthcare Professionals Qualification: A Systematic Scoping Review Protocol | 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 Mapping Evidence in Teaching Palliative Care in Undergraduate Curriculum of Healthcare Professionals Qualification: A Systematic Scoping Review Protocol Sphamandla Josias Nkambule, Bernhard Gaede, This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4313706/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Clinical Practice Guidelines recommend interprofessional collaboration in palliative care. However, healthcare profession educators lack clear curricular guidance, particularly for undergraduate programs, to adequately train future professionals for effective participation in such teams. Objective This systematic scoping review protocol aims to address this gap by: (i) mapping evidence on key characteristics of teaching palliative and end-of-life (EOL) care to undergraduate healthcare and social care students, and (ii) identifying the nature and effectiveness of educational interventions for improving palliative care education in the undergraduate curriculum. Methods and Expected Outputs The protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol Extension for Scoping Reviews (PRISMA-P-ScR) guidelines, while the proposed systematic scoping review study will be conducted based on methods and steps identified by Arksey and O’Malley and experts in the field. We will conduct systematic searches across five EBSCOhost databases using relevant search terms. Additionally, a limited grey literature search will be conducted on the first 100 results of Google Scholar and Open-Grey. The selection process will follow PRISMA-Extension for Scoping Reviews. Two independent reviewers will screen titles and abstracts for eligibility. Data extraction will be done on standardized forms in duplicate with cross-checking by a third reviewer. Braun and Clarke's thematic analysis approach, combining thematic and directed content analysis, will be employed for analysis. Intervention effectiveness will be narratively summarized based on the TIDieR checklist. Meta-analysis will be considered if applicable and data is homogeneous. Discussion Palliative care education (PCE) is a crucial element of undergraduate health professions education. This study's findings may aid educators in fostering optimal learning among healthcare students, who can then positively influence community health outcomes. Ethics and dissemination The protocol was submitted for ethical clearance to the University of KwaZulu-Natal's Biomedical Research Ethics Committee and granted exemption from ethics review (00024289). We will disseminate findings through scientific journal publication and by sharing a summary with relevant institutions and attendees at health promotion and interprofessional education conferences. Protocol registration number: CRD42023481892 https://www.crd.york.ac.uk/prospero/export_details_pdf.php Palliative Care End-Of-Life Care Terminal Care Education Primary Health Care Training Healthcare Professionals Figures Figure 1 Figure 2 STUDY BACKGROUND A staggering 78 per cent of the estimated 56.8 million people who need palliative care globally reside in low- and middle-income countries (LMICs), including 25.7 million in the last year of life. This translates to only 14 per cent of those who could benefit from palliative care actually end up receiving it, highlighting a significant gap in access, particularly for LMIC populations. 1 Remission and survival rates for palliative care patients in most African countries are adversely affected by late detection, diagnosis, limited training of health care providers, and lack of resources for treatment and palliative care services in health facilities. 2, 3 South Africa’s unique disease burden, characterised by a high prevalence of HIV, tuberculosis (TB), and non-communicable diseases (NCDs) like cancers and injuries, intensifies the existing gap in palliative care services. This is particularly true for infectious diseases like TB and HIV, which are known to cause significant suffering in LMICs. 4 This underscores the critical necessity for comprehensive and integrated approaches to palliative and end-of-life care education and service provision, especially in regions facing such significant health challenges. Health Policy Context of the study: Global, Continental and National The pressing need for palliative care in Africa is further highlighted by the World Health Assembly Resolution 67.19 passed in 2014. This resolution specifically called on member states to integrate palliative care into comprehensive care throughout a person’s life. 5 Request number four of the resolution explicitly addresses education and training, urging countries to include palliative care as a standard part of healthcare professional education and training. This includes integrating basic and continuing education on palliative care into undergraduate medical and nursing programs, as well as in-service training for care providers at the primary care level, including doctors, nurses, primary care workers (such as community health workers), spiritual caregivers (those who provide emotional and religious support to patients and families), and social workers. However, despite international recognition and clear steps outlined in resolutions like the World Health Assembly Resolution 67.19, translating the definition of palliative care into accessible services for Africans remains a challenge. This disconnect between the urgent demand for palliative care in regions such as South Africa and the insufficient advancements made in establishing comprehensive educational and training initiatives, as advocated by international resolutions underscores the need for stronger implementation efforts to ensure that palliative care becomes a true pillar of Universal Health Coverage (UHC) on the continent. Countries can not meet the United Nations Sustainable Development Goal Three, specifically Target 3.8, without including palliative care and pain relief. 6 South Africa has adopted the policy of National Health Insurance intended to promote access to promotive, preventive, curative, rehabilitative and palliative care services of sufficient quality to be effective while not exposing citizens to financial hardship. 7 Palliative Care in Undergraduate Health Professions Education. A scoping review was conducted to examine the provision of Palliative Care services in Africa from 2005 to 2016. 4 The study followed the guidelines set by the World Health Organisation (WHO) for the public health strategy of palliative care, 8 which include the implementation of services, educational initiatives, policy development, medicine availability, and professional engagement. The review findings revealed a significant presence of these services in Kenya, South Africa, and Uganda. 4 Stand-alone palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zimbabwe. 4 The South African National Department of Health adopted the National Policy Framework and Strategy on Palliative Care 2017–2022 to promote the development and delivery of Palliative Care services. 7 However, despite these efforts, the lack of access to Palliative Care services on the African continent was further emphasised by the Lancet Commission Report, which provided recommendations concerning Human Resources in this context: “Establish palliative care as a recognised medical and nursing speciality; Make general palliative care and pain relief competencies a mandatory component of all medicine, nursing, psychology, social work, and pharmacy undergraduate curricula; Require that all health and other professionals involved in caring for patients with serious, complex, or life-threatening health conditions receive basic training in palliative care and pain relief.” 3 Current undergraduate health professional curricula throughout Africa have elements of Palliative Care education that are poorly quantified despite palliative care being recognised as an emerging discipline in health care. Therefore, there is an urgent need to review and strengthen curricula to provide an inter-professional approach to palliative care education for the African health professional, allowing future fit professionals to competently deliver on the growing Palliative Care needs of the continent. This will lay the foundation for a sustainable, high-quality and accessible palliative care system integrated into primary health care, community and home-based care, and supporting care providers such as family and community volunteers. 9 The rationale for the study While accreditation bodies have mandated teaching basic palliative and end-of-life (EOL) care across healthcare professions training curricula, 9 there has been limited guidance for educators on what or how to teach and evaluate students’ competence, particularly in the undergraduate curriculum for HCP qualification. Moreover, there is a lack of extensive evidence regarding the nature and effectiveness of educational interventions to improve palliative care education and whether these interventions result in positive outcomes. A preliminary systematic search was performed using the EBSCOhost platform, searching two databases, Medline and CINAHL, and finding no scoping reviews for palliative care education and training in the undergraduate curriculum for HCP qualification. In addition, the two international perspective registers of systematic and scoping review databases, PROSPERO and the Open Science Framework (OSF), were searched respectively, and no similar review protocols were identified. Therefore, due to this limited evidence, our aims were broad, which was more suited for a scoping review rather than a systematic review, which would be, to sum up, the best available research on palliative care education (PCE) across the undergraduate curriculum for HCP qualification. Aim This scoping review aims to systematically map the research done in palliative care education (PCE), as well as to identify the nature and effectiveness of educational interventions to improve palliative and end-of-life (EOL) care education across the undergraduate curriculum for HCPs qualifications. Objectives To systematically map the scope of available published knowledge about teaching palliative and EOL care across the undergraduate curriculum for HCP qualification. Sub-objectives To identify studies that have used educational and training interventions for palliative and end-of-life (EOL) care teaching across HCP training curricula; To critically appraise and identify curricular components of effective interventions in the undergraduate curriculum for HCP qualification; and To use this critically appraised evidence base to inform the design of palliative and end-of-life (EOL) care teaching across HCP training curricula. METHODOLOGY Study Design - Protocol and registration This scoping review protocol is part of a more extensive study [ Details of the bigger project goes here ], and the protocol for the complete review is available in the PROSPERO data repository registries – ID CRD42023481892 https://www.crd.york.ac.uk/prospero/export_details_pdf.php . As part of the more extensive study, a scoping review was chosen as the best method to systematically synthesise qualitative and quantitative evidence on the nature and effectiveness of currently available educational interventions to improve palliative care education for health and social care professionals in the undergraduate curriculum. The protocol for the scoping review was developed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for a scoping review (PRISMA-P-ScR), which permitted the forwarding of a six-step scoping review protocol (see Supplementary Appendix for the completed PRISMA-P Checklist). 10 The proposed comprehensive systematic scoping review of the literature will be conducted according to the Levac et al . (2010) adaptation to Arksey and O’Malley (2005) framework for scoping review methods and experts in the field. 11, 12 The review findings will be reported per the PRISMA 2020 statement - an updated procedure for reporting review studies (see Fig. 1 for the PRISMA-2020 flowchart). 13 --- Step 1: Identifying the review question As an integral component of the framework’s preliminary phase, the research team received guidance from the expert team in formulating comprehensive and specific research questions. Additionally, the study protocol’s design, the selection of search terms for the literature review, and the identification of relevant databases were established through a collaborative process involving iterative consultations with our research team, key informants possessing expertise in curricular design, implementation, and assessment of healthcare professional qualifications in both general and specific contexts related to palliative and end-of-life care. Furthermore, the input of an experienced medical librarian was sought in this process. To determine whether the research question qualified for a scoping review project, we utilised the PICO (participants; interventions; comparator; outcomes) nomenclature framework recommended by the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis: 2020 Edition (Fig. 2 ). 