The Ideology Of The Cancer Cell

Published Date: 02 Nov 2017

Childhood cancer always comes as biggest heartbreaking shock to the family. Childhood cancer is treated uncompromisingly, often with a amalgamation of chemotherapy, radiation, and surgery, at a time of life when bodies are growing and developing. Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it can result in death. Cancer is treated with surgery, radiation, chemotherapy, hormone therapy, biological therapy, and targeted therapy.

The World Health Organization reports that the distribution of cases of death among children under 5 years around 150 per100, 000 populations who have died with cancer in the past year. Childhood cancer is the second leading causes of death globally among children under 15 years of age is causing 11.9% of deaths.

The World Health Organization reports that in India the distribution of cases of death among children under 5 around 108 per100, 000 populations are dying with cancer. The below 15 years children may estimate 12,060 in numbers however taking almost care 80% survive by 5 years & above. "Surviving Childhood Cancer" In spite of advanced medical care, is still causing second leading cause of death, it is expected that around 1,340 children to lose their lives in 2012.

The World Health Organization reports that in South-East Asian Region the distribution of cases of death among children under 5 years around 125 per100,000 population are dying with cancer.

The newspaper reports states that one in every 10,000 children in India is affected by cancer. According to statistics, 1.6 to 4.8 of all cancer cases reported in the country is among children below 15 years of age. On the occasion of international childhood cancer day, on February 15, experts from the city speak about childhood cancer and treatments available. In India the reported incidences of childhood cancer have increased over the last 25 years (The Hindu, Feb 2012)

The reports on childhood cancer in India states that around 1.68-1.48% are suffering from the disease. Among them 70% of them lives in villages and they have relatively less. (Arora R.S, 2010)

The Global Survey reports states that the number of childhood cancer exceeds 200,000 and more than 80% are from the developing countries. In United States approximately 10,400 children under age 15 were diagnosed with cancer and about 1,545 children had died due to cancer. which makes cancer the leading cause of death in children 1 to 14 years of age. (Global Survey On Childhood Cancer , 2007)

The report states that although significant advances have been made, unfortunately chemotherapy affects other parts of the body. Common side effects from chemotherapy include pain, diarrhea, constipation, mouth sores, hair loss, nausea, vomiting (National Cancer Institute, 2007)

The problem which the cancer children face physically are unexplained weight loss, headaches, early morning vomiting ,increased swelling or persistent pain in the bones, joints, back or legs, lump or mass in the abdomen, neck, chest, pelvic or armpit region. Development of excessivebruishing,bleeding,rash,infections,nausea,vomitting,constant tiredness, paleness, eye or vision changes and recurrent or persistent fever, even psychological issues which lead to psychological problems. Worries can be about developing new health problems, feeling of resentment, discrimination, depression, loneliness, etc.,

Caregivers are taking more responsibility for providing care for children with cancer caregivers have become important members of the health care team they have to cope with a wide range of physical, emotional and social consequences of the diseases. Health professionals are now rely on the family caregivers to manage medications, help to control symptoms and side effects apart from providing support send guidance. The health educators should care for the child with COPE,

C for creativity

O for optimism

P for planning

E for expert opinion

Orderly and systematic plan such as 1.getting the facts 2.reviewing what you can do, 3.decide on the best strategy 4.consider obstacles 5. Carry out and adjust your plan. Problems are easier to solve when they are just starting and early intervention can often prevent problems from becoming serious.

SIGNIFICANCE AND NEED FOR THE STUDY

Cancer cell growth is different from normal cell growth. cancer cells can also invade other tissues, something that normal cells cannot do. Supportive care treatment of disease side effects or symptoms from various members of health care team, including dieticians and child life therapists can make nutritional aspects of treatment less difficult. Making tasty high calories snacks and possible alternative to oral nutrition are part of supportive care. Giving care to cancer children is a sense of satisfaction and confidence. Families who give care often feel closer to each other and to the young person who is ill. The ultimate goal of nursing care is to ensure the child's comfort, safety and prevent complications.

As there is a transition of children from hospital to home setting the caregivers who were depending on the health care professionals are unable to cope with giving care at home. Hence education is a must for caregivers.

Cancer treatments often go on for months and then must be resumed if the disease comes back. As a result, younger persons with cancer and their families must be prepared to cope with a wide range of physical, emotional, and social consequences of the disease and treatments for extended periods of time. In addition, as time in the hospital is shortened and as more and more treatments are given in the clinic, family caregivers are taking on more responsibility for providing care.

As a result, younger persons with cancer and their families must be prepared to cope with a wide range of physical, emotional, and social consequences of the disease and treatments for extended periods of time. In addition, as time in the hospital is shortened and as more and more treatments are given in the clinic, family caregivers are taking on more responsibility for providing care. Health professional assumes that, they can rely on caregiver of children to give care, provide support and encouragement to the young children with cancer, and also to manage medications, control symptoms and side effects, diet therapy, improve physical activity and report problems that require professional intervention.

