Download “A STUDY TO EVALUATE THE EFFECTIVENESS OF

“A STUDY TO EVALUATE THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME REGARDING
KNOWLEDGE OF EARLY DETECTION AND PREVENTION
OF PROSTATE CANCER AMONG SELECTED ADULT MALES
IN NELAMANGALA, BANGALORE”
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
2011-2013
Mr. PUNITH KUMAR.Y.R
1st YEAR M.Sc NURSING
MEDICAL SURGICAL NURSING
HARSHA COLLEGE OF NURSING
NH-4, NELAMANGALA
BANGALORE
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
Mr. PUNITH KUMAR.Y.R
1ST YEAR M.SC. NURSING,
1
NAME OF THE CANDIDATE HARSHA COLLEGE OF
NURSING,
AND ADDRESS
NELAMANGALA,
BANGALORE.
HARSHA COLLEGE OF
2
NAME OF THE INSTITUTION
NURSING,
NELAMANGALA,
BANGALORE
3
4
COURSE OF THE STUDY
1st YEAR M.Sc NURSING
MEDICAL SURGICAL NURSING
AND SUBJECT
DATE OF ADMISSION TO
06-05-2011
THE COURSE
TITLE OF THE TOPIC
“A
5
STUDY
STRUCTURED
TO
EVALUATE
TEACHING
THE
EFFECTIVENESS
PROGRAMME
OF
REGARDING
KNOWLEDGE OF EARLY DETECTION AND PREVENTION OF
PROSTATE CANCER AMONG SELECTED ADULT MALES IN
NELAMANGALA, BANGALORE”
2
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
The prostate is a small, walnut-sized structure that makes up part of a man's reproductive
system. It wraps around the urethra, the tube that carries urine out of the body. Prostate cancer is
a form of cancer that develops in the prostate, a gland in the male reproductive system. Most
prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The
cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly
the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems
during sexual intercourse, or erectile dysfunction.
Prostate cancer is the third most common cause of death from cancer in men of all ages and is
the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found
in men younger than 40.
People who are at higher risk include:

African-American men, who are also likely to develop cancer at any age

Men who are older than 60

Men who have a father or brother with prostate cancer
Other people at risk include:

Alcohol abusers

Farmers

Men on fat rich diet, especially animal fat

Tyre plant workers

Painters

Men who have been exposed to cadmium metal
The PSA blood test is often done to screen men for prostate cancer. Because of (prostate specific
antigen) PSA testing, most prostate cancers are now found before they cause any symptoms.
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The symptoms listed below can occur with prostate cancer (Most of the time these symptoms are
caused by other prostate problems that are not cancer):

Delayed or slowed start of urinary stream.

Dribbling or leakage of urine, most often after urinating

Slow urinary stream

Straining when urinating, or not being able to empty out all of the urine

Blood in the urine or semen

Bone pain or tenderness, most often in the lower back and pelvic bones.
Prostate biopsy is the only test that can confirm the diagnosis. There are no obvious strategies to
prevent this disease, so screening has been considered as a possible intervention to reduce the
number of deaths.
Tissue from the prostate is viewed underneath a microscope. Biopsy results are reported using
something called a ‘Gleason grade’ and a ‘Gleason score’.
The ‘Gleason grade’ shows how aggressive the prostate cancer might be. It grades tumors on a
scale of 1 - 5, based on how different from normal tissue the cells are.
Often, more than one ‘Gleason grade’ is present within the same tissue sample. The Gleason
grade is therefore used to create a Gleason score by adding the two most predominant grades
together (a scale of 2 - 10). The higher the Gleason score, the more likely the cancer is to have
spread beyond the prostate gland:

Scores 2 - 4: Low-grade cancer

Scores 5 - 7: Intermediate- (or in the middle-) grade cancer. Most prostate cancers fall
into this category.

Scores 8 - 10: High-grade cancer (poorly-differentiated cells)
“Screening” means applying a test to a defined group of persons in order to identify an early
stage, a preliminary stage, a risk factor or a combination of risk factors of a disease.
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Two tests are available to screen for prostate cancer: prostate-specific antigen (PSA) and digital
rectal examination (DRE). The first of these is a blood test, and the second is a physical
examination by a doctor where a finger is passed into the rectum to directly feel for enlargement
or a nodule in the prostate gland. The subsequent diagnostic test is a prostatic biopsy taken
through the rectum. This paper will discuss the use of PSA as part of a screening program.
The following tests may be done to determine whether the cancer has spread:

CT scan

Bone scan
In the early stages, talk to your doctor about several options, including surgery and radiation
therapy. In older adult males, simply monitoring the cancer with PSA tests and biopsies may be
an option.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to
remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or
performance. Problems with urine control are common after surgery and radiation therapy.
Surgery is usually only recommended after a thorough evaluation and discussion of the benefits
and risks of the procedure.

