A Study to Evaluate the Effectiveness of Structured Teaching Program regarding Psychological Impact of Treatment Induced Alopecia in Cancer patients at selected hospitals, Bangalore, Karnataka, India

 

Sajithkumar P S¹*, C. Venkata Raju², Dhanyamol C P³

¹Nursing Officer, Department of Nursing (M.Sc. in Mental Health Nursing), AIIMS Bhubaneshwar, India.

²Nursing Officer, Department of Nursing (M.Sc. in Medical and Surgical Nursing), ESIC Hospital, Hyderabad, India.

³Assistant Professor, Department of Nursing (M.Sc. in Mental Health Nursing),

S.V.S Nursing College, Mahabubnagar, India.

 

 

ABSTRACT:

Cancer is a group of diseases with similar characteristics, the recovery from disease involves chemotherapy, radiotherapy, and surgery. The use of chemotherapeutic drugs and radiotherapy leads to numerous side effects that impair life style and activities in daily life. Alopecia is one among them, which leads to devastating effects on clients.  The current research was endeavoured to examine the on knowledge regardingEffectiveness of Structured Teaching Program Regarding Psychological Impact of Treatment Induced Alopecia in Cancer Patients at Selected Hospitals, Bangaloreby one group pre-test and post-test design was selected with an intermediary educational intervention program i.e. structured teaching program on Psychological Impact of Treatment Induced Alopecia in Cancer Patients as an experiment. The sample size was 60 cancer clients who are admitted at selected hospitals in Bangalore,  by using a non-probability convenient sampling technique and were evaluated successfully. The outcomes demonstrated that the mean post-test knowledge is significantly higher than the mean pre-test knowledge scores at ‘t’ = 34.44, P < 0.01 level. The mean post-test psychological impact score is significantly higher than the mean pre-test psychological impact scores of ‘t’ = 44.47, P < 0.01 level. Modified gain scores indicated that higher the score, lower the impact. The study findings indicate that Structured Teaching programon treatment-induced alopecia, the patients’ knowledge had enhanced. Their psychological impact was reduced.

 

 

 

INTRODUCTION:

Hair loss as a result of anti-cancer therapy has been described in medical literature for more than 40 years. While not considered to be a life-threatening or dose-limiting side effect, it is one of the most obvious and emotionally distressful aspects of cancer treatment.

 

Many oncologic references state that alopecia is an assault to physical appearance, body image, sexuality, and self-esteem. The way we look and the image we project says a great deal about the ways in which we value ourselves. When these values include portions of our physical appearance that are altered by therapy, yet the competing factor in this inner struggle for equilibrium as physical appearance changes is in the cancer patient’s drive for survival. The overwhelming will to survive is basic throughout our human community, and the patient must adapt or remain maladapted to physical and psychological changes precipitated by disease and treatment¹.

 

Cancer is presently the third leading cause of mortality in the 15-45 age group. By the turn of the century, one in every 18 males and one in every 15 females is likely to suffer from cancer in the country².

 

Hair is a body appendage that throughout history has been a symbol of social, cultural and political climate, in addition to connoting religious affiliations. Hair loss on the other hand has been associated with a loss of attractiveness, individuality, a state of disgrace and illness, in addition to the aging process. One of the most general side effects of chemotherapy is hair loss (Alopecia). Hair loss as a result of anticancer therapy has been described in the medical literature for 40 years. Nurses largely believe that while it may not be classified as life-threatening or dose-limiting side effect, it is one of the most tangible, difficult, emotionally painful side effects, it has built our present body of knowledge about alopecia and the patients experience³.

 

Alopecia can range from sporadic thinning of hair to complete baldness. Several factors may contribute to the severity of hair loss including drug dose and schedule as well as hair care practices. Prevention of alopecia has been in focus in the medical and nursing field. Since the late 1960s mechanical, physical and biological measures have been used with varying success. The goal of prevention is primarily the reduction of patient distress; by chemotherapy induced alopecia. Patient reactions to alopecia vary and may be dependent on the individual importance of hair, prognosis, and degree of expected hair loss, the amount of information and preparation given and physical and psychological coping mechanisms⁴.

