Caring for cancer patients in acute cancer care settings: Voices of South African nurses.

Little is known about the experience of nurses in Africa caring for cancer patients. This study was undertaken to provide a straightforward description of the experiences of South African nurses caring for patients in acute cancer care settings. Purposive sampling selected 20 nurses with whom there were in-depth interviews. Most of the participants were female registered oncology nurses with more than five years' experience. Three themes were identified: defining the cancer nursing experience, the challenges experienced in caring for cancer patients, and challenges imposed by the healthcare system. Most of the participants believed they were called by God to care for cancer patients. However, the challenges they experienced led to guilt feelings and believing the care they provided was insufficient. They were subjected to workplace violence, missed the support from senior nursing management, and displayed signs of burnout. Addressing these challenges could limit their emotional distress and prevent burnout.

An Inquiry into Cancer-Related Knowledge, Understanding, and Health-Seeking Behavior of Men Living in South Africa.

In 2018, we conducted a survey among a convenience sample of men (n = 205) living in a resource-poor, semi-urban community in South Africa. We aimed to describe what they know about cancer by asking questions about cancer-related knowledge and understanding, and health-seeking behavior. We also investigated possible relationships between the variables. We used a researcher-administered questionnaire to collect the data and descriptive statistics and quantitative content analyses for the analysis. Chi-square was used to examine the relationships. The mean age of the sample was 35 years, and 49.8% (n = 102) attended 11 or 12 years of school. One-third (32.7%; n = 67) indicated they knew what cancer was, but only 28.8% (n = 59) gave an explanation: "very dangerous/a killer/worse than HIV" were the most common explanations. Only 24.9% (n = 51) were able to identify a possible warning sign, and "feeling very sick" was the most common. However, more than 60% considered six of the seven warning signs of cancer as serious. When suspecting they might have cancer, most (77%; n = 159) indicated they would tell the preferred person within 1 week, while 5.9% (n = 12) would tell "nobody." Although the majority (52.2%; n = 107) felt their partners and families motivated them to seek healthcare when sick, 28.3% (n = 58) needed permission to consult a professional. Educating the community about cancer in a culturally sensitive manner, irrespective of their educational level and perceived knowledge of cancer, could improve knowledge and understanding and lead to seeking healthcare timely.

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.

Experiences of young women who underwent female genital mutilation/cutting.

AIM AND OBJECTIVES: To describe the FGM/C experiences of young women living in Nigeria. BACKGROUND: Globally, several activities have been targeted at ending female genital mutilation/cutting (FGM/C). However, the practice is ongoing, especially in countries such as Nigeria, which is reported to be having a population boom. Therefore, there is a need to investigate the FGM/C experiences of young women in such countries so that efforts towards ending it can be accelerated using evidence-based, community-led interventions. DESIGN: A qualitative descriptive design. METHODS: The study took place in two states of south-eastern Nigeria with a high prevalence of FGM/C. The snowball sampling method was used to recruit 22 women, aged 20-40, who had undergone FGM/C. Participant's experiences were explored through semi-structured interviews, and the qualitative content analysis was used for data analysis. The consolidated checklist for reporting of qualitative studies guided the reporting of this study. FINDINGS: Three themes and seven subthemes emerged from the data. The themes were as follows: cultural issues, life as a circumcised woman and the future with FGM/C. Half of the participants could not recall their experiences on the day of their circumcision, as they were circumcised at infancy. However, those who were older when circumcised experienced it as a painful, traumatic experience forced upon them. Some of the participants experienced sexual and childbirth problems due to this procedure, and this was of great concern to them. CONCLUSION: Female genital mutilation/cutting was a traumatic experience forced on the participants. They felt helpless as they could not choose and had to do the "right thing." Despite the trauma and complications caused by the cutting, some still supported the continuation of the practice. RELEVANCE TO CLINICAL PRACTICE: Understanding the experiences of genitally mutilated women could assist healthcare practitioners in rendering quality, and contextualised services to these women.

Knowledge and Practices of Cervical Cancer and Its Prevention Among Malawian Women.