Surgery to remove the prostate and some of the tissue around it is an option when the
cancer has not spread beyond the prostate gland. This surgery is called radical
prostatectomy.

Possible problems after the surgeries include difficulty controlling urine or bowel
movements and erection problems.
Radiation therapy uses high-powered x-rays or radioactive seeds to kill cancer cells.
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Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It
may also be used after surgery, if there is a risk that prostate cancer cells may still be present.
Radiation is sometimes used for pain relief when cancer has spread to the bone.
Proton therapy is another kind of radiation used to treat prostate cancer. Doctors aim proton
beams onto a tumor, so there is less damage to the surrounding tissue.
Testosterone is the body's main male hormone. Prostate tumors need testosterone to grow.
Hormonal therapy is any treatment that decreases the effect of testosterone on prostate cancer.
These treatments can prevent further growth and spread of cancer.
Hormone therapy is mainly used in men whose cancer has spread to help relieve symptoms.
There are two types of drugs used for hormone therapy.
Much of the body's testosterone is made by the testes. As a result, removal of the testes (called
orchiectomy) can also be used as a hormonal treatment. This surgery is not done very often.
Chemotherapy and immunotherapy are used to treat prostate cancers that no longer respond to
hormone treatment. An oncology specialist will usually recommend a single drug or a
combination of drugs.
Following a vegetarian, low-fat diet or one that is similar to the traditional Japanese diet may
lower your risk. This would include foods high in omega-3 fatty acids. Finasteride (Proscar,
generic) and dutasteride (Avodart) are drugs used to treat benign prostatic hyperplasia (BPH)1.
6.1 NEED FOR THE STUDY
Prostate cancer is a major cause of death among men in European countries, with nearly
1,45,000 cases and 56,000 deaths in the European Union in 1998. Rates of incidence vary
considerably among countries, and appear to be increasing because of more frequent and better
diagnostic tests, an aging population and probably a true increase in incidence.
It is typically diagnosed in men in their 60’s (median age at diagnosis in the US is 68 years but
the range is wide, upwards of 45years). Prostate cancer is the most commonly diagnosed cancer
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in American men. It is estimated that 240,000 Americans will be diagnosed with prostate cancer
in 2011. More than 34,000 men will die of the disease, making prostate cancer the second largest
cancer killer in men. Prostrate cancer is an uncommon cancer in the developing countries
affecting 4-5 men per 100,000 population in India. The rate of prostate cancer per 100,000
population in the US is 85 (20 fold difference versus men living in India). The number of
prostate cancer cases among Indian immigrants to the US has gone up substantially probably due
to change of life style in their adopted country. This unfortunately is the case with all other
cancers as well (such as breast and colon cancer) with current numbers for cancer, which are
intermediate between the US figures and the natives in India2.
Information relating to cancer incidence trends in a community forms the scientific basis for the
planning and organization of prevention, diagnosis and treatment of cancer. Here the cumulative
risk and trends in incidence of prostate cancer in Mumbai, India, is estimated using data
collected by the Bombay Population-based Cancer Registry During the 15 year period, a total of
2864 prostate cancer cases (4.7% of all male cancers and 2.4% of all cancers) were registered by
the Bombay Population-based Cancer Registry. The annual percentage changes were computed
for the evaluation. Cumulative incidence rates percentages were calculated by adding up the age
specific incidence rates at single ages and then expressed as a percentage from the year 1986 to
2000.
The probability estimates indicated that one out of every 59 men will contract a prostate cancer
at some time in his whole life and 99% of the chance is after he reaches the age of 50.
Prostate cancer is one of the first five leading site of cancers in Delhi. The incidence rate is
higher in North India compared to South India and it is rapidly increasing. A population based
case-control study on prostate cases was therefore carried out in Delhi to identify potential risk
factors. Cases were each matched with two controls. Past smoking and current alcohol
consumption significantly increased the risk of prostate cancer. No statistically significant
association was found with family history of cancer or prostate cancer. The risk of prostate
cancer declined with increasing dietary consumption of tea, citrus fruits and melon. A
statistically significant marginal increase in the odds ratio was observed with the consumption of
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eggs, fish and sunflower oil. Though an increased risk of prostate cancer was evident among
vasectomised men, the association was not statistically significant.
Pakistan, India, Sri Lanka, Bangladesh, Nepal and Bhutan, with their total population of more
than 1,500 million, make up the subcontinent of South Asia. Despite massive diversity across the
region, there are sufficient similarities to warrant a collective approach to chronic disease
control, including development of cancer control programs. In males, oral and lung cancer are
either number one or two, depending on the registry, with the exceptions of Quetta in the far
north, Larkana and Chennai. Moderately high numbers of pharyngeal and/or laryngeal cancer are
