Posted on 24th Sep 2024 12:30:11 AM Medicine
Abstract
This study is carried out on the knowledge among the nurses about chemotherapy in Rajshahi Medical college Hospital oncology ward. About of 50 nurses who were interviewed to assess their knowledge about the chemotherapy and hospital management that admitted patients.
Nearly 8o% of the respondents were more than 32 years. The mean age of the respondents was 27 years and the range was 8 years. Majority of the respondents about 88% were female. And Majority of 86% of respondents were Muslim And remain 8% were Hindu and 6% were Christian. About 66% of the respondents have S. Sc. 2o% H. Sc. B. A. / B. Sc. 8%. The remaining 6% of the respondents were Masters or others degree. In this about 72% of respondent’s professional qualifications were diploma in midwifery and nursing, 20% of B. Sc. in public health, but remaining 08% were M. Ph. In this Medical College about 34% of respondent’s job experiences were 16-20 years, 50% were 2-15 years and the remaining 16s% were 21-25 years / more.
A direct questionnaire was taken to 50 nurses in the Hospital to assess their knowledge of chemotherapy. Response rate and Knowledge scores ranged from Yes / No and grading with complete knowledge, partial knowledge and one point given to wrong knowledge. Statistically significant factors that influencing knowledge score were related to the nursing profession, nursing qualification, current nursing post, current training and current workplace. According to the data collection among the total respondents about 70% knowledge yes and no answer about 30%. According to the grading of the knowledge about 35% of nurses knowledge was complete, 38% was partial, 19% was wrong answer, and 26% was do not know. Among that maximum nurses good knowledge in the oncology ward, surgery and medicine Ward. In the paediatric word, nephrology and neuro medicine and surgery nurses’ knowledge was average.
Review of Literature
Chemotherapy
Cytotoxic chemotherapy is the main systemic treatment currently used to treat cancer. It is a treatment, which can without exception, cause extreme harm to patients, staff and the environment if the drugs are not prescribed, handled and administered safely and correctly. It continues to be a rapidly expanding treatment modality for many malignant and some non-malignant diseases. Treatment regimes are also becoming increasingly complex. Nurses are undertaking this role not only in specialist cancer centers but also ingeneral hospital settings and the community. Furthermore, chemotherapy is now more likely to be administered on an outpatient basis; this trend will continue to rise over the coming years due to the significant increasing numbers of patients receiving chemotherapy and financial constraints (Taylor and Birch, 2004). In recent years, there has been a trend toward increasingly aggressive cancer care in the last weeks of life (Earle et al., 2008; Earle et al., 2004). Beginning a new chemotherapy regimen within 30 days of death or continuing existing chemotherapy1 treatment within 14 days of death has been identified as an indicator of aggressive cancer care (Earle et al., 2003).
Evidence of this trend is well documented. In a seminal study, Earle et al. (2004) reviewed data from the National Cancer Institute‘s Surveillance, Epidemiology, and End Results (SEER) registries along with Medicare claims of patients who died from solid tumor cancers (1993 through 1996). Findings revealed that among patients who received chemotherapy, a consistently increasing proportion received it very near death. In 1993, nearly 14% received chemotherapy within two weeks of dying; by 1996, that figure increased to 18.5%. The proportion of patients who received a new chemotherapy regimen within the last 30 days of life also increased (from 4.9% to 5.7%), but was not statistically significant. Additional studies report results consistent with Earle et al. (2004). A prospective study following 40 non-small cell lung cancer (NSCLC) patients found that 100% received chemotherapy at some point during the course of their illness. Forty percent of participants received chemotherapy in the last 30 days of life and 23% underwent chemotherapy in the two weeks prior to death (Temel et al., 2008). A retrospective study of multiple community oncology practices across the country found that more than 43% of NSCLC patients received chemotherapy within the last 30 days of life (Murillo and Koeller, 2006). Of those, 28% received second-line chemotherapy (chemotherapy administered after the first treatment has failed or stopped working), and 21% received third-line chemotherapy (chemotherapy administered after the first and second treatments have failed or stopped working). Twenty percent of patients in this study underwent chemotherapy within two weeks of death; 28% of those were second-line, and 18% were third-line. An Australian study found that among deceased cancer patients who had received chemotherapy at any time, 18% were treated within 30 days of death, and 8% within two weeks of death (Kao et al 2009).