Malawi has the highest incidence of cervical cancer in the world. Due to various challenges the country faces in terms of cervical cancer control, women have a poor chance to survive this disease. The purpose of our study was to describe the knowledge and practices of cervical cancer and its screening as well as the educational preferences of women living in a rural community in the Chiradzulu District. We conducted a survey among women between the ages 30 and 45, used convenience sampling, a calculated sample size (n = 282) and structured interviews to collect the data. A questionnaire adapted from a previous study served as data collection instrument. The data were analysed in Microsoft Excel and chi-square (p < .05) was used to investigate the relationships between the variables. Content analyses analysed the open-ended questions. The mean age of the sample was 36.1 (SD ± 5.1) and the highest percentage (37.4%; n = 98) belonged to the Yao ethnic group. The majority attended primary school (66.0%; n = 173), were married (74.4%; n = 195) and depended on a small business as source of income (55.7%; n = 146). Most of the women (93.4%; n = 247) had heard of cervical cancer and the visual inspection with acetic acid (VIA) screening programme (67.9%; n = 178) but only 22.9% (n = 60) indicated they had been screened. Lack of knowledge of the screening programme was the most common reason for not being screened. Having a demonstration of the VIA procedure was the most popular educational method (92.0%; n = 241) which gives a fresh approach to educational programmes aimed at preventing cervical cancer.

The Outcomes of an Educational Program Involving Men as Motivators to Encourage Women to Be Screened for Cervical Cancer.

Cervical cancer is a major health problem in South Africa. Despite having a national, population-based screening program, screening coverage is as low as 13%. Based on the role men could play in increasing cervical cancer screening and the low level of knowledge, men living in the study setting had about this health issue, we developed and pilot tested an educational program aimed at empowering men to teach their female partners and family members about cervical cancer and motivate them to be screened. The study setting was Ward 23 in Muldersdrift, a semi-urban, resource poor area situated northeast of Johannesburg. We used an intervention research design to assess the outcomes of our educational program. The primary outcome was screening uptake, with knowledge the secondary outcome. Statistics and face-to-face and telephone interviews, guided by questionnaires, were used to collect the data which were analyzed by means of descriptive statistics and content analysis. A total of 120 men (n = 120) participated in the educational program and 100 (n = 100) completed the post-test questionnaire. Only 30 women (n = 30) reported for screening. The men's knowledge improved after the education program but did not guarantee that they would educate women about cervical cancer as only 55% (n = 66) indicated they taught a female family member or their partner. Cultural restrictions were the most common reason presented for not teaching women about this health issue. Ways of supporting men to overcome cultural barriers prohibiting them from discussing matters related to sexuality should be explored, before refining and replicating the intervention.

The Knowledge of South African Men Relating to Cervical Cancer and Cervical Cancer Screening.

Cervical cancer is the second most common cancer in South African women, but the most common cancer in Black women. Despite having a national cervical cancer screening programme, most women present with advanced disease. Men play a role in cervical cancer as the HPV, the major cause of cervical cancer, is sexually transmitted. The purpose of our study was to describe the knowledge men, living in Muldersdrift, had about cervical cancer, cervical cancer screening and the cervical cancer screening programme and how they preferred to be taught about these health issues. We used a survey design and convenience sampling to select 101 men older than 18 years (n = 101). A pretested self-developed questionnaire was used as the data collection instrument, and the data were analyzed using the SPSS version 22-computer program and quantitative content analyses. The Fischer's exact test measured associations between variables (p = 0.05). The ages of the sample (n = 101) ranged from 18 to 92 years; most were from the Zulu cultural group, unemployed and unmarried. The majority (66.3%, n = 67) had not heard of cervical cancer, the cervical cancer screening programme (60.4%, n = 61) or the Pap smear (67.3%, n = 68). Age and educational level did not influence having ever heard of these health issues. HPV infection was the most well-known risk factor, and the very late symptoms of cervical cancer were the least known. Most men preferred to be educated in a group, which provided a practical, feasible and cost effective way of educating men living in this community about these health issues.

Holding conversations with cancer patients about sexuality: Perspectives from Canadian and African healthcare professionals.