also consistently observed, with prostate cancer now becoming visible in the more developed
cities. Coordination of activities within South Asia is a high priority for cancer control in the
region.
Epidemiologic studies have suggested several factors that may play a role in prostate cancer. In
most instances, the evidence is fragmentary or inconsistent (e.g., certain occupational exposures,
sexually transmitted infectious agents, sexual activity level, history of benign prostatic
hyperplasia, vasectomy, androgenic hormones, weight or obesity, cigarette smoking, alcohol
consumption, and vitamin D, vitamin E, and selenium intake).
The evidence for dietary fat and red meat intake is somewhat stronger and more consistent, but
as yet is inconclusive. Age, race, and a family history of prostate cancer are the only well
established risk factors for prostate cancer. The widespread use of PSA screening and early
detection programs are thought to explain most of the changing patterns in prostate cancer
incidence, although the benefit of screening on the mortality from this disease remains
undetermined. The overall age-adjusted mortality rate peaked in 1991, and a 6.7% decline was
observed by 1995. The magnitude of this decline is about 1.8 deaths per 100,000 men per year.
The purpose of this monograph is to provide a descriptive review of temporal trends (1973-1995)
in the epidemiological and clinical characteristics of prostate cancer adult males ascertained
through the population-based cancer registries that participate in the Surveillance, Epidemiology
and End Results (SEER) Program of the National Cancer Institute. Age-adjusted and agespecific incidence rates (1973-1995) are shown by race for blacks and whites. Recent data (19901995) for racial minorities and Hispanic populations are described separately. Incidence trends
8
are examined by age, histologic grade, and stage of disease at diagnosis and first course of
treatment. Relative survival following the diagnosis of prostate cancer is also examined.
Mortality data are provided by the National Center for Health Statistics and the rates are based
on prostate cancer deaths between 1973 and 1995 for the SEER areas and for the entire United
States population3.
The Surveillance, Epidemiology and End Results (SEER) Program was established in 1973 as
part of the National Cancer Institute. The SEER Program has a mandate to collect cancer
incidence, treatment, and survival data, which can be used to monitor the impact of cancer in the
United States population. There are currently eleven SEER geographic areas that maintain
population-based cancer reporting systems, including the states of Connecticut, Hawaii, Iowa,
New Mexico, and Utah, and the metropolitan areas of Atlanta, Georgia, Detroit, Michigan, Los
Angeles, San Francisco-Oakland, and San Jose-Monterey, California and Seattle-Puget Sound,
Washington. These regions cover about 14% of the total United States population and were
selected to provide information from diverse population subgroups such as various racial and
ethnic groups as well as urban and rural residents. Data used for this report are primarily from
the nine standard SEER geographic areas for the period 1973-1995. Data from two more recently
added registries, San Jose-Monterey and Los Angeles, California, were available only for the
period 1988-1995 and are included in some analyses as indicated.
The primary measures associated with assessing the impact of cancer in the general population
are the number of new cases per year per 100,000 persons (incidence rate), the number of deaths
per year per 100,000 persons (mortality rate), and a determination of the proportion of adult
males alive at some point subsequent to the diagnosis of their cancer (relative survival rate).
This report includes incidence, mortality and relative survival data from 1973 through 19954.
So, the available statistics says that there is a need for the study regarding the incidence of
prostate cancer in India as the incidence of prostate cancer in the world is growing to an alarming
levels.
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6.2 REVIEW OF LITERATURE
Review of literature provides basis for future investigations, justifies the need for
replication, throws light up on feasibility of the study, and indicates constraints of data collection
and help to relate findings of one another. There are three sections included in Review of
Literature.
Section A: Contains the review of literature regarding the knowledge of prostate cancer.
Section B: Contains the review of literature regarding the early detection and prevention of
prostate cancer.
Section A: The review of literature regarding the knowledge of prostate cancer
Arnold-Reed DE, Hince DA conducted a study on “Knowledge and attitudes of men
about prostate cancer” with an objective to ascertain the current level of understanding among
older men about prostate cancer, including treatment options and their potential side effects.
Questionnaires administered by general practitioners in five general practices in the Perth
metropolitan and regional areas of Western Australia. Convenience sample of 503 men aged 4080 years, with or without prostate cancer, presenting for routine consultations between January
and August 2006. Knowledge and attitudes of men about prostate cancer, and predictors of
knowledge. Eighty per cent of men did not know the function of the prostate, and 48% failed to
identify prostate cancer as the most common internal cancer in men. Thirty-five per cent had no
knowledge of the treatments for prostate cancer and 53% had no knowledge of the side effects of
treatments. Asked how they would arrive at a decision about treatment, 70% said they would ask
the GP or specialist for information on all their options and then decide themselves. Which
conclude that there is a deficit in knowledge about prostate cancer among men in the at-risk age
