Introduction
Non-communicable diseases (NCDs) are now responsible for most global deaths, and malignancy forms the most leading factor for death and the single most significant obstacle to rising life expectancy in any 21st century country in the world. Nearly 9.6 million deaths occurred in 2018 due to malignancy. Worldwide, cancer is responsible for around 1 in 6 deaths (WHO 2018).1
AK Gandhi et al. (2016) evaluated India as having a quickly expanding malignant growth analyzed populace. The frequency of malignant growth is relied upon to reach up to 1.75 million cases by 2020, from 1.45 million cases in 2016. With the restriction of care administrations, focusing on preventable malignant growth cases is powerful to handle the expanding weight of disease.2 Almost 70 percent of Indian diseases (40 percent related to tobacco, 20 percent related to contamination, and 10 percent related to others) are brought about by chance factors that might be modifiable and preventable. The analyst is breaking down these factors with a unique spotlight on the Indian situation. The discoveries that guide in the structure of more extensive application preventive methodologies.3
Intravenous (IV) intravenous administration is the most widely used method for the treatment of medicines for parenteral cancer. Intravenous administration has a more rapid onset of intervention than intramuscular management. Larger amounts of fluids compared with intramuscular or subcutaneous administration are handled with intravenous administration. Vesicant or irritant medications which can cause tissue damage may be administered intramuscularly or subcutaneously intravenously. Cancer medications for intravenous administration should be prepared for IV push injection in Syringes.4
Need of the Study
The United States populace is relied upon to ascend from 305 million of every 2010 to 365 million out of 2030. The full continuum of malignant growth conclusion p.a. Can ascend from 1.6 million out of 2030 to 2.3 million. 1/70th of diseases are analyzed among the more established ones by 2030. Since the frequency of malignant growth rises exponentially with more seasoned patients, it is anticipated that there will be an ascent in more established disease patients that will challenge expanding social insurance office and human services experts.5
The examiner in this way went over a huge number of studies that anticipated the propelling issues related with parenteral chemotherapy in an extensive survey of the writing. Human services experts need better control of the issue. Thusly, through clinical experience, the analyst felt the requirement for a methodical answer for get the issue at the grass root level instead of looking for helpful systems for the patients until they showed up with the complaints related with post-impact chemotherapy. The analyst in this manner intended to enable the patients to control the post-impact of chemotherapy toward the beginning of chemotherapy to decrease the occurrence and force of post-impacts of chemotherapy.6
Statement of the Problem
A study to evaluate the effectiveness of structured interventional programme on knowledge regarding post effect of parenteral chemotherapy and its management among patients admitted in oncology units of selected hospitals of Madhya Pradesh.
Objectives of the Study
To evaluate the knowledge regarding post effect of parenteral chemotherapy and its management among patients admitted in oncology units.
To compare the knowledge regarding post effect of parenteral chemotherapy and its management before and after the administration of structured interventional programme among patients admitted in oncology units.
To evaluate the effectiveness of structured interventional programme on knowledge regarding post effect of parenteral chemotherapy and its management among patients admitted in oncology units.
To find an association of the pre-test knowledge score of patients admitted in oncology units with their selected demographic variables.
Hypotheses
H1: There will be significant difference between mean pre-test and post-test knowledge score regarding post effect of parenteral chemotherapy and its management among patients admitted in oncology units at P< 0.05 level.
H2: There will be a significant association of the pre- test knowledge score of patients admitted in oncology units with their selected demographic variables at P< 0.05 level.
Setting of the study
The study was conducted in oncology unit of S.G.P.T. government cancer hospital, Indore which is 65 bedded hospital with chemotherapy and radiation facility. Government cancer hospital was established in 1969. Total patients admitted in hospital for chemotherapy were 2554 patients.
Population
In present study, target population consisted of patients admitted in oncology units for receiving chemotherapy of Madhya Pradesh.