14 The main research question that the proposed scoping review will address: What is the nature and effectiveness of teaching palliative and end-of-life (EOL) care to students in the undergraduate health and social care professionals qualifications curriculum? More specifically, the scoping review seeks to address the following research sub-questions: What is the evidence on the nature of educational interventions to improve palliative and end-of-life (EOL) care teaching in the undergraduate curriculum for health and social care professionals qualifications? What is the effectiveness of educational interventions to improve palliative and end-of-life (EOL) care teaching in the undergraduate curriculum for health and social care professionals qualifications? The eligibility criteria for including studies in this review in order to answer the aforementioned questions are based on the relevant components of the PICOd-T (Study Design - Time) framework and the research question. Thus, the PICOd-T framework is employed to ensure that the boundaries of the proposed scoping review research question are clearly defined. The eligible studies will be included once they have been evaluated independently, reproducibly, and systematically by two reviewers. For studies to be considered eligible, studies must provide evidence of one of the factors listed in Table 3 . A third reviewer will resolve disagreements between the two reviewers; reviewers will also pilot-test the inclusion/exclusion criteria to reach a consensus before beginning the study selection process ( Step 3: Study selection and eligibility screening ). Step 2: Identifying relevant studies - Search Strategy and Data Sources The systematic, comprehensive, and reproducible searches to identify relevant studies will initially be conducted via electronic search sources – searching reputable bibliographic databases and indexing services (and platforms) – followed by searches of supplementary information sources to capture primary studies addressing the main review question. With the assistance of a professional medical librarian, the first author will conduct all direct electronic and supplementary information source systematic searches, using a pre-defined and piloted search strategy (see Table 1 ), to capture both published and unpublished (grey) literature to be screened for eligibility for inclusion in this review. Search Strategy The first author, a medical librarian and subject specialist with experience in designing, implementing, and assessing HCP qualifications in general and in the palliative and EOL care domain, co-developed the comprehensive search strategy (see Table 1 for details of the search strategy metrics). All authors were given an equal opportunity to review the draft to ensure the correct use of indexing terminology and Medical Subject Headings (MeSH) descriptors before it was pilot-tested on a subset of records from the PubMed database (see Table 1 pilot test results). In accordance with the approach of Bethel et al ., (2021), a search summary table (SST) will be used to report on the performance of the search strategy in effective searching databases. The SST is a viable and reproducible method for reporting and evaluating the search strategy’s effectiveness (see Table 2 for the example of the SST metrics that will be used for this purpose). 15 Data Sources Electronic search sources The systematic and comprehensive searches will be conducted from the following electronic databases to source articles published on the topic of teaching palliative and end-of-life (EOL) care to students in the undergraduate curriculum of HCPs qualification, using the pilot-tested search strategy: WEB of Science, PubMed, and EBSCOHost Web (Academic Search Complete, PyscInfo, MEDLINE with Full Text, and Health Source: (Nursing/Academic Edition)). Furthermore, evidence on palliative care teaching interventions will be sourced from the South African National Clinical Trial Register and the ISRCTN registry. The mentioned databases will be searched from their inception to the present, regardless of the publication language. This procedure aims to obtain as many articles as possible from electronic search sources and to ensure that all relevant articles or reports are captured before the study selection and eligibility screening process begins. Searching other resources – supplementary information search In addition, supplementary search methods will include hand-searching of relevant journals, reference lists of identified peer-reviewed articles and grey literature, and as well as forward and backwards citation chasing. The reviewers will further browse through the link entitled “Related Articles” option, which searches for similar citations using an intricate algorithm that scans titles, abstracts, and MeSH terms to detect more studies (Table 3 ). Systematic reviews and other review papers are not eligible for inclusion; however, reference lists of relevant reviews, preprints, and conference abstracts will be screened for more relevant primary studies not captured by the search strategy. Furthermore, the appropriate trial publications reference lists will be checked for unidentified randomised clinical trials. The systematic search management The SST will also be used to present and keep records of the systematic searches retrieved information, such as the summative metrics of effective searching suggested by Cooper et al ., (2018), and additional metrics providing further useful search-related information for the librarian or information specialist. 16 The SST will be completed in two stages. In stage one, all the references that the search strategy retrieves from each electronic database, including all duplicates, will be exported to EndNote X9 (version 19.1.0.12691) – a reference management software, which will be used to create a virtual library (Thomson Reuters, Stamford, CT, USA). 17 Every record in the virtual library will be given a code for the database name where the record was found. Stage two involves re-running the searches in the databases where most of the included references were found to determine whether references not found during the original search were in the database and, if so, whether the search strategy retrieved them. Step 3: Study selection and eligibility screening The study selection and eligibility screening method is multi-step and involves two reviewers. The eligibility screening approach for eligible articles will be carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, as represented in the PRISMA 2020 Flow Diagram Fig. 1 . First, two reviewers will screen the title and abstracts for relevance independently and in duplicate, and articles that pass initial screening by either reviewer will undergo full-text review independently and in duplicate by the same two reviewers. Standardised, pilot-tested eligibility forms will be used for both title and abstract screening and for full-text review (see Supplementary Appendix for the completed screening tool). Disagreements about study eligibility will be resolved through consensus discussion or will be resolved by a third reviewer in the case of ongoing disagreement. Kappa statistics will be calculated to assess the inter-rater reliability of full-text review, using Cohen’s Kappa coefficient (κ) statistic on Stata 13.0SE (StataCorp College Station, TX, USA), a robust statistic used for inter-rater reliability testing. 18 Step 4: Data extraction/ or collection process A standardised data extraction form informed by the template for intervention description and replication (TIDieR) checklist and guide for describing interventions will be created to capture relevant information from the included studies (see Supplementary Appendix for the data extraction form). 19 The form will consist of fields for study characteristics, participant demographics, teaching/ or communication strategies employed, outcome measures, and key findings Two independent reviewers will extract data from the included studies using the standardised data extraction form to detect inter-rater errors and decrease data errors and bias. The reviewers will extract data from the included articles independently and in duplicate. A third reviewer will verify the data related to study characteristics, such as publication information, study dates, population characteristics, interventions, outcomes, and study methods, which are required to assess the risk of bias. In the meta-analysis, the nature of the data, such as continuous outcomes (mean differences or standardised mean differences) or dichotomous outcomes (odds ratios or risk ratios (ORs)) will be calculated if necessary, and if the data is available, only measures most adjusted for one or more sets of potential confounders such as socio-demographic and lifestyle factors will be extracted by the two reviewers to reduce confounding and measurement errors and to ensure consistency across studies and reduce bias. Requests for missing data Missing data will be identified and recorded within the review. Where papers provide insufficient details about the intervention, such as what is delivered and by whom, an effort would be made to contact the authors to obtain previously unpublished information and clarify any missing data. In cases of non-response or inadequate clarity from contacted authors (i.e. retrieval of missing data is not possible), that study/outcome will be eliminated from the review. Step 5: Assessment of study methodological quality, risk of bias, and the certainty of evidence The methodological quality and risk of bias of each included study will be assessed by two reviewers independently, using appropriate methodological quality assessment tools depending on the design of the included studies using the guidance produced by the NHS Centre for Reviews and Dissemination and the Cochrane Collaboration. 20, 21 Tools to assess the methodological quality As recommended, the MERSQI (Medical Education Research Study Quality Instrument) Scale and Newcastle-Ottawa Scale Education (NOS-E) [ 19 , 20 ] will be used to determine the methodological quality of the included studies. 22, 23 The two instruments will be used as they assess different aspects of quality and risk of bias, acting in a complementary fashion. As described in previous studies, a score above the sample median MERSQI score (12.5) and NOS-E score (2.5) will be considered the threshold for high methodological quality. 22 Furthermore, the risk of bias for RCTs will be assessed using the Cochrane risk of bias tool, which will take into account random sequence generation, allocation concealment, participant and personnel blinding, insufficient outcome data, and selective reporting. Each domain will be evaluated independently by both reviewers and classified as ‘high,’ ‘low,’ or ‘uncertain’ regarding bias. Studies will be considered to be at an overall ‘high’ risk of bias if they are judged to be at ‘high’ risk of bias in any domain, ‘uncertain’ risk of bias if they are judged to be at an uncertain risk of bias in any one domain, with no domains at high risk of bias, and an overall ‘low’ risk of bias if they are not judged to be at ‘high’ or ‘uncertain’ risk of bias in any domain. All risk of bias assessment will be judged at the outcome level. Tools to assess the risk of bias (or publication bias) Publication bias will be assessed using visual inspection of funnel plots, where sufficient numbers of studies will exist to permit interpretation. 24 Tools to assess the certainty of evidence (quality of evidence / the strength of the body of evidence) The overall quality of evidence (or certainty in the findings) for each outcome obtained will be evaluated using the five GRADE principles (trial bias risk, consistency of effect, imprecision, indirectness, and publication bias). The completed GRADE checklist and reasons for up- or down-grading assess the quality of a body of evidence based on study methodological quality, results from sensitivity analysis, and by downgrading and upgrading the baseline quality score according to the domains specified in the GRADE guidelines. 25 We will generate a table that summarises our findings using GradePRO software. 26 Step 7: Collating, summarising, and reporting the results Systematic scoping reviews provide an executive overview of current evidence by answering broad questions. 27 Thus, following the completion of the data extraction step, we will generate a comprehensive summary of the data extracted from the included studies. The summary will consist of two key presentation components: Numerical presentation : We will create a compiled findings table that provides a descriptive overview of the key pre-specified study outcomes and type of included studies, as depicted in Fig. 2 . Additionally, we will employ an interactive web-based graphic design tool, specifically Canva version 2.93.0, to generate a world map. 28 This map will help visualise the geographical distribution of the summary of the included studies, offering insight into global patterns. Narrative presentation : To ensure a holistic analysis, we will synthesise the essential characteristics of all the included studies. We will archive this by documenting the structure of the intervention of interest – all educational interventions used to teach palliative and end-of-life (EOL) care education to health and social care professionals in the undergraduate curriculum – will be captured by recording pedagogy, course content and learning outcomes. This will consist of data including, but not limited to, educational method, educational content, length/duration, outcome measures, outcome results and implementation ‘barriers and facilitators’ such as financial support. Strategy for data synthesis The data synthesis process will involve the following steps: Thematic Analysis : We will conduct a thematic analysis of the extracted data to identify recurring themes, concepts, and patterns related to key characteristics of teaching palliative and end-of-life (EOL) care to students in the undergraduate health and social care professionals qualification curriculum. This will involve coding and categorising the extracted data into meaningful themes and sub-themes; Qualitative Summary : We will provide a qualitative summary of the key findings from the included studies. This will involve synthesising the results narratively, highlighting similarities, differences, and trends in the effectiveness of a series of identified interventions to improve palliative care education for health and social care professionals in the undergraduate curriculum; Subgroup Analysis : If a sufficient number of studies with similar characteristics and outcomes are identified, we may conduct subgroup analyses based on factors such as study design, geographical location, or types of Educational methods/ Pedagogies employed in the Teaching of PC. This will enable us to explore potential variations in the effectiveness of different interventions – to improve palliative care education for health and social care professionals in the undergraduate curriculum – within specific subgroups; and Meta-analysis (if applicable) : If the included studies are deemed suitable and homogeneous, we will consider conductinga meta-analysis to provide a quantitative synthesis of the data. Furthermore, the authors will delve into the implications of these findings for future research, practice, and policy. 