 

The major responsibilities of the nurse for patients with anti cancer therapy would be to deliver physical care to manage alopecia, provide psychosocial support to build or sustain coping capacity, education to encourage active participation in decision making and self care⁵.

 

Whitse, Gvan and Devon selected 170 rural cancer patients using purposive sampling technique to assess their information needs on cancer chemotherapy, its side effects and care at home. The findings of the study showed that knowledge deficit on care of the patient proved to be one of the most frequently (78%) identified problems although the patient and family had often received care at the community oncology centre from specialist health care professionals. This indicates that cancer patients and families very often lack knowledge regarding side effects of chemotherapy and care at home⁶.

 

Hence it is essential for the patients be familiar with the treatment, its effects on hair and relieving measures.

 

MATERIALS AND METHODS:

Variables Under Study

Independent variable (IV): Structured teaching program (STP)

 

Dependent variable (DV): performance in the pre-test Performance in the post-test

 

Attribute variables (AV) : Personal characteristics which include

Age, Gender, Religion, Residence, Marital status, Type of family, Educational qualification, Occupation, Income, Type of treatment, and Course of treatment.

 

Setting of the Study:

The study was conducted at the Oncology Department, Srinivasam cancer care and Sri Shankara cancer Hospital and Research centre, Bangalore, which has a separate Department for Oncology Medicine and Radiotherapy. The total number of cancer patients coming for treatment varies between 80-100 in a month. Familiarity with the setting and availability of the required sample were also considered while selecting the study group.

a.   Population

The target population of the study was cancer patients with treatment-induced alopecia in Oncology Department of Srinivasam cancer care and Sri shankara Cancer Hospital and Research centre, Bangalore, Karnataka. A total number of 60 subjects were chosen for the study.

b.   Sample and Sampling Technique

The sample consists of a population selected to participate in a research study. In the study, a purposive sampling method through non-probability sampling approach was used for selection of subjects.

c.   Criteria for Selection of the Sample

Inclusion criteria:

·       Cancer patients aged between 18 to 65 years receiving treatment and having alopecia at the Department of Oncology, Srinivasam cancer care and Sri Shankara Cancer Hospital and Research centre, Bangalore.

·       Cancer patients who consented to participate in the study.

·       Cancer patients who can communicate in Kannada or English.

Exclusion criteria:

·       Cancer patients not willing to participate in the study.

·       Cancer patients who are not conscious and could not comprehend and answer.

 

Selection and Development of Tool

A structured interview schedule was selected for the study. It was considered to be the most appropriate instrument to elicit the response from subjects who are not able to read Kannada / English.

 

A.  Development of the Tool:

A structured interview schedule was prepared to assess knowledge, psychological impact of cancer patients on concepts of cancer, treatment and its side effects and management of alopecia. The steps carried out in preparing the tools are:

·       Literature review.

·       Preparation of blue print.

·       Consultation with guide, co-guide, subject experts, experts of oncology and clinical psychology.

·       Establishment of validity and reliability.

a.   Review of Literature:

Review of literature from books, journals, published and unpublished research studies were reviewed and used to develop the tool.

b.   Preparation of Blue Print:

A blue print of items pertaining to two domains of learning, that is knowledge and psychological impact was prepared. There were 12 items on (18.64%) knowledge domain, 48 (81.36%) on psychological impact which includes 4 (8.33%) are related to general wellbeing, 11 (22.91%) on physical dimension, 20 (41.66%) items on psychological dimension and 13 (27.08%) items on social dimension.

 

Description of the Tool:

In the present study the following tools were used.

Part-A: consisted of 11 items related to socio-demographic data of the subjects such as age, gender, family income per month, religion, residence, marital status, type of family, occupation, education, course of treatment, and type of treatment.

Part-B: structured schedule consisted of 12 items on knowledge about cancer, its treatment and treatment-induced alopecia. Each item of the schedule has 1 to 5 correct answers, every correct answer would fetch one mark, the total score of the knowledge schedule is 34. There are three levels of knowledge, low knowledge score range is 0-11, moderate knowledge score range is 12-22 and high knowledge score range is 23 and above.