Cancer treatment can have a significant impact on an individual's sexuality. However, cancer survivors are reporting that very few healthcare professionals are talking with them about the topic. This work was undertaken to gain an increased understanding about the dialogue between cancer care professionals and cancer patients regarding the topic of sexuality. It was anticipated the effort would allow the identification of barriers that could limit dialogue between patients and healthcare providers, as well as offer insight regarding how to overcome such barriers in busy clinical settings. A Canadian sample of 34 healthcare professionals were interviewed and 27 African nurses engaged in a focus group discussion. A content analysis revealed similarities in terms of personal discomfort with the topic and feeling unprepared to discuss it with patients. There were notable differences between the two samples in terms of the barriers related to culture and tradition. African nurses reported significant cultural barriers, stigma and discrimination influencing conversations about sexuality with cancer patients in contrast to their Canadian counterparts.

The palliative chemotherapy decision and experiences of South African patients and their families.

AIMS: To describe what motivates cancer patients, treated at a private cancer care centre in Port Elizabeth, South Africa, to undergo palliative chemotherapy and how the patients and their families experienced this treatment. METHODS: A descriptive qualitative design was used. Researchers conducted 22 in-depth interviews with 11 purposively selected patients and 11 family members nominated by the patients. Qualitative content analysis was used to analyse the data. FINDINGS: The patient participants consisted of two males and nine females between the ages 40 and 79, who had been diagnosed with various cancers. The family members consisted of six husbands, two wives and three sons, with ages ranging from 20 to 79. Three themes arose from the patient data and three from the family data. CONCLUSION: Hope informed the palliative treatment decision. Despite being told that the chemotherapy would not cure them, patients hoped for additional time and even a cure. The families supported the patient's decision and shared their hopes. The family members were aware of the side effects their loved ones were experiencing, but still experienced the treatment as positive. Giving and receiving support was important and religion, the families and staff and fellow patients at the cancer care centre were identified as sources of support.

Promoting Early Detection of Breast Cancer and Care Strategies for Nigeria.

Breast cancer is the most common cancer in women particularly in developing countries like Nigeria, with high mortality, and economic costs. Worldwide, it is predicted that more than one million women are diagnosed with breast cancer, and more than 400,000 will die from the disease every year. A comparative integrative review of the literature from Nigeria and Canada showed that in Canada, there is positive association between wide spread education, early detection, the disease stage at diagnosis, and survival rates. In Nigeria, presentation with the advanced stage of the disease makes survival very low. The primary factors responsible for the late presentations are lack of awareness, misconceptions about breast cancer causes, and treatment outcomes. It is recommended that guidelines and policies about breast cancer early detection, care strategies, and ongoing management pathways be produced, disseminated, and adopted. The guidelines will assist practitioners and patients in making informed decisions and choices about the most appropriate health care for their specific clinical situations. The implementation of evidence-based guidelines will most likely help to improve care processes, the quality of clinical decisions and patient treatment outcome.

Suitability of quality-of-life outcome measures in palliative care in the South African setting.

OBJECTIVE: Quality of life (QoL) is a multidimensional, subjective, and highly individual phenomenon. The current study speaks to the QoL domains identified by palliative patients living in Africa. The need to identify these domains has been recognized but seemed to still be lacking. This study filled this knowledge gap by providing the domains and by giving directions in terms of the assessment of QoL in palliative patients living in resource-restricted communities in South Africa. METHOD: We followed a multi-method approach and conducted a literature review to identify and describe the multidimensional QoL instruments used in African palliative care. A secondary analysis design and open-coding method was employed to identify the domains influencing the QoL of palliative patients living in a resource-restricted South African community, after which we compared these domains to the domains assessed by the identified QoL instruments. RESULTS: We found that two multidimensional QoL of life instruments-the Missoula-Vitas Quality of Life Index (MVQoLI) and the Functional Assessments of Chronic Illness Therapy-Palliative Care (FACIT-Pal)-have been used in African palliative care and have identified various domains, grouped as four themes: physical concerns, psychosocial issues, financial restraints, and existential issues. The patient-identified QoL domains were to a great extent not assessed by the MVQoLI and FACIT-Pal. SIGNIFICANCE OF RESULTS: Our study highlights the complexity of QoL and QoL assessment. A more accurate representation of the QoL of palliative patients living in resource-restricted communities might be obtained by using individualized measures or exploring what QoL means to these patients and selecting QoL instruments accordingly.

