Knowledge of Nursing Students Regarding Management of Cancer-Related Fatigue at A University
Galukeni Kadhila1*, Faith Rosa-lee Tsanigab2 and Hernengaten Konjore3
1Masters of nursing Science, Post Graduate Diploma in Clinical nursing education, Bachelors of Nursing Science, University of Namibia, Namibia
2Bachelors of Nursing Science, University of Namibia, Namibia
3Post Graduate Diploma in Clinical nursing education, University of Namibia, Namibia
*Corresponding author
Joseph Galukeni Kadhila, Masters of nursing Science, Post Graduate Diploma in Clinical nursing education, Bachelors of Nursing Science University of Namibia, Namibia.
ABSTRACT
Cancer treatment comes with its plethora of side effects and fatigue is the most common one cancer related fatigue. Even though fatigue is one of the highest complaints in cancer patients undergoing treatment, it went overlook for a long time. The study aimed to analyse the knowledge among fourth-year nursing students regarding the management of cancer-related fatigue at a University, Khomas Region. The research used a non-experimental, descriptive, quantitative research approach with the use of a cross-sectional questionnaire. The sampling method used was simple random sampling, of participants that meet the inclusion criteria. The study population were made up of all the 4th year nursing students enrolled under bachelor’s degree at a University which amounts to approximately 73 research participants. The results demonstrated a good understanding on the knowledge of Cancer related fatigue. However, the study also demonstrated that the students’ level of knowledge regarding its management diminished in comparison. The findings of the study call for different strategies to be created to improve the knowledge of students on the management of CRF.
Keywords: Cancer-Related Fatigue, Knowledge, Management
Key Points
- Fatigue is one of the highest complaints in cancer patients undergoing treatment, it went overlook for a long time.
- Cancer has affected humans since the prehistoric times however, the prevalence has vastly increased since then as a result of genetic predisposition and an increase in the number of carcinogens exposed to the human body.
Introduction
Cancer is defined as a disease in which somatic cells grow uncontrollably and spreads to adjacent tissue and other parts of the body [1]. Cancer treatment comes with its plethora of side effects and fatigue is the most common one cancer related fatigue [2]. Even though fatigue is one of the highest complaints in cancer patients undergoing treatment, it went overlook for a long time. According to the cancer-related fatigue is defined as “a distressing, persistent, subjective feeling of physical, emotional, and/or cognitive exhaustion related to cancer or cancer treatment that is not linked to recent activity and interferes with usual functioning”. Fatigue is ranked as the most common side effect of cancer treatment with chemotherapy, radiotherapy, and many other types of treatments.
The statistics shows that cancer is one of the four major non-communicable diseases and the top 5 types of cancers the frequent the Namibian population among both sexes is listed in chronological order from the highest as; Breast cancer, Cervix uteri cancer, Prostate cancer, Kaposi sarcoma and finally Colorectal cancer [3]. The University of Namibia, School of Nursing aims to produce healthcare workers with the skillsets to identify, assess and manage community health problems in the most effective and most efficient way. Student nurses are well educated on holistic nursing care and the theories that proves its significance. However, judging by the syllabus, one of the most prominent by-products of cancer that even affect survivors, is disregarded.
Objectives
The objectives of the study were to describe the level of knowledge of fourth year student nurses at the University of Namibia.
Methods
The design for this study was a non-experimental, descriptive, quantitative research approach with the use of a cross-sectional questionnaire. The study population was 73 nursing students using random sampling from August to September 2023.The pilot test was conducted on 2 students.
Data Collection
The researcher designed a self-administered questionnaire that was divided into three sections: Section A providing geographical data for example age and sex. Section B Knowledge of regarding Cancer-related Fatigue as a phenomenon. Section C Knowledge on the Management of cancer - related fatigue. Data collection commenced as the ethical clearance was received from the School of Nursing and Public Health and written informed consent from the participants. Data was analysed using SPSS Version 26 and it was presented in tables and figures.
Ethical Considerations
The four principles required to guide research included, respect of persons, beneficence, non-maleficence and justice. Permission to carry out this study was obtained from the University of Namibia School of Nursing public health SoNEC 54/2023 and written informed consent from the participants.
Table 1 indicates the data gathered from the responses of the participants in the survey. The section primarily consists of true and false questions regarding the general knowledge regarding cancer related fatigue of fourth year nursing students from the University of Namibia, main campus. The total number of participants where 65.