In present study accessible population consisted of patients admitted in oncology units for receiving chemotherapy at S.G.P.T. cancer hospital, Indore.
Sample & sample size
In this study, the sample comprised of total 300 patients who were admitted in oncology units for receiving chemotherapy.
Sampling technique
In this study Non- probability convenient sampling technique was used to select the sample from the population. During selection eligibility, feasibility, convenience and willingness of sample were considered by the researcher.
Variables
Independent variable
The structured interventional programme on Knowledge regarding post effect of chemotherapy and its management is the independent variable in this study.
Dependent variable
Knowledge of patients admitted in oncology unit is the dependent variable in the present study.
Extraneous variables
In the present study age, gender, marital status, educational status, occupation area, residence, history of cancer in family, history of recurrent infections, habits, number of chemotherapy cycle receiving, body system affected with cancer and previous information about parenteral chemotherapy post effect and its management.
Development and description of tool
Data collection tools are the procedure and instruments used by the researcher to observe or measure the key variables in the research problem.
The study aimed to evaluate the effectiveness of structured interventional programme on knowledge regarding post effect of parenteral chemotherapy and its management among patients admitted in oncology units.
According to the objectives of the study, the following tools were developed to collect the data:
Description of tool
The tool consisted of two sections:
Section A: Demographic variables i.e. age, gender, marital status, educational status, occupation area, residence, history of cancer in family, history of recurrent infections, habits, number of chemotherapy cycle receiving, body system affected with cancer and Previous information about parenteral chemotherapy post effect and its management.
Section B: It consisted of 36 multiple choice questions about parenteral chemotherapy post effect and its management. Multiple choice questions were categorized in five parts:
Part I-A: Questions regarding knowledge on oncology.
Part-B: Questions regarding knowledge on parenteral chemotherapy.
Part-C: Questions regarding knowledge on observations before and during parenteral chemotherapy.
Part-D: Questions regarding knowledge on post effect of parenteral chemotherapy.
Part-E: Questions regarding knowledge on management of post effect of parenteral chemotherapy.
Scoring: (Total score - 36)
Inadequate- Less than 40% (0-14)
Moderate- 41% - 70% (15-25)
Adequate- 70% - 100% (26-36)
Reliability of the tool
The knowledge tool consisted of 36 items. Reliability of the knowledge tool was assessed using split half method. All the odd items totals were calculated and all the even items totals were calculated. Pearson coefficient of correlation was applied between these two totals. The r value obtained was 0.81. As we had used split half method, Spearman Brown correlation was applied. The reliability of the knowledge tool was obtained 0.89. Thus, our tool is highly reliable in reproducibility.
Pilot study
The investigator obtained formal permission from administrator of Index Medical Hospital and Research Centre. The purpose of this study and confidentiality was explained to patients. The investigator selected 30 patients as per the inclusion criteria for the pilot study. They were selected by convenient sampling technique. Group was assessed for the knowledge of post effects of parenteral chemotherapy and its management. The structured interventional programme was implemented and post-test was done on the same.
The analysis revealed that the overall pre-test mean was 9.77 and post-test mean was 22.73. The t value was found to be 12.79 which was statistically significant.
Table 1
Comparison of mean pre-test and post-test knowledge score
|
Group |
No. |
Knowledge Score [Mean ± SD] |
‘t’ value |
P value |
|
Pretest |
30 |
9.77± 3.76 |
12.79, df=29 |
P<0.05 |
|
Posttest |
30 |
22.73± 6.07 |
The participants showed positive response towards the intervention and the pilot study helped the investigator to make modifications in the tool to precede it for the main study. In the knowledge questionnaire the number of items was reduced to 36 from 40 as the questions were difficult to answer for the participants.
Pilot study aided the investigator to check the feasibility of conducting the main study, to determine the method of statistical analysis and to assess the time required for data collection.