group, encompassing areas that could delay diagnosis and treatment. Overall, the men preferred
some GP or specialist involvement in treatment decision making5.
Demark-Wahnefried W conducted a study on “Knowledge, beliefs, and prior screening
behavior among blacks and whites reporting for prostate cancer screening” with an objective to
determine prostate cancer-related knowledge, beliefs, and prior screening behavior was
10
administered to men participating in prostate cancer screening events at nine major sites in the
southeast. Since prostate cancer disproportionately affects blacks, a primary focus of the analysis
was to determine if differences in responses exist between racial groups. A 20-question,
multiple-choice survey to ascertain prostate cancer knowledge and beliefs, demographics, and
health care access information was administered at nine major southeastern sites participating in
Prostate Cancer Awareness screening events. Potential differences between the responses of
blacks and whites were tested using the Cochran-Mantel-Haenszel test (P < 0.05), adjusting for
differences among sites. Major findings of this study on 286 black and 1218 white men are as
follows: (1) only 28% of black or white men report that their doctor ever discussed a test for
prostate cancer with them; (2) blacks were less likely to have a regular doctor (P = 0.03) or ever
to have had a digital rectal examination (P < 0.001) or prostate-specific antigen testing (P =
0.005); (3) blacks were less likely to report knowing someone with prostate cancer (P < 0.001)
and were more apt to report their acquaintances experiencing post-treatment impotence than
whites (P = 0.03); they were less likely to report that "a man with prostate cancer can lead a
normal life" (P < 0.001) or that "men can have prostate cancer without symptoms" (P < 0.001);
(4) a substantial number of all men did not know that race and/or heredity are risk factors; and
(5) "peace of mind" was the leading reason why men (63% of whites and 50% of blacks)
attended prostate cancer screening events. which concluded as there are a number of similarities
deficits among black and white men regarding knowledge and beliefs related to prostate cancer.
Important differences, however, in access to screening, perception of the disease and its
treatment, and knowledge of risk factors exist between racial groups and represent significant
barriers to early detection among African Americans6.
Wilkinson S, List M conducted a study on “Educating African-American men about
prostate cancer: impact on awareness and knowledge” with an objective to determine whether an
education program on prostate cancer could improve awareness and knowledge among AfricanAmerican men. African-American men have the world's highest incidence of prostate cancer and
more than twice the mortality compared with white men. Screening programs for prostate cancer
have not been successful in attracting African-American participation. One explanation is a poor
awareness and knowledge about the disease among this high-risk population. We surveyed 900
African-American adults attending prostate cancer education seminars in community settings
throughout Illinois between March 1998 and January 2001. Participants were asked to complete
11
a multiple-choice questionnaire on topics related to prostate cancer. The main outcome measures
were a change in awareness and knowledge of prostate cancer after the 1-hour educational
seminar. The mean survey score improved from 26.0% before the seminar to 73.3% after it (P
<0.0001). Every multiple-choice question was answered correctly more often after the seminar
than before it. Increasing levels of education and income were associated with higher before and
after scores (P <0.001). Men achieved a significantly greater score improvement (mean 48.1%)
compared with women (mean 41.1%; P = 0.006). Previous screening for prostate cancer was
reported by 23% of the participants. Using logistic regression analyses, higher levels of
education and income correlated with higher rates of screening. After the seminar, 63.1% stated
the intention to undergo screening. Which concluded that prostate cancer awareness and
knowledge can improve dramatically after a 1-hour seminar on the topic. Additional studies to
evaluate the long-term retention of knowledge and impact on behavior are warranted7.
Smith GE, DeHaven MJ conducted a study on “African-American males and prostate
cancer: assessing knowledge levels in the community” which says although the available
evidence indicates that African-American males are at risk for developing prostate cancer, little
is known about the level of awareness among African Americans about prostate cancer or how
receptive they are to screening. This study examined the level of knowledge African-American
males have about prostate cancer and the factors affecting knowledge levels. Face-to-face
interviews were conducted among a sample of African-American males older than 25 years. All
respondents were asked if they knew what prostate cancer was (N = 897), and those older than
age 40 (N = 556) answered a series of seven questions related to prostate cancer. An index was
created that reflected respondents level of knowledge about prostate cancer. Slightly more than
19% of the sample scored relatively high on the index related to prostate cancer knowledge, but
30% answered three or fewer questions correctly. Income, marital status, education, and type of
insurance were significantly related to a respondent's level of knowledge. Having a regular
physician and discussing prostate screening with a physician were both positively related to a
respondent's level of understanding. This study indicates that African-American men do not have
