Download Literature review done for the study is presented under the following

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Ms. BALJEET KAUR
I YEAR M.SC( NURSING)
1.
NAME
OF
THE
CANDIDATE
AND ADDRESS
NOOR COLLEGE OF NURSING
NO:5, NOOR BUILDING, RMV 2ND
STAGE,
BHOOPASANDRA
MAIN
ROAD, BANGALORE – 94.
2.
3.
4.
NAME OF THE INSTITUTION
NOOR COLLEGE OF NURSING,
BANGALORE.
COURSE OF THE STUDY AND
I Year M. Sc (Nursing),
SUBJECT
Medical Surgical Nursing.
DATE OF ADMISSION TO THE
COURSE
01.10.2011
“A Study to Assess the Level of Knowledge
5.
and Attitude of Caregivers on Physiological,
TITLE OF THE STUDY
Psychological
Needs
of
Chronically
ill
Patients with Cancer Admitted in Selected
Hospital, Bangalore”
1
6. BRIEF RESUME OF THE INTENTED WORK
6.1 INTRODUCTION
Man is a social animal and was created by the nature thousand years ago. In
ancient period man was just similar like the animal was not having any culture and
surviving like the tribal’s. Later as every human has their own basic desires in which
priority was given to the physiological needs and psychological needs.
Many author those who have given their various views about physiological needs.
Maslow was one among them who has given his own view about the basic human needs
and here he gave the priority to the physiological needs.
He has introduced the hierarchy model and described the basic needs of the
person. The basic needs were classified into the five levels. The most basic or first level,
includes the physiological needs, such as oxygen, nutrients, fluids, body temperature,
elimination, shelter, sex, obesity, position changing support, medication etc.
Maslow hierarchy is extremely useful to caregivers to prioritize patients nursing
care needs. Basic physiological and safety needs are usually the first priorities, especially
when a patients is severely dependent physically on caregivers.
Oxygen is the important component of environment. It combined with globin and
forming oxy hemoglobin which is supplied to the tissue. The second physiological need
of the human is meeting adequate nutrition and fluids. Food which is inadequately
prepared or stored that is subjected to unsanitary conditions, increase the patients risk for
2
infections and food poisoning and other symptomatic conditions the cancer patients
should be taken care for their better nutrition, pattern and nutritional needs.
The temperature and humidity management is another physiological need of
patients. If temperature is altering it indicates the infections in the body, so proper
maintenance of body temperature and humidity of the patients is very much important.
Normal elimination pattern is included in the physiological needs which balance
the normal health of the person. Mobility, position changing, massage of body,
supporting and exercise are other physiological needs should be provided by the caregivers if the patients is unable to take self care who are chronically ill. There should be
some reasons for the caregivers to relive the pain of the patients.1
The word cancer, abbreviated ca, is a term that frightens most people. Cancer is
synonymous “C” the term malignant neoplasm. The word neoplasm is derived from the
Greek word which means new, and plasma which means growth of new tissue (molding).
A neoplasm is defined as an abnormal new growth of tissue that serves no useful purpose
and may harm the host organism.2
Other terms that suggest malignant neoplasm include tumor, malignancy,
carcinoma, and aberrant cell growth. Hippocrates coined the word carcinoma, meaning a
tumor that spreads and destroys the host. However Galen was the first to describe cancer
as being crab like in nature.3
Globally it is estimated that there are 7.6 million new cancer cases, of which 52%
occurs in developing countries. The magnitude of problems of cancer in the India
subcontinent in terms of sheer number is most alarming. There is predicted sharp increase
in new cases from 10 million in 2000 to 15 million in 2020 in developing and developed
countries.
3
The population of India is now over billion with an estimated 1.5 million cases of
cancer diagnosed per year. The population of U.S is 295 million and yet 1.5 million
cancer cases will be diagnosed .the estimated new cases of cancer in India percent are
newly 6.5 lakh and at the start of the next millennium estimated 806.000.
