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EFFECTIVENESS OF INFORMATION EDUCATION AND COMMUNICATION PACKAGE IN TERMS OF KNOWLEDGE AND KNOWLEDGE ON PRACTICE REGARDING MANAGEMENT

OF SELECTED SIDE EFFECTS OF CHEMOTHERAPY AMONG PATIENTS WITH CANCER UNDERGOING

CHEMOTHERAPY AT DR.G.V.N HOSPITAL, SINGARATHOPE, TRICHY.

By

MS. RUSHA. B Reg. No: 30106204

A DISSERTATION SUBMITTED TO

THE TAMILNADU DR. M. G. R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE

DEGREE OF MASTER OF SCIENCE IN NURSING (MEDICAL AND SURGICAL NURSING)

APRIL- 2012

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CERTIFICATE

Certified that this is the bonafied work of Ms.Rusha.B, Final year M.Sc(Nursing) student of Sara Nursing College, Tirrupur, Submitted in partial fulfillment of the requirement for the Degree of Master of Science in Nursing to The Tamil Nadu Dr. M.G.R. Medical University, Chennai, under the Registration No.

30106204.

College Seal:

Signature: ……….

PROF. M. KANDASAMY, M.Sc(N)., (Ph.D)., PRINCIPAL,

SARA NURSING COLLEGE, DHARAPURAM,

TIRUPPUR (DT).

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TABLE OF CONTENTS

CHAPTER CONTENT PAGE

NO

I INTRODUCTION

• Need for the study

• Statement of the problem

• Objectives

• Operational Definitions

• Assumptions

• Hypothesis

• Delimitations

• Conceptual framework

II REVIEW OF LITERATURE

• Literature related to Cancer

• Literature related to Chemotherapy and its side effects

• Literature related to Information ,Education and Communication package

III METHODOLOGY

• Research approach

• Research Design

• Variables

• Description of settings

• Population

• Sampling

• Description of the tools

• Validity and reliability

• Pilot study

• Method of data collection

• Plan for data analysis

IV ANALYSIS AND INTERPRETATION

V DISCUSSION VI SUMMARY, CONCLUSION, IMPLICATIONS

AND RECOMMENDATIONS BIBLIOGRAPHY

ANNEXURES

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LIST OF TABLES

TABLE

NO TITLE

PAGE NO 4.1 Distribution of subjects according to their demographic

variables in experimental and control group.

4.2 Effectiveness of Information, Education and Communication Package on level of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy.

4.3 Correlate the post test level of knowledge score and post test level of knowledge on practice score regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

4.4 Association between post test level of knowledge with selected demographic variables among patients with cancer undergoing chemotherapy in experimental group.

4.5 Association between post test level of knowledge on practice with selected demographic variables among patients with cancer undergoing chemotherapy in experimental group.

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LIST OF FIGURES

FIGURE

NO TITLE

PAGE NO 1.1 Conceptual framework.

4.1 Level of knowledge regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

4.2 Level of knowledge on practice regarding

management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

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LIST OF ANNEXURES

ANNEXURE TITLE

PAGE NO A Letter seeking permission to conduct a research study

B Tool for data collection

C Letter requesting opinion and suggestion of experts for content validity of the research tool

D Certificate of validation E List of experts

F Certificate for editing

G Information, Education and Communication package

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ABSTRACT

A Study to evaluate the effectiveness of Information, Education and Communication Package in terms of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy at Dr.G.V.N. Hospital, Singarathope, Trichy.

The study was conducted at Dr.G.V.N Hospital, Singarathope, Trichy. Quasi experimental research design was used for this study. Permission was obtained from the director of the hospital and data collection was done over a period of 4 weeks. The investigator had selected 70 (35 experimental, 35 control) subjects with cancer undergoing chemotherapy through convenience sampling technique. Oral consent was obtained. In pretest structured questionnaire was used for assessing the level of knowledge and checklist was used for assessing the level of knowledge on practice for both the groups. Then the Information, Education and Communication Package administered to the subjects of experimental group with lecture, video clipping, pamphlets and chart for 20 minutes. No intervention was given for control group.

Then the post test level of knowledge and knowledge on practice of the subjects was assessed after 15 days with the help of same questionnaire and checklist for knowledge and knowledge on practice for the both groups respectively. Descriptive and inferential statistics were used to analyse the findings of the study.

There was a significant difference found (P< 0.01) on knowledge and knowledge on practice between experimental and control group. The mean post test score of knowledge among experimental group was 19.8 (±2.46), whereas in control group it was 13.5 (±3.66).The mean post test score of knowledge on practice among experimental group was 12.4 (±1.40), whereas in control group it was 8.77 (±2.39).

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There was a positive correlation found between the post test level of knowledge and knowledge on practice in experimental group(r=0.8) and control group (r=0.7).There was a significant association (P<0.05) in the post test level of knowledge with selected demographic variables like food habits and post test level of knowledge on practice with selected demographic variables like locality and food habits in experimental group.

The findings of the study shows that Information, Education and Communication Package produce a significant increase in the level of knowledge and knowledge on practice of patients with cancer undergoing chemotherapy. The study helps the oncology nurse to gain more knowledge and knowledge on practice regarding management of selected side effects of chemotherapy.

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CHAPTER I INTRODUCTION

Cancer is a group of more than 200 diseases with symptoms of unrestrained growth cells in one of the body organs or tissues. Cancer is one of the second largest killer diseases next to heart diseases. The world wide incidence of cancer is estimated at seven million with an annual mortality of about five million it is projected that by the year 2015 two third cancer will occur in the developing world. Management of cancer consists of surgery, radiation and chemotherapy. Nurses spend more time with the patients than others members of the team; a nurse has a better opportunity to know that with his physical and emotional condition on a daily basis.(Alka saxena, 2010)

Cancer was recognized in ancient times by skilled observers who gave it its name from Latin ‘cancri’ meaning crab because it stretched out in many directions like the legs of a crab. The image of the crab suggested by Hippocrates for superficial cancer in the advanced stages gives it a meaning of incurability. (Hogan, 2009)

Cancer is a collective term describing a large group of diseases characterized by uncontrolled growth and spread of abnormal cells. The most common form of cancer is carcinoma, which originates in the skin or in the glandular tissue such as the breast or prostate gland. Another form of cancer, sarcoma, affects connective and supportive tissue such as bone, muscle, cartilage and fat. Melanomas are more serious, often, but not always, manifested as skin cancers. Lymphomas affect the lymphatic system throughout the body, while leukemia’s are cancers of the blood- forming organs. (Fazal, 2009)

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The diagnosis of cancer forces a person to rally physiologic and psychological energy to cope with this life threatening event. This places additional demands on establishing living patterns and suddenly changes the individual appraisal of and satisfaction with his or her current level of physical, emotional, and social functioning. In recent decades psychosocial factors have been added to known physical factors involved in the experience of cancer and quality of life. Quality of life is affected not only by the far reaching and lasting effects of cancer but also by the client variables of self esteem, learned resourcefulness and social support.