adequate knowledge about prostate cancer. Although many African Americans may be getting
the prostate cancer message, educational efforts need to be strengthened to reach the less affluent
and the less educated. These findings also raise questions about why more African-American
12
men are not being screened and why more primary care physicians are not discussing prostate
cancer with their African-American adult males8.
Section B: The review of literature regarding the early detection and prevention of prostate
cancer
Ajape AA, Babata A, Abiola conducted a study on “Knowledge of prostate cancer
screening among native African urban population in Nigeria” which says that Cancer of the
prostate a worldwide public health concern. It is the most commonly diagnosed cancer in men
and ranked second as the cause of cancer-related deaths, to evaluate the awareness and attitude of
the populace to screening for cancer of the prostate. It is a cross-sectional study involving 156
respondents. A structured questionnaire detailing the biodata, the knowledge of cancer of
prostate, the practice of screening by prostate specific antigen (PSA) estimation and the readiness
to undergo screening by the respondent was used to obtain the set-out objectives. A total of 156
respondents completed the questionnaire and forms the basis of further analysis. The mean age
of the respondents is 44.15 (+/- 11.9) years. Majority of the respondents were civil servant
(51.9%) followed closely by politicians. About 23.1% of them have no formal education while
53.8% have acquired tertiary education. The result shows that 78.8% have never heard any
information on cancer of the prostate and only 5.8% have heard about PSA. None of the
respondents have ever had PSA test done, even once. Eighty four per cent of the respondents are
ready to pay for prostate cancer screening test by PSA assay. We conclude that there was
remarkable lack of awareness of prostate cancer among the Nigerian native African urban
populace. Prostate cancer screening and serum PSA test for screening is globally unknown
among them9.
Gigerenzer G, Mata J, Frank R conducted a study on “Public knowledge of benefits of
breast and prostate cancer screening in Europe” which says that making informed decisions
about breast and prostate cancer screening requires knowledge of its benefits. However, countryspecific information on public knowledge of the benefits of screening is lacking. Face-to-face
computer-assisted personal interviews were conducted with 10,228 persons selected by a
representative quota method in nine European countries (Austria, France, Germany, Italy, the
Netherlands, Poland, Russia, Spain, and the United Kingdom) to assess perceptions of cancerspecific mortality reduction associated with mammography and prostate-specific antigen (PSA)
13
screening. Participants were also queried on the extent to which they consulted 14 different
sources of health information. Correlation coefficients between frequency of use of particular
sources and the accuracy of estimates of screening benefit were calculated. Ninety-two percent
of women overestimated the mortality reduction from mammography screening by at least one
order of magnitude or reported that they did not know. Eighty-nine percent of men overestimated
the benefits of PSA screening by a similar extent or did not know. Women and men aged 50-69
years, and thus targeted by screening programs, were not substantially better informed about the
benefits of mammography and PSA screening, respectively, than men and women overall.
Frequent consulting of physicians (r = .07, 95% confidence interval [CI] = 0.05 to 0.09) and
health pamphlets (r = .06, 95% CI = 0.04 to 0.08) tended to increase rather than reduce
overestimation. The vast majority of citizens in nine European countries systematically
overestimate the benefits of mammography and PSA screening. In the countries investigated,
physicians and other information sources appear to have little impact on improving citizens'
perceptions of these benefits10.
Davis SN, Diefenbach MA conducted a study on “Pros and cons of prostate cancer
screening: associations with screening knowledge and attitudes among urban African American
men” which Discuss the pros and cons of prostate cancer screening tests, rather than routine
screening, is recommended to support informed screening decisions, particularly among African
American men. This study explored physician explanation of pros and cons of the prostatespecific antigen (PSA) test and digital rectal exam (DRE) and its association with knowledge and
screening attitudes. Two hundred-one African American men were asked if a physician had ever
provided a comprehensive explanation of pros and cons of the PSA test and DRE. All men
completed a 10-item prostate cancer knowledge scale and a subset completed a 26-item attitudes
measure. Only 13% of the sample reported receiving a comprehensive explanation. Also,
prostate cancer knowledge in the sample was low (mean = 43% correct). Multivariate analyses
revealed that total prostate cancer knowledge was associated with men receiving a
comprehensive explanation (p = .05), as well as past prostate cancer screening (p = .02) and
younger age (p = .009). Although comprehensive explanation of prostate cancer screening was
related to total prostate cancer knowledge, it was unrelated to a subset of items that may be
central to fully informed screening decisions. Furthermore, comprehensive explanation of
14
prostate cancer screening (p = .02), along with DRE recommendation (p = .009) and older age (p
= .02), were related to fewer negative screening attitudes. Findings suggest that continued focus
on patient education and physician communication is warranted11.
Oladimeji O, Bidemi YO conducted a study on ” Prostate cancer awareness, knowledge,
and screening practices among older men in Oyo State, Nigeria” which says that prostate cancer