Table 2. presents data collected on the knowledge of the management for CRF in the form of a Likert scale.
Discussion of findings
Demographic data
The demographic data of the study population was gathered to describe the participants of the study and find any common characteristics among the participants. The total number of participants were N=65. Upon data collection, it was estimated that a large majority of the participants who took part were female (90.8%) as opposed to the males only making up 9.2% of the entire study population. Furthermore, the study revealed that a large portion of the participants that took place in the study were from age 20-25 were n=56 and percentage of (86.2%) and the minorities were age 26-30 with a number of n=2 (3.1%), age 30-35 were n=4(6.2%), age 35-40 were n=2(3.1%) and lastly age 40+ were n=1(1.5%). Analysis on the highest level of qualification of the participants, majority being Grade 12 Certificate in secondary education were n=60 and a percentage of 93.8%. The minority being a certificate in tertiary education were n=3(4.7%) and diploma in tertiary education were n=1 (1.6%). The demographic data collected only centred around what held great significance to the findings of the focus study. The rest of the data collected focused of the topic of cancer related fatigue.
Knowledge of students regarding cancer related fatigue
The study analysed the knowledge of fourth year nursing students on the management of cancer related fatigue. The first section explored the student’s knowledge of cancer related fatigue’s nature. The responses to the first question under these sections explored whether the students could be correctly deduced a short description for cancer related fatigue from the given options. out of a total number of 65 respondents 35 of the participants answered the question correctly with a percentage of 53.8% that it occurs because of a disturbance in red blood cell production during cancer treatment. Meanwhile 22(33.8%) responded that it is the psychological effects of cancer with no physical effects, 7 (10.8%) answered that it is the same as normal Fatigue by those without core morbidities, and last 1(1.5%) mentioned that it does not exists. A little over a half of the population answered the question correctly related to previous literature it is predominantly linked to cancer induced and chemotherapy induced anaemia [4]. The other large subset of the population chose that CRF it is only the psychological effects of cancer with no physical effects. Even though literature does discuss it as having many psychological characteristics, the physical characteristics are just as prominent [5].
Upon analysing the students of whether a Low HB is associated with CRF, it was found that majority n=54 (83.1%) answered correctly that it is true, whereas n=11(16.9%) answered incorrectly that it is false. Previous studies found that there is a greater association between CRF and Anaemia [4].
The following question analysed whether cancer-related fatigue only affects patients that went through chemotherapy and n=40 (61.5%) answered correctly that this is false, whereas n=25 (38.5%) answered incorrectly. Expressed that CRF’s aetiology is primarily linked to anaemia usually occurring because of therapeutic cancer radiotherapy and chemotherapy also called chemotherapy-induced anaemia [6].
The following statement questioned whether cancer- related fatigue can have psychological results and lead to depression was stated where n=63 (96.9%) answered correctly according to Cleveland Clinic Medical professional (2021). The small percentage of 3.1% answered incorrectly.
Following that statement, “Cancer Related Fatigue does not affect one’s Quality of Life.” Was stated and, 9.2% (n=6) incorrectly responded that it was true, whereas 90.8% (n=59) correctly responded that it was false. When the respondents were analysed on whether medication can cause cancer related fatigue, 76.2% (n=48) correctly responded that it was true, and 23.8% (n=15) incorrectly responded that it was false. As discussed by medication such as vincristine, vinblastine, and cisplatin often cause cancer fatigue [7].
Moving on, the next variable assess the participants on whether post treatment Cancer Survivors are at high risk developing fatigue, 87.7% (n=57) correctly responded that it was true, however 12.3% (n=8) incorrectly responded that it was false. The last variable of the section questioned the participants on whether CRF can be prevented and 70.8% (n=46) incorrectly responded that it was true, however 29.2% (n=19) correctly responded that it was false.
In comparison to a 2015 study conducted on healthcare practitioners on CRF, they demonstrated that 15% of the participants had specialised education on this disease and 68% had some knowledge about the topic [8]. Another piece of literature these results can be compared to is a previous piece of research conducted on patients where the results shows that there is great need for healthcare practitioners to provide knowledge on this topic because more than half of the study participants (mainly elderly) have expressed that they are not well informed about this topic because a third of the study participants have expressed limited knowledge regarding this topic [9]. Even though the first question answered showed that approximately ½ of the students do lack knowledge on the description of CRF, the rest of the variables show good student knowledge regarding the phenomenon.
