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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 3  |  Page : 195-205

Effect of palliative care program on nurses’ performance regarding prostate cancer and patients’ outcomes


Department of Medical Surgical Nursing, Faculty of Nursing, Zagazig University, Sharkia, Egypt

Date of Submission16-Apr-2020
Date of Decision30-Apr-2020
Date of Acceptance04-May-2020
Date of Web Publication20-Aug-2020

Correspondence Address:
Eman A Metwaly
Department of Medical Surgical Nursing, Faculty of Nursing, Zagazig University, 44519
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_13_20

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  Abstract 


Background Patients with chronic illnesses may experience extreme symptoms, including physical, spiritual, and psychosocial effects. Preventing and managing these symptoms while optimizing the quality of life throughout the dying process is the goal of palliative care.
Aim To evaluate the effect of palliative care program on nurses’ performance regarding prostate cancer and patient’s outcomes.
Sample and methods: research design A pretest/posttest quasi-experimental design was used to achieve the aim of the study.
Setting The study was conducted in the Oncology and Urology Departments at Zagazig University Hospital, Sharkia, Egypt.
Patients A purposive sample of 30 nurses and 30 patients had been selected.
Tools of data collection Four tools were used: a structured interviewing questionnaire for nurses, observational checklists for palliative care, a structured interview questionnaire for patients, and symptom index.
Results The results of the present study showed that 83% of studied nurses had satisfactory level of knowledge in the postprogram phase. Moreover, 83.3% of studied nurses had satisfactory level of practice after the program implementation. There was improvement in patients’ compliance regarding nutrition, medication, and lifestyle after applying the palliative care program, with mean±SD of 9.1±1.71, 12.1±2.5, and 10.3±3.4, respectively. Moreover, 80% of the studied patients had decreased symptoms after the program, though the decrement was not significant.
Conclusion In light of the current study results, it can be concluded that the palliative care program had a positive effect on improving nurses’ knowledge and practice, which reflected then on improving patients’ outcomes.
Recommendation In-service training for newly recruited nurses will help to update their knowledge and improve their practice.

Keywords: nurses’ performance, palliative care, prostate cancer


How to cite this article:
Metwaly EA, Hamad AH. Effect of palliative care program on nurses’ performance regarding prostate cancer and patients’ outcomes. Egypt Nurs J 2019;16:195-205

How to cite this URL:
Metwaly EA, Hamad AH. Effect of palliative care program on nurses’ performance regarding prostate cancer and patients’ outcomes. Egypt Nurs J [serial online] 2019 [cited 2020 Sep 30];16:195-205. Available from: http://www.enj.eg.net/text.asp?2019/16/3/195/292491




  Introduction Top


Prostate cancer occurs when a normal prostate cell begins to grow out of control. In many cases, prostate cancer is a slow-growing cancer that does not progress outside of the prostate gland before the time of diagnosis (Adamu et al., 2018). Prostate cancer cells are more likely to divide and spread faster from the prostate to other regions of the body. Often, prostate cancer spreads first to tissues that are near the prostate, including the seminal vesicles and nearby lymph nodes (Shamieh and Hui, 2015).

On the contrary, metastatic prostate cancer is a life-threatening illness, hence a palliative care approach may be beneficial to this group. Recently, new treatment modalities have been developed for men with metastatic prostate cancer, but the possibility to improve life should also be balanced against the men’s quality of life, particularly in the presence of adverse effects (Holm et al., 2018).

Dietary and lifestyle modifications should form a part of effective adverse effect management, as keeping a healthy weight can help manage or reduce some of the adverse effects of treatments, such as urinary problems after surgery (Huri et al., 2016). Moreover, men with a healthy weight are more likely to find medical treatments for erectile dysfunction effective, and some dietary modifications may help with gastrointestinal adverse effects such as diarrhea (Henson et al., 2013).