The influence of chronic pain on the daily lives of underprivileged South Africans.

Chronic pain is a major public health problem that changes lives and has devastating consequences for the person experiencing the pain, the family, and society. Living with chronic pain is not easy, especially in South Africa where the public health care system, serving 80% of the population, fails people suffering from chronic pain. The purpose of the study was to explore how experiencing chronic pain influenced the daily lives of underprivileged patients receiving nursing care at the palliative care clinic serving a resource-poor community in Tshwane, South Africa. A qualitative descriptive phenomenologic design was selected for the study. Nine purposively selected community members, registered as patients at the palliative care clinic and who suffered chronic pain, participated in the study. In-depth interviews were conducted and Tesch's coding process was used to analyze the data. Data gathering and analysis were done concurrently to determine data saturation. Four themes arose from the data: pain as a multidimensional experience, the influence of pain on physical activities, the psychosocial influence of pain, and the influence of pain on spirituality. Participants' experience of pain tells of severe suffering that hindered them in performing activities of daily living. Participants were confronted with total pain and were caught in a vicious circle where pain was responsible for severe suffering and their suffering added to their pain. However, strong religious beliefs improved pain and gave hope for the future.

"Not a nice experience, not at all": Underprivileged women's experiences of being confronted with cervical cancer.

OBJECTIVE: Research on women's experiences of cervical cancer as a health problem focuses primarily on cervical screening, while their experiences of cervical cancer as a disease seem to be underresearched. This study addresses this understudied area and aims to yield insight into the experiences of underprivileged women confronted with this disease. METHOD: Our study was qualitative, exploratory, and contextual with descriptive and interpretive elements. The context of the study was a radiation oncology department at an academic hospital in the Gauteng Province of South Africa. The target population was all patients diagnosed with cervical cancer referred for treatment at the specific hospital. Convenience sampling selected participants typical of the population. Nineteen open-ended unstructured interviews were conducted after demographic data were collected. One question was posed: "Please tell me what made you think there was something wrong with you?" Thematic analyses were used to analyze the data. RESULTS: The average age of participants was 47.2 years, with a youngest participant of 29 and oldest of 70. Three themes arose from the data: experiencing the symptoms of cervical cancer, hearing the bad news, and what remained unsaid. SIGNIFICANCE OF RESULTS: Being confronted with cervical cancer is a traumatic experience. Women suffer unexplained, severe, humiliating vaginal bleeding and unrelieved pain. They have to face a dual healthcare system: on the one hand, unaffordable effective private healthcare and, on the other, the free-of-cost public healthcare that failed them. The bad news of their cervical cancer is most commonly broken in a kind and sympathetic manner, yet misunderstandings and a need for additional information prevail after the bad news conversation. Having to inform their families of their cancer adds to their suffering.

Zambian women's experiences and understanding of cervical cancer: a qualitative study.

OBJECTIVE: Cervical cancer is the most common cancer in Zambian women, and approximately 28% of all patients with cancer seen at the Cancer Diseases Hospital in Lusaka experience this disease. Our objective was to gain insight into the knowledge, understanding, and experiences of women treated for cervical cancer at the specific hospital. METHODS: We selected a qualitative research design and descriptive phenomenological approach for the study. Twenty-one (n = 21) semistructured interviews directed by an interview schedule were conducted. We used Patton's open coding steps and a template analyses style guided by the 4 themes of the interview schedule to analyze the data. RESULTS: Most participants indicated that they did not know and understand anything of cervical cancer. They believed they were bewitched and consulted traditional healers and used traditional medicine. Most described that they experienced symptoms for extended periods of time before they were diagnosed. They described how the offensive vaginal bleeding and watery discharge they experienced led to isolation, rejection, and humiliation. The participants said they did not understand how they would be treated and treatment was described as a terrible experience. CONCLUSIONS: The women's lived experiences of cervical cancer tell of severe suffering. They knew and understood very little about this disease. Their suffering became so unbearable that some wanted to end their lives. They were subjected to the opinions of others who knew equally as little but were quite willing to speak out, judge, and reject. Most battled through the treatment and the distressing adverse effects because it was their only hope to become better. RECOMMENDATIONS: Zambian women must be empowered with knowledge and skills to protect themselves against cervical cancer. Suggestions for improving outcomes include changing high-risk behavior, taking advantage of screening opportunities, recognizing the signs of cervical cancer, and seeking health care without delay.

