Cancer Pain Management: Teaching Program for Terminally ill Cancer Patients

Mrs. Sheeba Chellappan¹, Dr. Rajamanickam Rajkumar², Dr. Merlin Jeyapal³

¹Associate Professor, PhD Scholar, Christian College of Nursing, Neyyoor and Post, Kanyakumari Dist, Tamilnadu, India.

²Professor, Dept. of Community Medicine, Meenakshi Medical College Hospital and Research Institute,

Kanchipuram India.

³Vice Principal/ Professor, C.S.I. Jeyaraj Annapackiam College of Nursing, Madurai, India.

*Corresponding Author Email: sheeba.1978@gmail.com

ABSTRACT:

Background: Although cancer patients experience multiple physical symptoms as well as psychological, the symptom of pain is considered as most critical. Unrelieved pain affects all dimensions of quality of life including the ability to achieve a peaceful death. The prevalence of cancer pain is estimated as 25% for those newly diagnosed, 33% for those undergoing active treatment and greater than 75% for those with advanced disease. Aim: The aim of the study is to assess the effect of structured teaching program regarding pain management on knowledge of terminally ill cancer patients in selected hospital, Kanyakumari District. Methods: A quantitative Approach with one group pretest post test pre-experimental research design was adopted to carry out the study. Data were collected using questionnaire from 30 samples selected by purposive sampling. Results: In pretest, 50% of them had inadequate knowledge regarding pain management, 46.7% of them had moderately adequate knowledge and 3.3% of them had adequate knowledge. After teaching program, 20% of them had adequate knowledge 70% of them had moderately adequate knowledge and only 10% had inadequate knowledge regarding pain management. The calculated ‘t’ value (2.97) was higher than the table value at 0.05 level of significance. Conclusion: Pain is one of the common factors which decide the quality of life among terminally ill cancer patients. The knowledge regarding pain helps them to cope with their journey with cancer. Structured teaching program improve their knowledge regarding pain and thus help to adjust their journey accordingly.

KEYWORDS: pain, terminally ill patients, cancer, pain management, structured teaching program, knowledge.

INTRODUCTION:

Although cancer patients experience multiple physical symptoms as well as psychological, the symptom of pain is considered as most critical. Unrelieved pain affects all dimensions of quality of life including the ability to achieve a peaceful death.

The prevalence of cancer pain is estimated as 25% for those newly diagnosed, 33% for those undergoing active treatment and greater than 75% for those with advanced disease. Pain prevalence is also high in specific cancer type such as head and neck cancer (49%). With such high prevalence, cancer pain should be anticipated and responded as early as possible.¹ Pain prevalence is high in developing countries due to late diagnosis and limited opioid access. The barrier to pain management has been classified as patient, professional and system obstacles. A study done on quality of life, barrier to pain management and pain knowledge among 83 patients found that the overall pain knowledge score was moderate to high but knowledge deficit persisted for items related to addiction. After implementation of intervention “passport to comfort” model to improve pain management, the knowledge of pain significantly increased for the interventional group to 87% in first month and 88% in third month.²A study done on knowledge and barriers to pain management in caregivers of cancer patients receiving home care reported that 46 to 94% of caregivers agreed various concern that are barriers to reporting pain and using analgesics. The areas of greater concern were about opioid related side effects, fear of addiction and the belief that pain meant disease progression. Also the results showed that caregivers with higher pain management knowledge score had significantly fewer barriers to cancer pain management.³Researchers studied the effectiveness of planned teaching program on knowledge regarding non curative care of terminally ill cancer patients among caretakers and found that the mean post test knowledge score 29.65 was higher than the mean pretest knowledge score 15.75. The structured teaching program was effective in improving the knowledge of caretakers.⁴the earlier personal interactions with terminally ill cancer patients and their primary caregivers made the investigator to realize the need for interventions to improve pain knowledge of terminally ill cancer patients. So the investigator was interested in this study.The aim of the study was to assess the effect of structured teaching program regarding pain management on knowledge of terminally ill cancers patients in selected hospital, Kanyakumari District.