In Karnataka state in the southern part of India, it is estimated that annually there
are 35,000 incident cancers, where at the prevalent cancer amounts to about 1, 50,000
more than one third of these cancer cases are seen and attended to Kidwai Memorial
Institute of Oncology.4
Psychosocial and behavioral aspect of cancer has increased steadily over the last
40 years. Anxiety along with the depression, has been described the most common
psychosocial reaction among patients with cancer. It is essential to realize that each
patients with cancer reacts to the diagnosis differently and has unique concerns and
problems regarding the diagnosis and treatments, each patients copes with the illness in
his or her own way.5
Among caregivers, the odds of anxiety disorders are 1.7 times and the odds of
depression were 1.5 times those of non-caregivers. The evidence is more equivocal and
generally weaker for the association between caregiving and physical morbidity, such as
self-rated health or number of illnesses. Physical morbidity in caregivers has most often
been associated with patients problem behaviors, patients cognitive impairment, and with
caregiver’s own depression and anxiety.
Caregivers report fatigue and inadequate time for sleep and self-care. Compared
with non-caregivers, family members involved in high levels of care have significantly
increased odds of not getting enough rest, not having time to exercise, not having leisure
activities, and forgetting to take prescription drugs. Some reports reveal that caregivers
have higher levels of prescription medication use, such as antidepressants and hypnotics,
have higher levels of health care utilization, and do not engage in preventive health
behaviors.6
4
Epidemiological studies suggest that the caregivers of chronologically ill patients
with cancers are having the poor knowledge and attitude in meeting the physiological
needs of patients with cancers.
With respect to knowledge and attitude of the caregiver in meeting the
physiologic needs of chronically ill patients with cancers, cancer can have a serious
impact on caregivers as well as on the patients. Caregivers also play the very important
role in the care of the patients with cancer. So it is necessary to assess the knowledge and
attitude of caregivers in meeting the physiologic need of their patients, because in spite
handling the patients they have many other duties in household, work and leisure, and
other constraint, which may give ill effect in providing the care to patients by the
caregivers and also there is mounting evidence that during advanced stages of illness,
changes in family roles and the burden placed on family caregivers may negatively affect
quality of life for cancer patients, as well as their caregivers.
6.2 NEED FOR THE STUDY
Cancer is a condition in the world which makes the person to suffer because of
bad impact of disease. All round 30 years have been almost crossed the cancer is a
condition which is more severely affecting the today’s population. It remains the second
leading cause of the death. Cancer leaves the bad impact on the patients and his family
members or caregivers with respect to care of the patients and meeting their physiological
needs. This is all because of the longitivity of the duration of illness.
Physiological needs are one level of Maslow’s hierarchy of basic needs which
includes, the ventilation, food, fluids, body temperature, elimination, position changing,
pain management, shelter, sex, etc, which are very much essential for the patients who
are chronically ill ,and due to their inability to reach these physiological needs.1
Mainly the family members are the caregivers for the chronically ill patients with
cancers. Nurses are playing vital role in the care of the patients. But still there are many
needs of the patients which can be full filled by the caregivers of the patients such as
5
feeding the patients, providing water for drinking, changing the comfortable position,
pain management, support, checking the body temperature providing the elimination
needs etc. these thinks cannot be reached by the patients and some times there can be
inability of the nurse also to reach the requirement of patients, so the family member are
playing important role in providing physiological needs of the patients.
Studies have shown that many care givers are available in the hospital with the
patients to care them but still they do not have the adequate knowledge and positive
attitude in providing the care. It is important for the care givers to learn and understand
the importance of those care and needs, which are essential for the patients to be
provided. They can clarify these doubts from the nurse so that they can reach the
expectations of the patients.
Family care givers are available in the hospital but they do not know what the
main physiological needs are and what the prior physiological needs of the patients are.
Though they are in the hospital with the patients but it is unworthy for the patients. These
things are very essential for the care givers to learn from the nurse and through other
resources.
World wide there are over 10.9 million cases of cancer. Each year 4.7 million are
reported in developed countries and nearly 5.5 million are in the less developed countries.