Patients with chronic illness may experience extreme symptoms, including physical, spiritual, and psychosocial effects. Preventing and managing these symptoms while optimizing the quality of life throughout the dying process is the goal of palliative care (Schroeder and Lorenz, 2018). Factors important to seriously ill patients include adequately controlling pain and other symptoms, achieving a sense of self-control, finding meaning in life, and relieving the care burdens of family and loved ones while strengthening and completing those same relationships (Rome et al., 2011). Nurses are a crucial component of palliative care teams. Overall, the need for palliative care has increased significantly (Callahan et al., 2011).

In concordance with the WHO definition of palliative care, palliative nurses provide nursing care to patients (e.g. symptom, pain, and wound management) and their families (e.g. psychological support and information provision), with the aim of improving quality of life and easing suffering (Sekse et al., 2018). Palliative care nurses work in the inpatient palliative care unit, which mainly serves patients who are at the end of life, or in the outpatient palliative care clinic (Omran and Obeidat, 2015).

Nurses are the largest workforce in health care globally and in a strategic position to influence the quality of palliative care delivery throughout the course of illness (International Society of Nurses in Cancer Care, 2015). They have a critical role in reducing the burden of suffering for individuals who are struggling with the effect of illness and who are dying owing to the disease. Actually, the role of nursing has been, and continues to be integral to the delivery of palliative care (Schmidlin and Oliver, 2015). When individuals who are living with, or dying owing to, life-limiting illnesses have access to nurses who can provide knowledgeable and compassionate care, definitely, the burden of suffering will be reduced and the quality of living and dying will be improved (Fitch et al., 2015). On the contrary, the lack of training and awareness of palliative care among health professionals constitutes a major barrier to the improvement of care (Ragnhild and Tveit, 2018). Therefore, the aim of the current study was to evaluate the effect of palliative care program on nurses’ performance regarding prostate cancer and patients’ outcomes.


  Significance of the study Top


Globally, there is an increased burden of chronic serious illnesses, which result in deterioration of quality of life for patient, medication adherence, inability to work, out of pocket expenses, and a high toll on caregivers. All of these changes increase the global needs for palliative care services (Hajata and Steinb, 2018).

Previous research studies have clarified that there is a lack of research in palliative clinical practice. Actually, the WHO (2015) identified lack of palliative care education as a major barrier to provide safe and optimal palliative care services. This lack prompted initiatives to recommend the need for palliative care as a requirement for nursing care and training (Balicas, 2018). Hopefully, the results of this study might establish evidence-based data that may be useful for nursing and other health care professionals’ practice and research. Moreover, the findings of this research may help in optimizing the quality of service provided to this group of patients, which will be reflected positively on the quality of patient’s care, prevent complications that affect the length of hospital stay, mortality rate, the patient’s outcomes, patient’s recovery, and hospital cost. Moreover, it is expected that this effort will generate attention and motivation for further research studies in this area.


  Aim Top


The aim of this study was to evaluate the effect of palliative care program on nurses’ performance regarding prostate cancer and patients’ outcomes.

Objectives

The study was conducted with the following objectives:
  1. Assess the most common health problems for the patient with prostate cancer.
  2. Assess nurses’ knowledge and practice regarding palliative care for patients with prostate cancer.
  3. Design and implement palliative care program for nurses based on nurses’ and patients’ actual needs.
  4. Evaluate the effect of palliative care program on nurse’s knowledge, practice, and patients’ outcomes.


Research hypothesis

  1. The palliative care program will have a positive effect on nurses’ knowledge and practice regarding care for patient with prostate cancer.
  2. The palliative care program will improve the outcomes of patients with prostate cancer.



  Patients and methods Top


Design

Pretest/posttest quasi-experimental design was used to achieve the aim of the study.

Setting

The study was conducted in the Oncology and Urology Departments at Zagazig University Hospital.

Sample

Regarding nurses, a purposive sample of 30 nurses was recruited. Nurses included in this study were performing actual patient care, had different educational levels and years of experience, and willing to participate in the study. Nurses who had less than 1 year of experience in the Oncology and Urology Departments were excluded from the sample.

