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NURSES’ KNOWLEDGE AND PRACTICE OF PALLIATIVE CARE AND ASSOCIATED FACTORS FOR MANAGEMENT OF CANCER PATIENTS
Background to the Study
Cancer is a global health problem. It is a leading cause of death and a major burden of disease worldwide (Cancer fact sheet 2014). Each year, tens of millions of people are diagnosed of cancer around the world, and more than half of the patients eventually die from it (Yale, 2006). According to Ahmedin, Melissa & Desantis (2010), cancer has an estimated worldwide incidence of 10million new cases per year, 46% of which are in developed countries. According to World Cancer Research Fund International (2013) there are an estimated 14.1 million cancer cases around the world in 2012, of these 7.4 million cases were men and 6.7 million women. This number is expected to increase to 24 million by 2035.
Cancer has been identified as a leading cause of death in economically developed Countries and the second leading cause of death in developing countries (American Cancer Society, 2011). As elderly people are most susceptible to cancer, and population of aging continues to grow in many countries, cancer will remain a major health problem around the globe (Xiaomei, & Herbert, 2007). The disease burden of cancer is partly carried more by countries that lack the resources for cancer awareness and prevention, early detection, treatment or palliative options to relieve pain and human suffering (Jeffrey, 2008)
Palliative Care (PC) a specialized type of care emerged as a response to the unmet needs of patients with life threatening illnesses such as cancer. Palliative Care as described by the World Health Organization (WHO, 2009) is “an approach that improves the quality of life of patients and their families facing the problem associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”. Palliative care is a specialized type of health care that focuses on providing relief whatever the prognosis. Palliative care is caring for those who are seriously sick with advanced sickness and is all about patient first. It is inclusive of immediate family members. Palliative care is a continuous care that addresses the totality of the physical, emotional, spiritual and social needs of the patient. As stated in Cancer Fact Sheet (2014), relief from physical, psychological and spiritual problems can be achieved in 90% of advanced cancer patients through palliative care; it is a humanitarian need for people with cancer and other chronic fatal diseases worldwide. PC is a whole person care provided by interdisciplinary team of physicians, nurses, social workers, chaplains and other health professionals.
Palliative care is now being offered to many patients with chronic illness but the majority of patients treated in palliative care programme are still cancer patient (Morrow, 2010). The benefits of PC for cancer patients is significant, they have the greatest need of the special care because they are often in pain and emotionally affected by fear, depression, anxiety and discomfort(Morrow, 2010). There has been a great need for improved palliative care for cancer patients. Expert palliative care often times helps patients tolerate cancer treatment for longer periods of time with less discomfort.
As stated by American Society of Clinical Oncology (2005), palliative care builds on the model of holistic medicine. It addresses all the palliative component of illness and is also concerned with providing support for the patient’s family, friends and caregivers. Palliative care can be given in varied settings such as hospital, cancer centre, nursing home, doctor’s office, patient’s home (American Society of Clinical Oncology, 2011).
Improving PC management in acute hospital settings has been identified as a priority internationally (Gott, 2013). During the past twenty years, the focus on patient’s quality of life increased greatly (Centre for Advance Palliative Care, 2013). There has been a great need for improved palliative care for cancer patients. According to Meier, (2013) as greater understanding of cancer and its treatment therapies (both conventional and nonconventional therapies) is made known, the need for a more specialized programme of nursing care (PC) arises. American Academy of Hospice and Palliative Medicine (2013) stated that there were 1,635 hospital palliative care teams in America as at April 2013. This equates to one specialist for every 20,000 older adults living with a severe chronic illness. In developing countries, the shortage of palliative care teams is greater. According to Meier (2013), Malaysia with a population of 25million people, has only 4 palliative care specialists in the whole country (as at March, 2012).This is like one palliative specialist to more than six million people (Meier, 2013). In Nigeria, available data indicate that “about 1.7 million Nigerians are at present in need of Palliative care” (Fagbemi, 2015).
Despite the fact that palliative care specialist are fewer, palliative care need grows. As stated by Onwumere (2013), the case of expanding PC is now clear with the escalating patient report. He further stated that PC should be integrated into the health care configuration. Smith (2013), opined that giving palliative care alongside usual care is now the accepted best practice. This he said helps patient live longer, probably live better, less distressed, less depressed; even the patients’ relatives tend to adjust better at the death of the patients. PC increases excellence of care in all non-communicable diseases, people die in peace with their dignity not debased. Considering the numerous benefits of PC, one can easily say that patients with chronic illness need nothing less than palliative care.
Onwumere (2013), stated that experts argue that health practitioners and patients have poor knowledge of palliative care; hence individualistic approach becomes fad to the management of terminal cancer patients. Poor knowledge can lead to poor perception as one cannot comprehend what one does not know. According to Prem, et al (2012),the overall level of knowledge of Palliative Care was poor. Nolton, Borbasi & Redden (2005), observed that nurses have difficulty in recognizing when the need for specialized palliative care arises and physicians are reluctant to negotiate palliative care. Nurses believed that PC was medicalized with treatment generally curative to the last breath (Nolton et al 2005). As observed by Fletcher and Panke (2011), the term palliative care was largely unknown by majority of the public and widely misunderstood by care providers. They also noted that physicians mainly equate PC with terminal phases of illness. Prem et al (2012) asserted that one of the important factors influencing a successful delivery of palliative health care is the health care professionals’ knowledge and experiences which determine their procedure and behaviour during treatment of patients. As knowledge influence practices and responses, there is then need to determine the nurses knowledge of palliative care which might determine their practice of it.