OBJECTIVES:

· To assess the pre and post test knowledge score among terminally ill cancer patients regarding pain management.

· To compare the pre and post test knowledge score among terminally ill cancer patients regarding pain management.

· To associate selected demographic variables with the pre test knowledge score of terminally ill cancer patients regarding pain management.

HYPOTHESIS:

· There is no difference in the pre and post test knowledge score among terminally ill cancer patients regarding pain management.

· There is no association between selected demographic variables with the pre test knowledge score of terminally ill cancer patients.

Conceptual Framework:

This study is based on Ernestine Wiedenbachs – prescriptive theory. A prescriptive theory directs action towards explicit goal. This theory consists of three factors or concepts. The central purpose refers to what the practitioner recognizes as essential to the particular discipline. In this study, central purpose refers to improvement in pain management among terminally ill patient with head and neck cancer. Prescription refers to the action that the nurse plans to fulfill the central purpose. In this study prescription refers to structured teaching program given to terminally ill patient with head and neck cancer to improve the knowledge regarding pain management. The realities are the immediate situations that influence the fulfillment of the central purpose. Wiedenbachs defines 5 realities: the agent, the recipient, the goal, the mean and framework (Fig 1).

MATERIALS AND METHOD:

A quantitative approach with one group pretest post test pre-experimental research design was adopted to carry out the study.

Setting:

The study was conducted in Kanyakumari Medical Mission Neyyoor, Kanyakumari District, which is 600 bedded teaching hospital in the South Indian State of Tamil Nadu. The institution is more than 175 year old. International Cancer Center is one of the wings of Kanyakumari Medical Mission, famous for cancer treatment in Tamil Nadu. This center provides outpatient and inpatient services to cancer patients.

Population:

The population of the study was terminally ill patients with head and neck cancer admitted in International Cancer Center, Neyyoor, Kanyakumari District.

Sample:

The sample consisted of 30 terminally ill patients with head and neck cancer admitted in International Cancer Center, Neyyoor, Kanyakumari District.

Sampling method:

Purposive sampling was used to select the sample. Terminally ill patients with head and neck cancer needing pain management and who met the inclusion criteria were selected.

Criteria for sample selection:

Inclusion criteria:-

· Patient who was terminally ill with head and neck cancer need pain management education.

· Patient who can understand and speak Tamil.

· Patient who were willing to participate in the study.

Measures:

The tool consisted of two sections; Section I addressed the demographic variables of terminally ill patients with head and neck cancer. Section II addressed knowledge questionnaire which was prepared by the investigator after extensive review of literature and discussion with the experts in Nursing and Medical field. It consists of 20 items addressing different aspects of pain management. Each questions consisted of four responses. The correct response was given 1 mark. The maximum attainable score was 20. The total score was converted in to percentage and interpreted as follows; Above 75% was considered as adequate knowledge, 50-74% was considered as moderately adequate and <50 was considered as inadequate.

Validity:

Content validity was determined by obtaining the opinion of expert from Medical, Nursing and Statistical field. A pilot study was done and the questionnaire was found to be relevant to the setting of the study.

Protection of study participants:

The study was conducted after getting permission from Medical Superintendent and Head of the Department of Kanyakumari Medical Mission, Neyyoor. Oral permission was obtained from the terminally ill patients with head and neck cancer after explaining the purpose of the study.

Data collection procedure:

The data were collected for 6 weeks. Thirty terminally ill patients with head and neck cancer were personally interviewed with prepared interview guide. Each day, the researchers interviewed 2 to 3 patients based on the inclusion criteria. The data collection was done as follows.

Phase I:

The researcher developed rapport with the terminally ill patient with head and neck cancer and explained the purpose of the study. Oral consent was obtained and the researcher interviewed the study participant for 20 minutes. The questionnaire on demographic and clinical details was completed by the researcher. Knowledge questionnaire was administered using interview technique.