Regarding patients, a purposive sample of 30 patients had been selected from the previously mentioned study settings. The patients involved in this study were able to communicate verbally and agreed to participate.

Tools for data collection

Four tools were used by the researchers to collect the data:
  1. Tool 1: a structured interviewing questionnaire for nurses: designed by the researchers after reviewing related literature (Huriet al., 2015) to assess nurses’ knowledge regarding palliative care for patient with prostate cancer. The questionnaire covered four parts as the following:
    1. Part 1: demographic characteristics of the studied nurses: it included seven close-ended questions about age, sex, marital status, qualifications, years of experiences, and training courses.
    2. Part 2: nurses’ knowledge regarding prostatic gland: it included four multiple-choice questions about anatomy of the prostate gland, function, location, and diseases of prostate.
    3. Part 3: nurses’ knowledge regarding prostatic cancer: it consisted of nine multiple-choice questions about definition of prostate cancer, risk factors, signs and symptoms, diagnosis, treatment and adverse effects of treatments, and complications.
    4. Part 4: nurses’ knowledge about palliative care for patient with prostate cancer: it consisted of 12 multiple-choice questions about definition of palliative care, purpose, the given time, palliative care team, and methods of relieving symptoms such as loss of appetite, constipation, mouth dryness, coughing, bone ache, anxiety, and sleep disturbances.
  2. Scoring system for structured interviewing questionnaire for nurses: each question is scored ‘0’ for the incorrect answers or do not know and ‘one’ for the correct answers, and these points are counted for each nurse. The total score was calculated for each nurse. The nurses’ general knowledge is classified into satisfactory if the score more than or equal to 60% from the maximum score or unsatisfactory knowledge if it is less than 60%.
  3. Tool 2: observational checklists for palliative care: it was adapted from Perry and Potter (2010) and Bullocket al.(2012) and modified by the researchers to assess nurses’ practice regarding palliative care before and after the program. It contained four checklists for the most common health problems for patients with prostate cancer.
    1. Checklist for dyspnea: it contained 18 items to assess nurse’s practice about dyspnea.
    2. Checklist for gastrointestinal symptoms: it contained 10 items to assess nurse’s practice about gastrointestinal tract symptoms.Checklist for fatigue: it contained 12 items to assess nurse’s practice about fatigue.
    3. Checklist about pruritus: it contained 10 items to assess nurse’s practice about purities.
  4. Scoring system for nurse observational checklist for palliative care: the items observed to be done were scored as ‘1,’ and the items were not done as ‘0.’ For each area, the scores of the items were summed up and the total divided by the number of the items, giving a mean score of this part. These scores were converted into a percent score. The practice was considered adequate if the percent score was 60% or more and inadequate if less than 60%.
  5. Tool 3: a structured interview questionnaire for patients: it was designed by the researchers after reviewing related literature (Sanfordet al., 2013) covered the following three parts:
    1. Part 1: sociodemographic characteristics for patients: it contained seven close-ended questions about age, marital status, educational level, job, income, financial support for treatment, smoking history, and previous experience with palliative care.
    2. Part 2: patient and family history, and risk factors for prostate cancer: it contained 11 questions about medical diagnosis, duration, comorbidities, cancer stage, diagnostic tests, exercises, and previous family history of cancer.
    3. Part 3: patient compliance with therapeutic regimen: it consisted of three parts about patient compliance with nutrition, medication, and lifestyle modification. Every item was answered by never (1), sometime (2), or always (3).
    4. Tool 4: symptoms assessment scale of patients with prostate cancer: it was adopted from Weisbordet al.(2004) to assess the common and severity of symptoms in patients with prostate cancer. It contained 30 questions. Enrolled patients were asked to report the presence (yes/no) of each symptom at any time during the previous 7 days using a five-point Likert scale (1=not at all to 5=very much).


