In-hospital psychoeducation for family caregivers of Nigerian children with cancer (The RESCUE Study).

OBJECTIVES: High levels of caregiver burden (CB) are experienced by informal caregivers of pediatric patients with cancer. There is increasing evidence highlighting the extent of CB across sub-Saharan African countries, although there remains lack of interventions that target improvements in their experience. This study aimed to determine the impact of a structured psychoeducation program on caregivers' outcomes relating to preparedness to provide care, burden of caregiving, and quality of life (QoL). METHODS: This quasi-experimental (pre-and-posttest) design, involved family caregivers of children on admission for cancer treatment in 4 Nigerian tertiary hospitals. Eligible participants received 2 structured, psychoeducational training sessions delivered by a multidisciplinary oncology team, focusing on the management of patients' condition, spiritual care, self-care, and support. RESULTS: Subjects were mainly female (79.5%) and mostly mothers to children undergoing cancer treatment (74.7%). Commonest cancer type was acute lymphoblastic leukemia (23.9%) with evidence of metastatic disease found in 9.6% of children. Significant improvements were observed between pre- and posttest for unmet needs (z = -9.3; p < 0.001), preparedness for caregiving in palliative care (PCPC) (z = -7.0; p < 0.001), and overall QoL (z = -7.3; p < 0.001). A significant reduction in CB was also reported (z = -8.7; p < 0.001). SIGNIFICANCE OF RESULTS: This psychoeducational intervention (PEI) resulted in significant improvements in unmet needs, CB and significant improvements in PCPC. However, a reduction in QoL of the family caregivers was also observed. Findings from this study should encourage the use of well-crafted PEIs, delivered within hospital settings to promote improvements in outcomes for informal caregivers of hospitalized children suffering from cancer, in an African context. Further intervention development is required to better understand intervention components influencing changes in outcomes, while exploring feasibility testing and adaptation to similar settings in Nigeria and within Africa.

Nurses' Perceived Challenges in the Management of Hospitalized Cancer Patients in a Comprehensive Cancer Center in Southeastern Nigeria.

OBJECTIVE: Nurses' challenges in poor-resource countries like Nigeria have been understudied. This study determined nurses' perceived challenges in management of hospitalized cancer patients in a comprehensive cancer center in southeast of Nigeria. METHODS: The descriptive study included 133 registered nurses working in medical-surgical and oncology wards.  A 37-item questionnaire included seven (7) questions on socioeconomic, 16 questions related to nurse's knowledge, and 14 questions related to cancer treatment and the hospital facility.  A significant challenge was defined as a mean score of more than 3 in a Likert scale 5 points. RESULTS: Challenges included a shortage of nurses (inadequate numbers of skilled nurses in oncology and other wards with mean±sd score (4.73±0.58), lack of continuing education  on current trends in the management of cancer (4.03±0.45), and lack of oncology trained nursing experts for job mentoring (4.24±0.77). Others were managing patients facing chemotherapy related side-effects (3.06±2.12), high cost of treatment borne by cancer patients (4.41±0.68) and exorbitant hospital bills (4.72±0.48), non-availability of drugs (4.09±0.87) and institutional policy bottlenecks affecting subsidizing treatment costs (4.09±0.84). Cancer care affected mainly by inadequate and functional equipment (4.24±0.55), and with no staff remuneration (4.53± 0.85). CONCLUSION: Nurses' Perceived Challenges were related to professional, institutional, and those related to patient.

Perceived Barriers to Cervical Cancer Screening Uptake among Women of an Urban Community in South-Eastern Nigeria.

OBJECTIVE: This survey examined the barriers to cervical cancer screening uptake by adult women in Nnewi, a town located in southeast Nigeria. METHODS: In this descriptive survey, data were collected data from 379women aged between 21 and 65 years using the adapted version of the Health Belief Model Scale for Cervical Cancer and Pap smear test questionnaire. RESULTS: The major perceived barriers to the practice of cervical cancer screening were fear of the result (2.32±1.05), lack of knowledge of what pap smear is (2.32±0.90), and lack of information about when and where pap smear could be done (2.25±1.07). The logistic regression model showed that the following perceived barriers predicted uptake of cervical cancer screening (P< 0.05): time constraint (P = 0.001, OR= 3.368, CI=  1.455, 4.11); attitude of healthcare workers (P = 0.008, OR= 6.642; CI= 2.764, 18.196); knowledge of test frequency (P = 0.005, OR= 1.443; CI 0.946, 3.811); fear of result(P = 0.001, OR= 3.660, CI=0.679, 4.061); lack of information on when and where pap smear could be obtained (P = 0.010; OR= 6.732; CI= 2.286, 10.490); distance from test centre (P = 0.003; OR= 1.387; CI=0.126, 2.193); not knowing what it is for (P = 0.024, OR10.895, CI = 2.938, 14.401).

Perceptions of burden of caregiving by informal caregivers of cancer patients attending University of Calabar Teaching Hospital, Calabar, Nigeria.