(Leli.w.pedro, 2009)

Chemotherapy drugs affect all cells-tumor cells as well as normal ones. The side effects experience are the result of the drugs affect on normal, actively dividing cells. The faster cells divide, the more sensitive they are to chemotherapy. Some other fastest dividing cells in our body or bone marrow, the cells that lining the stomach, mouth and intestine and hair cells. The goal of chemotherapy is to give enough drug to kill tumor cells without causing permanent damage to normal cells. The amount of chemotherapy that can safely be given to a patient is based on that drugs potential to damage normal tissue-drug toxicity. (Anderson,2011)

Chemotherapy is a common treatment for cancer, bone marrow diseases, and immune system disorders. It works by killing cells in the body that grow abnormally fast dividing cells, side effects are triggered in places where such cells are common.

Chemotherapy has many common side effects including hair loss, fatigue, nausea, vomiting, diarrhea, constipation, stomatitis, and loss of appetite. (Blake, 2010)

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Side effects of treatment cause inconvenience, discomfort, and occasionally even fatality to patients. This is extremely important to understand since the expected outcome from therapy is based on delivering treatment at the dose and schedule of the treatment plan. In others words, side effects not only cause discomfort and unpleasantness, but may also limit a patient’s ability to achieve the best outcome from treatment by preventing the delivery of therapy at its optimal dose and time. (Texas, 2011)

Education to patient is an important function of the nurse.Patient sought teaching from a variety of sources, that nurses and other patients were the most helpful source. Although most patients wanted as much information as possible, so they would be prepared for managing the side effects. Need based education of cancer patients regarding chemotherapy would enable to cope with the stressors related to chemotherapy and managing the side effects. (Takur binay, 2011)

Need for the study

“Cancer has become one of the 10 leading causes of death in India. It is estimated that there are nearly 1.5 to 2 million cancer cases at any given point of time.

Over seven lakh new cases of cancer and 3 lakh deaths occur annually due to cancer.

Nearly 15 lakh patients require facilities for diagnosis, treatment and follow up at a given time”. (Agarwalla, 2011)

Leading sites of cancer are oral cavity, lungs, oesophagus and stomach amongst men and cervix, breast and oral cavity amongst women, Nearly 2 lakh people suffer from cancer while 40,000 new cancer cases are being detected every year.

(National Cancer Registry Programme, 2011)

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1,4,37,000 new cases was diagnosed and more than 5,65,000 people will die of this disease. (WHO, 2010)

“About 14 crore men and 7 crore women above the age of 15 consume tobacco, a major reason behind causing cancer, in India. Approximately 55,000 children are taking to tobacco habit each day.” The proportion of men, who smoke, rises from 4 per cent at ages 15 to 19 years to 45 per cent at ages 40 to 59 years and 21 per cent of persons age 15 and above are reported to chew tobacco in any form, percentage of women chewing tobacco was more than that of their counterparts. (sha Ranjan Parija, 2011)

Reasons behind increase in number of cancer patients were growing ageing population and increase life expectancy. In cancer, patient need love and affection more than the medical treatment. ( Krupasindhu Panda, 2011)

The age old fear of cancer still persists indeed relatively the image of cancer has grown grim “The cold knife and the hot rays” really produce cures nearly a third of all patients with cancer are now being saved as judged by the fact that they are still alive For five years after diagnosis. (Morris fisherbein, 2005)

Patients receiving chemotherapy are at risk these patients are now more likely to encounter of developing with a number of informational issues. These patients are now more likely to encounter problems outside the hospital setting where there is limited opportunity for discussion with oncology specialists and nurses. Therefore, it is now vitally important that they receive the necessary preparatory information during their chemotherapy sessions (Guoping, 2005)

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The past decade has bought major advances in the medical management of cancer, significant toxicities often accompany the potential benefits of chemotherapy.

One of the most common toxicities associated with chemotherapy administration is the development of stomatitis. Stomatitis is estimated to occur in 40% all patients undergoing chemotherapy, and its incidence is two to three times higher in patients with hematologic management and those undergoing bone marrow transplant.

(Wojtaszek, 2004)

Diarrhea is a common side effects of chemotherapy. The incidence of all grades of diarrhea during chemotherapy has been reported to be high as 82% with up to one third of patients experiencing severe (grade 3 or 4) diarrhea. (Lisa Fayed, 2009)

Anemia is when red blood cell (RBC) production is low or destruction is high.

It is determined by the hemoglobin or haematocrit in a CBC. It has been reported that during chemotherapy 75% patients experiencing anemia. In that 31% patients receiving blood transfusion. (Patricia A. Demoor, 2007)

Hair loss affects many people undergoing cancer treatment. Depending on the chemotherapy drugs given, there may be a total loss of hair, thinning of hair or no loss at all. This is one of the most difficult side effects to deal with emotionally. (Texas, 2011)

Fatigue is better known as a side effect of radiation treatment, chemotherapy can also cause long-lasting fatigue. 40% of survivors were still experiencing fatigue and Constipation occurs in patients receiving chemotherapy.57% patients had acute constipation lasting for 2 or more weeks during chemotherapy. (Farzanna, 2011)

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The Investigator from her personal experience, during her clinical postings at oncology wards & outpatient departments identified many side effects leading to reduced self esteem, reduced concentration related to side effects of chemotherapy. Hence the investigator feels from her experience and review that there is a need to give Information, Education and Communication Package regarding Management of selected side effects of chemotherapy.

Statement of the problem

A Study to evaluate the effectiveness of Information, Education and Communication Package in terms of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy at Dr.G.V.N. Hospital, Singarathope, Trichy.

Objectives

• To assess the level of knowledge regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

• To assess the level of knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

• To evaluate the effectiveness of Information, Education and Communication Package in terms of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy.

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• To correlate the post test level of knowledge score with post test level of knowledge on practice score regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

• To find out the association between post test level of knowledge and selected demographic variables among patients with cancer undergoing chemotherapy in experimental group.

• To find out the association between post test level of knowledge on practice and selected demographic variables among patients with cancer undergoing chemotherapy in experimental group.

Hypothesis

H1: There will be a significant difference between the mean post test score of knowledge and knowledge on practice among the patients with cancer undergoing chemotherapy who receive Information, Education and Communication Package and who do not receive Information, Education and Communication Package at P<0.05 level of significance.

H2: There will be a significant relationship between post test level of knowledge and post test level of knowledge on practice among patients with cancer undergoing chemotherapy in experimental and control group.

H3: There will be a significant association between post test level of knowledge and selected demographic variables among patients with cancer undergoing chemotherapy in experimental group at P <0.05 level of significance.

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H4: There will be a significant association between post test level of knowledge on practice and selected demographic variables among patients with cancer undergoing chemotherapy in experimental group at P <0.05 level of significance.