Part-C: consisted of48 (81.36%) on psychological impact which includes 4 (8.33%) are related to general wellbeing, 11 (22.91%) on physical dimension, 20 (41.66%) items on psychological dimension and 13 (27.08%) items on social dimension. The respondent has to answer not at all, very little, moderately and very much. Schedule consisted of both 17 positive and 31 negative statements. In the positive statements if the respondent answers “not at all” gets score 1, “very little” score 2, “moderately” gets score 3 and “very much” gets score 4. In the negative statements if the respondent answers “not at all” gets score 4, “very little” score 3, “moderately” gets score 2 and “very much” gets score 1.

 

Content Validity of the Tool:

8 experts, comprising of 4 nurse educators, 2 clinical psychologists and 2 oncologists, established content validity of the tool. The experts were requested to give their opinions and suggestion regarding the relevance of the tool for further modification of items to improve the clarity and content of the items. The final tool got its shape after modification based on the opinions of the guide and co-guide. It consisted of socio-demographic data 11 items, knowledge 12 items and psychological impact 48 items which had 100% agreement

 

Reliability of the Tool:

The tool, after validation was subjected to test for its reliability. The tool was administered to 10 treatment-induced alopecia of cancer patients. The reliability was established by using Karl Pearson correlation. Coefficient of correlation of test-retest knowledge was found to be r = 0.84. Since the computed correlation of knowledge score was high, the tool was found to be reliable for the study.

 

B.  Development of Structured Teaching Program (STP)

The structured teaching program was developed based on the review of the related research / non-research literature and the objectives stated in the blue print. (Appendix J)

The following steps were adopted to develop the STP.

·       Development of content blue print.

·       Development of STP.

·       Establishment of content validity of STP.

·       Pre-testing of STP.

 

Pilot Study:

A pilot study was conducted from 3^rd December 2015 to 24^th December at the Oncology Department, Srinivasam cancer care Hospital, Bangalore. An administrative approval was obtained from the Medical Director and the Head of the Department of Oncology to conduct the pilot study and the main study.

 

Six cancer patients undergoing cancer treatment were selected conveniently for 2 days that is three patients on 1 day and three patients on 2^nd day. On day 1, all the three patients were interviewed with a structured schedule and pre-test was conducted. On the same day, STP was administered for 1 hour. On day 2, three patients were interviewed, pre-test was conducted and on the same day STP was administered for 1 hour.

 

Post-test was administered on 24^th December that is 21 days after the structured teaching program was administered.

Procedure for Data Collection:

Permission from the Concerned Authority:

Formal permission was obtained from the superintendent and also from HODs of Oncology department, Srinivasam cancer care & Sri Shankara cancer Hospital and research Centre, Bangalore to conduct the study.

 

Period of Data Collection:

The data was collected from 1^st of January 2016 to 30^th of February 2016, a period of 2 months.

 

Pre-test:

Simple interview technique was used to collect data from treatment induced alopecia of cancer patients after obtaining a consent from the subjects. The investigator used to collect data from 5 to 8 subjects per day, it took about 40 to 45 minutes to complete the schedule from each subject.

 

Implementation of STP:

Structured teaching program was conducted for a batch of 8 to 10 subjects after conducting pre-test for a period of one hour on two consecutive days. Flip charts, OHP transparencies, charts were used as visual aids to facilitate easy understanding. Live demonstration of alternative methods to cover head and preventive measures developing self-help group, individual counseling, group counseling.

 

Post-test:

The same pre-test schedule was used for the post-test. Post-test was conducted on the 21^st day after STP.

 

Data Analysis Plan:

The data obtained was analyzed in terms of the objectives of the study using descriptive and inferential statistics. The plan of data analysis was as follows:

·       Organize data in a master sheet or computer.

·       Frequencies and percentages for the analysis of background data.

·       Mean, median and standard deviation of pre-test and post-test score.

·       ‘t’ values to determine the significance of the difference between pre-test, post-test knowledge score.