Content validity and reliability

Once the tools of the data collection were prepared, their face validity and content validity were ascertained by a panel of five experts, that is, three professors from the Faculty of Nursing, Zagazig University, and two professors of Urology and Oncology Department from Faculty of Medicine, Zagazig University, who revised the tools for clarity, relevance, applicability, comprehensiveness, and ease of implementation. The agreement percentage was between 80 and 100%. In light of their assessments, minor modifications were applied. The observational checklists showed reliability, with a Cronbach’s α coefficient (r) of 0.97.

Description of palliative care program

Procedure

The study was conducted in four phases: preparatory phase, planning phase, implementation phase, and evaluation phase.
  1. The preparatory phase:

    The researchers reviewed the related materials and literature extensively. The detected needs, requirements, and deficiencies were translated to aims and objectives of the palliative program. Teaching materials were prepared as audiovisual materials and handouts.
  2. Planning phase:

    Palliative care program in form of booklet was developed and designed in Arabic language by the researchers based on the opinion of a panel of experts and related literature.
  3. Implementation and evaluation phase:
    1. Selection of patients, the collection of data, and the implementation of the palliative care program lasted over a period of 10 months, starting from March 2019 to December 2019, which was classified as follows: 2 months as pretest period (from March 2019 to April 2019), 6 months for implementation the program (from May 2019 to October 2019), and 2 months as posttest period.
    2. The researchers introduced themselves and explained the purpose of the study to the patients. The researchers assured that the data collected and information would be confidential and used only to improve their knowledge. The data were collected by the researchers using simplified Arabic language.
    3. The program consisted of 19 sessions: one session to identify the objective and the importance of the program. Six sessions were theoretical, and 12 were practical. Each group interview took ∼30 min in each theoretical session and 45 min in each practical session. The study patients were grouped (4–5), and the researchers interviewed study patients at the morning and afternoon shift every day.


Palliative care program (booklet) consisted of two parts

First part was the theoretical part: it covered the following: anatomy of prostate the gland, location and function, prostate cancer, risk factors of prostate cancer, stages of cancer, symptoms, diagnosis, treatment, surgery, adverse effects of all types of treatment (radiation therapy, hormonal, chemotherapy, cold therapy, biological therapy, and surgery), how to relieve these adverse effects, definition of palliative care, team of palliative care, and aspects of palliative care.

Second part was the practical part: it covered the following: the care of dyspnea, coughing, difficult of swallowing, chronic fatigue, loss of appetite, mouth dryness, nausea and vomiting, abdominal distention, constipation, itching, anxiety, and depression; Kegel’s exercises; relaxation techniques such as deep breathing exercises, muscles relaxation of all the body, and mental relaxation; dietary managements and weight reduction; and stop smoking.

Evaluation phase: each nurse and patient in the study was evaluated two times using the same data collection tools: one before the palliative care program (pretest) and second occurred 1 month after completion of the palliative care program (posttest).

Pilot study

A pilot study was carried out on five nurses and five patients within the selected criteria to test the tools for clarity, relevance, comprehensiveness, understanding, applicability and ease for implementation. Those who shared in the pilot study were not excluded from the main study sample because there were no changes in the study tools.

Administrative design

An official permission was granted by the Research Ethics Committee at the Faculty of Nursing and by the director of Zagazig University Hospital before conducting the study. Additional oral consent was taken from the nurses and patients who participated in the study after explaining its purpose.

Ethical considerations

All ethical issues were taken into consideration during all phases of the study. The ethical research considerations in this study included the following: the research approval was obtained before the program implementation, the objectives and the aims of the study were explained to the participants, the researcher confirmed the anonymity and confidentiality of patients, and patients were allowed to choose to participate or not and had the right to withdraw from the study at any time without penalty.

Statistical analysis

All data were collected, tabulated, and statistically analyzed using SPSS 20.0 for windows (2011; SPSS Inc., Chicago, Illinois, USA). Quantitative data were expressed as the mean±SD and range, and qualitative data were expressed as absolute frequencies (number) and relative frequencies (percentage). Moreover, paired t-test was used to compare between two dependent groups having normally distributed variables. Wilcoxon signed ranks test was used to compare between two dependent groups having non-normally distributed variables. The Pearson correlation coefficient was used to measure the strength of a linear association between various study variables, where the value r=1 means a perfect positive correlation and the value r=−1 means a perfect negative correlation. All tests were two sided. P value less than 0.05 was considered statistically significant, P value less than 0.001 was considered highly statistically significant, and P value more than or equal to 0.05 was considered statistically insignificant.