12 Stage 7 details are still being worked out, and they may be repeated or changed if reviewers deem them necessary. Ethics and dissemination No ethical clearance is required for this study. The results of the proposed systemic scoping review will be disseminated electronically, in print, and through conference presentations as well as key stakeholder meetings. DISCUSSION The proposed systematic scoping review aims to deliver comprehensive evidence on palliative care education (PCE) and identify the nature and effectiveness of educational interventions to teach palliative and end-of-life (EOL) care education to health and social care professionals in the undergraduate curriculum. Most importantly, the proposed scoping review’s purpose is not to rate the quality of evidence or come to conclusions about best practices, but rather to offer the scope of available published knowledge about teaching palliative and EOL care across the undergraduate curriculum for health and social care professionals qualification. We believe that by adopting this approach, we will be able to ascertain the educational experience of both learners and educators. This will entail taking into account the needs of learners, the interactions between learners and educators, the interactions among learners themselves, the contributions made by the department, and the utilisation of information to nudge behaviours and improve decision-making skills around palliative and EOL care. Furthermore, a key area of work that will commence as part of the project’s more extensive study (and is likely to outlive the lifespan of the project) is to engage with key stakeholders regarding the inclusion of palliative and EOL care into all undergraduate curricula for health and social care professionals qualification programs in Africa. It is envisaged that a consensus statement will be developed and shared in a range of forums, in particular the African Palliative Care Association, Africa-wide family medicine structures such as Primafamed and WONCA Africa as well as AFREhealth, in which they will be consulted, thus providing valuable insights beyond what has been captured through scoping review project. Strengths and limitations of this study A strength of this study is that it will apply a broad review of multidisciplinary databases covering Public Environmental Occupational Health, Nursing, Health Care Sciences Services, Medicine General Internal, Education Scientific Disciplines, Educational Research, Social Sciences Interdisciplinary and other Web of Science Core Collection Citation Topic providing a comprehensive assessment of published literature on courses designed on these subjects. See the Supplementary Appendix file for the search strategy pilot results analysis completed for the Web of Science database report. A limitation of this study is that only peer-reviewed literature in English will be included, which will limit the scope of this review to articles published in English-speaking countries or those published in English. Abbreviations EOL care End-of-life WHO World Health Organization PRISMA-P-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol Extension for Scoping Reviews HCPs Healthcare Professionals Declarations Funding This study was supported by grant 1R25TW011217 from the US National Institutes of Health (NIH)/Fogarty International Center (FIC) which also includes co-funds from the U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and the President’s Emergency Plan for AIDS Relief (PEPFAR) to the African Forum for Research and Education in Health (AFREhealth). The Grant Principal Investigators are Profs. Nelson K .Sewankambo (contact PI), Prisca Adejumo, Jean Bisimwa Nachega, Fatima Suleman. Patient consent They are not required. Provenance and peer review Not commissioned; externally peer-reviewed. Acknowledgements The authors would like to thank the University of KwaZulu-Natal (UKZN) for providing resources for this review. ADDITIONAL INFORMATION Competing Interests The authors declare that they have no competing interests. Authors’ Contributions Sphamandla Josias Nkambule and Bernhard Gaede conceived the study, conducted the analysis, interpreted the data, drafted the manuscript, and edited it. All authors approved the final submitted version of the manuscript. Authors’ Information Sphamandla Josias Nkambule is a Doctoral Research Fellow in Public Health Medicine with the School of Nursing and Public Health Medicine at the University of KwaZulu-Natal; Quality Evidence for Health System Transformation (QuEST), RSA QuEST Network Center at Harvard T.H. Chan School of Public Health, The Centre for AIDS Programme of Research in South Africa (CAPRISA); West African Institute of Public Health (and Academy) (2023 Young Professionals in PH Cohort); and an Assistant Project Manager at the School of Education, University of KwaZulu-Natal, South Africa; and a teaching assistant at Durban University of Technology, Centre for General Education, South Africa. Bernhard Gaede is a family physician currently appointed as Associate Professor and Head of the Department of Family Medicine at the University of KwaZulu-Natal (UKZN) in South Africa. Prior to this appointment, he was the Director of the Centre for Rural Health at UKZN. He worked in rural hospital settings for over a decade before joining UKZN. References Organisation WH. Assessing the development of palliative care worldwide: a set of actionable indicators. 2021. Hallenbeck JL. Palliative care perspectives: Oxford University Press; 2022. 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Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ : British Medical Journal. 2014;348:g1687. Chalmers I. The Cochrane collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care. Annals of the New York Academy of Sciences. 1993;703:156-63; discussion 63. Dissemination C. Systematic reviews: CRD's guidance for undertaking reviews in healthcare. York: University of York NHS Centre for Reviews & Dissemination. 2009. Cook DA, Reed DA. Appraising the quality of medical education research methods: the medical education research study quality instrument and the Newcastle–Ottawa scale-education. Academic Medicine. 2015;90(8):1067-76. Reed DA, Beckman TJ, Wright SM, Levine RB, Kern DE, Cook DA. Predictive validity evidence for medical education research study quality instrument scores: quality of submissions to JGIM’s Medical Education Special Issue. Journal of general internal medicine. 2008;23:903-7. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34. Guyatt G. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Chinese J Evidence-Based Med. 2009;9:8. Antoniou SA, Antoniou GA. The GRADE approach to appraising the evidence or how to increase the credibility of your research. The American Journal of Surgery. 2020;220(2):290-3. Daudt HM, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC medical research methodology. 2013;13:1-9. Prasad VN, Koti VB. Melanie Perkins: poised to redesign Canva from tech unicorn to tech giant? The CASE Journal. 2023. Tables Table 1 : Search strategies with MeSH descriptors and truncation, with pilot-test results from PubMed, will be adapted for other databases. Number Search Terms Record Retrieved # 1 Health Professions Undergraduate Students: Medical Doctors OR Nursing Professionals OR Midwifery Professionals OR Midwives OR Dentists OR “Dieti*” OR “medical technology*” OR Pharmacists OR Dentist OR dental assistant OR emergency care practitioner OR emergency care assistant OR emergency care technician OR Emergency Medical Technician OR Occupational Therapist OR Physiotherapy Therapist OR Dialysis Technician OR Speech Language Pathologist OR Audiologist OR Physiotherapy OR Optometrist OR Healthcare Chaplain OR General practitioner OR Primary care physician OR Community Health practitioner OR Pharmacy technician OR Dental Therapy OR Oral Hygiene OR Epidemiologist OR Public Health Nurse OR Radiologist OR Clinical Technology OR health profession* OR “Healthcare profession*”AND 82,597 # 2 Palliative and End-of-Life (EOL) Care: “palliative care” OR “dying with dignity” OR “pain management” OR hospice∗ OR grief∗ OR bereavement∗ OR “Terminal care” OR Hospic* OR “Hospice Care” OR ”palliative care education” OR education∗ AND 186,448 # 3 Education, Teaching: “educational programs” OR programs∗ OR Student OR Undergraduate OR seminars∗ OR classes∗ Or teaching∗ OR teach OR educat* OR training* OR Education OR Training OR Learning OR Teaching OR Workshop* AND 615,583 # 4 Combined Systemic Searches: # 1 AND # 2 AND # 3 3,448 Note: The Comparators ( The Standard Teaching ) and Outcomes ( Any assessment of the “impact.”) is as reported in the study. Free text terms / natural language terms: (synonyms, UK/ US terminology, medical/ laymen’s terms, acronyms/abbreviations, drug brands, more narrow search terms) Consider: phrase searching, proximity operators, truncation, wildcards, field qualification (e.g. textword). Controlled vocabulary terms / Subject terms (MeSH terms, Emtree terms) Consider: explode, major headings, subheadings Table 2 : The Search Summary Table (SST), will be used to report on the search strategy performance. Project Title: Teaching Palliative Care in the Undergraduate Curriculum of Healthcare Professional Qualification: A Systematic Scoping Review Included references Format Database Searches [ date run: / / ; date re-run: / / ] Supplementary Searches PubMed Web of Science PsycINFO CINAHL MEDLINE fcs bcs hs wss org Included ref 1 Included ref 2 No. of included refs No. of unique refs Yield 3,448 No. of refs screened Sensitivity Precision Search-related information for the librarian or information specialist The summative metrics of effective searching No. of database searched = Overall sensitivity = Sum of yields = Overall precision = No. of refs that underwent Title & Abstract screening = NNR = No. of refs that underwent Full-text (FT) screening = NNR FT = No. of included refs from database searching = NNS = Total no. of included refs = Codes Supplementary search codes Format codes x = found from the search fcs = forwards citation search jnl = journal article y = in database; found when search strategy re-run bcs = backwards citation search ths = PhD thesis n = not in the database hs = hand search z = in the database; not found using the search strategy wss = web site search Other codes (red) = databases where searches re-run org = from contacting organisations FT = full text NNR = number needed to read. 1/overall precision NNR FT = number needed to read at FT to find one included reference NNS = number needed to screen to find one reference to include for FT screening Table 3 : Eligibility criteria according to the PICOd-T (Study Design - Time) nomenclature framework Criteria Inclusions Exclusions Population Studies conducted in any part of the world with human participants, Healthcare Professions Undergraduate students/ or graduate-entry programmes students and/or academic staff teaching across health profession, both full-time and part-time students within the clinical, medical, research and/ or educational setting, irrespective of study setting, will be eligible for inclusion. Reported study participants will be included irrespective of gender, ethnicity, culture, race, and comorbidities background. Research studies involving non-human participants as participants, Non-HCPs Undergraduate students. Intervention (or Exposure) Studies with human participants (health professional students) exposed to formal palliative and End-of-Life (EOL) care teaching/ or curriculum content and describe teaching methods, approaches/ or practices employed with a focus on achieving stated learning outcomes/ objectives and associated curriculum evaluation included. Studies will be included either reporting on intervention pedagogies in teaching palliative and end-of-life (EOL) care. For example: Focused on Reflection, Experiential Learning, Role-modelling, Dialectic Methods, and Didactic Methods Studies that focused on ad-hoc palliative/ or EOL care learning experiences (e.g., a once-off visit to an EOL unit), rather than integrated course content Studies which do not adequately describe the intervention will be excluded. Comparator Studies reporting on outcomes of interests, interventions support with no support/ or standard teaching (approaches/ practices) will represent the comparator. Comparisons of the various approaches/ practices For example: modalities, processes, objectives, motivations, challenges, facilitating characteristics/ resources in the teaching, education/ or training competencies in palliative and end-of-life (EOL) care) Outcomes Studies reporting on any outcome related to the effectiveness of teaching strategies (e.g., structured interviews with students, student satisfaction surveys, tests and exams, content analysis, peer observation feedback or specific outcome measures) in palliative and end-of-life (EOL) care) For example impact of teaching palliative and end-of-life (EOL) care on the host