·       λ ² values to determine the association between level of knowledge and demographic variables.

 

This chapter has dealt with research methodology, which consists of evaluative research approach using one group pre-test, post-test research design. The chapter also describes setting and population and sample, the development of an instrument, knowledge and psychological impact scale and structured teaching program. The chapter ends with the description of data collection, data collection procedure and plan for data analysis.

 

RESULT:

Analysis of effectiveness of structured teaching program on knowledge and psychological impactof cancer patients with treatment induced alopecia.

This section deals with analysis and interpretation of data collected to evaluate the effectiveness of structured teaching program on knowledge. The mean, median, standard deviation and ‘t’ value were computed and the findings were presented in Table. The following null hypothesis was formulated for testing effectiveness of structured teaching program on knowledge of cancer patient with treatment-induced alopecia. The findings were presented under fallowing two sub sections.

1.      Effectiveness of structured teaching program on knowledge of cancer patients with treatment induced alopecia.

H_O1: There will be no significant difference between the pre-test and post-test knowledge of the cancer patients with treatment induced alopecia.

2.      Effectiveness of structured teaching program on psychological impact

H_O2: There will be no significant difference between the pre-test and post-test of the respondents.

 

Mean, Standard Deviation and t-value of Knowledge Scores of Cancer Patients with Treatment Induced Alopecia

** Significant                                                           df – 59

 

Knowledge score reveals that in the pre-test there was minimum score of 12 and maximum of 28, mean score was 20.12 and standard deviation of 4.01, whereas in the post-test the; minimum score was 26 and maximum was 38, the mean sore was 30.62 and standard deviation was 2.62. The knowledge scores in the table show that there was significant increase of knowledge in the post-test. Comparison of mean pre and post-test knowledge scores showed significant difference at P < 0.01 level
(t = 34.44) (Fig. 12).

 

 

Fig. 12 Pre and post mean knowledge score

 

Hence the stated Null hypothesis H₀₁ was rejected and research hypothesis was accepted.

Psychological impact score reveals that in the pre-test the minimum score was 79 and maximum was 125, mean score was 104.00 and standard deviation 11.48, whereas in the post-test minimum score was 140 and maximum was 181, mean score was 164.78 and standard deviation 8.35. The psychological impact scores in the table show that there was a significant increase of psychological impact score in the post-test. Comparison of mean pre and post-test psychological impact scores showed significant difference at P < 0.01 level (t = 64.47)(Fig. 13). Hence the stated Null hypothesis H_O2 is rejected and research hypothesis is accepted.Analysis of Association Between Socio Demographic Variables with Pre-test Knowledge and Psychological Impact.

 

 

Mean, Standard Deviation and t-value of Psychological Impact Scores of Cancer Patients with Treatment Induced Alopecia

** Significant                                                                                                                                           df – 59

 

 

The data collected was organized and analyzed by computing Chi Square test of significance. The findings were presented under the following two sub sections.

 

Fig 13 Pre test – Post test Mean Psychological Impact Scores

 

a)     Association between socio demographic variables of cancer patients at pre-test knowledge level.

b)    Association between socio demographic variables of cancer patients at pre-test psychological impact level.

 

The following null hypotheses were formulated to test the association of socio demographic variables with measured variables.

H_O3: There will be significant association between the knowledge scores of treatment-induced alopecia of cancer patients and demographic variable.

H_O4: There will be significant association between the psychological impact scores of treatment-induced alopecia of cancer patients and demographic variable.

 

Association Between Socio Demographic Variables and Pre-test Knowledge Levels of Cancer Patients with Treatment Induced Alopecia

** Significant at P < 0.01 level, * Significant at P < 0.05 level, NS: Non significant

 

Table infers the association between demographic variable with their level of knowledge. There was significant relationship between type of family and knowledge level of cancer patients. Out of 60 patients 35 (58.33%) of them are above the median in which 28 (46.66%) of them belonged to nuclear family and 7 (11.66%) to joint family, which indicates that nuclear family has better knowledge on treatment induced alopecia. Chi square value of 6.63, P <0.01 shows that there was significant association between type of family and knowledge level, which could possibly be due to increased health consciousness among nuclear family.