Phase II:

Structured teaching program on pain management was given for 45 minutes. Various aspects pain management was included in the teaching program.

Phase III:

Post test was done after one week with the same knowledge questionnaire. The scoring was done according to scoring procedure. The gathered data were analyzed and interpreted in the light of objectives.

RESULTS:

Out of 30 participants, 56.6% of them were above 55 years, 56.6% of them were males, 46.7% of them had primary education and 60% of them had income between Rs.2500 and Rs.5000. Sixty seven percent were coolies and 83% belongs to Hindu religion. Out 17 males, 64% of them were using tobacco, 53% of them were smokers and 42% of them were alcoholic.

Level of Knowledge before and after the program:

Fig 2. Level of Knowledge before and after the program

In pretest, 50% of them had inadequate knowledge regarding pain management, 46.7% of them had moderately adequate knowledge and 3.3% of them had adequate knowledge. After teaching program, 20% of them had adequate knowledge, 70% of them had moderately adequate knowledge and only 10% had inadequate knowledge regarding pain management.

Comparison of pre and post test level of knowledge score:

The data in Table.1 shows that the mean post test knowledge score (13.3± 2.72) was significantly higher than the mean pretest knowledge score (10.33± 3.5). The calculated‘t’ value (2.97) was higher than the table value at 0.05 level of significance. Hence the null hypothesis was rejected. Thus it supported that structured teaching program on pain management was effective in improving the knowledge of terminally ill cancer patients.

Table1: Mean, mean difference, standard deviation and t value of the pre test and post test knowledge score. N=30

S. No	Category	Mean	SD	Mean Difference	t
1	Pretest	10.33	3.5
				2.97	2.628
2	Posttest	13.3	2.72

Association between Demographic variables and pretest knowledge score:

There no significant association between demographic variables such as age, sex, income, educational status and duration of illness with pre test knowledge score. Thus the null hypothesis was accepted at 0.05 level of significance.

DISCUSSION:

The study showed that majority of the terminally ill cancer patient had inadequate knowledge regarding pain management before the structured teaching program. After the structured teaching program, 70% of them had moderately adequate knowledge. The post test mean score (13.3±2.7) was significantly higher than the pretest score (10.33±3.5). These finding were supported by the study done by sun V.C et.al which showed that after passport to comfort intervention, the knowledge on pain was improved among interventional group. It was also supported by the study done by Babu RL et.al. They found that teaching program regarding non curative care of terminal illness was effective among care taker of terminally ill cancer patients. Some of the limitation regarding the study includes the following. The study was done for a 6 weeks with 30 samples in a single setting. So further studies are recommended with large sample size in different settings.

CONCLUSION:

Pain is one of the common factors which decide the quality of life of terminally ill cancer patients. The knowledge regarding pain helps them to cope with their journey with cancer. Structured teaching program improve their knowledge regarding pain and thus help to adjust their journey accordingly.

REFERENCE:

1. Paice JA., Ferrel B. The management of cancer pain. Cancer J Clin. 2011. 61(3). 157-182

2. Sun VC., Borneman T., Ferrel B et.al. Overcoming barriers to cancer pain management; and institutional change model. Journal of pain symptom manage. 2007. 34: 359-369.

3. Hazard VA., Deborah CB., Thomas T and Susan H. Knowledge of and Barriers to pain management in caregivers of cancer patients receiving home care. Cancer Nursing. 30(1). 2007 PP 31-37.

4. Babu RL., Mali N and Mahadeo S. Effectiveness of planned teaching program on knowledge regarding non curative care of terminally ill cancer patients among care takers. International Journal of science and Research. 2014. 3(4); 198-205.

Received on 18.05.2016 Modified on 25.05.2016

Asian J. Nur. Edu. and Research.2017; 7(2): 151-154.

DOI: 10.5958/2349-2996.2017.00030.1