In developed countries cancer is 2nd most common cause of death and epidemiological
evidence points to emergence of a similar trend is the developing country. Cancer is
currently the cause of 12% of ill death worldwide. Approximately 20 years time the
number of deaths annually due to cancer will increase from about 6 million to 10
million.7
Lung cancer has been the most common cancer world wide. Since 1985 and by
202 accounted for 1.35 million new cases (12.4% of world total) and 1.18 million deaths
(17.6%) of world total. Although it is most frequent cancer in men world wide . Lung
cancer is second to produce cancer incidence is developed countries. Breast cancer is by
6
far the most frequent cancer of women, accounting for 23% of all cancer because of its
high incidence and relatively good prognosis breast cancer is the most prevalent cancer in
the world, with an estimated 4.4 million women alive who have had the disease
diagnosed within the last 5 years composed to 1.4 million survivors men and women
from lung cancer.8
In India the estimated number of new cancer per year is about 7 lacks and over
3.5 lacks people die of cancer each year, out of these 7 lacks new cancer about 2.3 lacks
(33%) cancer are tobacco related.9
The national cancer registry project (NCRP) initiated in 1981-82 continued to
collect authentic data on cancer occurrence in country. The data for the year 1996 showed
a crude incidence rate (per 100000) in the metropolitan cities from 53.7 in Bangalore to
76.6 in Chennai among men and from 68.7 in Bangalore to 93.6 in Chennai among
women.
A population revealed that the population of coverage of cancer cases was 72% in
Bangalore, 100% in Chennai and 78% in Mumbai the five year relative survival for
female breast cancer was 46.8% in Bangalore, 49.5% in Chennai and 55% in Mumbai.
The age adjusted incidence rate of esophageal cancer in women in Bangalore is
one of the highest (8.3 per 100000) in the world, in women cancer of the cervix and
breast together account for over 40% of the cancer in urban women and 65% of cancer in
the rural registry in Barshi.10
In today’s world the people are very busy with their life style and the work. They
suffer with lot of stress and problems they do not find the time to care their relatives even
though they are critically ill. They are ready to leave their patients in the hospice and
palliative care center or old age center but they are unable to meet the patients
requirement. There are many reasons which make such types of feeling in the caregivers.
7
They even forget that today to whom they are ignoring they had given birth to them or
have played a vital role for their life.
There is mounting evidence that during advanced stages of illness, changes in
family roles and the burden placed on family caregivers may negatively affect quality of
life for cancer patients, as well as their caregivers. It was found that patients’
dependencies in tasks of daily living, symptom severity, and immobility had a direct
effect on the burden and depression experienced by family members providing care. It
also showed that older caregivers seem to have difficulty with tasks and physical
demands of spouse illness, whereas the difficulties of younger couples are in the affective
domain. These younger individuals may feel angry, frustrated, and depressed. Other
studies report that females experience more distress than males.
Study shows its need because the majority of caregivers report that their
caregiving responsibilities are experienced as a burden. Caregiver burden is the distress
that caregivers feel as a result of providing care. It is specific to care and differs from
anxiety, depression, and other emotional and more general responses. Disease and
treatment each impact the prevalence and intensity of caregiver burden. This burden may
arise as a result of increased caregiver demands that accompany the progressive
deterioration of the patients.
There is mounting evidence that patients and family members have different
perceptions of care needs during the cancer care trajectory. These differences may be the
result of long-standing family roles and communication patterns. If these patterns are not
appreciated, they may contribute to caregivers’ reactions and sense of burden, add to the
conflict, and hence to caregiver distress.
Open communication about illness and care may facilitate family coping. The
added stress of caring for a patients with advanced cancer exacerbates problems in family
relations and personal mental health problems. It has enhanced that the number of illness
demands experienced by the male spouse of a female patients living with chronic illness
was a significant predictor of spousal depression. Subsequently, marital adjustment was
8
affected significantly by the male partner’s level of depression as well as by the problems
associated with the wife’s illness.6
In the light of above fact and personal experience of the investigator as a
staff in the clinical area while assessing the knowledge and attitude of caregivers, it was
observed that most of the caregivers had lack of knowledge and favorable attitude in
meeting the physiological needs of cancer patients . Hence the research was interested in
the above area and wanted to impact knowledge and attitude of caregivers regarding
meeting the physiological needs of patients with cancers.
6.3
Statement of the Problem
A Study to Assess the Level of Knowledge and Attitude of Caregivers on
Physiological, Psychological Needs of Chronically ill Patients with Cancer Admitted in
Selected Hospital, Bangalore
6.4
Objectives of the Study
1.
Assess the level of knowledge of caregivers on physiological & psychological
needs of the chronically ill patients with cancer.
2.
Assess the level of attitude of caregivers on physiological & psychological needs
of the chronically ill patients with cancer.
3.