Operational definitions Effectiveness

It refers to the statistical significant change in knowledge and knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer who undergoing chemotherapy after the administration of Information, Education and Communication Package.

Knowledge

It refers to the respondents response to the question regarding management of selected side effects of chemotherapy as measured by structured questionnaire.

Knowledge on Practice

It is the level of performance expressed by the patients with cancer undergoing chemotherapy regarding management of selected side effects of chemotherapy as evaluated by check list.

Selected side effects of chemotherapy

In this study it includes nausea, vomiting, fatigue, hair loss, infection, oral ulcer, diarrhea, anemia, nerve and muscle problem and constipation.

Patients with cancer

It refers to the individuals aged above 21years who are diagnosed to have cancer irrespective of site and sex.

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Information, Education and Communication

It consists of teaching by lecture, video clipping, pamphlets and chart regarding management of selected side effects of chemotherapy.

ASSUMPTIONS

• Information, Education and Communication package is an economical and efficient way of meeting the learning needs of most of the patients with cancer undergoing chemotherapy.

• Patients with cancer undergoing chemotherapy may have poor knowledge regarding management of selected side effects of chemotherapy.

DELIMITATIONS

• The study was conducted only among participants from Dr.G.V.N.Hospital, Singarathope, Trichy.

• The investigator did not have a control on teaching given by nurses, doctors and other personnel of the health team.

• The data collection period was limited to 4 weeks.

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Conceptual Framework

A conceptual framework or model refers to concepts that structure or offers a frame work of preposition for conducting research. The conceptual framework comprises of interrelated concepts linked together, which explain the phenomenon of interest of the investigator, this explains the nature of relationship between the concepts and guides the investigator to propose the study and work on it systematically.

The investigator adopted Kurt Lewin’s theory which is primarily focusing on change in the behavior. This change in man occurs in stages. This theorist explains that the change occurs in three sequential steps.

The investigator assumes the restraining factors are psychological problems, family problems, poor socio economic status, values and beliefs and negative attitude.

The enhancing factors are family support, availability of primary health services , availability of nursing care, guidance and counseling services.

• Unfreezing

• Changing

• Refreezing

Unfreezing

When desire for change develops the people are motivated to change either internally or by some external force, which causes disequilibrium in the system, so the system is more vulnerable to change. Here in the present study investigator as a change agent who is an external force assess the existing level of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy in order to motivate them.

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Changing

Change occurs when people examine, accept try the innovation. During this stage people experiences series of knowledge transformation, ranging from acceptance Commitment to accomplishing change. The investigator has planned to administer the Information, Education, communication package regarding management of selected side effects of chemotherapy in order to help the patients.

Refreezing

Refreezing occurs when change is established as an accepted and permanent part of the system. This involves integrating or internalizing the change and then maintaining the investigator was assessed the new change by assessing the post test level of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy.

If the patients have gained adequate knowledge and knowledge on practice regarding management of selected side effects of chemotherapy it may reveal that the patients internalized the change and that in turn promote the practice to improve quality life. This has to be enhanced.

If the patients have still inadequate knowledge and knowledge on practice regarding management of selected side effects of chemotherapy, it reveals that there is no change in the patients, so they have to be motivated for change.

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12

Factors enhancing to gain information on management of selected side effects of chemotherapy.

™ Psychological problem

™ Family problem

™ Values and beliefs

™ Socio economic status

™ Negative attitude

UNFREZING Assessing the demographic variables and pretest level of knowledge by using structured questionnaire and knowledge on practice by using checklist regarding management of selected side effects of chemotherapy.

Client with cancer

UNFREZING Assessing the demographic variables and pretest level of knowledge by using structured questionnaire and knowledge on practice by using checklist regarding management of selected side effects of chemotherapy.

CHANGING

Administration of information, Education and communication package on management of selected side effects of chemotherapy.

Nurse Investigator

Experimental Group

Patient internalized the change as evidenced by improved level of knowledge and knowledge on practice

Adhere to the practices of management to improve the quality of life.

Control Group

Patient did not

internalize the change as evidence by

inadequate level of knowledge and knowledge on practice.

Poor adherence

to the practices

and managemen

t and poor quality of

life.

FIGURE : 1.1 MODIFIED CONCEPTUAL FRAME WORK BASED ON KURT LEWIN’S CHANGE THEORY (1939) Factors restraining to gain

information on management of selected side effects of chemotherapy

™ Psychological problem

™ Family problem

™ Values and beliefs

™ Socio economic status

™ Negative attitude

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CHAPTER II

REVIEW OF LITERATURE

This chapter presents the survey of literature made to gain more knowledge about the problem area. Systematic review aims to discover all the research undertaken on a subject, highlight findings available from individual studies and thus help to inform and improve practice. During the years, various studies have been conducted on knowledge and knowledge on practice of patients with cancer undergoing chemotherapy regarding management of selected side effects of chemotherapy.

In this study the review of literature conducted to gain in depth knowledge on the topic of study presented under the following topics:

• Literature related to cancer

• Literature related to chemotherapy and its side effects

• Literature related to Information, Education and Communication Package

LITERATURE RELATED TO CANCER

Hansen.L, Skeie .G, Landberg. R, (2011) conducted a cohort study on intake of dietary fiber, especially from cereal foods, is associated with lower incidence of colon cancer. The purpose of this study was to examine associations between intake of dietary fiber and risk of incident colon and rectal cancer and to determine if fiber source (vegetables, fruits, potatoes, cereals) impacted the association. Sample of the study was,168 incident cases (691 colon, 477 rectal cancer),. For men, an inverse association was observed between intake of total fiber and the risk of colon cancer per an incremental increase of 10 g day(-1) , IRR (95% CI): 0.74 (0.64-0.86). Intake of cereal fiber per 2 g day(-1) was associated with an IRR of 0.94 (0.91-0.98), which

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was also seen for intake of cereal fiber from foods with high fiber content (≥5 g per 100 g product), where the IRR per 2 g day(-1) was 0.94 (0.90-0.98). In women, intake of cereal fiber per 2 g day(-1) was also associated with lower risk of colon cancer, 0.97 (0.93-1.00). No clear associations were seen for rectal cancer.

Inoue. I, Mukoubayashi. C, Yoshimura .N, (2011) conducted a population- based case-control study on elevated risk of colorectal adenoma with Helicobacter pylori-related chronic gastritis. Data was selected from 239 colorectal adenoma cases based on histological evaluation and 239 age-matched adenoma-free controls, and evaluated colorectal adenoma risk according to stage of H. pylori-related chronic gastritis as determined by serum tests for H. pylori antibody titer and pepsinogen.