organisation, assessors, and assessees (Healthcare Professionals Undergraduate students), any assessment or programme evaluation of the “impact”; “outcome*”; “benefit”; AND the achievement of “attributes”; “skill*”; “knowledge”; “behaviour”; “personal growth” or “reflect*”; “transformation.” Research studies reporting on other outcomes, not in line with the outcomes of interest. Studies that did not report clear outcomes Study Design Only original, primary studies of both quantitative and/ or qualitative study designs that are peer-reviewed and published in English, irrespective of publication year, will be eligible for inclusion Reviews studies ( However, reference lists of relevant reviews will be checked for primary studies ) Authors of studies published only as abstracts will be contacted and asked to provide further detail. If no further detail is available, the study will be excluded. Time From inception – up to April 2023 Language Studies written in English will be included to avoid loss or distortion by translation from studies written in another language. Non-English language quantitative and qualitative studies will be translated. Note: Initial exclusion criteria were studies published in languages other than English and did not have the search keywords in the title or abstract. The inclusion/ exclusion criteria will be tested through piloting by two reviewers to establish agreement prior to commencing the study selection process. Supplementary Files PRISMAPchecklistAFREhealthPalliativeCareProject.docx PalliativeCareProjectInstrumentsFileOne.docx Cite Share Download PDF Status: Posted Version 1 posted 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-4313706","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":315446347,"identity":"e74a4156-584e-437a-8d5a-84aa1edd560f","order_by":0,"name":"Sphamandla Josias Nkambule","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie3RMUsDMRTA8RcCcQl2TSi0X+EdgYpY6VfJUTiXGxw7lUjBLjc4nljwK/gRTgN27HqlDpWCXRwyFnTw7roJwRsd8h8DP16SBxAK/cM6lMydxmGvc2KaA/yTyDl9BXedKJkVxLQiuGIJyd1L/FTqlgQsH+w4FgrX+/2Og1X9B0PcAaZ9nyAzfqY4vvXkJo1mFRmQRUFlBiwyHkIpxy7HD3W6SUlNhlRo6AJw4iPsSGxs1sv3hjCh6ReAGPkIpyyReUXuSjhejAvNqikY+4ig1KLD+pPT6H6BV0qI+PY8Qz32kdHq+Warv+tVLrfuc3IRPeZjWx4m00sf+VWzlfrhLdYTCoVCIX8/2JdSKz7atMkAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-7770-6931","institution":"University of KwaZulu-Natal School of Nursing and Public Health","correspondingAuthor":true,"prefix":"","firstName":"Sphamandla","middleName":"Josias","lastName":"Nkambule","suffix":""},{"id":315446348,"identity":"8bd74a15-774f-479a-b82b-0752fa33901b","order_by":1,"name":"Bernhard Gaede,","email":"","orcid":"","institution":"University of KwaZulu-Natal Nelson R Mandela School of Medicine: University of 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al.13\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4313706/v1/0463b065e1a57891b52f79ab.png"},{"id":59552226,"identity":"3bfb65ba-6f5d-4bea-bd33-061cc7d9f222","added_by":"auto","created_at":"2024-07-03 06:35:37","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":652951,"visible":true,"origin":"","legend":"\u003cp\u003eFramework for determining the eligibility of the research questions | Source: The first and second authors designed and developed the diagram in accordance with the PICO nomenclature framework recommended by the JBI Manual for Evidence Synthesis.14\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4313706/v1/6e6f80472e4e99d08a008277.jpeg"},{"id":91473060,"identity":"5defc0d7-e125-4ad6-bab8-95e649970d02","added_by":"auto","created_at":"2025-09-16 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06:35:37","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":556913,"visible":true,"origin":"","legend":"","description":"","filename":"PalliativeCareProjectInstrumentsFileOne.docx","url":"https://assets-eu.researchsquare.com/files/rs-4313706/v1/a2defedbdf8a3e92bf26430d.docx"}],"financialInterests":"","formattedTitle":"Mapping Evidence in Teaching Palliative Care in Undergraduate Curriculum of Healthcare Professionals Qualification: A Systematic Scoping Review Protocol","fulltext":[{"header":"STUDY BACKGROUND","content":"\u003cp\u003eA staggering 78 per cent of the estimated 56.8\u0026nbsp;million people who need palliative care globally reside in low- and middle-income countries (LMICs), including 25.7\u0026nbsp;million in the last year of life. This translates to only 14 per cent of those who could benefit from palliative care actually end up receiving it, highlighting a significant gap in access, particularly for LMIC populations.\u003csup\u003e1\u003c/sup\u003e Remission and survival rates for palliative care patients in most African countries are adversely affected by late detection, diagnosis, limited training of health care providers, and lack of resources for treatment and palliative care services in health facilities.\u003csup\u003e2, 3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSouth Africa’s unique disease burden, characterised by a high prevalence of HIV, tuberculosis (TB), and non-communicable diseases (NCDs) like cancers and injuries, intensifies the existing gap in palliative care services. This is particularly true for infectious diseases like TB and HIV, which are known to cause significant suffering in LMICs.\u003csup\u003e4\u003c/sup\u003e This underscores the critical necessity for comprehensive and integrated approaches to palliative and end-of-life care education and service provision, especially in regions facing such significant health challenges.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eHealth Policy Context of the study: Global, Continental and National\u003c/h2\u003e \u003cp\u003eThe pressing need for palliative care in Africa is further highlighted by the World Health Assembly Resolution 67.19 passed in 2014. This resolution specifically called on member states to integrate palliative care into comprehensive care throughout a person’s life.\u003csup\u003e5\u003c/sup\u003e Request number four of the resolution explicitly addresses education and training, urging countries to include palliative care as a standard part of healthcare professional education and training. This includes integrating basic and continuing education on palliative care into undergraduate medical and nursing programs, as well as in-service training for care providers at the primary care level, including doctors, nurses, primary care workers (such as community health workers), spiritual caregivers (those who provide emotional and religious support to patients and families), and social workers.\u003c/p\u003e \u003cp\u003eHowever, despite international recognition and clear steps outlined in resolutions like the World Health Assembly Resolution 67.19, translating the definition of palliative care into accessible services for Africans remains a challenge. This disconnect between the urgent demand for palliative care in regions such as South Africa and the insufficient advancements made in establishing comprehensive educational and training initiatives, as advocated by international resolutions underscores the need for stronger implementation efforts to ensure that palliative care becomes a true pillar of Universal Health Coverage (UHC) on the continent.\u003c/p\u003e \u003cp\u003eCountries can not meet the United Nations Sustainable Development Goal Three, specifically Target 3.8, without including palliative care and pain relief.\u003csup\u003e6\u003c/sup\u003e South Africa has adopted the policy of National Health Insurance intended to promote access to promotive, preventive, curative, rehabilitative and palliative care services of sufficient quality to be effective while not exposing citizens to financial hardship.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003ePalliative Care in Undergraduate Health Professions Education.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA scoping review was conducted to examine the provision of Palliative Care services in Africa from 2005 to 2016.\u003csup\u003e4\u003c/sup\u003e The study followed the guidelines set by the World Health Organisation (WHO) for the public health strategy of palliative care,\u003csup\u003e8\u003c/sup\u003e which include the implementation of services, educational initiatives, policy development, medicine availability, and professional engagement. The review findings revealed a significant presence of these services in Kenya, South Africa, and Uganda.\u003csup\u003e4\u003c/sup\u003e Stand-alone palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zimbabwe.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe South African National Department of Health adopted the National Policy Framework and Strategy on Palliative Care 2017–2022 to promote the development and delivery of Palliative Care services.\u003csup\u003e7\u003c/sup\u003e However, despite these efforts, the lack of access to Palliative Care services on the African continent was further emphasised by the Lancet Commission Report, which provided recommendations concerning Human Resources in this context: “Establish palliative care as a recognised medical and nursing speciality; Make general palliative care and pain relief competencies a mandatory component of all medicine, nursing, psychology, social work, and pharmacy undergraduate curricula; Require that all health and other professionals involved in caring for patients with serious, complex, or life-threatening health conditions receive basic training in palliative care and pain relief.”\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCurrent undergraduate health professional curricula throughout Africa have elements of Palliative Care education that are poorly quantified despite palliative care being recognised as an emerging discipline in health care. Therefore, there is an urgent need to review and strengthen curricula to provide an inter-professional approach to palliative care education for the African health professional, allowing future fit professionals to competently deliver on the growing Palliative Care needs of the continent.\u003c/p\u003e \u003cp\u003eThis will lay the foundation for a sustainable, high-quality and accessible palliative care system integrated into primary health care, community and home-based care, and supporting care providers such as family and community volunteers.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe rationale for the study\u003c/h3\u003e\n\u003cp\u003eWhile accreditation bodies have mandated teaching basic palliative and end-of-life (EOL) care across healthcare professions training curricula,\u003csup\u003e9\u003c/sup\u003e there has been limited guidance for educators on what or how to teach and evaluate students’ competence, particularly in the undergraduate curriculum for HCP qualification. Moreover, there is a lack of extensive evidence regarding the nature and effectiveness of educational interventions to improve palliative care education and whether these interventions result in positive outcomes.\u003c/p\u003e \u003cp\u003eA preliminary systematic search was performed using the EBSCOhost platform, searching two databases, Medline and CINAHL, and finding no scoping reviews for palliative care education and training in the undergraduate curriculum for HCP qualification. In addition, the two international perspective registers of systematic and scoping review databases, PROSPERO and the Open Science Framework (OSF), were searched respectively, and no similar review protocols were identified. Therefore, due to this limited evidence, our aims were broad, which was more suited for a scoping review rather than a systematic review, which would be, to sum up, the best available research on palliative care education (PCE) across the undergraduate curriculum for HCP qualification.\u003c/p\u003e\n\u003ch3\u003eAim\u003c/h3\u003e\n\u003cp\u003eThis scoping review aims to systematically map the research done in palliative care education (PCE), as well as to identify the nature and effectiveness of educational interventions to improve palliative and end-of-life (EOL) care education across the undergraduate curriculum for HCPs qualifications.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo systematically map the scope of available published knowledge about teaching palliative and EOL care across the undergraduate curriculum for HCP qualification.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSub-objectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo identify studies that have used educational and training interventions for palliative and end-of-life (EOL) care teaching across HCP training curricula;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo critically appraise and identify curricular components of effective interventions in the undergraduate curriculum for HCP qualification; and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo use this critically appraised evidence base to inform the design of palliative and end-of-life (EOL) care teaching across HCP training curricula.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e "},{"header":"METHODOLOGY","content":"\u003ch2\u003eStudy Design - Protocol and registration\u003c/h2\u003e\u003cp\u003eThis scoping review protocol is part of a more extensive study [\u003cb\u003eDetails of the bigger project goes here\u003c/b\u003e], and the protocol for the complete review is available in the PROSPERO data repository registries – ID CRD42023481892 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.crd.york.ac.uk/prospero/export_details_pdf.php\u003c/span\u003e\u003cspan address=\"https://www.crd.york.ac.uk/prospero/export_details_pdf.php\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eAs part of the more extensive study, a scoping review was chosen as the best method to systematically synthesise qualitative and quantitative evidence on the nature and effectiveness of currently available educational interventions to improve palliative care education for health and social care professionals in the undergraduate curriculum. The protocol for the scoping review was developed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for a scoping review (PRISMA-P-ScR), which permitted the forwarding of a six-step scoping review protocol (see Supplementary Appendix for the completed PRISMA-P Checklist).