  Results Top


[Table 1] shows that 66.7% of the studied nurses had age more than 30 years, with mean±SD of 38.8±12.4. Moreover, 90% of them were females and 46.7% of them were diploma nurses. Overall, 66.7% had more than 5 years of experience, with mean±SD of 15.22±11.8 years. In addition, 83.3% of them were married and 80% had not received any training courses about palliative care.
Table 1 Frequency distribution of the nurses according to their sociodemographic characteristics (N=30)

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[Table 2] indicates that 90% of the studied nurses had unsatisfactory level of knowledge in preprogram phase, whereas 83.3% of them had satisfactory level of knowledge in postprogram phase, with mean±SD increased from 7.36±4.5 to 17.5±6, with highly statistical significant difference (P<0.001).
Table 2 Total nurses’ level of knowledge regarding palliative care before and after program (N=30)

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[Table 3] clarifies that 83.3% of the studied nurses had total satisfactory level of practice after the program. However, 83.3% of studied nurses had satisfactory level of practice regarding management of breathing difficulties and gastrointestinal symptoms after the program. On the contrary, 76.7% of studied nurses had satisfactory level of practice regarding management of fatigue and 80.0% of them had satisfactory level of practice regarding management of itching after the program, with highly statistical significant difference (P<0.0001).
Table 3 Nurses’ level of practice regarding palliative care before and after program (N=30)

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[Table 4] reveals that there was a strong positive correlation between total knowledge score and total practice score after the program, with highly statistically significant difference (P=0.0001).
Table 4 Correlation between total knowledge score and total practice score after program

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[Table 5] shows that 50% of the studied patients were aged more than 60 years old and 50% of them had age less than 60 years, with mean±SD 60±10.2. The table also shows that 56.7% of studied patients worked, 40% of them had intermediate level of education, 80% were married, 53.3% smokers, and 96.7% did not perform any type of exercise.
Table 5 Frequency distribution of sociodemographic characteristics of the studied patients (N=30)

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[Table 6] shows that the studied patients had disease duration between 2 and 60 months, with mean±SD of 14.3±16.6. Moreover, 83.3% of them had comorbidities, and 50% were treated with more than one line of treatment. Moreover, 70% had no family history of cancer, and all patients did not receive counseling about palliative treatment.
Table 6 Frequency distribution of medical history of the studied patients with prostate cancer (N=30)

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[Figure 1] displays that improvement in patient’s compliance regarding nutrition, medication, and lifestyle after applying the palliative care program than before with mean±SD 9.1±1.71, 12.1±2.5, 10.3±3.4 with highly statistical significant difference (P<0.001).
Figure 1 Patients’ compliance regarding therapeutic regimen before and after program (N=30).

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[Figure 2] shows that 80% of the studied patients had decreased symptoms after program, though the decrement was not significant.
Figure 2 Symptom assessment for patients with prostate cancer before and after program.

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  Discussion Top


The result of the current study illustrated that about two-thirds of the studied nurses had age more than 33 years. Moreover, most of them were females, and the majority of them were married. This was in agreement with Alshaikh et al. (2015), who mentioned in their thesis entitled ‘Nurses’ knowledge about palliative care in an intensive care unit in Saudi Arabia’ that two-thirds of the participants were females. Results are in the same line with Morsy et al. (2014), who revealed in the study entitled ‘Nurses’ knowledge and practices about palliative care among cancer patient in a University Hospital, Faculty of Nursing, Cairo University, Egypt’ that the majority of the studied sample was younger adult, but in contrary to Al Qadire (2014) who reported in the thesis entitled ‘Knowledge about palliative care: a cross-sectional survey’ in Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan, that more than half of the studied nurses had age less than 30 years.