 

Under the category of course of treatment and knowledge level, it was observed that majority 23 (53.33%) of them belonged to first course are below the median. Chi square value of 38.43, P<0.01 level, the obtained Chi square value is higher than the table value at the level of P< 0.01 which means that there is significant association between course of treatment and knowledge level. Subjects in the first course of treatment have less knowledge about treatment-induced alopecia.

 

The selected variables such as age, gender, family income, marital status, occupation, education, type of treatment and knowledge level were not found to have significant association with pre-test knowledge level of subjects. Hence Null hypothesis was accepted and research hypothesis was rejected for the above variables.

 

The variables such as type of family were found to have significant association with pre-test knowledge level of subjects at P<0.01 level (² value 6.63) and course of treatment was found to have significant association with pre-test knowledge level of subjects at P<0.01level. (² value 38.43). Hence the above stated Null hypothesis was rejected and the research hypothesis was accepted for the above said variables.

 

Analysis of association between socio demographic variables with pre-test psychological impact levels

H_O4: There will be no significant association between the psychological impact scores of treatment-induced alopecia of cancer patients and demographic variable.

 

Association Between Socio Demographic Variables and Post-test Psychological Impact Levels of Cancer Patients with Treatment Induced Alopecia

** Significant at P<0.01 level,

* Significant at P<0.05 level, NS Nonsignificant

 

Table infers the association between the demographic variables with post-test level of psychological impact. Between the age of subjects and level of psychological impact there is significant association. The chi square value was 32.8 at P<0.01 level. Majority 23 (38.33%) of them were below median which indicates younger age group have a high psychological impact. it is probably because they are very much concerned about their body image. As age advances psychological impact is minimized.

 

Association between marital status and psychological impact shows significance, Chi square value is 20.00 P<0.01 level. Psychological impact of unmarried, is high 10 (16.67%) all of them belong to below median scores. Where as among married there was almost equal distribution between above median 20 (33.33%) and below median 24 (40%) scores, which could be interpreted as happier the family life, lesser the psychological impact. Stressful family will have higher psychological impact. Among widowed, all of them 6 (10%) are above the median it may be they are not bothered about their body image.

 

The selected variables such as gender, family income, occupation, education, course of treatment and type of treatment and knowledge level were not found to have significant association with post-test knowledge level of subjects. Hence, null hypothesis was accepted and research hypothesis was rejected for the above variables.

 

The variables such as age was found to have significant association with post-test psychological impact level of subjects at P<0.01 level (λ² value 32.8) and marital status was found to have significant association with post-test psychological impact level of subjects at P<0.01level. (² value =20.00). Hence the above stated null hypothesis was rejected and the research hypothesis was accepted for the above said variables.

 

OTHER FINDINGS:

About tool and STP:

The tool was reliable and feasible. The structured teaching program was effective and was informative to the subjects.

 

DISCUSSION:

The present study was done to evaluate the effectiveness of structured teaching program regarding psychological impact of treatment-induced alopecia in cancer patients at selected hospitals, Bangalore.

The study was one group pre-test, post-test design conducted over a period of 8 weeks from 1^st January 2016 to 30^th February of 2016. A simple interview schedule was used for the study to assess the following domains.

Section A: Socio demographic variables of patients

Section B: Knowledge questionnaire

Section C: Psychological impact scale

 

The findings are discussed under the following sub headings

A.   Comparison of pre and post-test knowledge and psychological impact scores of cancer patients with demographic variables.

B.    Comparison of pre-test knowledge and psychological impact scores of cancer patients and association with socio demographic variables.

 

A. Comparison of pre and post-test knowledge and psychological impact scores of cancer patients with demographic variables.

1.   Comparison of pre and post-test knowledge scores and to find the effectiveness of structured teaching program

Knowledge score of respondents showed that pre-test mean score was 20.12 and standard deviation 4.01 whereas the post mean score was 30.62 and standard deviation was only 2.62. It showed that there was a significant gain in knowledge in the post-test after implementation of structured teaching program. The compared “t” value was found significant (t = 34.44) at P<0.01 level.