The debate about palliative chemotherapy
Late chemotherapy is typically considered palliative, as it is not intended to cure the cancer, but rather to relieve cancer symptoms, extend survival, or enhance or maintain quality of life (Doyle et al., 2001; Emanuel et al., 2003). However, there is a growing debate in the oncology literature as to whether palliative chemotherapy is truly palliative. Some suggest better EOL care would include stopping chemotherapy sooner in favor of purely palliative care (Appleton and Corboy, 2005). Others suggest that chemotherapy is indeed palliative, and that advances in pharmaceutical research will continue to make chemotherapy increasingly palliative as it becomes less toxic and side effects decrease (Reisfield and Wilson, 2005).
Perhaps the concern among some oncologists about late chemotherapy can be explained in terms of a principal precept in medicine: first, do no harm. New therapies that palliate with less toxicity are increasingly available. However, even in newer and less toxic forms, chemotherapy is a powerful and expensive medicine that is not without side effects. Whereas the benefits of its use near death are undocumented (Braga et al., 2007; Markman, 2007) and alternative treatments are available2, some oncology health professionals question not only whether the trend toward late chemotherapy is palliative, but also whether it succeeds in ―doing no harm.
The decision to use chemotherapy treatments at EOL is complex. So, the mere increase in the use of chemotherapy near death must not be taken as an indicator of the 8 appropriateness or inappropriateness of that trend (Archer, et al, 1999; Markman, 2006). According to Markman (2006), such a determination requires data from randomized prospective Phase III trials. However, such data are unavailable, in part because patients near death are almost always too sick to be eligible for enrollment in a study.
In the absence of data collected from dying patients, questions are being raised about the justification for increasing use of late chemotherapy. For example: what criteria justify the use of these agents so close to death? Are patients and families missing opportunities to prepare for the inevitability of death and for comfort care at home? How often might late chemotherapy be administered simply because it is easier than having an honest and direct conversation about poor prognosis? What are the alternatives to late chemotherapy and how do they compare to chemotherapy use in terms of length and quality of life? In sum, is the use of late palliative chemotherapy justified when weighing the benefits (length of life, quality of life) and burdens (costs, side effects, and missed opportunities)?
Costs
Given that chemotherapy is among the most expensive medical treatments available (Schrag, 2004 Meropol and Schulman, 2007;), it is reasonable to weigh its value against its costs. In recent years, more than 90% of U.S. Food and Drug Administration approved cancer drugs cost in excess of $20,000 for a 12-week regimen (Fojo and Grady, 2009). The cost of Cetuximab, a common chemotherapy for colorectal cancer, exceeds $50,000 per week (Meropol and Schulman, 2007). Chemotherapy regimens such as Irinotecan or Oxaliplatin are estimated to cost $20,000-$30,000 for a six month regimen. Moreover, these drugs are not used infrequently. Indeed, drugs prescribed by oncologists account for approximately 44% of all Medicare drug spending (Report to Congress, 2003).
Increasingly, the value of these expensive drugs is coming under scrutiny, especially when used in the last weeks of life. The U.S. spends about twice as much on cancer therapies compared to other nations, although survival results across countries are similar (Meropol & Schulman, 2007). In a review of recently approved drugs and clinical trials for cancer care, it has been argued that the benefits of these therapies are marginal - typically measured in additional days or weeks - and do not outweigh the costs (both financial and in quality of life). Further, it was recommended that the routine practice of prescribing drugs with marginal benefits to advanced cancer patients be strongly discouraged, because their cost makes this practice unsustainable (Fojo & Grady, 2009).