\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe proposed comprehensive systematic scoping review of the literature will be conducted according to the Levac \u003cem\u003eet al\u003c/em\u003e. (2010) adaptation to Arksey and O’Malley (2005) framework for scoping review methods and experts in the field.\u003csup\u003e11, 12\u003c/sup\u003e The review findings will be reported per the PRISMA 2020 statement - an updated procedure for reporting review studies (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the PRISMA-2020 flowchart).\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e---\u003c/p\u003e\u003ch2\u003eStep 1: Identifying the review question\u003c/h2\u003e\u003cp\u003eAs an integral component of the framework’s preliminary phase, the research team received guidance from the expert team in formulating comprehensive and specific research questions. Additionally, the study protocol’s design, the selection of search terms for the literature review, and the identification of relevant databases were established through a collaborative process involving iterative consultations with our research team, key informants possessing expertise in curricular design, implementation, and assessment of healthcare professional qualifications in both general and specific contexts related to palliative and end-of-life care. Furthermore, the input of an experienced medical librarian was sought in this process.\u003c/p\u003e\u003cp\u003eTo determine whether the research question qualified for a scoping review project, we utilised the PICO (participants; interventions; comparator; outcomes) nomenclature framework recommended by the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis: 2020 Edition (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe main research question that the proposed scoping review will address:\u003c/p\u003e\u003cp\u003eWhat is the nature and effectiveness of teaching palliative and end-of-life (EOL) care to students in the undergraduate health and social care professionals qualifications curriculum?\u003c/p\u003e\u003cp\u003eMore specifically, the scoping review seeks to address the following research sub-questions:\u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat is the evidence on the nature of educational interventions to improve palliative and end-of-life (EOL) care teaching in the undergraduate curriculum for health and social care professionals qualifications?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat is the effectiveness of educational interventions to improve palliative and end-of-life (EOL) care teaching in the undergraduate curriculum for health and social care professionals qualifications?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e\u003cp\u003eThe eligibility criteria for including studies in this review in order to answer the aforementioned questions are based on the relevant components of the PICOd-T (Study Design - Time) framework and the research question. Thus, the PICOd-T framework is employed to ensure that the boundaries of the proposed scoping review research question are clearly defined.\u003c/p\u003e\u003cp\u003eThe eligible studies will be included once they have been evaluated independently, reproducibly, and systematically by two reviewers. For studies to be considered eligible, studies must provide evidence of one of the factors listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A third reviewer will resolve disagreements between the two reviewers; reviewers will also pilot-test the inclusion/exclusion criteria to reach a consensus before beginning the study selection process (\u003cb\u003eStep 3: Study selection and eligibility screening\u003c/b\u003e).\u003c/p\u003e\u003ch2\u003eStep 2: Identifying relevant studies - Search Strategy and Data Sources\u003c/h2\u003e\u003cp\u003eThe systematic, comprehensive, and reproducible searches to identify relevant studies will initially be conducted via electronic search sources – searching reputable bibliographic databases and indexing services (and platforms) – followed by searches of supplementary information sources to capture primary studies addressing the main review question. With the assistance of a professional medical librarian, the first author will conduct all direct electronic and supplementary information source systematic searches, using a pre-defined and piloted search strategy (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e), to capture both published and unpublished (grey) literature to be screened for eligibility for inclusion in this review.\u003c/p\u003e\u003ch2\u003eSearch Strategy\u003c/h2\u003e\u003cp\u003eThe first author, a medical librarian and subject specialist with experience in designing, implementing, and assessing HCP qualifications in general and in the palliative and EOL care domain, co-developed the comprehensive search strategy (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details of the search strategy metrics). All authors were given an equal opportunity to review the draft to ensure the correct use of indexing terminology and Medical Subject Headings (MeSH) descriptors before it was pilot-tested on a subset of records from the PubMed database (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e pilot test results).\u003c/p\u003e\u003cp\u003eIn accordance with the approach of Bethel \u003cem\u003eet al\u003c/em\u003e., (2021), a search summary table (SST) will be used to report on the performance of the search strategy in effective searching databases. The SST is a viable and reproducible method for reporting and evaluating the search strategy’s effectiveness (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e for the example of the SST metrics that will be used for this purpose).\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eData Sources\u003c/h2\u003e\u003ch2\u003eElectronic search sources\u003c/h2\u003e\u003cp\u003eThe systematic and comprehensive searches will be conducted from the following electronic databases to source articles published on the topic of teaching palliative and end-of-life (EOL) care to students in the undergraduate curriculum of HCPs qualification, using the pilot-tested search strategy:\u003c/p\u003e\u003cp\u003eWEB of Science, PubMed, and EBSCOHost Web (Academic Search Complete, PyscInfo, MEDLINE with Full Text, and Health Source: (Nursing/Academic Edition)). Furthermore, evidence on palliative care teaching interventions will be sourced from the South African National Clinical Trial Register and the ISRCTN registry. The mentioned databases will be searched from their inception to the present, regardless of the publication language. This procedure aims to obtain as many articles as possible from electronic search sources and to ensure that all relevant articles or reports are captured before the study selection and eligibility screening process begins.\u003c/p\u003e\u003ch2\u003eSearching other resources – supplementary information search\u003c/h2\u003e\u003cp\u003eIn addition, supplementary search methods will include hand-searching of relevant journals, reference lists of identified peer-reviewed articles and grey literature, and as well as forward and backwards citation chasing. The reviewers will further browse through the link entitled “Related Articles” option, which searches for similar citations using an intricate algorithm that scans titles, abstracts, and MeSH terms to detect more studies (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSystematic reviews and other review papers are not eligible for inclusion; however, reference lists of relevant reviews, preprints, and conference abstracts will be screened for more relevant primary studies not captured by the search strategy. Furthermore, the appropriate trial publications reference lists will be checked for unidentified randomised clinical trials.\u003c/p\u003e\u003ch2\u003eThe systematic search management\u003c/h2\u003e\u003cp\u003eThe SST will also be used to present and keep records of the systematic searches retrieved information, such as the summative metrics of effective searching suggested by Cooper \u003cem\u003eet al\u003c/em\u003e., (2018), and additional metrics providing further useful search-related information for the librarian or information specialist.\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe SST will be completed in two stages. In stage one, all the references that the search strategy retrieves from each electronic database, including all duplicates, will be exported to EndNote X9 (version 19.1.0.12691) – a reference management software, which will be used to create a virtual library (Thomson Reuters, Stamford, CT, USA).\u003csup\u003e17\u003c/sup\u003e Every record in the virtual library will be given a code for the database name where the record was found.\u003c/p\u003e\u003cp\u003eStage two involves re-running the searches in the databases where most of the included references were found to determine whether references not found during the original search were in the database and, if so, whether the search strategy retrieved them.\u003c/p\u003e\u003ch2\u003eStep 3: Study selection and eligibility screening\u003c/h2\u003e\u003cp\u003eThe study selection and eligibility screening method is multi-step and involves two reviewers. The eligibility screening approach for eligible articles will be carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, as represented in the PRISMA 2020 Flow Diagram Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eFirst, two reviewers will screen the title and abstracts for relevance independently and in duplicate, and articles that pass initial screening by either reviewer will undergo full-text review independently and in duplicate by the same two reviewers. Standardised, pilot-tested eligibility forms will be used for both title and abstract screening and for full-text review (see Supplementary Appendix for the completed screening tool).\u003c/p\u003e\u003cp\u003eDisagreements about study eligibility will be resolved through consensus discussion or will be resolved by a third reviewer in the case of ongoing disagreement. Kappa statistics will be calculated to assess the inter-rater reliability of full-text review, using Cohen’s Kappa coefficient (κ) statistic on Stata 13.0SE (StataCorp College Station, TX, USA), a robust statistic used for inter-rater reliability testing.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eStep 4: Data extraction/ or collection process\u003c/h2\u003e\u003cp\u003eA standardised data extraction form informed by the template for intervention description and replication (TIDieR) checklist and guide for describing interventions will be created to capture relevant information from the included studies (see Supplementary Appendix for the data extraction form).\u003csup\u003e19\u003c/sup\u003e The form will consist of fields for study characteristics, participant demographics, teaching/ or communication strategies employed, outcome measures, and key findings\u003c/p\u003e\u003cp\u003eTwo independent reviewers will extract data from the included studies using the standardised data extraction form to detect inter-rater errors and decrease data errors and bias. The reviewers will extract data from the included articles independently and in duplicate. A third reviewer will verify the data related to study characteristics, such as publication information, study dates, population characteristics, interventions, outcomes, and study methods, which are required to assess the risk of bias.\u003c/p\u003e\u003cp\u003eIn the meta-analysis, the nature of the data, such as continuous outcomes (mean differences or standardised mean differences) or dichotomous outcomes (odds ratios or risk ratios (ORs)) will be calculated if necessary, and if the data is available, only measures most adjusted for one or more sets of potential confounders such as socio-demographic and lifestyle factors will be extracted by the two reviewers to reduce confounding and measurement errors and to ensure consistency across studies and reduce bias.\u003c/p\u003e\u003ch2\u003eRequests for missing data\u003c/h2\u003e\u003cp\u003eMissing data will be identified and recorded within the review. Where papers provide insufficient details about the intervention, such as what is delivered and by whom, an effort would be made to contact the authors to obtain previously unpublished information and clarify any missing data. In cases of non-response or inadequate clarity from contacted authors (i.e. retrieval of missing data is not possible), that study/outcome will be eliminated from the review.\u003c/p\u003e\u003ch2\u003eStep 5: Assessment of study methodological quality, risk of bias, and the certainty of evidence\u003c/h2\u003e\u003cp\u003eThe methodological quality and risk of bias of each included study will be assessed by two reviewers independently, using appropriate methodological quality assessment tools depending on the design of the included studies using the guidance produced by the NHS Centre for Reviews and Dissemination and the Cochrane Collaboration.\u003csup\u003e20, 21\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eTools to assess the methodological quality\u003c/h2\u003e\u003cp\u003eAs recommended, the MERSQI (Medical Education Research Study Quality Instrument) Scale and Newcastle-Ottawa Scale Education (NOS-E) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] will be used to determine the methodological quality of the included studies.