 

A similar study was conducted by Sheran P. 1999, found that only 56.7% of patients could recall the gross details of alopecia, despite a conference between oncologist and patients at the time of diagnosis. It shows that there was no significant gain of knowledge scores of patients. This may be due to the fact that the study was conducted at diagnostic stage. During this stage patients may not aware of disease process and have no knowledge regarding alopecia. In my study, subjects in the first course of treatment had low knowledge scores. As their course of treatment increases their knowledge scores also increased. It means frequent exposure to the treatment; other patients and health care personal might have increased their knowledge.

 

In the present study the mean post-test knowledge scores of cancer patients were significantly higher than the mean pre-test knowledge scores of cancer patients exposed to structured teaching program. This finding was supported by the study conducted by Chinnamna (1994) in which she found that the ‘t’ test computed on the difference between the post-test and the pre-test regarding the knowledge and attitude of cancer which was statistically significant.

 

In the present study cancer patients who were on chemotherapy were the respondents to evaluate the effectiveness of structured teaching program. This is supported by the study conducted by Irin Cardazo in which the respondents were cancer patients and it is found that teaching is effective in increasing knowledge of cancer patients regarding management of alopecia.

 

2.   Comparison of pre and post-test psychological impact scores and to find the effectiveness of structured teaching program.

 

Psychological impact was assessed based on general wellbeing, physical dimension, psychological dimension and social dimension. The psychological impact score reveals that in the pre-test there was minimum score of 79 and maximum of 125, mean score was 104.00 and standard deviation 11.48, whereas in the post-test minimum score was 140 and maximum was 181, mean sore was 164.78 and standard deviation 8.35. The psychological impact scores in the table show that there was a significant increase of psychological impact score in the post-test. Comparison of mean pre and post-test psychological impact scores showed significant difference at p < 0.01 level (t = 64.47). Increase of mean score from 104.00 to 164.78 indicated that higher the score lowers the impact and there was a significant decrease of psychological impact after the teaching program.

 

This study was supported by Batchelor D, identifying the impact of alopecia on patient self-image and quality of life. It is directed toward helping the patient and family to adapt to and cope with alopecia. Patient education, identification of available resources and supportive listening are therapeutic interventions. This showed that education and support to the patient has a definite effect on reducing psychological impact level.

 

B.  Comparison of pre-test knowledge and psychological impact scores of cancer patients and association with socio demographic variables.

1.   Association between socio demographic variables and pre-test knowledge level.

The association between socio demographic variables like age, gender, family income, marital status, occupation, education, type of treatment and knowledge level were found to be non-significant.

 

There was a significant association between type of family and knowledge level of cancer patients at P <0.01level (x2 6.63). Nuclear family 46.67 % fall above the median when compared to joint family.  This could possibly be due to increased health consciousness among nuclear family.

 

In a similar study conducted by Kupst and Schulman (1988) and Fife (1987) found that nuclear families with predominantly stable relationships and adequate support within the family unit were able to maintain their usual quality of life over an extended period of time. Joint families with preexisting problems experienced increased deterioration in family life and had difficulties in coping with cancer diagnosis and its implication.

 

At the same time, course of treatment and knowledge level subjects also showed a significant association at P<0.01 level (x2 value 38.43). It depicts that subjects in the first course of treatment have less knowledge about treatment-induced alopecia. Longer stay in the hospital helps in gaining high knowledge.

 

In a similar study conducted by Coebergh J.W.  (1996) on influence of patient knowledge level on the treatment induced alopecia in the Netherlands between 1973 and 1979. It showed that patients knowledge increases as they stay longer in the hospital (58% versus 54% P=0.25). It helps patients to understand and cope with alopecia.

 

2.   The association between pre-test psychological impact level with demographic variables

The association between socio demographic variables like gender, family income, occupation, education, course of treatment and type of treatment were not found to have significant association with pre-test psychological impact level of subjects.