Result
Section I: Description of demographic variables of patients admitted in oncology units
Table 2
Distribution of patients according to demographic variables (N=300)
Table 2 shows the distribution of patients according to demographic variables.
150 (50.0%) patients were in the age group 21-30 years, 19 (6.3%) patients were in the age group 31-40 years, 99 (33.0%) patients were in the age group 41-50 years and 32 (10.7%) patients were in the age group 51 years and above.
116 (38.7%) patients were males and 184 (61.3%) patients were females, showing a female preponderance in the study.
257 (85.7%) patients were married, 18 (6.0%) patients were unmarried and 25 (8.3%) patients were single. Majority of the patients were married.
81 (27.0%) patients had done their primary education, 151 (50.3%) patients had done their secondary education, 37 (12.3%) patients had done their higher secondary education, 23 (7.7%) patients were graduate and above and 8 (2.7%) patients had don their professional education.
37 (12.3%) patients were related to fibers, 124 (41.4%) patients were related to heat, 40 (13.3%) patients were related to radiation and 99 (33.0%) patients were related to none. Majority of the patients were related to heat.
152 (50.7%) patients were from rural areas and 148 (49.3%) patients were from urban areas. Majority of the patients were from rural areas.
111 (37.0%) patients were having a history of cancer in family and 189 (63.0%) patients did not had any history of cancer in family. Majority of the patients did not have any history of cancer in their family.
244 (81.3%) patients were having history of recurrent infections and 56 (18.7%) patients were having no history of recurrent infections. Majority of the patients were having history of recurrent infections.
54 (18.0%) patients had habit of smoking, 56 (18.7%) patients had habit of alcoholism, 39 (13.0%) patients had habit of tobacco chewing and 151 (50.3%) patients did not had any habit.
111 (37.0%) patients had received chemotherapy cycle I, 41 (13.7%) patients had received chemotherapy cycle II and 148 (49.3%) patients had received chemotherapy cycle III.
147 (49.0%) patients had cancer of the head and neck; 35 (11.7%) patients had cancer of cardiothoracic; 29 (9.7%) patients had cancer of GI system; 55 (18.3%) patients had cancer of genitourinary system and 34 (11.3%) patients had cancer of other body system. Majority of the patients had cancer of the head and neck.
130 (43.3%) patients had previous information about parenteral chemotherapy and its management; while 170 (56.7%) patients did not had any such information. Majority of the patients did not have any previous information about parental chemotherapy and its management.
Section II: Effectiveness of structured interventional programme on knowledge regarding post effect of parenteral chemotherapy and its management among patients admitted in oncology units.
Table 3
Comparison of pretest and posttest knowledge score
|
S. No. |
Knowledge Score |
Pretest |
Posttest |
||
|
No. |
% |
No. |
% |
||
|
1. |
Inadequate (0-14) |
195 |
65.0 |
50 |
16.7 |
|
2. |
Moderate (15-25) |
91 |
30.3 |
58 |
19.3 |
|
3. |
Adequate (26-36) |
14 |
4.7 |
192 |
64.0 |
|
|
Total |
300 |
100.0 |
300 |
100.0 |
Table 3 shows the comparison of pretest and posttest knowledge score.
The knowledge questionnaire consisted of 36 multiple choice questions with only 1 option correct. For every correct answer 1 mark was given and for every wrong answer 0 mark was given. These marks were further graded as Inadequate knowledge (0-14 marks); Moderate Knowledge (15-25 marks) and Adequate Knowledge (26-36 marks).
In the pretest, 195 (65.0%) patients had obtained inadequate knowledge score, 91 (30.3%) patients had obtained moderate knowledge score and 14 (4.7%) patients had obtained adequate knowledge score.
Then an intervention in the form of structured interventional programme was given to these patients and again the same set of knowledge questionnaire was readministered and evaluated.
In the posttest, 50 (16.7%) patients had obtained inadequate knowledge score, 58 (19.3%) patients had obtained moderate knowledge score and 192 (64.0%) patients had obtained adequate knowledge score.