INTRODUCTION: Cancer care is devastating to families. This research studied the informal caregivers' perceptions of burden of caregiving to cancer patients attending University of Calabar Teaching Hospital, Calabar. METHODS: The research adopted a cross-sectioned descriptive design and 210 caregivers providing care to advanced cancer patients were purposively selected. Data were collected using a researcher developed questionnaire and standardized Zarit Burden Interview scale (ZBIS). Data collected were analysed using descriptive and chi-square statistics with the help of SPSS 18.0 and PAS 19.0 softwares. RESULTS: The results indicated that the caregivers were in their youthful and active economic age, dominated by females, Christians, spouses, partners and parents. The burden levels experienced by the caregivers were as follows: severe (46.2%), moderate (36.2%) and trivial of no burden (17.6%). The forms of burden experienced were physical (43.4%), psychological (43.3%), financial (41.1%) and social (46.7%), quite frequently and nearly always. Psychological and social forms of burden had the highest weighted score of 228 in terms of magnitude of burden. The result further showed that there was a significant (P = 0.001) and inverse association between caregivers' burden and the care receivers' functional ability. The level of burden also increased significantly (P = 0.000) with the duration of care, while there was also a significant (P = 0.01) relationship between caregivers' experience of burden and their desire to continue caregiving. CONCLUSION: Caregiving role can be enhanced by provision of interventions such as formal education programme on cancer caregiving, oncology, home services along side with transmural care.

Attitudes of cancer patients in a university teaching hospital in southeast Nigeria on disclosure of cancer information.

OBJECTIVE: The attitudes of cancer patients from southeast Nigeria on disclosure of cancer information were studied to ascertain their information needs and what information was disclosed to them by their physicians. METHODS: Structured questionnaires were administered on all consenting cancer patients that were managed at the University of Nigeria Teaching Hospital Enugu between July and October 2011. The data collected were analysed with Statistical Package for Social Sciences version 18. RESULTS: Two hundred and forty-four patients participated in the study. Ninety-five per cent of the participants wanted to know the nature of their diagnosis, but 76.7% admitted to being informed of the diagnosis by their doctors. Nearly 54% of participants will like to be informed of a bad prognosis, but only 1.8% was informed. The word cancer was used to disclose the diagnosis to 69.4% of the patients, but 108 (44.3%) patients did not have any idea what cancer meant, 39.8% knew it as an incurable disease whereas 8.6% described it as a tumour or abnormal growth. Patient factors that significantly improved the disclosure of diagnostic information were education (p = 0.044) and site of the cancer (p = 0.043). CONCLUSIONS: Most of the surveyed cancer patients in University of Nigeria Teaching Hospital Enugu desire to know the truth about the diagnosis of their disease, and more than 50% of them desire to know when the disease becomes terminal and death is imminent. Physicians in southeast Nigeria should consider the information needs of the individual patients and tailor their disclosure practices to meet these individual needs.

Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

BACKGROUND: The use of Complementary and Alternative Medicine (CAM) by cancer patients is very common and varies between populations. The referenced English literature has no local study from Africa on this subject. This study was conducted to define the prevalence, pattern of use, and factors influencing the use of CAM by cancer patients at the University of Nigeria Teaching Hospital Enugu (UNTH-E), Nigeria METHOD: Face-to-face interviews using semi-structured questionnaire were used to determine the use of CAM by cancer patients. All consenting cancer patients were interviewed as they presented at the core surgical units of the UNTH- E, from June 2003 to September 2005. RESULTS: 160 patients were interviewed; 68 (42.5%) were males and 94 (57.5%) were females. Ages ranged from 13-86 years. Breast, urogenital system, gastrointestinal system, and soft tissue cancers predominated. One hundred and four patients (65.0%) have used CAM at some time during their current cancer illness; 56 (35.0%) patients have not used any form of CAM. There were more females than males among the non-CAM users. The use of CAM was not affected by age, marital status, level of education, religious affiliation, or socioeconomic status. The most frequently used CAMs were herbs (51.9%), faith/prayer healing (49.4%), aloe vera (23.1%), Forever Living Products (16.3%), medicinal tea (14.4%), and Blackstone (12.5%). Over 23% of those who used CAM were satisfied, but 68.3% were disappointed. Most users (67.3%) did not see any benefit from the CAM, but 25% could describe some specific benefits. More than 21% of users reported various unwanted effects. While 86.5% of CAM users will use orthodox medicine instead of CAM in the future, 9.6% will use the two together to help each other. Most users (79.8%) will not repeat CAM or recommend its use for cancer. The majority of patients (55.8%) did not mention their use of CAM to their doctors - mostly because the doctor did not ask. CONCLUSION: CAM use is common among cancer patients in Nigeria. Most users do not obtain the expected benefits, and adverse events are not uncommon. Every clinician in the field of oncology should ask his/her patients about the use of CAM; this knowledge will enable them to better counsel the patients.