Hansson H; et al., (2012) conducted a descriptive study to assess the experience of a hospital based home care programs in the families of children with cancer in Denmark. After 4 month program findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. It enhanced their quality of life during child's cancer trajectory.

Schmieglow K, et al., (2011) conducted a descriptive study to reviewed five studies to evaluate the potential effects of hospital based home care for children with cancer. It is widely applied in pediatric oncology. The studies that indicate hospital based home care for children is feasible and carries no crucial negative effects for children with cancer.

As the investigator specialized in pediatric nursing and during the postings at pediatric oncology ward, saw many children suffering with cancer and their parents who were anxious because they didn't know how to support their child after discharge from the wards. So, this made the investigator to choose this research study. Hence the investigator wanted to develop a homecare management to guide and support the caregivers of children with cancer at home.

STATEMENT OF THE PROBLEM

A pre experimental study to assess the effectiveness of multimedia package on knowledge and attitude regarding homecare management for cancer among caregivers of children with cancer at selected hospital, Chennai.

OBJECTIVES

To assess the pre test level of knowledge and attitude regarding homecare management for cancer among caregiver of children with cancer.

To evaluate the effectiveness of homecare management on level of knowledge and attitude regarding homecare management for cancer among caregiver of children with cancer.

To correlate the mean differed knowledge score with attitude score regarding homecare management for cancer among caregiver of children with cancer.

To associate the mean differed level of knowledge and attitude score with selected demographic variables.

OPERATIONAL DEFINITION

EFFECTIVENESS

It refers to the change in knowledge and attitude regarding home care management for cancer among caregivers of children with cancer which is assessed by structured questionnaire and 4 point likert scale devised by the investigator.

MULTIMEDIA PACKAGE ON HOMECARE MANAGEMENT

It refers to the information package regarding homecare management for cancer devised by the investigator and includes information,

Diet therapy, Physical activity, Side-effects of various therapies and Infection control measures for children with cancer which is communicated using Lecture & Pamphlets .

Infection control measures and Diet therapy for children with cancer is educated using Video clipping

Physical activity for children with cancer is demonstrated by the investigator.

KNOWLEDGE

It refers to the questions understanding and ability of the caregiver of children with cancer to answer regarding homecare management which is assessed by using structured questionnaire

ATTITUDE

It refers to an expressed beliefs and ideas of caregiver of children with cancer on homecare management which is assessed by using 4 point likert scale.

CARE GIVER OF CHILDREN WITH CANCER

It refers to the significant caretaker who takes care of the children under 12 years of age diagnosed with cancer and living with disease for about 0-3 years.

ASSUMPTION

Caregiver of children with cancer may have some knowledge regarding homecare management for cancer.

Enhanced knowledge may create a positive attitude towards home care management for cancer among caregiver of children with cancer.

NULL HYPOTHESIS

NH 1: There is no significant difference in the pre & post test level of knowledge and attitude regarding homecare management for cancer among caregiver of children with cancer.

NH 2: There is no significant relationship between pre and post test level of knowledge with attitude regarding homecare management for cancer among caregiver of children with cancer.

NH 3: There is no significant association of the mean differed knowledge score and attitude score with selected demographic variables among caregiver of children with cancer.

DELIMITATION

The study is delimited to a period of 4 weeks.

CONCEPTUAL FRAMEWORK

The study is based on modified J.W kenny's open system model (1999).

The researcher adopted Kenny's open system model for conceptual framework. This theory was introduced by Jennet W. Kenny. She was born in the year 1946 at Scotland. The open system model was formulated in the year 1999.The open system enumerates various aspects of system and interaction. She formulated various theories based on management.

The researcher applied Kenny's open system model in order to assess the effectiveness of multimedia package regarding home care management for cancer among caregivers of children with cancer. This involves interaction between the researcher and the caregiver of children with cancer.

An open system is a system which continuously interacts with its environment. The interaction can take the form of information, energy or material transfers into or out of the system boundary, depending on the discipline which defines the concept. An open system should be contrasted with the concept of an isolated system which exchanges neither energy and matter nor information with its environment.

Open system theory is useful in breaking the whole process into sequential tasks to ensure goal realization. The three major aspects of the systems are:

Input

Throughput

Output

Input is any type of information, energy and material that enters the systems from environment through its boundaries. In this study it refers to pre assessment of knowledge regarding home care management of caregivers of children with cancer by using structured questionnaire and obtaining demographic variables from the caregivers of children with cancer.

Throughput is that any information, energy or material that is given to the caregivers of children with cancer on multimedia package which includes diet therapy, physical activity, side effects of various therapy, infection control measures in the system boundaries. In this study, the process includes the transformation of knowledge regarding home care management for cancer to the caregivers of children with cancer.