Subjects with colorectal adenoma were more likely to be smokers and have hypercholesterolemia. H. pylori infection was a risk factor for adenoma as a whole (crude odds ratio [OR]: 2.26, 95% confidence interval [CI]: 1.44-3.55). Analysis of distal adenoma cases showed that adenoma risk was significantly increased in the presence of H. pylori infection, but there was no further increase in risk with CAG. H.

pylori-related chronic gastritis is likely to be involved in the development of colorectal neoplasms, and its progression appears to increase the risk, particularly for proximal adenomas.

Slattery. ML, Lundgreen. A, Herrick .JS, (2011) conducted a study on genetic variation in bone morphogenetic protein and colon and rectal cancer. Bone morphogenetic proteins (BMP) are part of the TGF-β-signaling pathway; genetic variation in these genes may be involved in colorectal cancer. The aim of the study is to evaluate the association between genetic variation in BMP1 (11 tagSNPs), BMP2 (5 tagSNPs), BMP4 (3 tagSNPs), BMPR1A (9 tagSNPs), BMPR1B (21 tagSNPs),

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BMPR2 (11 tagSNPs) and GDF10 (7 tagSNPs) with risk of colorectal cancer and tumor molecular phenotype. Data used from population-based case-control studies (colon cancer n = 1,574 cases, 1,970 controls; rectal cancer n = 791 cases, 999 controls) and observed that genetic variation was associated with risk of developing colon cancer, with 20 to 30% increased risk for most high-risk genotypes. A summary of high-risk genotypes showed over a twofold increase in colon cancer risk at the upper risk category (OR = 2.49 95% CI = 1.95, 3.18). BMPR2, BMPR1B, BMP2 and GDF10 were associated with rectal cancer. BMPR2 rs2228545 was associated with an almost twofold increased risk of rectal cancer. The risk associated with the highest category of the summary score for rectal cancer was 2.97 (95% CI = 1.87, 4.72).

Cross .J, Ferrucci. M, (2010) conducted a prospective study on meat consumption and colorectal cancer risk: an investigation of potential mechanisms underlying this association. prospective cohort with a detailed questionnaire on meat type and meat cooking methods linked to databases for estimating intake of mutagens formed in meats cooked at high temperatures .2,719 colorectal cancer cases were ascertained from a cohort of 300,948 men and women. The hazard ratios (HR) and 95% confidence intervals (95% CI) comparing the fifth to the first quintile for both red (HR, 1.24; 95% CI, 1.09-1.42; P(trend) < 0.001) and processed meat (HR, 1.16;

95% CI, 1.01-1.32; P(trend) = 0.017) intakes indicated an elevated risk for colorectal cancer. In general, the elevated risks were higher for rectal cancer than for colon cancer, with the exception of MeIQx and DiMeIQx, which were only associated with colon cancer. In conclusion, we found a positive association for red and processed meat intake and colorectal cancer; heme iron, nitrate/nitrite, and heterocyclic amines from meat may explain these associations.

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Key .J, Appleby.N, Masset .G, Brunner. EJ, (2010) conducted a cohort study on vitamins, minerals, essential fatty acids and gastric cancer risk. dietary data was collected from using food diaries in seven prospective diaries in the United Kingdom Dietary Cohort Consortium. 565 cases of gastric cancer were matched with 1,951 controls on study centre, age, sex and recruitment date. Dietary intakes of retinol, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin D, calcium, iron, magnesium, potassium, n-6 fatty acids, n-3 fatty acids and the ratio of n-6 to n-3 fatty acids were estimated and their associations with gastric cancer examined using conditional logistic regression models, adjusting for exact age, height, weight, energy intake, alcohol intake, fiber intake, smoking, education, social class and physical activity. There were no statistically significant associations between gastric cancer risk and dietary intake of any of the vitamins, minerals or essential fatty acids .

Yhim .HY, Lee. NR, Song. EK ,(2010) conducted a study on prognostic significance of tumor human papillomavirus status for patients with anal squamous cell carcinoma treated with combined chemoradiotherapy. Retrospectively evaluated outcomes in 47 patients with anal SCC treated with combined chemoradiotherapy (CCRT) and determined tumor HPV status by HPV DNA chip method The median age was 65 years (range, 44-90 years). Sixteen (34%) patients were diagnosed with T stage 3 to 4, and 18 (38%) patients had regional nodal disease (N-positive). Thirty- five (75%) patients were HPV positive, and 31 (66%) patients were genotype 16 (HPV16-positive). Thirty-nine (83.0%) patients were positive for p16. After median follow-up of 51.7 months (range, 5.1-136.0 months), HPV16-positive group had significantly better 4-year progression-free survival (PFS, 63.1% vs. 15.6%, p <

0.001) and overall survival (84.6% vs. 39.8%, p = 0.008) than HPV genotype 16

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negative (HPV16-negative) group. Patients with p16-positive tumor also had a better 4-year PFS (52.5% vs. 25.0%, p = 0.014) than those with p16-negative tumor. In multivariate analysis for PFS, N-positive and HPV16-negative were independent prognostic factors for shorter PFS. Comparing patterns of failure, time to loco- regional failure was statistically superior in HPV16-positive over HPV16-negative groups (p = 0.006), but time to systemic failure was not different (p = 0.098).

Rudolph.A, Hein.R, Hoffmeister.M, (2009) conducted a study on copy number variations of GSTT1 and GSTM1, cancer risk and possible effect modification of cigarette smoking and menopausal hormone therapy. Copy number variations (CNVs) of the glutathione-S-transferase theta-1 (GSTT1) and glutathione- S-transferase mu-1 (GSTM1) gene loci can lead to complete lack of enzyme and have been associated with cancer risk. CNVs may modify cancer risk associated with smoking exposure and menopausal hormone therapy (MHT) use. investigated cancer risk associated with GSTT1 and GSTM1 CNVs and their interaction with smoking in 1796 cases .The interaction with MHT was assessed in the subset of 684 postmenopausal female cases and 681 controls. Trimodular genotypes (0/0, 1/0, 1/1) were determined with relative quantification based on multiplex real-time PCR. The associations with cancer risk as well as possible effect modifications were evaluated using conditional logistic regression analysis. CNVs of GSTT1 and GSTM1 were not significantly associated with cancer risk. Compared to the 1/1 genotype, ORs for the 0/1 genotype and the 0/0 genotype were 0.89 (95% CI: 0.77-1.04) and 0.97 (95% CI:

0.80-1.18) for GSTT1, and 0.99 (95% CI: 0.78-1.27) and 1.03 (95% CI: 0.81-1.31) for GSTM1. Compared to the non-null genotype, ORs for the null-genotype were 1.04 (95% CI: 0.87-1.23) for GSTT1 and 1.03 (95% CI: 0.91-1.18) for GSTM1. No significant interaction with smoking and MHT use was observed. The present study

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does not provide evidence for a strong association between cancer risk and CNVs of GSTT1 or GSTM1 or for an effect modification of smoking or MHT use.