Adverse effects and missed opportunities
Chemotherapy is powerful medicine that can generate adverse side effects and therefore impact quality of life. Chemotherapy can result in a wide range and number of toxicities such as pain, fatigue, insomnia, nausea, poor appetite, dry mouth, and constipation. It may also result in bleeding, hair loss, infection, cognitive changes, problems with sexual function and fertility, skin and nail changes, fluid retention, and damage to the central nervous system and heart. Each of these side effects has the potential to worsen quality of life. (NCI)
Nurses’ Attitudes towards Chemotherapy and Cancer
Psychologists argue that the attitudes we hold towards something will influence our behavior towards it (Miller, et al 2000). There appears to be little research undertaken to investigate nurses’ attitudes and beliefs regarding chemotherapy. There has been some work investigating nurses’ attitudes towards cancer as an illness. Corner (1988) critically reviewed research methods used to investigate nurses’ attitudes towards
cancer and found that ‘the research to date seems to reflect a consistent pattern of nurses’ and other health careers’ attitudes towards cancer which is largely negative and stereotyped, with cancer being seen as more devastating than other life threatening diseases’ From the findings of a further study undertaken by Corner and Wilson-Barnett (1992). Corner (1993) produced the Attitudes towards Cancer model to depict those factors, which were found to affect nurses’ attitudes, beliefs and feelings in relation to cancer. These included professional preparation for the role, culturally held beliefs and personal and professional experiences of cancer. Elkind (1982) surveyed 785 nurses to investigate what type of impression nurses may give the general public about cancer through their attitudes towards the disease, a number of nurses were found to hold very negative views of cancer. Elkind (1982) also found that while training and experience lead to a better understanding of the disease, the more experienced and knowledgeable nurses were likely to have doubts about the value of treatment for cancer. Only 21% of the nurses surveyed agreed with the statement ‘a patient with cancer can never be really cured’, whereas, 75% of the trained nurses surveyed agreed with the statement ‘treating cancer patients can do more harm than good’ (Elkind, 1982) Slevin et al. (1990) compared attitudes of medical oncologists, radiologists, oncology nurses, general practitioners, the general public and cancer patients, regarding the use of chemotherapy when the hypothetical probability of cure or benefit was varied. It was found that cancer patients were more likely to opt for aggressive treatment with a high degree of toxicity and minimal chance of benefit than any other group. At the same time, the radiologists and nurses were the least likely of all the groups to accept treatment. A later study undertaken in the United States by Damrosch et al. (1993) focused on comparing nurse and physician cancer specialists’ attitudes toward aggressive cancer treatments. They postulated that differences between nurses’ and physicians’ attitudes towards aggressive treatment were a source of conflict between the two and an important cause of stress for the nurse. This view was reflected in the study’s findings.
The evidence from the literature, therefore, suggests nurses have a generally negative attitude towards chemotherapy and this must be cause for concern. Nurses need to have a positive approach to treatment regimes to help patients effectively (Wherney-Tedder, 1997). However, all these studies identified above have not primarily investigated nurses’ feelings about administrating chemotherapy in any depth and are somewhat dated. Conversely findings from Verity’s (2002) study indicated that the participants tended to have a positive attitude towards chemotherapy. Verity (2002) concluded that this finding was due to the sample being a generally experienced and educated one, who could easily access expert support and who was working within a specialist centre for cancer. Once again it is difficult to generalize these findings.