\u003csup\u003e22, 23\u003c/sup\u003e The two instruments will be used as they assess different aspects of quality and risk of bias, acting in a complementary fashion. As described in previous studies, a score above the sample median MERSQI score (12.5) and NOS-E score (2.5) will be considered the threshold for high methodological quality.\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFurthermore, the risk of bias for RCTs will be assessed using the Cochrane risk of bias tool, which will take into account random sequence generation, allocation concealment, participant and personnel blinding, insufficient outcome data, and selective reporting. Each domain will be evaluated independently by both reviewers and classified as ‘high,’ ‘low,’ or ‘uncertain’ regarding bias. Studies will be considered to be at an overall ‘high’ risk of bias if they are judged to be at ‘high’ risk of bias in any domain, ‘uncertain’ risk of bias if they are judged to be at an uncertain risk of bias in any one domain, with no domains at high risk of bias, and an overall ‘low’ risk of bias if they are not judged to be at ‘high’ or ‘uncertain’ risk of bias in any domain. All risk of bias assessment will be judged at the outcome level.\u003c/p\u003e\u003ch2\u003eTools to assess the risk of bias (or publication bias)\u003c/h2\u003e\u003cp\u003ePublication bias will be assessed using visual inspection of funnel plots, where sufficient numbers of studies will exist to permit interpretation.\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e \u003cb\u003eTools to assess the certainty of evidence (quality of evidence\u003c/b\u003e/ \u003cb\u003ethe strength of the body of evidence)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe overall quality of evidence (or certainty in the findings) for each outcome obtained will be evaluated using the five GRADE principles (trial bias risk, consistency of effect, imprecision, indirectness, and publication bias). The completed GRADE checklist and reasons for up- or down-grading assess the quality of a body of evidence based on study methodological quality, results from sensitivity analysis, and by downgrading and upgrading the baseline quality score according to the domains specified in the GRADE guidelines.\u003csup\u003e25\u003c/sup\u003e We will generate a table that summarises our findings using GradePRO software.\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eStep 7: Collating, summarising, and reporting the results\u003c/h2\u003e\u003cp\u003eSystematic scoping reviews provide an executive overview of current evidence by answering broad questions.\u003csup\u003e27\u003c/sup\u003e Thus, following the completion of the data extraction step, we will generate a comprehensive summary of the data extracted from the included studies. The summary will consist of two key presentation components:\u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eNumerical presentation\u003c/b\u003e: We will create a compiled findings table that provides a descriptive overview of the key pre-specified study outcomes and type of included studies, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Additionally, we will employ an interactive web-based graphic design tool, specifically Canva version 2.93.0, to generate a world map.\u003csup\u003e28\u003c/sup\u003e This map will help visualise the geographical distribution of the summary of the included studies, offering insight into global patterns.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eNarrative presentation\u003c/b\u003e: To ensure a holistic analysis, we will synthesise the essential characteristics of all the included studies. We will archive this by documenting the structure of the intervention of interest – all educational interventions used to teach palliative and end-of-life (EOL) care education to health and social care professionals in the undergraduate curriculum – will be captured by recording pedagogy, course content and learning outcomes. This will consist of data including, but not limited to, educational method, educational content, length/duration, outcome measures, outcome results and implementation ‘barriers and facilitators’ such as financial support.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e\u003ch2\u003eStrategy for data synthesis\u003c/h2\u003e\u003cp\u003eThe data synthesis process will involve the following steps:\u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eThematic Analysis\u003c/b\u003e: We will conduct a thematic analysis of the extracted data to identify recurring themes, concepts, and patterns related to key characteristics of teaching palliative and end-of-life (EOL) care to students in the undergraduate health and social care professionals qualification curriculum. This will involve coding and categorising the extracted data into meaningful themes and sub-themes;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eQualitative Summary\u003c/b\u003e: We will provide a qualitative summary of the key findings from the included studies. This will involve synthesising the results narratively, highlighting similarities, differences, and trends in the effectiveness of a series of identified interventions to improve palliative care education for health and social care professionals in the undergraduate curriculum;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSubgroup Analysis\u003c/b\u003e: If a sufficient number of studies with similar characteristics and outcomes are identified, we may conduct subgroup analyses based on factors such as study design, geographical location, or types of Educational methods/ Pedagogies employed in the Teaching of PC. This will enable us to explore potential variations in the effectiveness of different interventions – to improve palliative care education for health and social care professionals in the undergraduate curriculum – within specific subgroups; and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eMeta-analysis (if applicable)\u003c/b\u003e: If the included studies are deemed suitable and homogeneous, we will consider conductinga meta-analysis to provide a quantitative synthesis of the data.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e\u003cp\u003eFurthermore, the authors will delve into the implications of these findings for future research, practice, and policy.\u003csup\u003e12\u003c/sup\u003e Stage 7 details are still being worked out, and they may be repeated or changed if reviewers deem them necessary.\u003c/p\u003e\u003ch2\u003eEthics and dissemination\u003c/h2\u003e\u003cp\u003eNo ethical clearance is required for this study. The results of the proposed systemic scoping review will be disseminated electronically, in print, and through conference presentations as well as key stakeholder meetings.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe proposed systematic scoping review aims to deliver comprehensive evidence on palliative care education (PCE) and identify the nature and effectiveness of educational interventions to teach palliative and end-of-life (EOL) care education to health and social care professionals in the undergraduate curriculum. Most importantly, the proposed scoping review\u0026rsquo;s purpose is not to rate the quality of evidence or come to conclusions about best practices, but rather to offer the scope of available published knowledge about teaching palliative and EOL care across the undergraduate curriculum for health and social care professionals qualification.\u003c/p\u003e \u003cp\u003eWe believe that by adopting this approach, we will be able to ascertain the educational experience of both learners and educators. This will entail taking into account the needs of learners, the interactions between learners and educators, the interactions among learners themselves, the contributions made by the department, and the utilisation of information to nudge behaviours and improve decision-making skills around palliative and EOL care.\u003c/p\u003e \u003cp\u003eFurthermore, a key area of work that will commence as part of the project\u0026rsquo;s more extensive study (and is likely to outlive the lifespan of the project) is to engage with key stakeholders regarding the inclusion of palliative and EOL care into all undergraduate curricula for health and social care professionals qualification programs in Africa. It is envisaged that a consensus statement will be developed and shared in a range of forums, in particular the African Palliative Care Association, Africa-wide family medicine structures such as Primafamed and WONCA Africa as well as AFREhealth, in which they will be consulted, thus providing valuable insights beyond what has been captured through scoping review project.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of this study\u003c/h2\u003e \u003cp\u003eA strength of this study is that it will apply a broad review of multidisciplinary databases covering Public Environmental Occupational Health, Nursing, Health Care Sciences Services, Medicine General Internal, Education Scientific Disciplines, Educational Research, Social Sciences Interdisciplinary and other Web of Science Core Collection Citation Topic providing a comprehensive assessment of published literature on courses designed on these subjects. See the Supplementary Appendix file for the search strategy pilot results analysis completed for the Web of Science database report.\u003c/p\u003e \u003cp\u003eA limitation of this study is that only peer-reviewed literature in English will be included, which will limit the scope of this review to articles published in English-speaking countries or those published in English.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.6105702364395%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;EOL care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"80.3894297635605%\" valign=\"top\"\u003e\n \u003cp\u003eEnd-of-life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.6105702364395%\" valign=\"top\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"80.3894297635605%\" valign=\"top\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.6105702364395%\" valign=\"top\"\u003e\n \u003cp\u003ePRISMA-P-ScR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"80.3894297635605%\" valign=\"top\"\u003e\n \u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol Extension for Scoping Reviews\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.6105702364395%\" valign=\"top\"\u003e\n \u003cp\u003eHCPs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"80.3894297635605%\" valign=\"top\"\u003e\n \u003cp\u003eHealthcare Professionals\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by grant 1R25TW011217 from the US National Institutes of Health (NIH)/Fogarty International Center (FIC) which also includes co-funds from the U.S. Department of State\u0026rsquo;s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and the President\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR) to the African Forum for Research and Education in Health (AFREhealth). The Grant Principal Investigators are Profs. Nelson K .Sewankambo (contact PI), Prisca Adejumo, Jean Bisimwa Nachega, Fatima Suleman.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThey are not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvenance and peer review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot commissioned; externally peer-reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the University of KwaZulu-Natal (UKZN) for providing resources for this review.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eADDITIONAL INFORMATION\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSphamandla Josias Nkambule and Bernhard Gaede conceived the study, conducted the analysis, interpreted the data, drafted the manuscript, and edited it. All authors approved the final submitted version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSphamandla Josias Nkambule\u003c/strong\u003e is a Doctoral Research Fellow in Public Health Medicine with the School of Nursing and Public Health Medicine at the University of KwaZulu-Natal; Quality Evidence for Health System Transformation (QuEST), RSA QuEST Network Center at Harvard T.H. Chan School of Public Health, The Centre for AIDS Programme of Research in South Africa (CAPRISA); West African Institute of Public Health (and Academy) (2023 Young Professionals in PH Cohort); and an Assistant Project Manager at the School of Education, University of KwaZulu-Natal, South Africa; and a teaching assistant at Durban University of Technology, Centre for General Education, South Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBernhard Gaede\u003c/strong\u003e is a family physician currently appointed as Associate Professor and Head of the Department of Family Medicine at the University of KwaZulu-Natal (UKZN) in South Africa. Prior to this appointment, he was the Director of the Centre for Rural Health at UKZN. He worked in rural hospital settings for over a decade before joining UKZN.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOrganisation WH. Assessing the development of palliative care worldwide: a set of actionable indicators. 2021.\u003c/li\u003e\n\u003cli\u003eHallenbeck JL. Palliative care perspectives: Oxford University Press; 2022.\u003c/li\u003e\n\u003cli\u003eKnaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, et al. Alleviating the access abyss in palliative care and pain relief\u0026mdash;an imperative of universal health coverage: the Lancet Commission report. The Lancet. 2018;391(10128):1391-454.\u003c/li\u003e\n\u003cli\u003eRhee JY, Garralda E, Torrado C, Blanco S, Ayala I, Namisango E, et al. Palliative care in Africa: a scoping review from 2005\u0026ndash;16. The Lancet Oncology. 2017;18(9):e522-e31.\u003c/li\u003e\n\u003cli\u003eOrganisation WH. Strengthening of palliative care as a component of comprehensive care throughout the life course. Sixty-seventh World Health Assembly. 