Armstrong.P, (2007) conducted a qualitative study on subjectivity, family, gender and health services among cervical cancer patients. Quantitative techniques are used to identify the socioeconomic, behavioral and biological characteristics. It was carried out to analyze the role of different social and cultural factors in the timely detection of cervical cancer. It was based on individual interviews with women diagnosed with cervical cancer (identified as the "cases"), their female friends and relatives (identified as the "controls") and the cases' husbands. The results showed that both: denial and fear are two important components that regulate the behavior of both the women and their partners. Women tend not to worry about their health, in general and neither about cervical cancer in particular, as a consequence of their conceptualizations regarding their body and feminine identify – both of which are socially determined. Furthermore, it is necessary to improve the quality of information provided in health services.

LITERATURE RELATED TO CHEMOTHERAPY AND ITS SIDE EFFECTS Moehler, (2011) conducted a study on multicentre biomarker-oriented AIO phase II trial of sunitinib for patients with chemo-refractory advanced gastric cancer.

Sunitinib monotherapy in pretreated patients with advanced gastric cancer (AGC) was investigated. Patients received sunitinib 50mg/day for 4 weeks with 2 weeks rest until disease progression or unacceptable toxicity. The primary end-point was objective response rate (ORR). Secondary end-points included progression-free survival (PFS), overall survival (OS) and safety.Fifty-two patients were enrolled and treated (safety population, SP). In the intention to treat population (n=51); the ORR was 3.9%,

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median PFS was 1.28 months [95% CI, 1.18-1.90], median OS was 5.81 months [95%

CI, 3.48-12.32], the estimated one-year survival rate was 23.7% [95%CI: 12.8-36.5].

In subgroup analyses, tumour VEGF-C expression compared with no expression was associated with significantly shorter median PFS (1.23 versus 2.86 months, logrank p=0.0119) but there was no difference in tumour control rate (p=0.142). In the SP, serious adverse events occurred in 26 patients, leading to 13 deaths, all sunitinib unrelated. Thirty-eight patients died from progressive disease, nine died <60 days after treatment start. Sunitinib monotherapy was associated with limited tumour response and good/moderate tolerability in this setting.

Taplin, (2010) conducted a study on nursing care strategies for the management of side effects in patients treated for colorectal cancer. Oncology nurses play a critical role in the detection and management of adverse effects resulting from the toxicity of colorectal cancer (CRC) treatment regimens. Standard chemotherapy for CRC involves combination 5-fluorouracil plus leucovorin, a regimen with a well- characterized toxicity profile that includes abdominal cramping and diarrhea, nausea and vomiting, skin and hypersensitivity reactions, fatigue, stomatitis, neutropenia and thrombocytopenia, and alopecia. Diarrhea is the principal dose-limiting toxicity.

Trimetrexate, a nonclassical antifolate, is currently being investigated in combination with 5-fluorouracil/leucovorin in phase II/III trials. In addition to the management of side effects, the psychosocial and educational needs of CRC patients require attention.

The rigorous treatment schedule presents patients with multiple obstacles in daily living, significantly impacting their quality of life. The oncology nurse is vital in managing the care of CRC patients and ensuring that their physical, psychosocial, and educational needs are met. Educating patients about adverse treatment effects empowers them to manage their symptoms and enables them to alleviate serious or

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life-threatening treatment complications. Three case studies are provided to illustrate and reinforce nursing management strategies for hypersensitivity reactions, fatigue, and psychosocial issues related to CRC treatment.

Pashankar,(2010 ) conducted a study on acute Constipation in patients receiving Chemotherapy for Cancer, they prospectively studied 61 patients.

Questionnaires were administered regarding demographics, chemotherapy, and bowel movement pattern during chemotherapy. Thirty-five patients (57%) had acute constipation lasting for 2 or more weeks during chemotherapy. 15 of 35 patients (43%) perceived constipation as a major/significant problem and 8 patients (23%) perceived constipation having a major/significant impact on lifestyle during chemotherapy. Constipation can be a significant problem with a negative impact on lifestyle during chemotherapy and needs aggressive management.

Weng XS,(2009) conducted a study on treatment of leucopenia with pure Astragalus preparation. It reports the effects of pure Astragalus preparation (PAP) in treating 115 cases of leucopenia. These cases were randomized and divided into two groups. Group I (58 cases) was treated by more concentrated PAP (every 10 ml equalled to 15 grams of Astragalus), Group II (57 cases) was treated by less concentrated PAP (every 10 ml equalled to 5 grams of Astragalus). The patients took the PAP twice a day, 10 ml each time. The course of treatment was 8 weeks for both groups. The results showed that effectiveness in Group I was 82.76%, while in Group II 47.37%, with a total effective rate of 65.22%, they were statistically different (P <

0.01). According to the comparison of average WBC counts after treatment, Group I was significantly higher than that of Group II (P < 0.05). There was an obvious rise of the WBC counts in both groups after treatment (P < 0.001). The results showed that

(29)

Astragalus is an effective drug in treating leucopenia, and increasing the dosage could enhance its effectiveness.

Bergkvist k, Wengster, (2009) conducted a study regarding symptom experiences during chemotherapy treatment with focus on nausea and vomiting.

Nausea and vomiting are common and well study symptoms in oral cancer care. Semi structured interviews were conducted and analysed using content analysis. Five main categories were identified as before cancer diagnosis being ill. Consequences on daily life going through chemotherapy treatment – looking forward to a normal life. The present findings suggest that the individual experiences of nausea and vomiting during chemotherapy treatment may have a profound effect on how treatment is perceived and may influence future decisions concerning further treatment.

Elliott, (2007) conducted a cohort study on analysis of drug costs for the management of chemotherapy-related side effects in advanced colorectal cancer.

Objective of the study is to assess whether there is a difference in associated drug costs for the management of chemo therapy-related side effects for patients with advanced colorectal cancer treated with raltitrexed (Tomudex, Zeneca Limited) or 5- FU plus folinic acid (Mayo regimen). The results showed that there was a significant reduction in the mean total drug cost per patient for the management of chemotherapy-related side effects in the raltitrexed group compared to the 5- FU/folinic acid treatment group (£,64.27 vs £139.14; P = .0016). Infection was the most costly individual side effect for both treatment groups but was lower in the raltitrexed cohort (£25.46 vs £59.93). Drug costs for the management of nausea and vomiting, pain and abdominal pain, and mucositis side effects were also considerably lower in the raltitrexed cohort.

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Christina .A, Rachel Kayl, (2006) conducted a study on side-effects of chemotherapy and quality of life in ovarian and breast cancer patients. Prospective, randomized, longitudinal studies that incorporate a pre-treatment assessment of symptom burden and perceived quality of life are necessary to define the severity and pattern of treatment-related change and subsequently guide intervention strategies.

Adjuvant chemotherapy has demonstrated efficacy in the management of ovarian and breast cancers. Chemotherapy associated with significant side-effects that adversely impact patient quality of life.