The experience of cancer pain in South African patients.

BACKGROUND: Most people with cancer experience pain caused by the disease and treatment. AIMS: To describe the experience of cancer pain of South African patients. METHODS: A qualitative descriptive design was used; 20 (n=20) participants were purposively selected and in-depth interviews were conducted. Inductive content analysis was used to analyse the data. FINDINGS: Two themes and five subthemes were identified. The themes were pain as a unique multi-dimensional experience, and that the unmet needs of the patient can influence their experience of pain. CONCLUSION: The participants experienced total pain. Emotional pain, enhanced by loneliness and unmet information needs was experienced, and this was felt by participants as the worst kind of pain. Pain was mediated by means of medication that did not work well for all, support, compassionate care and hope that God would cure them and take the pain away. RECOMMENDATION: A person-centred approach to pain management is needed, especially in diverse countries, such as South Africa, to better understand the complexity and influence of culture, language and education on the pain experience and to guide individual pain management.

The management of HIV- and AIDS-related pain in a primary health clinic in Tshwane, South Africa.

Pain has been recognized as an important, highly prevalent, and debilitating symptom of HIV and AIDS. In South Africa, many people living with HIV and AIDS utilize primary health clinics for pain management. Primary health clinics are nurse led and face a variety of challenges pertaining to pain management. The purpose of this study was to explore if HIV and AIDS pain is effectively managed in a primary health clinic in Tshwane, South Africa. The study aimed to explore the level and characteristics of HIV- and AIDS-related pain, the pain-related experiences of patients and if pain was managed according to the applicable guidelines of the Department of Health. A quantitative survey was conducted. The target population was HIV and AIDS patients who had been using the primary health clinic for chronic pain management. The sampling method was convenience (n = 500). Data were gathered by means of structured interviews and structured observation. The data were analyzed using the SSPS 15 program and open coding. The study provided evidence that HIV- and AIDS-related pain is not managed effectively. Despite repeated visits to the primary health clinic, the overwhelming majority of patients still experienced pain. Nurses added to the suffering, because they lacked knowledge of pain and pain management. It is recommended that nurses practicing in primary health clinics should be trained and supervised to effectively manage the pain of people living with HIV and AIDS.

Quality of life from the perspective of the palliative care patient in a resource-poor community in South Africa.

OBJECTIVE: Quality of life is an ill-defined term, as it means different things to different people. Quality of life has been well researched, especially with respect to people with cancer, but not necessarily from the perspective of the patient, and also, not in Third World, resource-poor countries. The objective of this study was to explore quality of life from the perspective of palliative care patients managed at a palliative care clinic serving a resource-poor community in Tshwane, South Africa. METHOD: An exploratory, qualitative phenomenological study was conducted. The target population for this study was all patients managed at a palliative care clinic serving a resource-poor community in Tshwane. Self-report data were gathered by means of in-depth interviews. The data were analyzed using a template analysis style as well as content analysis using open coding. Data analysis was done concurrently with data gathering. Data saturation was reached after 10 interviews (n = 10). RESULTS: Three themes arose from the data: factors that had a positive influence on quality of life, factors that had a negative influence on quality of life, and experience of quality of life. Work played the most important role in quality of life whereas only one participant linked symptom control with quality of life. Experiencing symptoms, rejection, and stigmatization had a negative influence on quality of life. Friends and religion played a significant role and added to quality of life. SIGNIFICANCE OF RESULTS: Life was a daily struggle for survival. Poverty was so overwhelming that quality of life was primarily measured in terms of the ability to buy food and other basic commodities.

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.