Output is the information that leave the system, enters the environment through the system. In this study it refers to improved level of knowledge either adequate, moderately adequate or inadequate level of knowledge after structured teaching program among caregivers of children with cancer. In this study, output is measured with structured questionnaire and 4 point likert scale.

The feedback for the system depends on the output which is either may be reinforcement or enhancement

CHAPTER ??? II

REVIEW OF LITERATURE

Review of literature entails systematic identification, selection and critical analysis of scholarly publications, unpublished scholarly print materials, audiovisual materials and personal communications to the problem of interest. Hence the investigator intended to review the literature available regarding Multimedia package on home care management using both research and non-research materials.

klassen A (2010) describes psychometric validation of the care of child with cancer questionnaire in Canada. A comprehensive evaluation of the psychometric properties of care of child with cancer was performed in 411parents of children undergoing treatment of cancer at five Canadian pediatric oncology centers.The construct validity demonstrated that the (CMCC) is a scientific sound measure and it will be helpful for assessing, increasing parental responsibility for care giving tasks associated with cancer care.

This chapter deals with a broad view of related literature and studies in the following sections.

Section-A : Reviews related to effectiveness of home care management.

Section???B : Reviews related to nutritional aspects regarding home care management of children with cancer.

Section???C : Reviews related to physical activity of children with cancer.

Section???D : Reviews related to the side effects of various cancer treatment

Section???E : Reviews related to infection control measures of children with cancer.

Section-A : Reviews related to effectiveness of home care management.

Hansson H; et al., (2012)51 conducted a descriptive study to assess the experience of a hospital based home care programs in the families of children with cancer in Denmark. After 4 month program findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. It enhanced their quality of life during child's cancer trajectory.

Schmieglow K, et al., (2011)35 conducted a descriptive study to reviewed five studies to evaluate the potential effects of hospital based home care for children with cancer. It is widely applied in pediatric oncology. The studies that indicate hospital based home care for children is feasible and carries no crucial negative effects for children with cancer.

Calisken Yilmaz M, et al., (2010)53 conducted a quasi experimental study to investigate the effectiveness of a discharge-planning program on helping caregivers to meet the physical care needs of children with cancer. The control group had 25 and experimental group had 24 children with their care givers. For the experimental group, discharge planning, discharge teaching home visits and telephone consultation were provided. The results revealed that discharge planning program had significant effect on the care needs of children with cancer and their care givers.

Section???B : Reviews related to nutritional aspects regarding home care management of children with cancer.

The prevalence of malnutrition in children with cancer range between 8% and 60% malnutrition is strongly associated with the nature of treatment and increases an individual's risk of infection. Clinical studies have suggested that nutritional intervention may decrease toxicity and improve survival in the oncology population.

Shipway L, et al., (2010)38 states in a article providing nutritional support for children during cancer treatment that children with cancer after experience a diminished oral intake and exhibit subsequent weight loss and poor nutrition as a result of the sideeffects of the treatments. This article studied the care of a 5 year old boy who developed nutritional problems to demonstrate the need for clear and systematic guidelines and protocols for nurses and health professionals.

Cohen J, et al., (2012)36 conducted a study to assess dietary pattern after treatment in child cancer survivors in Sydney. Dietary intake of 50 child cancer survivors were assessed with 3 day dairy food, parent child feeding practices, anthropometric data. Survivor were less than 13 years old and less than 5 years after treatment completion. Results revealed that 20% of child cancer survivors was overweight 54% were consuming over their estimated energy requirement . 44% of children did not meet requirement for folate , calcium and iron respectively. This group displayed poor dietary habits. Early intervention targeting diet any intake may prevent score of the deleterious long-term effects.

Craig W J, (2010)65 stated that health effects of vegetarian diets that, when vegetarian diet is approximately planned it can be nutritionally adequate for children can promote health and lower the risk of cancers and chronic diseases. fortified food provide shield against deficiency. Vegetarian diet provide low intake of dietary fiber and many health promoting phytochemicals.

Mosby T , et al., (2009)32 article reveals that 'Nutritional assessment for children with cancer' that children undergoing anti cancer therapy are at higher risk for secondary malnutrition including obesity and growth retardation. Periodic nutritional assessment are important .Various ways of assessing nutritional status of children with cancer are, subjective and objective data, screening method including global assessment medical history, physical examination, biochemical data ,nutritional index, anthropometric measures use of growth chart. These methods will enable local health care providers to accurately assess the nutritional status of children with cancer and plan adequate nutritional intervention.

Weitzmen Z(2008) article states that 'dietary therapies for cancer' that complementary and alternative therapies(CAM) include dietary practices some of which claimed to cure cancer. observational studies shown plant based diets reduce the risk for some adult type cancers. Many CAM diets prescribe a similar low fat, high fiber high fruit and vegetable type diet.