Arakawa, (2005) conducted a evaluative study on the effectiveness of progressive muscle relaxation in reducing nausea, vomiting and anxiety induced by chemotherapy in Japanese patients. Subjects comprised of 60 cancer chemotherapy patients who were hospitalized in a cancer centre. The subjects either were randomly assigned to the experimental (or) control group. In addition to routine nursing care, subjects in the experimental received contact with the investigator. Nausea and vomiting were measured using the Rhodes index of Nausea and vomiting, the result verified that PMR training was most effective than was routine nursing care in reducing the nausea and vomiting induced by chemotherapy.

Hanson, Johnson, McDaniel and Rhodes,(2004) conducted a study on sensory perception of patient on selected Anti–Neoplastic chemotherapy (ANCT) protocols. A convenience sample of 54 subjects was assessed from three Midwestern hospitals and one physicians practice. A sensory response from subjects before, during and after one to six cycles of their initial course of treatment on one of two emetogenic ANCT protocols was elicited. The senses for which subjects most

(31)

frequently provided descriptors were taste, touch and smell descriptors varied from some sensation according to the chemotherapy drug protocols.

Bonura, (2003) conducted a randomized clinical trial study on fatigue in cancer patients receiving chemotherapy. The aim of the study is discussion about available information on the characteristics, causes and potential treatments of fatigue in cancer patients receiving chemotherapy. The results showed that fatigue is now an evermore considered aspect of the toxicity of chemotherapy.

Borelli and Trojan,(2002) conducted a study on the adverse chemotherapy effects on skin and mucous membranes. Mucocutaneous side effects of chemotherapeutic agents are frequent, especially alopecia and stomatitis. The latter can be close limiting or can be dose limiting or can endanger the patient in case of secondary infections. Despite the completely different mode of action of new substances or immunotherapeutic agents like monoclonal antibiotics the same range of side effects can be observed.

Jason todd estrina,(1999) conducted a retrospective study on review of blood transfusions in Cancer Patients with Anemia. Out of 331 patients receiving chemotherapy, 103 (31%) patients received a blood transfusion. Each of these charts was reviewed and sorted by diagnosis, treatment medications, and past transfusion and/or treatment history. The average hemoglobin at time of transfusion was 7.9 g/dl.

Higher hemoglobin levels at transfusion were observed for patients over the age of 60 and patients who received prior chemotherapy. Lower hemoglobin levels at transfusion were observed for patients receiving Epoetin Alfa and sarcoma patients.

The average number of red blood cell (RBC) units transfused was 5.1 per patient.

More units were given to patients receiving etoposide, while fewer units were given to

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those receiving ifosfamide, created a transfusion severity index (TSI) to jointly measure these two variables. The results of this study identify transfusion needs associated with certain groups of cancer patients and with certain types of chemotherapy drugs.

LITERATURE RELATED TO INFORMATION, EDUCATION AND COMMUNICATION PACKAGE

David, (2008) conducted a study to assess the effectiveness of Structured Teaching Programme on knowledge and attitude regarding chemotherapy among patients with oral cancer in a cancer institute. Data collected from 40 patients with oral cancer the mean pretest knowledge scores of oral cancer patients regarding chemotherapy was (10.75), SD = 2.216 before receiving where as the mean post test knowledge score was (18.13), SD = 0.939 after receiving structured teaching programme. In order to test the difference between the two means‘t’ test was computed and the obtained ‘t’ value at df (39) was 21.871, which was significant at 0.05 level. The mean posttest attitude score (28.35) SD = 1.099 was higher than the mean pre test. The attitude score 20.65 at df 39. The obtained‘t’ value 19.454 at df 39 was significant at 0.05% level. Since the obtained‘t’ value was higher than the table value. It indicates that Structured Teaching Program on Chemotherapy had a significant role in increasing the knowledge and change in attitude regarding Chemotherapy.

Samia, Syed Faizan Ali, (2007) conducted a cross sectional study on knowledge and awareness about Cervical Cancer and Its Prevention amongst Interns and Nursing Staff in Tertiary Care Hospitals in Karachi. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied. Only 26%

(33)

of the study population was aware of one or more risk factors. Thirty seven percent recognized Pap smear as a screening test. In total only 37 out of 400 respondents were aware of the HPV vaccine. The study results showed that the majority of working health professionals are not adequately equipped with knowledge concerning cervical cancer. Continuing Medical Education program should be started at the hospital level along with conferences to spread knowledge about this disease.

Hatisfield Wolfe, (2005) conducted a study on development of a teaching book let for oncology patient’s assessment and skin care. Oncology patients often experience skin breakdown because of chemotherapy often the loss of skin integrity is neither identified nor treated until it becomes severe and painful. Nursing staff identified the need to develop a book let that would both instruct adult oncology patients concerning necessary skin care following therapy and encourage them to collaborate with the nursing skill. Participants were given a hand held mirror as an aid to assess skin changes. Feedback from both staff and patients are very positive.

Dodd.MJ., (2004) conducted a study on measuring informational intervention for chemotherapy and self-care behaviour. Little is known about how cancer patients manage the side effects of chemotherapy, 48 patients receiving chemotherapy were randomized in to four groups to determine their self-care behaviours. The first group received drug information only, the second group received information on side effect management techniques the third group received combined drug and SEMT information, the fourth group were controls. Pre and post intervention scores on chemotherapy knowledge, self-care behaviors. Self-care behavior and general affective state were evaluated by analysis of covariance patients who received

(34)

drug information alone (or) in combination with other information performed more self-care behaviors

Alka Saxena,(2003) conducted a evaluation study on effectiveness of structured teaching programme regarding cancer chemotherapy and its side effects management on knowledge and attitude among nursing personnel working in a cancer hospital. Data collected from 30 nursing personnel administering chemotherapy. The study utilized an evaluative approach and a simple random technique was used for selecting a sample. Mean post test knowledge score (39.46) of nursing personnel were found to be significantly higher than their mean pre test knowledge score (32.93) as evident from ‘t’ value (29)=10.9,p<0.05 level. The mean post test attitude score (49.13) of nursing personnel was found to be significantly higher than their mean pre test attitude scores(48.8) ‘t’ value (29)=6.15,p< 0.05 .Structured teaching programme was effective in increasing knowledge and developing favourable attitude regarding cancer chemotherapy administration and its side effects management.

Lock.k, willson.B, (2003) conducted a study on information needs of cancer patients receiving chemotherapy in an ambulatory care setting. The purpose of this study was to assess the information needs of cancer patients receiving chemotherapy and to explore their preferred styles of receiving education in an ambulatory care setting. Patient information needs and preferences were measured using 17 item questionnaire this descriptive study included a sample of 101 cancer patients undergoing outpatient. Chemotherapy side effects of treatment, drug information, and coping strategies. Some patients expressed a preference for information in their primary language. The results support the use of online learning, in this setting.

