Evaluating the Knowledge Change Before and After Continuing Cancer Education in Malawian Nurses.

Malawi has a high cancer incidence and mortality. Efforts to train and educate oncology nurses have been identified as an area of need. This study evaluates the educational needs of oncology nurses in Malawi and the effects of a virtual cancer education program on improving the knowledge of cancer epidemiology, treatment, and nursing care of common cancers among oncology nurses in Malawi. The educational programs consisted of four sessions at one-month intervals focused on Cancer Screening, Survivorship, Radiation Therapy, and Complementary and Alternative Therapies. A pretest-posttest design was used. Overall, there was an increase in knowledge at each session: cancer screening (47% vs 95%), survivorship (22% vs 100%), radiation therapy (66% vs 100%), and complementary and alternative therapies (63% vs 88%). Using virtual continuing education sessions is an effective tool to enhance the knowledge of oncology nurses in Malawi. These education sessions can serve as an example of how other Schools of Nursing and cancer centers in high-resource countries can collaborate with hospitals and Schools of Nursing in low- and middle-resource countries to support the advancement of oncology nursing knowledge, and ultimately, oncologic care.

Palliative Nursing in Africa: Scoping the Landscape of Evidence Focusing on Cancer Care.

AIM: The aim of this study was to describe the research output of African's nurses in the field of palliative care from January 1, 2012 to December 31, 2021. METHODS: A scoping review was conducted. The key words Africa and nursing in combination with palliative care, end of life, terminal care, hospice, and supportive care were used to search the databases Cumulative Index to Nursing and Allied Health Literature, PsychINFO, PubMed, Scopus, and Web of Science. Only studies authored by a nurse with an African affiliation focusing on issues related to advanced cancer were included. The data were captured onto an extraction sheet and analyzed by means of descriptive statistics and content analyses. RESULTS: Of the 522 articles identified, only 16 met the inclusion criteria. The work originated from eight African countries was primarily qualitative and focused on the family and caregivers. Pain was the only symptom investigated. CONCLUSIONS: Studies focusing on symptoms, psychosocial, spiritual, end of life care as well as studies testing nursing interventions are urgently needed. Interregional research could also assist with building the current evidence.

Kusankha Pamodzi: Health Care Decision-Making Preferences Among Patients with Cancer in Malawi.

Background: Oncology teams are encouraged to include patient preferences and goals of care in determining appropriate treatment courses. There are no existing data from Malawi exploring decision-making preferences among cancer patients. Methods: In the oncology clinic in Lilongwe, Malawi, 50 patients were surveyed for decision making. Results: Most participants (70%, n = 35) preferred to engage in shared decision making regarding cancer treatment. About half (52%, n = 24) did not feel that their medical team involved them in decision making and 64% (n = 32) felt that they were never or only sometimes listened to by the medical team. Nearly all (94%, n = 47) preferred to have their medical team inform them how likely treatments are to lead to cure. Conclusions: Shared decision making was the preferred mode of treatment decision making by the majority of the surveyed cancer patients in Malawi. Cancer patients in Malawi may have similar preferences to cancer patients in other low-resource settings regarding decision making and communication.

Systematic review of psychosocial interventions for adult cancer patients and their family caregivers in Sub-Saharan Africa.

Cancer is becoming a public health issue in the Sub-Saharan Africa (SSA). This systematic review aims to synthesise psychosocial interventions and their effects on the health outcomes of adult cancer patients and their family caregivers in SSA. We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included psychosocial interventions targeted adult cancer patients/survivors or their family caregivers in SSA. This review identified five psychosocial interventions from six studies that support adult cancer patients and their family caregivers in SSA. The interventions focused on providing informational, psycho-cognitive, and social support. Three interventions significantly improved quality of life outcomes for cancer patients and their caregivers. Significant gaps exist between the rapidly increasing cancer burdens and the limited psychosocial educational interventions supporting adult cancer patients and their families in SSA. The reviewed studies provide preliminary evidence on development and testing interventions that aim to improve patients' and caregivers' quality of life.

Psychosocial experiences of cancer survivors and their caregivers in sub-Saharan Africa: A synthesis of qualitative studies.

OBJECTIVE: To synthesize and examine current literature on survivorship experiences and psychosocial oncologic care programs of individuals affected by cancer in sub-Saharan Africa (SSA). METHODS: This was a systematic review guided by the PRISMA 2020 guidelines. We searched 6 databases for articles published from inception to 21 October 2021. Articles were appraised using the Johanna Briggs Institute's Checklist for Qualitative Research. For data synthesis, we used the World Health Organization (WHO) quality of life framework [WHOQOL] to organize experiences into 6 domains/themes. RESULTS: Twenty-five qualitative studies were included in the synthesis. Studies focused on psychosocial care of adults (>18 years) affected by cancer in SSA. The common WHOQOL domains were social relations, spirituality/religion/personal beliefs, and psychological. CONCLUSION: Findings echo need for individuals with cancer and their caregivers. Healthcare professionals are an essential resource for information and support services that can be tailored to individuals need. This synthesis highlighted caregiver stress and stressors from the community that could impact care of individuals with cancer. A holistic approach is needed that incorporates professional and social aspects of care.