Thus, the structured interventional programme was very helpful in improving the knowledge score of the patients.
Table 4
Comparison of mean pretest and posttest knowledge score according to domains
Table 4 shows the comparison of pretest and posttest knowledge score in relation to various domains.
Knowledge on oncology: The mean pretest knowledge score was 1.25 ± 0.74, while the posttest knowledge score was 2.11 ± 0.98. The difference was found to be statistically significant (p<0.05), showing a significantly higher posttest knowledge in comparison to the pretest knowledge score.
Knowledge on parenteral chemotherapy: The mean pretest knowledge score was 1.48 ± 0.81, while the posttest knowledge score was 2.18 ± 0.73. The difference was found to be statistically significant (p<0.05), showing a significantly higher posttest knowledge in comparison to the pretest knowledge score.
Knowledge on observations before and during parenteral chemotherapy: The mean pretest knowledge score was 1.66 ± 0.54, while the posttest knowledge score was 2.47 ± 0.73. The difference was found to be statistically significant (p<0.05), showing a significantly higher posttest knowledge in comparison to the pretest knowledge score.
Knowledge on post effect of parenteral chemotherapy: The mean pretest knowledge score was 4.66 ± 2.31, while the posttest knowledge score was 7.89 ± 2.80. The difference was found to be statistically significant (p<0.05), showing a significantly higher posttest knowledge in comparison to the pretest knowledge score.
Knowledge on management of post effect of parenteral chemotherapy: The mean pretest knowledge score was 5.52 ± 3.36, while the posttest knowledge score was 9.79 ± 3.25. The difference was found to be statistically significant (p<0.05), showing a significantly higher posttest knowledge in comparison to the pretest knowledge score.
Overall: The mean pretest knowledge score was 14.74 ± 6.03, while the posttest knowledge score was 24.69 ± 7.12. The difference was found to be statistically significant (p<0.05), showing a significantly higher posttest knowledge in comparison to the pretest knowledge score.
Thus, the intervention was helpful in improving the knowledge score of the patients.
Table 5
Comparison of mean pretest and posttest knowledge score
|
Group |
No. |
Knowledge Score [Mean ± SD] |
‘t’ value |
P value |
|
Pretest |
300 |
14.74 ± 6.03 |
33.063, df=299 |
P<0.05 |
|
Posttest |
300 |
24.69 ± 7.12 |
The Table 5 shows the comparison of pretest and posttest knowledge score.
The mean pretest knowledge score was 14.74 ± 6.03, while the posttest knowledge score was 24.69 ± 7.12. The difference was found to be statistically significant (p<0.05), showing a significantly higher posttest knowledge in comparison to the pretest knowledge score.
Thus, the intervention was helpful in improving the knowledge score of the patients.
Section III: Association between the pre-test knowledge score of patients admitted in oncology units and their selected demographic variables
Table 6
Association between age with pretest score (N=300)
Conclusion
The study concluded that the Structured Interventional Programme has been successful in enhancing patient awareness on post effect of parenteral chemotherapy and its management. The study suggested that community health nurses, nurse practitioners, nurse administrators, nurse educators and health care providers use the structured interventional programme to increase awareness of patients receiving chemotherapy for cancer.
Acknowldgement
I would like to express my sincere gratitude to my sister Mrs. Pratika Thakur, mother Mrs. Shanta Thakur and father Mr. Vikram Singh Thakur for their encouragement, prayers and moral support. Special thanks to my in-laws Mr. Vikram Singh Thakur and Mrs. Kavita Thakur for their support and prayers for pursuing Ph.D.
I extend my sincere gratitude to my soul mate Mr. Dharmendra Thakur and my Loving child Akshat Thakur for being the backbone of my happiness. They bravely faced the hurdles of solitude in my absence. His compassion and love made me complete this thesis successfully.