Statement of Problem
Cancer remains one of the leading causes of morbidity and mortality worldwide and much of its burden occurs in the developing world (Kanavos, 2006). The global cost and socio-economic impact cannot be overemphasized. Available statistics showed that cancer killed 7.6million persons in 2008 worldwide and there is indication that the figure could double to 13million by 2030 (WHO, 2013).As observed by Institute of Human Virology (2012), Nigeria has a substantial increase in the incidence of cancer. This increase necessitates palliative care by health personnel especially nurses to attend to the needs of these patients, yet data indicate that vast majority of world’s population does not have access to palliative care (WHO,2013). In many countries, PC is still unrecognized and there are insufficient resources for end of life care and for patients with life limiting conditions.
In some states of Nigeria, PC programme are evolving. For instance, University of Nigeria Teaching Hospital (UNTH) Enugu has incorporated Palliative Care as a component of care policies with their patients receiving specialized palliative care. This was observed by the researcher during her course of 6weeks clinical posting in the hospital. In addition to this, the PC association of Nigeria had organized two workshops known to the researcher in Enugu State of which she attended one in 2010.InAnambra State, Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi is regarded as the cancer centre of the state housing the cancer registry. Statistics from the registry showed that a large number of patients, 4350 in the year 2011 and 5002 in 2012 reported of cancer in the hospital and its environ. This indicated that cancer patients attend the hospital yet from the researcher’s observation those patients disease burden and pain control and other palliative care needs were unmet. The question now arises: Who renders PC to these patients? Are nurses in the hospital knowledgeable about PC, and how exactly do they practice PC? Berry (2013) stated that nurses play a crucial role among palliative care teams in addressing the physical, social and spiritual needs of these patients. In search of answers to the above questions, this study was justified.
Aim of the Study
The study investigated nurses’ knowledge, and practice of palliative care and associated factors for management of cancer patients in selected hospitals in Anambra State, Nigeria.
Specifically the Objectives of the Study were to
- Ascertain the nurses’ level of knowledge of PC for cancer patients in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi and Anambra State University Teaching Hospital (ASUTH), Amaku
- Determine whether or not nurses practice PC for cancer patients in NAUTH Nnewi and ASUTH Awka.
- Identify challenges facing PC practices in NAUTH and ASUTH.
- Identify factors that enhance knowledge, and practice of PC in the management of cancer patients.
- What level of knowledge do nurses hold of PC in cancer management?
- Do nurses in tertiary health institutions in Anambra State practice Palliative Care?
- What are the challenges hindering the practice of PC in NAUTH and ASUTH?
- What are the factors that enhance knowledge, and practice of palliative care in cancer management?
- There is no significant relationship between nurses’ level of knowledge of palliative care and their practice in cancer management.
- There is no association between nurses’ years of experience and their knowledge of PC.
- No significant difference exists in the palliative care practices among nurses with university degree and those with diploma in nursing.
- There is no significant relationship between nurses’ year of experience and their practice of PC.
- There is no significant difference between the level of knowledge and practices of PC among nurses in the two institutions.
Scope of the Study
This study will be delimited to professional nurses’ knowledge, and practice of palliative care in teaching hospitals in Anambra state. It will be focused on nurses working currently in the Paediatric, Medical, Surgical wards, Intensive care unit and clinics where cancer patients are cared for. The variables of interest were: the level of knowledge, practice and challenges of PC, years of experience, and qualifications of nurses.
Significance of the Study
This study will help to reveal areas of gap in the knowledge, and practice of palliative care, as well as identify factors that enhance knowledge and practice of PC. Findings of the study may be of immense benefit to the patients and their relations, health policy makers, nurses and other health personnel. The patients may stand to gain if policy makers buy the idea of the result and consider it in making decisions on PC. The guiding policies may motivate health workers’ interest to seek for knowledge, specialise in areas of pc with subsequent best practices. Patients who receive the best practices will inversely have improved quality of life. In addition, findings of the work will add to existing body of knowledge in the field of study. Other researchers who may wish to replicate this or similar topic in another locality will find the work useful.
Operational definition of Terms
- Knowledge of PC: knowledge of PC is the understanding one has of palliative care. One has adequate knowledge if one is able to answer correctly at least half of the questions on knowledge of palliative care (8 out of 16) in the study data collection tool.
- Practice of PC: It is the act of rendering s
- pecialized palliative care service to patients in need of it as measured by items 22 to 27 in the questionnaire.
- Palliative care: Is the care that focuses on providing the best quality of life for patients and their families facing life-threatening illnesses such as administering pain killer drugs to patients with advanced cancer “by clock” not on demand.
- Associated factors are the variable that can influence or interfere with the nurses’ knowledge, and practice of palliative care. Example is years of experience.