The results of the present study showed that less than half of the studied nurses had diploma degree in nursing, and more than two-thirds of them had more than 5 years of experience. This result is in agreement with Morsy et al. (2014), who revealed that approximately half of the studied sample had more than 10 years of experience in working with patients with cancer, but contrary to Al Qadire (2014), who revealed that approximately three-quarters of the participants had a bachelor’s degree as the highest education level, and approximately one-third of them had less than 5 years of clinical experience.

In the current study, most studied nurses did not receive any training courses about palliative care. This finding was supported by Behr (2014), who illustrated in the thesis entitled ‘Evaluation of impact of end-of-life nursing education consortium (Elnec) education on registered nurses, doctorate degree of nursing practice, Rueckert-Hartman College for Health Professions, Regis University, Denver, USA’ that none of the participants reported previous work experience on a designated palliative care unit or service.

Regarding nurses’ level of knowledge, the present study demonstrated that most of the studied nurses had unsatisfactory level of knowledge in preprogram phase. This may be owing to the fact that palliative care is not well integrated within the health care system and is based on the efforts of individuals rather than health care policy. This finding agreed with Knapp et al. (2009) and Ronaldson et al. (2008), who reported that nurses had insufficient knowledge regarding the principles and practice of palliative care. This finding was in the same line with Prem et al. (2012), who illustrated that nurses had poor knowledge of palliative care principles, with the worst scores on psychiatric, dyspnea, and gastrointestinal problems subscales, correspondingly, and in line with Alshaikh et al. (2015), who mentioned that nurses had insufficient knowledge of palliative care and how to apply it in ICU setting.

The results of the current study revealed that most studied nurses had satisfactory level of knowledge in postprogram phase, with highly statistically significant difference. This explained that better knowledge about palliative care is associated with a more positive attitude by nurses and with communication skills, empathy, and pain management, and that education in palliative care is essential to improve nurses’ knowledge and practice. This finding was supported by Kim et al. (2011) who reported that there was a significant positive effect of educational courses on palliative care for nurses and other health care providers. This is similar to Behr (2014), who mentioned that there was a statistically significant difference in the postintervention and preintervention scores.

Regarding nurses’ level of practice, the results of the present study clarified that the studied nurses had unsatisfactory level of practice in preprogram phase. This may be owing to the finding that most studied nurses did not receive any training courses about palliative care. This result was in the same line with Al Qadire (2014), who illustrated that overall performances of nurses were not good.

The results of the current study revealed that nurses’ practice level improved in the postprogram phase. Most studied nurses had satisfactory level of practice regarding management of breathing difficulties, gastrointestinal symptoms, and management of itching after program implementation. Moreover, more than three-quarters of the studied nurses had satisfactory level of practice regarding management of fatigue after program, with highly statistically significant difference. This finding indicated that continuous education in nursing is needed to promote development of knowledge, skills, and attitudes of nurses and to improve the quality of care given for this group of patients. The study indicated that the formed training courses played important role in enhancing and updating nurses’ knowledge and performance. Moreover, this approved that observation and guidance play critical roles in improving nurses’ skills in practices.

This finding was supported by Morsy et al. (2014), who mentioned that nurses obtained the highest practice score regarding patients with breathlessness. Most nurses assessed respiration (rate, rhythm, and depth), presence of sputum, the type of cough (productive or dry), and oxygen saturation using pulse oximetry. This is similar to Alshaikh et al. (2015), who revealed that nurses showed good physical care, and similar to Begum and Khanam (2015), who revealed that practice of palliative care was observed to be adequate in 48%, moderately adequate in 43%, and inadequate in 9%. However, the results contradicted White et al. (2013), who conducted a study about palliative nurses’ perceptions of practices and challenges and revealed that palliative nurses viewed end-of-life and palliative nursing competencies based on the needs of patients and families rather than a ranked list of important skills.