Patients identified one – one discussion with nurses and doctors as the preferred way

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to receive information in order to meet the individual needs of cancer patients, education should be provided in a variety of learning modalities.

Brawn and Jazieh, (2002) conducted a study on developed a patient information packet 71 (PIP) for veterans with cancer receiving chemotherapy. The PIP contained information about chemotherapy side effects, when to call for help, available resources and information about support groups. The pip had helped 13 patients to call the hospital and had helped 16 patients decide whom to call. The pip which was developed to meet the specific needs of this patient population and was well received and utilized.

Mccaughan and Thompson,(2002) conducted a study to assess information needs of cancer patients receiving chemotherapy at a day care unit in Northern Ireland. All patients attending their first chemotherapy treatment at the regional cancer center were invited as participants in the study. At the end of their first chemotherapy session, a nurse explained the nature of the study to the patient and requested their co-operation. 75 patients who attended the chemotherapy day care unit for a three-month period has initially agreed to participate. About 84.2% respondents felt that people should be told all information available about their medical condition (Including rare side effects).

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CHAPTER-III

METHODOLOGY

Methodology is a significant part of any study, enables the researcher to project the research undertaken. Research methodology is the systematic way to carry out an academic study and research in flawless manner. The methodology enables the researcher to project a blue print of the details, data, approach, analysis, findings of research undertaken. The present study was conducted to find out the effectiveness of Information, Education, and Communication Package in terms of knowledge and knowledge on practice among the patients with cancer.

Research Approach

Quantitative evaluative approach was considered as an appropriate research approach to evaluate the effectiveness of Information, Education and Communication Package among the patients with cancer undergoing chemotherapy.

Research Design

Quasi experimental design was used for this study.

E O1 X O2 C O1 O2 E - Experimental group C - Control group

O1 - Pre test on knowledge and knowledge on practice X - Information, Education and Communication Package O2 - Post test on knowledge and knowledge on practice

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Variables

Independent variable : Information, Education and Communication Package Dependent variable : Knowledge, Knowledge on practice

Description of setting

The study was conducted in Dr.G.V.N Hospital, Singarathope, Trichy. It is a 200 bedded super speciality hospital that is a branch of the Dr.G.V.N Institute of medical sciences and society , Trichy which has 4 branches comprising 450 beds and serving the community since 1939, which is about 175kms from Sara Nursing College. In this hospital per day 25 patients were receiving chemotherapy among them 10 patients were receiving first cycle chemotherapy.

Population

The population of this study was patients with cancer undergoing chemotherapy.

Sampling Sample

The sample of this study was patients with cancer undergoing chemotherapy and who are admitted at Dr.G.V.N Hospital,Singarathope, Trichy during the study period and those who met the inclusion criteria.

Sample size

The investigator had selected 70 (35 in the experimental group and 35 in the control group) subjects with cancer undergoing chemotherapy.

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Sampling technique

Convenience sampling technique was used for this study.

Criteria for sample selection

The sample was selected based on the following inclusion and exclusion criteria.

Inclusion Criteria

• Patients with cancer undergoing chemotherapy and who were admitted at Dr.G.V.N.Hospital, Singarathope,Trichy.

• Patients with cancer undergoing chemotherapy and who were willing to participate in this study.

• Both male and female patients.

• Patients who can speak and understand Tamil.

• Patients receiving first cycle chemotherapy.

Exclusion Criteria

• Patients who are unconscious.

• Patients who are terminally ill.

• Patients who are having mental illness.

• Patients who are not willing to participate in this study.

Description of tool

Section-A : Demographic variables

A Structured interview schedule was used to assess the demographic data like age, sex, religion, educational status, occupational status, family monthly income, marital status, locality, food habits, previous source of information, family history of

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cancer, duration of illness and site of cancer. No score was allotted for this section and it was used for descriptive analysis.

Section-B : Structured Questionnaire

This part consisted of structured questionnaire with 25 multiple choice questions regarding management of selected side effects of chemotherapy. The structured questionnaire was translated in Tamil. The accuracy of the translation was confined by back translation. There was one correct answer and 3 distracters for each question. For every correct answer a score of one awarded and for every wrong answer a score of zero awarded. The total possible score was 25. The total score of each subject was calculated and converted in to percentage and interpreted as follows, 75% and above Good knowledge

51-74% Average knowledge 50% and below Poor knowledge

Section- C : Check List

It consisted of Check list. The entire procedure was broken in to 15items. The Check list was translated in Tamil. The accuracy of the translation was confined by back translation. Each actions had 2options (Yes / No). If the participant said ‘yes’ for the action was awarded a score of one. If they said ‘no’ a score of zero was awarded.

The maximum obtainable score for the check list was 15. The total score of each subject was calculated and converted in to percentage and interpreted as follows,

75% and above Adequate practice

51-74% Moderately adequate practice 50% and below Inadequate practice

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Validity

Validity of the tool was obtained on the basis of opinion of Medical surgical experts (4 Medical Surgical Nursing specialist,1 Medical Oncologist). The tool was found valid. Minor suggestions were given for questioning technique, suggestions were incorporated.

Reliability

To ensure the reliability of the tool, it has been administered to 6 patients with cancer undergoing chemotherapy. The reliability of the knowledge questionnaire was established by Karl Pearson’s correlation co-efficient, by test-retest method and reliability was r=0.85. The reliability of the checklist was established by Inter-rater reliability method and reliability was r=0.92. Hence the tool was reliable and was used for this study.

Pilot Study

In order to find out feasibility and practicability, a pilot study was conducted at Thanjavur cancer centre in Thanjavur for a period of 1 week (16.06.2011 to 23.06.2011 ) among 10 (5 in the experimental,5 in the control) patients with cancer undergoing chemotherapy. The study was found feasible to conduct.

Method of data collection Ethical consideration

Formal permission was obtained from the chairman of Dr.G.V.N Hospital and Informed consent was obtained from the subjects.

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Period of data collection

Data collection was done over a period of 4 weeks from 29.06.2011 to 28.07.2011.

Data collection procedure

The data collection was done at Dr.G.V.N.Hospital,Singarathope,Trichy.

Permission was obtained before data collection. The objective of the study was explained to the director and other professionals to get the cooperation during the procedure. Oral consent was obtained. 70 (35 in the experimental group, 35 in the control group) patients with cancer undergoing chemotherapy was selected on the basis of convenience sampling technique. Then the investigator did a pretest on the level of knowledge and knowledge on practice. Structured questionnaire was used for assessing the level of knowledge and checklist for assessing the level of knowledge on practice for both the groups. Then the Information, Education and Communication Package administered to the subjects of experimental group with lecture, video clipping, pamphlets and chart for 20 minutes. No intervention was given for control group. Then the post test level of knowledge and knowledge on practice of the subjects was assessed after 15 days with the help of same questionnaire and checklist for knowledge and knowledge on practice for the both groups respectively.