2014:9-14.\u003c/li\u003e\n\u003cli\u003eCarlsen L, Bruggemann R. The 17 United Nations\u0026rsquo; sustainable development goals: A status by 2020. International Journal of Sustainable Development \u0026amp; World Ecology. 2022;29(3):219-29.\u003c/li\u003e\n\u003cli\u003eAlbertus C. The national policy framework and strategy on palliative care 2017‒2022: what\u0026rsquo;s in it for terminally ill inmates in South Africa? Obiter. 2020;41(4):671-84.\u003c/li\u003e\n\u003cli\u003eOrganisation WH. Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers. 2018.\u003c/li\u003e\n\u003cli\u003eRawlinson F, Gwyther L, Kiyange F, Luyirika E, Meiring M, Downing J. The current situation in education and training of health-care professionals across Africa to optimise the delivery of palliative care for cancer patients. Ecancermedicalscience. 2014;8.\u003c/li\u003e\n\u003cli\u003eShamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj. 2015;349.\u003c/li\u003e\n\u003cli\u003eArksey H, O\u0026apos;Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32.\u003c/li\u003e\n\u003cli\u003eLevac D, Colquhoun H, O\u0026apos;Brien KK. Scoping studies: advancing the methodology. Implementation science. 2010;5:1-9.\u003c/li\u003e\n\u003cli\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021;88:105906.\u003c/li\u003e\n\u003cli\u003eAromataris E, Munn Z. JBI manual for evidence synthesis: Joanna Briggs Institute; 2020.\u003c/li\u003e\n\u003cli\u003eBethel AC, Rogers M, Abbott R. Use of a search summary table to improve systematic review search methods, results, and efficiency. Journal of the Medical Library Association: JMLA. 2021;109(1):97.\u003c/li\u003e\n\u003cli\u003eCooper C, Varley-Campbell J, Booth A, Britten N, Garside R. Systematic review identifies six metrics and one method for assessing literature search effectiveness but no consensus on appropriate use. Journal of clinical epidemiology. 2018;99:53-63.\u003c/li\u003e\n\u003cli\u003eHupe M. EndNote X9. Journal of Electronic Resources in Medical Libraries. 2019;16(3-4):117-9.\u003c/li\u003e\n\u003cli\u003eViera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam med. 2005;37(5):360-3.\u003c/li\u003e\n\u003cli\u003eHoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ : British Medical Journal. 2014;348:g1687.\u003c/li\u003e\n\u003cli\u003eChalmers I. The Cochrane collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care. Annals of the New York Academy of Sciences. 1993;703:156-63; discussion 63.\u003c/li\u003e\n\u003cli\u003eDissemination C. Systematic reviews: CRD\u0026apos;s guidance for undertaking reviews in healthcare. York: University of York NHS Centre for Reviews \u0026amp; Dissemination. 2009.\u003c/li\u003e\n\u003cli\u003eCook DA, Reed DA. Appraising the quality of medical education research methods: the medical education research study quality instrument and the Newcastle\u0026ndash;Ottawa scale-education. Academic Medicine. 2015;90(8):1067-76.\u003c/li\u003e\n\u003cli\u003eReed DA, Beckman TJ, Wright SM, Levine RB, Kern DE, Cook DA. Predictive validity evidence for medical education research study quality instrument scores: quality of submissions to JGIM\u0026rsquo;s Medical Education Special Issue. Journal of general internal medicine. 2008;23:903-7.\u003c/li\u003e\n\u003cli\u003eEgger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34.\u003c/li\u003e\n\u003cli\u003eGuyatt G. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Chinese J Evidence-Based Med. 2009;9:8.\u003c/li\u003e\n\u003cli\u003eAntoniou SA, Antoniou GA. The GRADE approach to appraising the evidence or how to increase the credibility of your research. The American Journal of Surgery. 2020;220(2):290-3.\u003c/li\u003e\n\u003cli\u003eDaudt HM, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team\u0026rsquo;s experience with Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework. BMC medical research methodology. 2013;13:1-9.\u003c/li\u003e\n\u003cli\u003ePrasad VN, Koti VB. Melanie Perkins: poised to redesign Canva from tech unicorn to tech giant? The CASE Journal. 2023.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Search strategies with MeSH descriptors and truncation, with pilot-test results from PubMed, will be adapted for other databases.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"84.6938775510204%\"\u003e\u003cstrong\u003eSearch Terms\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\u003cstrong\u003eRecord Retrieved\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e# 1\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"84.6938775510204%\"\u003e\u003cstrong\u003eHealth Professions Undergraduate Students:\u003c/strong\u003e\u003cbr\u003eMedical Doctors OR Nursing Professionals OR Midwifery Professionals OR Midwives OR Dentists OR \u0026ldquo;Dieti*\u0026rdquo; OR \u0026ldquo;medical technology*\u0026rdquo; OR Pharmacists OR Dentist OR dental assistant OR emergency care practitioner OR emergency care assistant OR emergency care technician OR Emergency Medical Technician OR Occupational Therapist OR Physiotherapy Therapist OR Dialysis Technician OR Speech Language Pathologist OR Audiologist OR Physiotherapy OR Optometrist OR Healthcare Chaplain OR General practitioner OR Primary care physician OR Community Health practitioner OR Pharmacy technician OR Dental Therapy OR Oral Hygiene OR Epidemiologist OR Public Health Nurse OR Radiologist OR Clinical Technology OR health profession* OR \u0026ldquo;Healthcare profession*\u0026rdquo;AND\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e82,597\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e# 2\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"84.6938775510204%\" valign=\"top\"\u003e\u003cstrong\u003ePalliative and End-of-Life (EOL) Care:\u003c/strong\u003e\u003cbr\u003e\u0026ldquo;palliative care\u0026rdquo; OR \u0026ldquo;dying with dignity\u0026rdquo; OR \u0026ldquo;pain management\u0026rdquo; OR hospice\u0026lowast; OR grief\u0026lowast; OR bereavement\u0026lowast; OR \u0026ldquo;Terminal care\u0026rdquo; OR Hospic* OR \u0026ldquo;Hospice Care\u0026rdquo; OR \u0026rdquo;palliative care education\u0026rdquo; OR education\u0026lowast; AND\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e186,448\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e# 3\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"84.6938775510204%\" valign=\"top\"\u003e\u003cstrong\u003eEducation, Teaching:\u003c/strong\u003e\u003cbr\u003e\u0026ldquo;educational programs\u0026rdquo; OR programs\u0026lowast; OR Student OR Undergraduate OR seminars\u0026lowast; OR classes\u0026lowast; Or teaching\u0026lowast; OR teach OR educat* OR training* OR Education OR Training OR Learning OR Teaching OR Workshop* AND\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e615,583\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\u003cstrong\u003e#\u0026nbsp;\u003c/strong\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"84.6938775510204%\" valign=\"top\"\u003e\u003cstrong\u003eCombined Systemic Searches:\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e# 1 AND # 2 AND # 3\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\"\u003e3,448\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u0026nbsp;\u003c/strong\u003eThe Comparators (\u003cem\u003eThe Standard Teaching\u003c/em\u003e) and Outcomes (\u003cem\u003eAny assessment of the \u0026ldquo;impact.\u0026rdquo;)\u003c/em\u003e is as reported in the study. \u003cstrong\u003eFree text terms / natural language terms:\u0026nbsp;\u003c/strong\u003e(synonyms, UK/ US terminology, medical/ laymen\u0026rsquo;s terms, acronyms/abbreviations, drug brands, more narrow search terms) \u003cem\u003eConsider: phrase searching, proximity operators, truncation, wildcards, field qualification (e.g. textword).\u0026nbsp;\u003c/em\u003e\u003cstrong\u003eControlled vocabulary\u003c/strong\u003e \u003cstrong\u003eterms / Subject terms\u0026nbsp;\u003c/strong\u003e(MeSH terms, Emtree terms) \u003cem\u003eConsider: explode, major headings, subheadings\u003c/em\u003e\u003cem\u003e\u003cbr\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The Search Summary Table (SST), will be used to report on the search strategy performance.\u003c/p\u003e\n\u003ctable style=\"width: 100%;border: none;margin-left:-.75pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width:100.0%;border:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eProject Title:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;Teaching Palliative Care in the Undergraduate Curriculum of Healthcare Professional Qualification: A Systematic Scoping Review\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:16.74%;border:solid windowtext 1.5pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eIncluded references\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eFormat\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width:51.24%;border-top:none;border-left: none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eDatabase Searches [ \u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003edate run: \u0026nbsp; / \u0026nbsp; \u0026nbsp; / \u0026nbsp;; date re-run: \u0026nbsp;/ \u0026nbsp;/\u003c/span\u003e\u003c/em\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;]\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width:25.14%;border-top:none;border-left: none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eSupplementary Searches\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:16.74%;border:solid windowtext 1.5pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ePubMed\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.76%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eWeb of Science\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ePsycINFO\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eCINAHL\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eMEDLINE\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003efcs\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:5.9%;border-top:none;border-left:none;border-bottom: solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ebcs\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan 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style='font-family:\"Calibri\",sans-serif;color:black;'\u003eorg\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:16.74%;border-top:none;border-left:solid windowtext 1.5pt;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eIncluded ref 1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.76%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd 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Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan 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1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:5.9%;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.46%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 15.75pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:16.74%;border-top:none;border-left:solid windowtext 1.5pt;border-bottom:solid windowtext 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style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.76%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.8%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:5.9%;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New 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style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:16.74%;border-top:none;border-left:solid windowtext 1.5pt;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.5pt;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eSensitivity\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.88%;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.76%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.8%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.92%;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:5.9%;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:16.74%;border:solid windowtext 1.5pt;border-top: none;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ePrecision\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.88%;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:15.76%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.8%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.88%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:7.92%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:5.9%;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable style=\"border: none;width:100.0%;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.24%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eSearch-related information for the librarian or information specialist\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.82%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:33.46%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eThe summative metrics of effective searching\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.48%;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.24%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNo. of database searched =\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.82%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:33.46%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eOverall sensitivity =\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.48%;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.24%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eSum of yields =\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.82%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:33.46%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eOverall precision =\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.48%;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.24%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNo. of refs that underwent Title \u0026amp; Abstract screening \u0026nbsp;=\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.82%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:33.46%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNNR =\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.48%;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.24%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNo. of refs that underwent Full-text (FT) screening =\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.82%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:33.46%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNNR FT =\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.48%;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.24%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNo. of included refs from database searching =\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.82%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:33.46%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNNS =\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:6.48%;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.24%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eTotal no. of included refs =\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:14.82%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:33.46%;background:white;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:6.48%;padding:0in 5.4pt 0in 5.4pt;height:15.75pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable style=\"border: none;width:100.0%;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.28%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eCodes\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:34.46%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eSupplementary search codes\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.26%;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eFormat codes\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:45.28%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ex = found from the search\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:34.46%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003efcs = forwards citation search\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.26%;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ejnl = journal article\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.28%;padding: 0in 5.4pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ey = in database; found when search strategy re-run\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:34.46%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ebcs = backwards citation search\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.26%;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eths = PhD thesis\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.28%;padding: 0in 5.4pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003en = not in the database\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:34.46%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ehs = hand search\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.26%;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.28%;padding: 0in 5.4pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ez = in the database; not found using the search strategy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:34.46%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003ewss = web site search\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.26%;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eOther codes\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.28%;padding: 0in 5.4pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:red;'\u003e(red) =\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003edatabases where searches re-run\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:34.46%;padding:0in 5.4pt 0in 5.4pt;height:15.0pt;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eorg = from contacting organisations\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.26%;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eFT = full text\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;padding: 0in 5.4pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNNR = number needed to read. 1/overall precision\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;padding: 0in 5.4pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNNR FT = number needed to read at FT to find one included reference\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;padding: 0in 5.4pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Calibri\",sans-serif;color:black;'\u003eNNS = number needed to screen to find one reference to include for FT screening\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp width=\"33.673469387755105%\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e: Eligibility criteria according to the PICOd-T (Study Design - Time) nomenclature framework\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003eCriteria\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003e\u003cstrong\u003eInclusions\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\u003cstrong\u003eExclusions\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003eStudies conducted in any part of the world with human participants, Healthcare Professions Undergraduate students/ or graduate-entry programmes students and/or academic staff teaching across health profession, both full-time and part-time students within the clinical, medical, research and/ or educational setting, irrespective of study setting, will be eligible for inclusion.\u003cbr\u003eReported study participants will be included irrespective of gender, ethnicity, culture, race, and comorbidities background.\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003eResearch studies involving non-human participants as participants, Non-HCPs Undergraduate students.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003eIntervention (or Exposure)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003eStudies with human participants (health professional students) exposed to formal palliative and End-of-Life (EOL) care teaching/ or curriculum content and describe teaching methods, approaches/ or practices employed with a focus on achieving stated learning outcomes/ objectives and associated curriculum evaluation included.\u003cbr\u003eStudies will be included either reporting on intervention pedagogies in teaching palliative and end-of-life (EOL) care.\u003cbr\u003eFor example: Focused on Reflection, Experiential Learning, Role-modelling, Dialectic Methods, and Didactic Methods\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003eStudies that focused on ad-hoc palliative/ or EOL care learning experiences (e.g., a once-off visit to an EOL unit), rather than integrated course content\u003cbr\u003eStudies which do not adequately describe the intervention will be excluded.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003eComparator\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003eStudies reporting on outcomes of interests, interventions support with no support/ or standard teaching (approaches/ practices) will represent the comparator. Comparisons of the various approaches/ practices\u003cbr\u003eFor example: modalities, processes, objectives, motivations, challenges, facilitating characteristics/ resources in the teaching, education/ or training competencies in palliative and end-of-life (EOL) care)\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003eStudies reporting on any outcome related to the effectiveness of teaching strategies (e.g., structured interviews with students, student satisfaction surveys, tests and exams, content analysis, peer observation feedback or specific outcome measures) in palliative and end-of-life (EOL) care)\u003cbr\u003eFor example impact of teaching palliative and end-of-life (EOL) care on the host organisation, assessors, and assessees (Healthcare Professionals Undergraduate students), any assessment or programme evaluation of the \u0026ldquo;impact\u0026rdquo;; \u0026ldquo;outcome*\u0026rdquo;; \u0026ldquo;benefit\u0026rdquo;; AND the achievement of \u0026ldquo;attributes\u0026rdquo;; \u0026ldquo;skill*\u0026rdquo;; \u0026ldquo;knowledge\u0026rdquo;; \u0026ldquo;behaviour\u0026rdquo;; \u0026ldquo;personal growth\u0026rdquo; or \u0026ldquo;reflect*\u0026rdquo;; \u0026ldquo;transformation.\u0026rdquo;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003eResearch studies reporting on other outcomes, not in line with the outcomes of interest.\u003cbr\u003eStudies that did not report clear outcomes\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003eOnly original, primary studies of both quantitative and/ or qualitative study designs that are peer-reviewed and published in English, irrespective of publication year, will be eligible for inclusion\u003cbr\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003eReviews studies (\u003cem\u003eHowever, reference lists of relevant reviews will be checked for primary studies\u003c/em\u003e)\u003cbr\u003eAuthors of studies published only as abstracts will be contacted and asked to provide further detail. If no further detail is available, the study will be excluded.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003eFrom inception \u0026ndash; up to April 2023\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\u003cstrong\u003eLanguage\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003eStudies written in English will be included to avoid loss or distortion by translation from studies written in another language.\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003eNon-English language quantitative and qualitative studies will be translated.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\u003cstrong\u003eNote:\u003c/strong\u003e Initial exclusion criteria were studies published in languages other than English and did not have the search keywords in the title or abstract. The inclusion/ exclusion criteria will be tested through piloting by two reviewers to establish agreement prior to commencing the study selection process.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Palliative Care, End-Of-Life Care, Terminal Care, Education, Primary Health Care, Training, Healthcare Professionals","lastPublishedDoi":"10.21203/rs.3.rs-4313706/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4313706/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical Practice Guidelines recommend interprofessional collaboration in palliative care. However, healthcare profession educators lack clear curricular guidance, particularly for undergraduate programs, to adequately train future professionals for effective participation in such teams.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic scoping review protocol aims to address this gap by: (i) mapping evidence on key characteristics of teaching palliative and end-of-life (EOL) care to undergraduate healthcare and social care students, and (ii) identifying the nature and effectiveness of educational interventions for improving palliative care education in the undergraduate curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and Expected Outputs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol Extension for Scoping Reviews (PRISMA-P-ScR) guidelines, while the proposed systematic scoping review study will be conducted based on methods and steps identified by Arksey and O’Malley and experts in the field. We will conduct systematic searches across five EBSCOhost databases using relevant search terms. Additionally, a limited grey literature search will be conducted on the first 100 results of Google Scholar and Open-Grey. The selection process will follow PRISMA-Extension for Scoping Reviews. Two independent reviewers will screen titles and abstracts for eligibility. Data extraction will be done on standardized forms in duplicate with cross-checking by a third reviewer. Braun and Clarke's thematic analysis approach, combining thematic and directed content analysis, will be employed for analysis. Intervention effectiveness will be narratively summarized based on the TIDieR checklist. Meta-analysis will be considered if applicable and data is homogeneous.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePalliative care education (PCE) is a crucial element of undergraduate health professions education. This study's findings may aid educators in fostering optimal learning among healthcare students, who can then positively influence community health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics and dissemination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol was submitted for ethical clearance to the University of KwaZulu-Natal's Biomedical Research Ethics Committee and granted exemption from ethics review (00024289). We will disseminate findings through scientific journal publication and by sharing a summary with relevant institutions and attendees at health promotion and interprofessional education conferences.\u003c/p\u003e\n\u003cp\u003eProtocol registration number: CRD42023481892\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ehttps://www.crd.york.ac.uk/prospero/export_details_pdf.php\u003c/p\u003e","manuscriptTitle":"Mapping Evidence in Teaching Palliative Care in Undergraduate Curriculum of Healthcare Professionals Qualification: A Systematic Scoping Review Protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 06:35:18","doi":"10.21203/rs.3.rs-4313706/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f58d1d5f-90d3-4932-85cd-2c2fa8327182","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-16T22:34:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-03 06:35:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4313706","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4313706","identity":"rs-4313706","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}