Co-relate the level of knowledge and attitude of caregivers on physiological,
psychological needs of the chronically ill patients with cancer.
4.
Associate the level of knowledge and attitude of caregiver with their selected
demographic variables
6.5 Operational Definitions
1. Knowledge
Knowledge refers to awareness and understanding of caregivers regarding
physiological & psychological needs of chronically ill patients with cancer admitted in
selected hospital, Bangalore
2. Attitude
It refers to opinion, belief and feelings expressed by the caregiver’s of chronically
ill patients with cancer regarding physiological & psychological needs.
9
3. Caregivers
Family member or close relatives who is in the age group of 20 to 50 years caring
for chronically ill patients with cancer admitted in a selected hospital.
4. Physiological need
Physiological needs are the basic human body requirements such as oxygen,
nutrition, fluid, temperature management, elimination, position changing, body massages,
sex, exercise and medications etc.
5.Psychological needs:
Psychological needs are the basic human psychological requirement such as
acceptance, friendship, affection, protected, satisfied, responsibility, worthy, intimacy
and worthy.
5. Chronically ill patients with cancer
The patients who are suffering with cancer for a long period such as
Gastrointestinal cancer, Lung cancer, Oral cancer, Breast cancer, Brain tumor, Blood
cancer and cancer of cervix since 3 years admitted in medical ward of selected
oncology hospital.
6.6
Assumptions
The study assumes that,
1. Caregivers of patients with cancers may have knowledge regarding Physiological
& psychological needs of chronically ill patients with cancers to some extent.
2. Caregivers of patients with cancers may have favorable attitude regarding meeting
the physiological & psychological needs of chronically ill patients with cancers.
10
6.8
Review of Literature
The term literature review refers to the activities involved in identifying and
searching information on a topic and developing an understanding of the state of
knowledge on topic.
Also review of literature is a written summary of the state and the art of a
research problem. Literature review is an essential step in the whole process of research.
Therefore the researcher has reviewed literature with regard to the problem by referring
books, journals, thesis, etc.
Literature review done for the study is presented under the following heading.
1. Studies related to general information on cancer and physiological needs.
2. Studies related to changes in Physiological needs due to cancer and its
management.
3. Studies related to knowledge and attitude of caregivers in meeting the
Physiological needs of the chronically ill patients with cancers.
1. Studies related to general information on cancer and physiological needs
Although cancer is often referred to as a single condition, it actually consists of
more than 100 different diseases. These diseases are characterized by the uncontrolled
growth and spread of abnormal cells.
A study was conducted to know wish of people with cancer by which they are cared
for in primary care. In most economically developed countries patients, their informed
11
and professional careers and policy makers are calling for more Care in the community
to involve patients with cancer, and their careers in designing a framework for providing
effective cancer care in primary care. The study revealed that patients with cancer and
their careers believes that there is an important and unique role for primary care in
offering continuity of care and information that is patients-centered and holistic,
throughout the cancer trajectory, from first presentation.11
A study was conducted on medically ill cancer patients with borderline personality
disorder (BPD) face formidable emotional challenges as they cope with cancer diagnosis
and treatment. The anxiety and discomfort associated with medical treatment can lead
them to have difficulties with caregivers, distort reality for emotional protection, or
exhibit outright aggression and self-destructiveness. Co-morbid substance abuse or a
history of physical or sexual trauma may further complicate cancer treatment. These
patients may be in particular need of symptom-focused psychotherapeutic management,
which must include comprehensive assessment and treatment of psychiatric symptoms,
measures to limit aggression and self-destructiveness, and staff and caregivers education
and support. These interventions can reduce patients' distress and maximize cancer
treatment outcomes.12
A cross sectional study was conducted on quality of life of cancer survivors and
their family caregivers. Although survivor’s rates for all cancer continue to increase, A
stratified random sample of 128 cancer survivors and 123 family caregivers (N=246)
were interviewed in an exploration, cross sectional design 1-6 years after cancer
treatment had ended. Approximately half (N=62) of the dyads were white and half
(N=61) were African American. Results indicated that cancer survivors reported
significantly higher quality of life, less fear of cancer recurrence and were support than
their family caregivers.13
An article explores the Management of cancer in the elderly. The causes and
clinical implications of the association between cancer and aging . Age is a risk factor for
cancer due to the duration of carcinogenesis, the vulnerability of aging tissues to
12
environmental carcinogens, and other bodily changes that favor the development and the
growth of cancer. Some tumors become more aggressive (ovarian cancer) and others,
more indolent (breast cancer) with aging. A comprehensive geriatric assessment indicates
which patients are more likely to benefit from cytotoxic treatment. Some physiologic
changes are common in persons with age. The administration of chemotherapy to older
cancer patients involves adjustment of the dose to renal function, prophylactic use of
myelopoietic growth factors, maintenance of hemoglobin levels around 12 g/dL, and
proper drug selection. With appropriate caution, older individuals may benefit from
cytotoxic chemotherapy to the same extent as the youngest patients.14
A study was conducted on different percespectives between seriously ill patients
and their family caregivers. The study data were from a national random sample of 988
terminally ill patients of whom 893 had caregivers who were also interviewed.