The Role and Responsibilities of the Nurse
Where once chemotherapy administration was the domain of doctors it has been the nurse in the last two decades who is responsible for ensuring that patients receive their treatments safely. During this time there have been significant changes in the number of patients undergoing chemotherapy treatments and the way it is administered. Tanghe et al (1994) suggest that the nurse has three main roles in the chemotherapy administration process (to educate patients, administer and manage side effects). It is also identified that nurses must provide emotional support to patients and their relatives (Dennison, 1995; Wilkinson, 1991) and act as a facilitator of learning and a role model to less experienced staff (Verity and Bloomfield, 2005). Other nursing responsibilities include taking all necessary actions to ensure that the environment and the nurse themselves are safe, e.g. disposing of waste safely and wearing protective clothing. Nurses therefore have a legal and professional responsibility to feel competent in this role and follow all of the procedures laid down by the organisation within which they work, to ensure the safe handling, delivery and disposal of cytotoxic drugs (Allwood, et al, 2002) Developments in chemotherapy practice and increasing numbers of patients receiving chemotherapy in the UK will mean that many more nurses are needed in various clinical settings to undertake this role. Worryingly it has been reported that there is a national shortage of qualified nurses working in this area (Taylor and Birch, 2004). What is apparent is that oncology nurses are playing a pivotal role in the rapid developments occurring in
chemotherapy practice and as such the role is continually evolving. Hence we are also now seeing an increasing number of nurse-led chemotherapy clinics (Harrold, 2002 Fitzsimmons et al., 2005; Munro, 2005) and chemotherapy triage telephone services (Groves, 2005). Future developments for the nurses’ role have also emerged in the literature. Taylor and Birch (2004) describe the implementation of a new pilot role that of chemotherapy support worker (CSW), this initiative involved extending the role of the health care assistant (HCA). The HCA was provided with knowledge and skills to then support the nursing team but not actually administer chemotherapy in the chemotherapy setting. The educational support received appears comprehensive and was delivered over a four-day HCA ‘training in cancer care course’ and then a further ten specific study days to meet identified learning needs. Clinical skills, such as cannulation, flushing lines and disconnecting treatment, were taught in the clinical area and supported by an experienced practitioner acting as an enthusiastic mentor. Overall, this initiative was positively evaluated and the CSW was viewed as a valuable addition to the team, so much so that Taylor and Birch (2004) contend that this role in the future could be expanded to include administrating chemotherapy. With the advent NHS Knowledge and Skills Framework (Skills for Health, 2005), this is plausible. The role of the nurse in the chemotherapy process should be explored to ensure future developments, such as the CSW, role are properly developed and supported in other clinical settings.
CONTENTS
Abstract
Chapter-1. INTRODUCTION
1.1 General Introduction
1.2 The term chemotherapy
1.3 History of chemotherapy
1.4 Goal of chemotherapy
1.5 Types of chemotherapy
1.6 Advantage of chemotherapy
1.7 Adverse effect of chemotherapy
1.8 Safety precaution
1.9 Research question
1.10 Variable used in study
1.11 Objectives
Chapter-2. REVIEW OF LITERATURE
2.1 Chemotherapy
2.2 The debate about palliative chemotherapy
2.3 Nurses attitude toward chemotherapy cancer
2.4 The Role and Responsibility of the Nurses
Chapter-3. MATERIALS AND METHODS
3.1 The study design
3.2 Study place
3.3 Sample size
3.4 Research instrument
3.5 Translation of the Instrument
3.6 Data collection
Chapter-4. RESULTS
Chapter-5. DISCUSSION
Chapter-6. CONCLUSION
Chapter-7. REFERENCES
Chapter-8. APPENDICES
List of Tables
Table 1: Demographic information of the participated nurses in the Rajshahi Medical College Hospital
Table 2: Information regarding knowledge of the participated nurses regarding administration of chemotherapy
List of Figures
Figure 1: Religion Distribution of the participants (n=50)
Figure 2: Knowledge level of toxicities of anti cancer drug.
Figure 3: Total knowledge level of respondent.
Thesis, Assessment, Nurses, Knowledge, Regarding, Administration, Chemotherapy, Oncology, Ward, Rajshahi, Nursing, Medical, College, Hospital
Share on Facebook