 

The association between the demographic variables with pre-test level of psychological impact. Between the age of subjects and level of psychological impact shows significant association. The chi square value was 32.8 at P<0.01 level. Majority 23 (38.33%) of them are below median which indicates younger age group has high psychological impact. It is probably because they more concern about their body image. As age advances, psychological impact is minimized.

 

Association between marital status and psychological impact shows significance, Chi square value is 20.00 P<0.01 level. Psychological impact of unmarried is high 10 (16.67%). All of them belong to below median scores. Among married, there was almost equal distribution between above median 20 (33.33%) and below median 24 (40%) scores, which could be interpreted as happy in the family life, lesser is the psychological impact. Stressful family will have higher psychological impact. Among widowed, all of them 6 (10%) are above the median, it maybe they are not bothered about their body image.

 

The case study conducted by Burish TG reported that 60 patients was assessed on self-report, nurse observation, family observation, and psychological measurements and were followed for five sequential chemotherapy treatments. Results indicate that preparing patients for cancer chemotherapy, the effect of coping, preparation and relaxation intervention, increased patient’s knowledge of the disease and its treatment, reduced anticipatory side effects, reduced negative effect and improved general coping relaxation therapy. Patients showed some decrease in negative effect.

 

Davidhizar R determines in his study that hair loss, even when it occurs gradually, is usually accompanied by psychologic discomfort. For some chemotherapy patients, the prospect of hair loss is viewed with more dread than any of the other physical discomforts that accompany chemotherapy. Nurses can inform the patient in advance of anticipated hair loss, suggest techniques for coping with hair loss.

 

This study was supported by few investigators that patients of alopecia are at the elevated risk of psychosocial difficulties, self-care (Dianne MR), therapeutic approaches (Hesketh PJ), emotional distress (Richard R), scalp cooling worthwhile (Tierney AJ).

 

CONCLUSION:

The psychological impact of cancer patients with treatment-induced alopecia is a life-altering uncertainty which creates a catastrophic crisis, because the traumatic prospect of losing hair profoundly changes life. It is found more in cancer patients with treatment-induced alopecia. This chapter presents the conclusions drawn, Implications, Limitations, Suggestions and Recommendations

 

The following conclusions were drawn on the basis of the findings of the study.

 

·       Maximum number of patients was in the age group of 18-35 followed by age group 36-50. Majority of the patients were females. Maximum number of patients are in the group of income less than Rs. 2000. Majority of subjects were Hindus. Majority of subjects were from the rural area. Maximum number of subjects were married and leading a happy life. Majority of subjects belonged to nuclear family. Most of the subjects were self-employed. Majority of the subjects studied up to PUC. Nearly fifty percent of the subjects were in the category of first course of treatment. And majority of the subjects were receiving chemotherapy.

·       The subjects had less knowledge regarding alopecia, its prevention and management.

·       Maximum number of subjects had suffered from recognizable signs symptoms of psychological impact.

·       The difference in pre-test and post-test scores of knowledge and psychological impact patterns revealed the effectiveness of structured teaching program in all the domains and it was highly significant, as observed between pre-test and post-test mean scores.

·       Over all observation showed that structured teaching program on knowledge and psychological impact regarding treatment-induced alopecia was effective. The ‘t’ test, which was computed between pre-test and post-test knowledge scores, indicates the actual gain in knowledge. Hence, it was concluded that planned teaching program was effective as a teaching method to improve knowledge, reduce the psychological impact level. Hence it was concluded that structured teaching program was effective.

·       It was also found that there was significant association between type of family and knowledge level, and course of treatment and knowledge level.

·       There was a significant association between age of patients and the level of psychological impact, marital status and level of psychological impact.

 

IMPLICATIONS OF THE STUDY:

The findings of this study have implications in various areas of nursing namely; nursing practice, nursing education, nursing administration and nursing research.