Frequencies and type’s non concordanace were computed for patients caregiver’s pairs.
The proportion of concordant reports among pairs of patients and caregivers ranged from
53% to 66%. Among pairs showing non concordant patients, lower care giving needs,
and different fears about future few demographic or clinical predictors were associated
with nonconcordinance. Concordinance between patients and their caregivers responses
ranged widely and patients were more likely to express concern about were more likely to
express concern about patients physical suffering.15
2. Studies related to changes in physiological needs due to cancer and its
management
A study was conducted on decision making in palliative radiation therapy;
reframing hope in caregivers and patients with brain metastasis. Twenty patients and 19
caregivers (including eight patients and caregivers pairs) were recruited into the study.
The study revealed that patients generally focus on current informational needs while
caregivers want more information about the future (e.g.: life expectancy and anticipated
symptoms) Caregivers expressed frustration when unable to explore future needs because
patients were unprepared to discuss prognostic issues. Participants expressed substantial
relief when offered whole brain radiation therapy after the diagnosis.16
13
A cross-sectional study was conducted to explore fatigue levels and fatiguecoping strategies in lung cancer patients receiving chemotherapy. The data were collected
from 101 nursing cancer patients receiving chemotherapy. The study revealed mean
fatigue score for the total sample was 8.0 (SD=5.0, range =0.20) indicating light-tomoderate fatigue. The majority of patients (n=76, 75.2%) had baseline hemoglobin level
of < or =12g/dl and significantly greater (t=2.7; P<0.01) mean fatigue score (8.8 SD 4.6)
than patients with hemoglobin >12 g/dl (6.2 SD 5.7) fatigues levels were significantly
higher patients receiving a third course of chemotherapy than in those receiving a first
course (F=3.7, P=0.03). this study highlighted the management of fatigue problems in
lung cancer patients receiving chemotherapy, especially in respecting patients self-report
of fatigue-management strategies.17
A study was conducted on effects of care giving demand, mutuality and
preparedness on family care giver outcomes during cancer treatment to test a model of
family care giving derived from the interactions approach. In this study 87 family
caregivers of adult receiving treatments for solid tumors or lymphoma. The model
explained statistically significant proportion of variance in each out come, with different
pattern of association across outcomes. Finally further research should explore models
that address implementation of the care giving role to better elucidate how family
caregivers learn and carry out the important role.18
A study was conducted on technology dependence in home care impact on
patients and their family caregivers The purpose of this review is to explore how home
technology care affects patients, family caregivers, and QOL. A literature search was
conducted to identify studies of home parenteral nutrition and other technology
prescribed home care. Study resulted that technology dependence influences healthrelated QOL. Patients and their family caregivers must balance the positive aspects of
being in the home environment with the challenges of administering complex therapies at
home. Patients and caregivers need additional support to reduce the physical, emotional,
social, and financial burdens they experience.19
14
A journal gives information on the knowledge of, attitudes toward, and perceived
barriers to pharmacologic management of cancer pain were examined in a random
statewide sample of nurses (N = 790), using an 82-item questionnaire. Although only 7%
of the nurses reported working in oncology settings, 59% of the nurses reported having
worked with patients with cancer in the last 6 months. The scores on the knowledge test
ranged from 11% to 93% correct, with a mean percent correct of 56. 4% (+/- 0. 92) .