Plan for data analysis

Descriptive statistics was used for categorical data, Independent ‘t’ test was used to determine the effectiveness of Information, Education and Communication Package, karl Pearson correlation coefficient was used to find the relationship between posttest level of knowledge and knowledge on practice in experimental and control group and Chi-square test was used to associate the post test level of knowledge and knowledge on practice of patients with cancer undergoing chemotherapy with their selected demographic variables in experimental group.

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CHAPTER IV

ANALYSIS AND INTERPRETATION

Research data must be processed and analyzed in an orderly fashion so that patterns and relationship can be discerned and validated, and hypotheses can be tested. Quantitative data analyzed through statistical analysis includes simple procedures as well as complex and sophisticated methods. (Polit, 2004)

This chapter presents the analysis and interpretation of data collected from 70 subjects to evaluate the effectiveness of Information, Education and Communication and Package on level of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy at Dr.G.V.N.Hospital, Singarathope, Trichy. The results obtained were classified and tabulated and the following analysis were performed in fulfilling the objective of the study.

The data analysis presented as following sections,

Section A - Distribution of subjects according to their demographic variables in experimental and control group.

Section B - i) Assessment of level of knowledge regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

ii) Assessment of level of knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

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Section C - Effectiveness of Information, Education and Communication package on level of knowledge and knowledge on practice regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy.

Section D - Correlate the post test level of knowledge score and post test level of knowledge on practice score regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

Section E - Association between post test level of knowledge and selected demographic variables among patients with cancer undergoing chemotherapy in experimental group.

Section F - Association between post test level of knowledge on practice and selected demographic variables among patients with cancer undergoing chemotherapy in experimental group.

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Section A

Table 4.1 : Distribution of subjects according to their demographic variables in experimental and control group.

n = 70

S.No Demographic Variables

Experimental Group (n = 35)

Control Group (n = 35)

Total (n = 70)

f % f % f %

1 AGE

21-30 years 31-40 years 41-50 years Above 51 years

- 13 15 7

- 37.14 42.86 20

- 12 13 10

- 34.29 37.14 28.57

- 25 28 17

- 35.7

40 24.3

2 SEX

Male Female

20 15

57.14 42.86

18 17

51.43 48.57

38 32

54.3 45.7 3 RELIGION

Hindu Christian Muslim Others

18 5 12

-

51.42 14.3 34.28

-

20 4 11

-

57.14 11.43 31.43

-

38 9 23

-

54.3 12.9 32.9 -

4 EDUCATION

No formal education Primary school High school Higher secondary Collegiate

- 10 12 8 5

- 28.57 34.28 22.85 14.30

4 13

5 10

3

11.43 37.1 14.3 28.57

8.6

4 23 17 18 8

5.7 32.9 24.3 25.7 11.4

(45)

5 OCCUPATION Daily wage worker Self employee Private employee Government employee Home maker

10 6 4 3 12

28.57 17.14 11.4

8.6 34.28

9 2 8 2 14

25.7 5.7 22.9

5.7 40

19 8 12

5 26

27.1 11.4 17.1 7.1 37.1

6 INCOME

Rs.1500-3000 Rs.3001-5000 Rs.5001 above

15 13 7

42.86 37.14 20

12 14 9

34.29 40 25.71

27 27 16

38.6 38.6 22.9

7 MARITAL STATUS

Married Unmarried Divorced Widow Separated

32 3

- - -

91.4 8.6

- - -

30 2

- 3 -

85.7 5.7

- 8.6

-

62 5

- 3 -

88.6 7.1

- 4.3

-

8 LOCALITY

Rural Urban

13 22

37.14 62.86

17 18

48.57 51.43

30 40

42.9 57.1

9 FOOD HABITS

Vegetarian Non vegetarian

12 23

34.29 65.71

9 26

25.7 74.29

21 49

30 70

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10 PREVIOUS SOURCE OF INFORMATION Family members Friends

Mass media Health personnel

14 - 8 13

40 - 22.9 37.1

10 3 6 16

28.6 8.6 17.1 45.7

24 3 14 29

34.3 4.3

20 41.4

11 FAMILYHISTORY

OF CANCER Father

Mother Siblings No one

3 2 - 30

8.6 5.7 - 85.7

4 3 - 28

11.4 8.6

- 80

7 5 - 58

10 7.1 - 82.9

12 DURATION OF

ILLNESS Below 6 months 6 months-1 year Above 1 year

12 15 8

34.29 42.86 22.85

17 11 7

48.57 31.43 20

29 26 15

41.4 37.1 21.4 13 SITE OF CANCER

Ca Cervix Ca Oesophagus Ca Breast Ca Colon

10 12 5 8

28.5 34.3 14.3 22.9

10 12 5 8

28.5 34.3 14.3 22.9

20 24 10 16

28.6 34.3 14.3 22.9

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The table4.1 shows that according to their demographic variables majority of the subjects 15 (42.86%) were in the age group of 41-50 years in experimental group and 13(37.17%) were in the age group of 41-50 years in control group, Sex 20(57.14%) were male in experimental group and 18 (51.4%) were male in control group, Religion 18(51.4%) were Hindu in experimental group and 20 (57.14%) were Hindu in control group, Education status 12 (34.28%) had studied high school in experimental group and 13(37.1%) had studied primary school in control group, Occupation 12 (34.28%) were home maker in experimental group and 14 (40%) were home maker in control group.

Majority of the subjects 15 (42.86%) had monthly income of Rs.1500-3000 in experimental group and 14 (40%) had monthly income of Rs.3001-5000 in control group, Marital status 32 (91.4%) were married in experimental group and 30 (85.7%) were married in control group, Locality 22 (62.86%) were lived in urban area in experimental group and 18 (51.43%) were lived in urban area in control group, Food habits 23 (65.71%) were had the habit of non vegetarian in experimental group and 26 (74.29%) were had the habit of non vegetarian in control group, Previous source of information 14 (40%) were had through family members in experimental group and 16 (45.7% ) were had through health personnel in control group, Family history of cancer 30 (85.7%) were had no family history in experimental group and 28 (80%) were had no family history in control group, Duration of illness 15 (42.86%) were in the duration of 6 months to 1 year in experimental group and 17 (48.57%) were in the duration of below 6 months in control group and Site of cancer 12 (34.3%) were had cancer in oesophagus in experimental group and were had cancer in oesophagus in control group.

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40 SECTION B

20%

42.86%

37.1%

71.43%

28.5%

0%

8.6%

40%

51.4%

11.4%

42.9%45.7%

0 10 20 30 40 50 60 70 80 90 100

% of Patients with cance

Pretest knowledge in experimental group

Posttest Knowledge in experimental group

Pretest knowledge in control group

Posttest Knowledge in control group Good Knowledge Average Knowledge Poor Knowledge

Figure 4.1: Level of Knowledge regarding management of selected side effects of chemotherapy among patients with cancer undergoing chemotherapy in experimental and control group.

References

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