 

Nursing Practice:

Nurses have a vital role in helping patients to overcome psychological impact. Teaching program can be conducted by Oncology nursing personnel both in the outpatient as well as in the inpatient department for cancer patients undergoing treatment as the number of patients suffering from cancer is on the rise and the patients have limited knowledge about treatment-induced alopecia, which is temporary. So, measures should be taken to improve their knowledge. Education program with effective teaching strategies will help cancer patients to accept and tolerate the necessary treatment measures upto the most satisfying level of living and improve the quality of life.

 

As a nurse counselor she can conduct individual counseling, group counseling and organize self-help groups. A nurse should be able to recognize the physiological and psychological disorders and provide adequate counseling and guidance for them.

 

Nursing Education:

The nursing curriculum should consist of knowledge related to psychological impact in cancer patients, information using different methods of teaching. While training nursing student’s emphasis should be on mental health management during the course of diseases, its treatments, various drugs used, its side effects, which lead to psychological problems like alopecia and management. The student’s learning experience should encompass various specialties like mental health nursing in Oncology.

 

Nursing Administration:

The nurse administrator should take interest in providing information on specialized areas like mental health nursing in Oncology. The nurse administrator should plan and organize continuing nursing education program for Oncology Nurses to motivate them in conducting teaching programs on treatment, its side effects and its management, oncology nurses can also teach prevention and management of alopecia, etc. She should be able to plan and organize program taking into consideration the cost effectiveness and carry out successful educational program.

 

Nursing Research:

Various studies conducted by researchers show that the number of patients with cancer is increasing. But at the same time mortality rates are decreasing due to advances in treatment. There is need for extensive research in mental health nursing in oncology. Different methods of research can be done regarding the psychological impact of cancer patients in relation to alopecia and also awareness for early detection. Research should focus on modification of certain factors like life styles, environmental and dietary factors aimed at preventing cancer. Research should be done on practicing new methods of teaching to enable people to improve quality of life. Research also should focus on management of alopecia to enable cancer patients to go through the treatment with minimum discomfort and better quality of life.

 

LIMITATIONS:

1.     Small number of subjects and purposive sampling limits the generalization of the study.

2.     Long-term follow up could not be carried out due to time constraints.

3.     Sample subjects were selected only in Selected Hospitals.

4.     The study did not use any control group.

 

RECOMMENDATIONS:

Based on the findings of the study the following recommendations are made:

1.     A similar study may be replicated on a larger sample for wider generalization.

2.     A similar study can be conducted among cancer patients.

3.     A similar study may be replicated with a control group.

4.     A survey can be done to determine the amount of interest among nurses in educating cancer patients on psychological impact of treatment-induced alopecia and its management.

5.     An extensive teaching strategy protocol may be developed including all aspects of side effects of cancer treatment and its management.

6.     Manuals, information booklets and self-instruction module may be developed in other areas like cancer prevention, risk factors, life style modifications etc. among the general public.

 

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

 

ACKNOWLEDGMENTS:

The authors would like to thank Dhande Pathlab Diagnostic Pvt. Ltd. Pune for their kind support during haematological and all other lab studies.

 

REFERENCES:

1.      Dianne MR. Assessing patient self-care for side effects of cancer chemotherapy part 1. Cancer Nursing. Philadelphia: 1982; 12: 447–451.

2.      Vinod K. Indian cancer registry program. Five-year consolidated report of hospital-based cancer registries. 2000. 9, 45, 55.

3.      Hesketh PJ, Batchelor D, Golant M, Lyman GH, Rhodes N, Yardley D. Chemotherapy induced alopecia psychosocial impact and therapeutic approaches. Support Care Cancer. 2004 Jun 19; 736-38.

4.      Rosman S. Cancer and stigma: experience of patients with chemotherapy–induced alopecia. Educational Counsel. 2004 Mar; 52(3): 333–9.

5.      Batchlor D. Hair and cancer chemotherapy consequences and nursing care: a literature study. Euro Journal of Cancer Care. 2001 Sep; 10(3): 147-63.

6.      Whitse, Gvan, Devon. Home care in anti-cancer therapy. Nursing Times. London. 1996; 31(32): 21.

 

 

Received on 03.03.2022           Modified on 12.07.2022

Accepted on 01.10.2022          © A&V Publications all right reserved