Knowledge on the management of Cancer Related Fatigue
The following section analysed the knowledge of students on the management of CRF with the use of a Likert scale to convey the respondent’s perceptions. A total of 65 participants responded to the statement “during each screening patients should also be screen for cancer related fatigue” and showed that their view. Where n=45(69.2%) strongly agreed and n=12 (18.5%) agreed. n=4 (6.2%) remained neutral meanwhile n=2(3.1%) disagreed and 2(3.1%) strongly disagreed. The majority participants agreed to this statement where correct according to literature that guidelines suggest screening for fatigue by clinical healthcare providers [10].
Next responses analysed knowledge on the statement “Cancer related fatigue can be treated according to its pathology and therefore extensive screening is required.” Where 55(84.6%) strongly agreed and 2 (3.1%), n =1 (1.5%) remained neutral meanwhile n=2 (3.1%) disagreed and n=5 (7.7%) strongly disagreed. Majority of respondents were correct.
The next variable shows the responses from the statement “A Patient complaining of severe fatigue that persists longer than 6 months and a low ward HB, should be managed as a case of cancer-related fatigue.” Where n=47(72.3%) strongly agreed and n=4 (6.2%). However, n=2 (3.1%) remained neutral meanwhile n=2 (3.1%) disagreed and n=10 (15.4%) strongly disagreed. A large portion of the respondents were correct.
The next variable shows that most of the respondents remained neutral and disagreed to the statement “Suspected Cancer related fatigue should only be managed by doctors.” Where n=4(6.2%) strongly agreed and n=8 (12.3%) agreed which was incorrect. N=22 (33.8%) remained neutral meanwhile n=22 (33.8%) disagreed and n=9 (13.8%) strongly disagreed. More than a half were incorrect because there are many different non-pharmaceutical ways of managing CR that can be recommended by other member of the multidisciplinary team [11].
The following variable shows half of the population definitively agreed to the statement “Patient education, proper nutrition and hydration, exercise, and energy conservation is necessary to empowering the patient to control the fatigue.” Where n=35(53.8%) strongly agreed and n=24(36.9%) agreed. n=5(7.7%) remained neutral meanwhile n=0 disagreed and n=1(1.5%) strongly disagreed. This shows that more than half of the respondents answered correctly.
The last variable shows the responses to the statement “Cancer itself causes Cancer-related fatigue.” Where n=32(49.2%) strongly agreed and n=25(38.5%) agreed. n=8(12.3%) remained neutral meanwhile n=0 disagreed overall. The last variable displays the responses to the statement “Cancer related Fatigue is more common in patients post chemotherapy than post radiation therapy.” Where n=11(16.9%) strongly agreed and n=17(26.2%) agreed which was correct. n=32(49.2%) remained neutral meanwhile n=5(7.7%) disagreed overall and 0 strongly disagreed.
The findings from this study demonstrated that students have a good understanding on the management of CRF, however students seem to lack knowledge of the role nurses play in the management of CRF, as approximately more than half of the respondents were misguided. This almost mirrors the findings of on the study conducted on healthcare practitioners because they demonstrated a limited knowledge of the management of CRF when it came to listing five interventions, 27% could list all five interventions (these are mostly according to discipline with occupational therapists listing the most interventions), while 28% could not list any interventions which are surprisingly mostly practitioners in acute care hospitals [8].
Conclusion
This study investigated the knowledge of 4rth year nursing students regarding cancer related fatigue. The results of the study were imperative in different perspectives the fourth-year nursing students demonstrated a excellent understanding on the knowledge of Cancer related fatigue. However, the study also demonstrated that the students’ level of knowledge regarding its management diminished in comparison. The findings of the study call for different strategies to be created to improve the knowledge of students on the management of CRF.
Author Contribution
Joseph Galukeni Kadhila was responsible for supervision, drafting, data analysis and editing of the manuscript. University of Namibia, Faith Rosa-lee Tsanigab was responsible data collection, data analysis, University of Namibia. Hernengaten Konjore was responsible for co- supervision.
Funding Information
No funding was received for this study.
Data Availability
Data may be available on request from the corresponding author Mr Joseph Galukeni Kadhila, University of Namibia.
Acknowledgement
We would like to thank all the students that availed themselves to take part in our study from the University of Namibia, Khomas region Namibia.
Conflict of Interest
The authors declared no conflict of interest.
Relevance for Clinical Practice
When considering the epidemiological significance of cancer related fatigue, one needs to understand the magnitude of the incidence of cancer itself.
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