is the leading cause of cancer among Nigerian men. This study assessed the knowledge,
awareness, and screening practices among older men regarding prostate cancer in Oyo State,
Nigeria. A cross-sectional study used a multi-stage sampling technique to select 561 adult males.
A semi-structured questionnaire was used. Respondents' median age is 60.0 years. Prostate
cancer awareness was high [449 (80.0%)]. The overall mean knowledge of prostate cancer
causation, treatment, and prevention was 5.8 (± 3.0) out of a maximum of 16. Only 109 (19.4%)
perceived themselves at risk of developing prostate cancer, but only 4.5% have ever been
screened. Though knowledge and risk perception of prostate cancer were low, a majority of
respondents (81.5%) were willing to be screened for the disease. Community-based prostate
cancer educational interventions and provision of screening centers are needed for this group12.
Steele CB, Miller DS conducted a study on “Knowledge, attitudes, and screening
practices among older men regarding prostate cancer”
in which the study determined
population-based rates of reported prostate cancer screening and assessed prostate cancer-related
knowledge, attitudes, and screening practices among men in New York aged 50 years and older.
Two telephone surveys were conducted. One was included in the 1994 and 1995 statewide
Behavioral Risk Factor Surveillance System interviews, and the other was a community-level
survey that targeted Black men (African-American Men Survey). Prevalence estimates were
computed for each survey, and prostate cancer screening practices were assessed with logistic
regression models. Overall, fewer than 10% of the men in each survey perceived their prostate
cancer risk to be high; almost 20% perceived no risk of developing the disease. Approximately
60% of the men in each survey reported ever having had a prostate-specific antigen (PSA) test.
In both surveys, physician advice was significantly associated with screening with a PSA test or
a digital rectal examination. Also, race was significantly associated with screening in the
statewide survey. Many New York men appear to be unaware of risk factors for prostate cancer.
15
However, a substantial percentage reported having been screened for the disease; physician
advice may have been a major determining factor in their decision to be tested13.
Sothilingam S, Sundram M conducted a study on “Prostate cancer screening
perspective, Malaysia” which says that the incidence of prostate cancer in Malaysia is still low
compared to the west. This may be due to a true low incidence or lower detection rates. Prostate
Awareness Campaigns are held on a yearly basis to educate and encourage males over the age of
50 years to have their prostate examined. Such a campaign was organized in 2005 at the national
level involving 12 district hospitals. A total of 2770 participants attended the campaign. 38.7%
had no urinary symptoms and attended out of curiosity. Among the symptomatic adult males,
nocturia was the most bothersome in the majority. 84.6% of the participants also had some
degree of erectile dysfunction based on the IIEF questionnaire. 10.4% of participants had a PSA
> 4 ng/mL. Malay participants had the highest mean PSA level (2.32 ng/mL) and Indian
participants the lowest (1.30 ng/mL). 408 participants were called back for biopsy but only 183
agreed to the biopsy. 30 cancers were detected. At present Malaysia will benefit most by
continuing to conduct these awareness programmes to educate the public on prostate disease and
hopefully in future adult males will be less reluctant to have prostate biopsies taken when
indicated14.
Ilic D, Forbes KM conducted a study on “Lycopene for the prevention of prostate
cancer” which says that prostate cancer is a common cause of death in developed countries. A
prostate-specific antigen (PSA) test result greater than 4 ng/mL (nanograms/millilitre) has
commonly been used as the cut-off level for seeking further tests to diagnose the presence (or
absence) of prostate cancer. Lycopene is a member of the carotenoid family, which is found
abundantly in tomatoes, tomato-based products, strawberries, and watermelon. It has been
hypothesised that lycopene is a strong antioxidant, which may lower the risk of cancer (including
prostate cancer) in people who have diets rich in lycopene. With an objective to determine
whether lycopene reduces the incidence of prostate cancer and prostate cancer-specific mortality.
Secondary objectives include changes in PSA levels, prostate symptoms and the nature of
adverse events associated with lycopene use. Randomised controlled trials (RCTs) that
investigated the use of lycopene for the prevention of prostate cancer were eligible for inclusion
in this review. Which concluded that only three RCTs were included in this systematic review,
16
and the high risk of bias in two of the three studies, there is insufficient evidence to either
support, or refute, the use of lycopene for the prevention of prostate cancer. Similarly, there is no
robust evidence from RCTs to identify the impact of lycopene consumption upon the incidence
of prostate cancer, prostate symptoms, PSA levels or adverse events15.
Ma RW, Chapman K conducted a study on “A systematic review of the effect of diet in
prostate cancer prevention and treatment” which says that dietary therapy has been proposed as a
cost effective and noninvasive means of reducing the risk of prostate cancer (PC) and its
progression. There is a large volume of published studies describing the role of diet in the
prevention and treatment of PC. This article systematically reviews the data for dietary-based
therapy in the prevention of PC, as well as in the management of patients with PC, aiming to