Regarding the correlation between nurse’s knowledge and practice, the present study illustrated that there was a strong positive correlation between total knowledge score and total practice score after program, with highly statistically significant difference. This may be attributed to the importance of effective training program for improving nurses’ knowledge. This is contrary to Mohamed et al. (2017), who showed in the thesis entitled ‘Impact of palliative care program on nurse’s knowledge and practice regarding care of patients with end-stage renal disease,’ Zagazig Nursing Journal, Egypt, that there was no statistically significant correlation between level of nurse’s knowledge and practice and patient outcome.

The results of the current study illustrated that half of the studied patients had age more than 60 years, with mean±SD of 60±10.2 years. This might indicate that the prostate cancer is most common among old age persons. This result was supported by Castillejos-Molina and Gabilondo-Navarro (2016), who reported that 36.3% of cases are diagnosed during the seventh decade, with 31.6% between 70 and 79 years.

The present study revealed that less than half of the studied patients had intermediate level of education, and most were married. These results agreed with Cal et al. (2018), who cleared that the average age of the patients with prostate cancer who participated in the study was 65.92±8.63, 58.6% of the patients had primary education, 25.9% had elementary and upper education, and 15.5% of them were illiterate. Overall, 99.1% of the patients were married, and 63.8% lived in a nuclear family (only parents and children).

The results of the current study revealed that more than half of studied patients were smokers, and the most of them did not perform any type of exercise. This indicated that smoking is a prevalent health problem in Egypt, associated with malignant tumors. In addition, 36.7% of the studied patients were illiterates, so they did not have any information or guidelines about healthy lifestyle. This finding agrees with Bakitas et al. (2015), who illustrated that more than half of the participants used to smoke.

The present study found that more than half of the studied patients worked and the majority of them had comorbidities. This was not in accordance with Huen et al. (2019), who clarified that most of the studied patients were unemployed, and about three-quarters of them had at least one comorbidity. Moreover, the result disagreed with Bakitas et al. (2015), who found that approximately half of the participants were retired.

The results of the current study emphasized that there was improvement in patient’s compliance regarding nutrition, drug, and lifestyle after applying the palliative care program than before, with highly statistically significant difference. This result may be owing to that most of patients became aware of the disease risks and knew that if they did not comply with the therapeutic regimen, they would die, so they tried to preserve their life. This finding was supported by Sabry (2013), who mentioned in the thesis entitled ‘Factors affecting compliance for hemodialysis patients toward therapeutic regimen,’ unpublished Master Degree in Medical Surgical Nursing, Faculty of Nursing, Zagazig University, Egypt, that more than three-fifths of the patients were good compliant and more than one-third of them were poor compliant.

The results of the current study revealed that most studied patients showed improvement in cancer-related symptoms to a little bit after applying the program. This provides evidence that access to supportive nursing care can influence patient outcomes and importantly indicates that there are areas of care, in particular after cancer treatment, that nursing could improve. This was in the same line with Bruera and Yennurajalingam (2012), who found that at the first follow-up visit after the consultation, patients achieved significant improvements in most cancer-related symptoms.


  Conclusion Top


In light of the current study results, it can be concluded that the palliative care program had a positive effect on improving nurses’ knowledge and practice, which then reflected on improvement in patients’ outcomes.

Recommendation

In-service training for newly recruited nurses will help to update their knowledge and improve their practice.

Developed palliative care evidence-based program should be made available in all hospital to be followed by all nurses.

Further recommendation

Evaluating the future effect of such educational programs can be accomplished by furthering research to include conducting qualitative research to evaluate if patient care was significantly improved as a result of the educational program used.

Replication of this study on a large population sample at different geographical locations in Egypt was highly recommended.

Acknowledgements

Eman A. Metwaly contributed toward the development of tools, statistical analysis, data collection, and application of the program. Amal H. Hamad contributed toward the sample collection; provided the preprogram and postprogram test; applied the health education program; participated in preparation of videos, color brochure, and posters; participated in data collection; participated in the references collection and analysis of data; and administered the program.[39]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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