Implementation and Evaluation of Educational Videos to Improve Cancer Knowledge and Patient Empowerment.

PURPOSE: Low health literacy is a leading cause of treatment abandonment among patients receiving cancer care at Kamuzu Central Hospital (KCH) in Malawi. METHODS: We developed cancer educational videos featuring Malawian providers and played them in the KCH oncology clinic. The videos addressed cancer-related topics, including disease biology, common myths, diagnostic procedures, treatment, side effects, and survivorship. After 6 months of implementation, we compared results from 50 pre- and postintervention surveys to assess change in cancer knowledge and care experience. RESULTS: Both pre- and postintervention cancer knowledge were good: a median of nine questions were answered correctly of 11 in both assessments. Despite the intervention, most continued to incorrectly identify cancer as an infection (pre: n = 26, 52%; post: n = 25, 50%; P = 1.0), although improvements were observed in patients' knowledge of correct actions for fever at home (pre: n = 38, 76%; post: n = 43, 86%; P = .31). Care experiences were overall good. Postintervention results indicate that more patients felt always listened to by their providers (pre: n = 18, 36%; post: n = 29, 58%; P < .01). However, we also noted a higher rate of patient dissatisfaction of care as more patients felt that they could not understand chemotherapy counseling (pre: n = 11, 22%; post: n = 22, 44%; P < .01). Assessments of video satisfaction indicate that patients found the videos very helpful in terms of understanding their disease (n = 47, 96%) and side effects (n = 48, 98%) and felt empowered to speak up with their providers (n = 46, 96%). CONCLUSION: Standardized education materials for patients that can be feasibly implemented throughout sub-Saharan Africa are urgently needed. Cancer educational videos are a low-cost way to educate and empower patients with cancer in resource-constrained settings although in-person discussions remain a crucial part of care.

Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies.

Guided by the World Health Organization quality of life (WHOQOL) framework, this systematic review aimed to examine evidence about the prevalence and severity of QOL-related health problems and their influencing factors in Sub-Saharan Africa (SSA). We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included quantitative descriptive studies that measured overall and subdomains of QOL as the outcome in adult patients/survivors with cancer in SSA. Twenty-six descriptive cross-sectional studies (27 papers) that were conducted since 1988 in different SSA countries among patients with various types of cancer met our inclusion criteria. We found inconsistencies in how the prevalence and severity of QOL-related health problems have been researched and reported across studies, which complicated comparing findings and drawing conclusions. The most common factors that influenced the overall and subdomains of QOL included coping; internal and external locus of control; symptoms and symptom management; and religious beliefs and religious care. Demographics (e.g., age and marital status), cancer-related factors (cancer stage and type of treatment), and social determinants of health (e.g., education, access to information and resources, financial distress, and urban vs rural residency) also impacted QOL and its subdomains. Our findings indicate the significant need for recognizing and managing QOL-related problems for cancer patients and caregivers in SSA. Research needs to use culturally adapted, standardized assessment tools and analysis approaches to better understand the QOL challenges this population faces. Comprehensive supportive care is needed to address the complex QOL issues in resource-limited SSA.

What is the Role of the Oncology Nurse Leader in Building Oncology Nursing Capacity in Malawi?

As someone who wanted to make others smile, I realized that nursing was the only profession that could help me achieve my purpose. The realization of my love of nursing unfolded when I entered the Kamuzu College of Nursing in 2008. As a nursing student, I wanted to provide excellent nursing care. In my third year of my BScN studies, I had a clinical home-based rotation in Lilongwe, Malawi, where I was introduced to chronically ill patients. I realized that this chronically ill population was the most neglected in Malawi, similar to populations in other sub-Saharan African countries. My exposure to home-based community care redirected my passion to this population. After graduating with my BScN, I worked in a hospital's intensive care unit for two years, where I gained advanced skills and experience in the care of critically ill patients. My interest in oncology nursing began when I cared for a pediatric patient with Burkitt lymphoma who had large masses on the head and died from nasal bleeding. I felt that I did not have the knowledge to care for this patient and felt defeated. From that experience, I desired more knowledge about cancer, which led me to oncology nursing.

Living with cancer of the head and neck: A qualitative inquiry into the experiences of South African patients.

OBJECTIVE: To describe the experiences of South African patients living with head and neck cancer. METHODS: We used a qualitative descriptive design and conducted unstructured interviews with 18 (n = 18) purposive selected participants. Data saturation determined the sample size. Qualitative content analysis was used to analyse the data. RESULTS: The majority of the sample were Black males; on average, 50.8 years (SD ± 13.6) old. Two themes and eight subthemes arose from the data. The themes were living with the consequences of the illness and treatment, and coping with a changed life. The lives the participants knew before becoming sick changed and became a living hell; pain was a major problem as was eating and for some, communicating. The participants were stigmatised, ridiculed and rejected which added to their suffering. Receiving support from family and friends and their faith in God assisted them to cope with their changed lives. CONCLUSION: Our study poses various challenges to clinical practice. Pain management is of the utmost importance; the nutritional status of these patients should be monitored and best practices in terms of management applied. Raising awareness of cancer and its complications could improve knowledge and decrease blame, stigmatisation and rejection and improve patient outcomes.