Development and quality appraisal of entrustable professional activities for anticancer therapy nursing: groundwork for competency-based oncology education

BACKGROUND: The growing global cancer burden has intensified the need for nurses who can safely deliver complex systemic anticancer therapies. Competency-based education offers a structured way to define measurable learning outcomes, and entrustable professional activities (EPAs) translate these competencies into observable, assessable clinical tasks. However, oncology-specific EPA frameworks remain limited, particularly for systemic anticancer therapy nursing. This study aimed to develop a set of oncology-specific EPAs for systemic anticancer therapy (SACT) nursing and to evaluate their structural quality through expert consensus and structured quality appraisal, providing groundwork for competency-based oncology education. METHODS: This multi-phase methodological study was guided by a published 12-step EPA development framework, focusing on the development and pre-implementation phases (preparation, drafting, and quality appraisal). Core systemic anticancer therapy nursing tasks were employed to define the scope of EPA development and quality appraisal of EPA specifications. Draft EPAs were generated using a nominal group process and refined through a modified Delphi survey involving 22 participants. Structural quality was evaluated by a separate panel of six oncology experts using the Traditional Chinese version of the Entrustable Professional Activity Quality (EQual) rubric across three domains. EPAs that did not meet prespecified thresholds underwent iterative revision and re-appraisal. RESULTS: Consensus procedures produced seven EPAs for systemic anticancer therapy nursing. Initial EQual appraisal identified weaknesses primarily in the "discrete units of work" domain, particularly for a broad EPA on anticancer drug administration. In response, this EPA was decomposed into three phase-specific activities to enhance observability and assessment fidelity. After revision, all seven EPAs met or exceeded overall and domain-level EQual criteria. CONCLUSIONS: Integrating consensus-based development with structured quality appraisal yielded oncology-specific EPAs that are clinically relevant, structurally robust, and ready for piloting in clinical education and practice. The methodological contribution is the integration of consensus-based development with EQual-guided iterative refinement, including a rubric-anchored example of EPA decomposition. These EPAs provide a foundation for pilot implementation in competency-based SACT nursing education. Whether they ultimately support role clarity, feedback specificity, entrustment decisions, and patient-centred care will require future empirical study.