Nurses reported relatively liberal attitudes toward pain management, yet also reported
believing that 22% of patients overreport pain. Results are discussed with respect to
implications for practice and education.20
3. Studies related to knowledge and attitude of care giver in meeting the
physiological needs of the chronically ill patients with cancers
A study was conducted on knowledge and information needs of informal care
givers in palliative care to review current understanding of knowledge and information
needs. Seven electronic databases were searched for sample. The evidence was strongest
in relation to pain management, where inadequacies in care giver knowledge and the
importance to pain management, and the importance of education were emphasized. The
significance of effective communication and information sharing between patients, care
givers and service provider was also emphasized. Finally as palliative care shifts into
patients’s homes a more rigorously researched evidence base devoted to understanding
care givers knowledge and information needs is required. 21
A study was conducted on attitude and beliefs regarding the role of interventional
pain management at the end of life among care givers. It revealed that intrathecal and
epidural opioid analgesia represents a major advance in the management of cancer pain,
adding a new dimension to opioid therapy by allowing prolonged analgesia through the
use of significantly lower doses than those required for systematic administration.
Researcher found that all care givers were satisfied from using international pain relief
techniques at the end of life.22
15
A study was conducted on important needs of families in acute and palliative care
settings assessed with the Family Inventory of Needs Family support has been recognized
in the development of palliative care in Iceland, yet studies focusing on family needs are
lacking. The aims of this study were to evaluate the perceived care needs of family
members of patients receiving palliative care, to what extent these needs were met, and
whether needs differed based on background characteristics and site of care. Family
members of 111 patients from acute and palliative care settings agreed to participate, and
67 (60%) completed the study. The Family Inventory of Needs was used to quantify
family needs and to what extent they were met. All 20 needs measured were considered
important. The number of needs did not differ by site of palliative care. Overall, health
care professionals met 67% of needs. Needs were more likely to be met in specialized
palliative care settings than on acute units and the needs of spouses were more likely to be
met than others. 23
A cross-sectional survey of Japanese physicians with a self-reported questionnaire
was used. To clarify physician attitudes toward terminal dehydration and identify the
physician-related factors contributing to their attitudes . A total of 584 responses were
analyzed. In the vignette of a gastric cancer patients with an estimated survival of 1
month and almost impossible oral intake due to intestinal obstruction, 50% chose
intravenous hydration of 1,000 mL/d, while 24% selected more than 1,500 mL/d. For a
lung cancer patients with cachexia, 58% chose 1,000 mL/d, while 26% selected no
hydration or 500 mL. Multivariate analyses revealed that the physicians with more
positive attitudes toward intravenous hydration were significantly less involved in end-oflife care, more likely to regard the physiologic requirement of fluid and nutrition as
important in initiating intravenous hydration, more likely to believe that intravenous
hydration is effective for symptom palliation, and more likely to believe that intravenous
hydration is the minimum standard of care. Physicians have considerably divergent
attitudes toward intravenous hydration for terminally ill cancer patients. 24
16
7 Materials and Methods
7.1 Source of Data
Care givers between the age group of 21 to 50 years, who is providing care for
chronically ill patients with cancers admitted in medical ward of selected oncology
hospital, Bangalore.
i. Research Design
Research Design used in this study was Non Experimental, Descriptive &
Correlational Design
ii. Research Variables
1. Study Variables: Knowledge and attitude of Caregivers in Meeting the
Physiological & psychological Needs of Chronically ill Patients with cancers.
2. Demographic Variables: The demographic variables include Age, Gender,
Religion ,Occupation, Educational status, type of family, income , Marital Status,
Type of family, Relationship of care giver with the patients, Any previous
exposure with the person suffering with cancer, Duration of the illness of patients,
Type of diagnosis and mode of treatment of patients.
iii. Research setting
The setting will be medical ward of selected hospital, Bangalore.
iv. Population
Care givers between the age group of 20 to 50 years, who is providing care for
chronically ill patients with cancers admitted in medical ward of selected hospital,
Bangalore .
v. Sample
Care givers between the age group of 20 to 50 years, who is fulfilling the
inclusion criteria will be the sample. Sample size will be 90
17
vi. Criteria for sample selection
Inclusion Criteria
1. The care givers of 21 to 50 years age group who is providing care for chronically
ill patients with cancers admitted in medical ward of selected hospital.