provide clarity surrounding the role of diet in preventing and treating PC. Although conclusive
evidence is limited, the current data are indicative that a diet low in fat, high in vegetables and
fruits, and avoiding high energy intake, excessive meat, excessive dairy products and calcium
intake, is possibly effective in preventing PC. However, caution must be taken to ensure that
members of the public do not take excessive amounts of dietary supplements because there may
be adverse affects associated with their over consumption. The dietary recommendations for
patients diagnosed with PC are similar to those aiming to reduce their risk of PC16.
Ankerst DP, Koniarski T conducted a study on “Updating risk prediction tools: A case
study in prostate cancer” which says that online risk prediction tools for common cancers are
now easily accessible and widely used by patients and doctors for informed decision-making
concerning screening and diagnosis. A practical problem is as cancer research moves forward
and new biomarkers and risk factors are discovered, there is a need to update the risk algorithms
to include them. Typically, the new markers and risk factors cannot be retrospectively measured
on the same study participants used to develop the original prediction tool, necessitating the
merging of a separate study of different participants, which may be much smaller in sample size
and of a different design. Validation of the updated tool on a third independent data set is
warranted before the updated tool can go online. This article reports on the application of Bayes
rule for updating risk prediction tools to include a set of biomarkers measured in an external
study to the original study used to develop the risk prediction tool. The procedure is illustrated in
the context of updating the online Prostate Cancer Prevention Trial Risk Calculator to
17
incorporate the new markers % free PSA and [-2] pro PSA measured on an external case-control
study performed in Texas, U.S. Recent state-of-the art methods in validation of risk prediction
tools and evaluation of the improvement of updated to original tools are implemented using an
external validation set provided by the U.S. Early Detection Research Network17.
STATEMENT OF THE PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME
REGARDING
KNOWLEDGE
OF
EARLY
DETECTION
AND
PREVENTION OF PROSTATE CANCER AMONG SELECTED ADULT MALES IN
NELAMANGALA, BANGALORE”
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge regarding the early detection and prevention of prostate cancer
among adult males and prepare a structured teaching programmme.
2. To evaluate the effectiveness of structured teaching programme among adult males
regarding the early detection and prevention of prostate cancer.
3. To find out the association between pre test knowledge of Adult males regarding the
early detection and prevention of prostate cancer with selected demographic variables.
4. To assess the post test knowledge regarding early detection and prevention of prostate
cancer among adult males after structured teaching programme.
6.5 OPERATIONAL DEFINITIONS
Evaluate: Refers to significance of systematic determination of merit, worth,
significance of structured teaching programme on prostate cancer.
Effectiveness: Refers to the extent to which the structured teaching programmes on
prostate cancer has achieved the desired effect in improving the knowledge of adult
males as assessed by structured questionnaire
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Structured Teaching Programme: Refers to systematically planned group instructions
by lecture cum discussion method designed to provide information regarding prostate
cancer such as meaning, causes, signs and symptoms, management and prevention.
Knowledge: It is the understanding of information about a subject that has been obtained
by experience or study. In the present study, knowledge refers to understanding of
information about prevention of prostate cancer in adult males which has been measured
by structured interview schedule.
Prostate cancer: Prostate cancer refers to the medical condition in which there is a form
of tumor that develops in the prostate, a gland in the male reproductive system which
may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile
dysfunction.
6.6 ASSUMPTIONS
1. The researcher assumes that prostate cancer is a disturbing condition and the recurrence
rate is high.
2. The researcher assumes that the adult males undergoing screening lack knowledge
regarding therapy and prostate cancer.
3. The researcher assumes that the condition of adult males can be modified and improved
by some therapeutic steps.
6.7 HYPOTHESIS
H0–There is no significant difference between the post test knowledge scores and the
pretest knowledge scores of adult males regarding the early detection and prevention of
prostate cancer.
H1- There is a significant difference between knowledge scores of adult males regarding
the early detection and prevention of prostate cancer.
H2- There is a significant association between the knowledge of adult males regarding the
early detection and prevention of prostate cancer with selected demographic variables.
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6.8 VARIABLES OF THE RESEARCH
Independent variable: Structured Teaching Programme.
Dependent variable: Knowledge on prostate cancer.
Demographic variables: Age, education, marital status, socio economic status, source of
information, occupation etc.
6.9 DELIMITATIONS OF THE STUDY
 Study is limited to adult males aged 20-50 years.
 The study is limited to adult males who are present and are willing to participate in the
study.
 The study is limited to adult males who can actively communicate and who are literate.
7.0 MATERIALS AND METHODS
Methodology helps researcher to project a blue print of research undertaken. This includes
a series of steps from problem identification to the data collection.
7.1 SOURCES OF DATA
The data will be collected from the adult males those who are aged 20-50 years.
 RESEARCH APPROACH
The research approach for the present study is an evaluative research approach.
 RESEARCH DESIGN
The research design adopted for present study is quasi experimental, one group pretest
and post test design only.
 SETTING OF THE STUDY
The study will be conducted at selected areas of Nelamangala.
 POPULATION
Population in the study consists of adult males aged 20-50 years in selected areas of
Nelamangala.
 SAMPLES SIZE
The sample of the study will consist of 60 adult males aged 20-50 years in selected areas
of Nelamangala.
20
 SAMPLING TECHNIQUE
The proposed sampling technique adopted for the present study is simple
non-probability sampling technique
 SAMPLING CRITERIA
INCLUSION CRITERIA
o Adult males who are present during data collection.
o Adult males who are willing to participate in the research.
o Adult males who can read and write English or Kannada.
EXCLUSION CRITERIA
o Adult males who are not willing to participate in this study.
o Adult males who are not present during data collection.
o Adult males who cannot understand and communicate in Kannada or English.
7.2
METHODS OF DATA COLLECTION
TOOL FOR DATA COLLECTION
The tool for the proposed study is self administered structured questionnaire which would
be developed by researcher with the help of extensive literature and expert’s opinion.
METHOD OF DATA ANALYSIS NAD INTERPRETATION
The data collected will be spread into a master sheet for easy statistical analysis.
 Descriptive statistics:
To describe data collected by percentage, mean, mode, median and standard deviation.
 Inferential statistics:
1. Independent (unpaired)‘t’ test to find difference between the mean knowledge scores
of the adult males.
2. Chi square test to determine the association between the selected demographic
variables and the knowledge level of adult males regarding prostate cancer.
DURATION OF THE STUDY
The research is intended to complete within a time frame of 6-8 weeks
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7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO
BE CONDUCTED ON ADULT MALES OR OTHER HUMAN OR ANIMAL?
Yes, the structured teaching programme will be administered only among adult males in
selected areas of Nelamangala.
7.4 HAS
THE
ETHICAL
CLEARANCE
BEEN
OBTAINED
FROM
YOUR
INSTITUTION?
Yes, Ethical clearance will be obtained from the research committee of Harsha College of
Nursing, Bangalore.
The informed consent will be obtained from the samples for their willingness to participate in
the study.
Sample’s privacy, self esteem will be respected and maintained throughout the study and
information will not be disclosed or shared with anybody else.
22
8.0 LIST OF REFERENCES
1. Prostate cancer, Adam medical encyclopedia, sep 23, 2010, Available from:
http://www.nlm.nih.gov/medlineplus/encyclopedia.html
2. Statistics
of
prostate
cancer,
Available
from:
http://www.indoamerican-
news.com/?p=3712
3. Screening
of
prostate
cancer,
Available
from:
http://www.euro.who.int/Document/E82958.pdf
4. SEER programme, available from: http://www.cancerstaging.org/cstage/manuals/SEERrequirements-120910v0203.pdf
5. Arnold-Reed DE, Hince DA , Knowledge and attitudes of men about prostate cancer, The
Medical Journal of Australia. 2008 Sep 15;189(6):312-4.
6. Demark-Wahnefried W, Strigo T , Knowledge, beliefs, and prior screening behavior
among blacks and whites reporting for prostate cancer screening, Urology. 1995
Sep;46(3):346-51.
7. Wilkinson S, List M , Educating African-American men about prostate cancer: impact on
awareness and knowledge, Urology. 2003 Feb;61(2):308-13.
8. Smith GE, DeHaven MJ , African-American males and prostate cancer: assessing
knowledge levels in the community, Journal of National Medical Association. 1997
Jun;89(6):387-91.
9. Ajape AA, Babata A , Knowledge of prostate cancer screening among native African
urban population in Nigeria, Nigerian Quarterly Journal of Hospital Medicine, 2010 AprJun;20(2):94-6.
10. Gigerenzer G, Mata J, Frank R , Public knowledge of benefits of breast and prostate
cancer screening in Europe, Journal of the National Cancer Institute. 2009 Sep
2;101(17):1216-20. Epub 2009 Aug 11.
11. Davis SN, Diefenbach MA , Pros and cons of prostate cancer screening: associations with
screening knowledge and attitudes among urban African American men, Journal of the
National Medical Association. 2010 Mar;102(3):174-82.
23
12. Oladimeji O, Bidemi YO , Prostate cancer awareness, knowledge, and screening
practices among older men in Oyo State, Nigeria, International Quarterly of Community
Health Education. 2009-2010;30(3):271-86.
13. Steele CB, Miller DS, Knowledge, attitudes, and screening practices among older men
regarding prostate cancer, American Journal Public Health. 2000 Oct;90(10):1595-600.
14. Sothilingam S, Sundram M , Prostate cancer screening perspective, Malaysia, Urologic
Oncology. 2010 Nov-Dec;28(6):670-2.
15. Ilic D, Forbes KM, Hassed C, Lycopene for the prevention of prostate cancer, Cochrane
Database Syst Rev. 2011 Nov 9;11:CD008007.
16. Ma RW, Chapman K, A systematic review of the effect of diet in prostate cancer
prevention and treatment, Journal of Human Nutrition and Dietics. 2009 Jun;22(3):18799; quiz 200-2. Epub 2009 Apr 1.
17. Ankerst DP, Koniarski T , Updating risk prediction tools: A case study in prostate cancer,
Biometrical Journal. 2011 Nov 17. doi: 10.1002/bimj.201100062.
24
9. Signature of the candidate:
10. Remarks of the guide:
11. Name & Designation
11.1 Guide:
11.2 Signature:
11.3 Co-Guide:
11.4 Signature:
11.5 Head of the Dept:
11.6 Signature:
12.Principal
12.1 Remarks of the Principal:
12.2 Signature:
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