2. Care giver who is closely related to patients with cancers admitted in selected
hospital.
3. Caregivers of patients who are diagnosed to have gastrointestinal cancer, Lung
cancer, Brain tumor, Blood cancer and Cancer of cervix since 3 years.
4. Able to read and understand Kannada or English
5. Who are responding and interested to participate.
6. Available at the time of the study.
Exclusion Criteria
1. The care givers who are taking care of the patients for temporary period or not
regular care givers.
2.
Caregivers of patients diagnosed with other types of cancer.
vii. Sampling Technique
Sampling technique used in this study is non-probability convenience sampling
technique.
viii. Tools for Data Collection
Section A:. Structured interview schedule for collecting demographic data of patients
with cancers[Age, Gender, Religion ,Occupation, Educational status, type of family,
income , Marital Status, Type of family, Relationship of care giver with the patients,
Any previous exposure with the person suffering with cancer, Duration of the illness of
patients, Type of diagnosis and mode of treatment of patients.]
Section B: Structured Interview schedule with structured questionnaire to assess the
knowledge of care givers in meeting the physiological needs of chronically ill patients
with cancers
Section C: 3 Point Likert scale to assess the level of attitude of care givers in meeting
the physiological needs of the chronically ill patients with cancers.
18
ix. Method of data collection
After obtaining the permission from concerned authority and getting informed
consent from samples, assuring about the confidentiality of information, the investigator
will administer the structured interview schedule to assess demographic variable,
knowledge and three point likert scale to assess the attitude of care givers in meeting the
physiological needs of the chronically ill patients with cancers.
x. Plan for data analysis
The data collected will be analyzed using descriptive and inferential statistics.
Descriptive Statistics
 Frequency percentage distribution were used to study the demographic variables
of the caregivers of
patients with cancers such as Age, Gender ,Religion
,Occupation, Educational status, income , Marital Status ,Type the family,
Relationship of care giver with the patients, Any previous exposure with the
person suffering with cancer, Duration of the illness, Type of diagnosis and mode
of treatment.
 Mean and standard deviation were used to determine the knowledge and attitude
of caregivers of the patients with cancers.
 Distribution of scores on the knowledge and attitude in meeting the physiological
needs of the chronically ill patients with cancers to be interpreted by summarizing
into three categories such as inadequate, moderate, and adequate.
Inferential Statistics
 Correlation-co-efficient for correlating knowledge and attitude of caregivers in
meeting the physiological needs of chronically ill patients with cancers.
 Chi-square for association of the knowledge and attitude with selected
demographic variable will be used.
xi. Projected Outcome
The investigator will be able to identify existing knowledge and attitude of
caregivers on physiological & psychological needs of chronically ill patients with
cancers. Based on the findings the investigator will prepare instructional module
regarding meeting physiological and psychological needs of chronically ill patients with
cancers which will help to improve the knowledge and attitude of care givers.
19
7.3
Does the study require any investigation or intervention to the
patients or other human being or animals?
Yes, the study requires minimum investigation on knowledge and attitude of
caregivers on physiological & psychological needs of chronically ill patients with cancers
because, the investigator is planning only for descriptive study and no active
manipulation is involved in the study. No other investigation which cause any harm will
be done for the subjects.
7.4 Has ethical permission clearance obtained from your institution?
Yes, permission will be obtained from the head of institution and formal permission
is obtained from concerned authority of selected hospital, Bangalore.
20
8. References
1. Dorothy R Marlow, Barbara A. Redding. Text Book of Pediatric Nursing. 6th ed.
New Delhi: Harcourt India Pvt. Ltd; 2001; 20.
2. Luckmann and Sorensons. Medical Surgical Nursing.4thed. Philadelphia: W.B
Sounders Company; 1997; 118-21.
3. Lewis, Colier, Hettkemper, Dirksen. Medical Surgical Nursing .6th ed. Mosby
Publication; 2000; 261-62.
4. National cancer institute, kidwai memorial institute of technology. SEER cancer
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9.
Signature of the Candidate
10.
Remarks of the guide
11.
11.1 Name and Designation
of
the
guide
(in
block
letters)
11.2 Signature
11.3 Co –Guide
11.4 Head of Department
11.5 Signature
12.
12.1
Remarks
of
the
Chairman and Principal
12.2 Signature
23
24