Leitzmann. C (2005) presented an article on nutrition in institute of nutritional science, Germany on vegetarian diets advantages wholesome vegetarian diets are appropriate for all stages of life cycle, including children. it reveals that,vegetarian diet are beneficial in the prevention and treatment of certain disease such as cancer and side effects of cancer treatment like osteoporosis.

Ladas EJ; et al(2006) conducted a interventional survey in institutions of children's oncology consortium in Newyork ,USA. To evaluate standards of nutritional care in pediatric oncology .The results found that there was no consistency in the provision of nutrition services. There was no standardized nutrition protocol being employed in the pediatric population.

Section???C : Reviews related to physical activity of children with cancer.

Yen CH; et al (2011) conducted a case control study to examine the feasibility and effects of a home based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia in Pennsylvania, USA. A 6 week home based aerobic exercise intervention were implemented for control group. Findings indicated that children who received the exercise intervention reported significantly lower ''general fatigue''. Home based exercise program may reduce fatigue for ALL children who are undergoing maintenance chemotherapy.

Rueegg CS; et al (2012) conducted a survey among Swiss children cancer survivor. Sample included 1058 survivors who were diagnosed with cancer 1976-2003 at age of 0-15 years registered in the registry. Daily physical activities were reported by 52% of survivors 62% engaged in sports.

Hnang T ; et al (2011) conducted a review to summarize literature that describe the impact of exercise on health and physical function among children during and after treatment of cancer.15 intervention trials published between 1993 and 2011 suggested that children younger than age 21 years with cancer diagnosed. Evidence from studies indicate that effect of exercise include increased cardio pulmonary fitness, improved muscle strength and flexibility, reduced fatigue and improved physical function.

Hennessy E ;et al (2010) conducted a cross sectional study to determine relationship between parenting style and child physical activity in Maryland, USA. About 99 parent child dyads were studied 76 children engaged in 113.4 min of moderate vigorous physical activity (MVPA)then those of uninvolved parents (127.5 vs. 97.1 P <0.05),while parents who provided above average levels of support had children who participated in more minutes of MVPA. High level of parental re-inforcement were associated with higher levels of child physical activity.

Paxton R; et al, (2010)41 conducted a descriptive study to explore factors associated with improving health related quality of life in survivors of childhood cancer. Total of 215 survivors modest linear association was observed between leisure time physical activity (LTPA) and overall health related quality of life (HRQOL). Among adolescent survivor of childhood cancer LTPA was significantly associated with physical function, overall HRQOL, cognitive function, body appearance and social function.

Section???D : Reviews related to the side effects of various cancer treatment

Miller E; et al (2011)81 conducted a descriptive study to describe the prevalence ,frequency, severity and distress in hospitalized children with cancer of 39 patients (ages 10-17) diagnosed with cancer the most common symptoms (prevalence greater than 34%) were nausea, fatigue, decreased appetite, pain and feeling drowsy. The presence of these symptoms significantly impacted symptom experienced by the child. Nausea and its related symptoms have received little attention and more effective interventions are warranted.

Breen M, et al., (2009)45 stated that ''supportive care for children during cancer treatment '' that children and their families come into contact of large number of health professional. The side effects of cancer treatment include fever, infection, gastrointestinal upset, altered body image and psychological impact on children and their families.

Rheingans J, et al., (2008)57 conducted a national descriptive survey of 509 pediatric oncology nurses to assess management of patients, 7 most distressing symptoms. Results revealed that pain is the most commonly reported symptom and trouble in sleeping is the least common.Pain has the greatest numbers of interventions to treat and hair loss the least.

William P D, (2006)80 conducted a descriptive study to monitor therapy related symptoms among children receiving cancer treatment in Kanascity , USA using therapy related symptoms checklist administered to caregivers of 11 children. All children experienced nausea, most frequent symptom were Fatigue ,Fever, Vomiting, Pain ,Hair Loss. Care strategies received were diet, nutrition, life style changes

Haddy TB; et al (2009)43 conducted a study to assess the late effects of cancer in long term survivors after treatment for childhood acute leukemia among 324 survivor in Washington, USA. The results revealed that defective physical growth was most commonly reported , followed by disturbed neuro-cognitive function, emotional difficulties, cardiac abnormalities, hypertension, oesteoporosis, osteopenia, fractures and secondary neoplasms.

Kelly KM (2008) stated that ''bringing evidence to complementary and alternative medicine in children with care'' that, children with cancer frequently use complementary and alternative medicine(CAM). Dietary supplements are commonly used CAM modality 35% to 50% of children with cancer in surveys completed in united states. Less is known about the use of dietary supplements in developing countries. Evidence of some dietary supplements providing some benefits to children with cancer reviewed are anti-oxidant status may affect chemotherapy tolerance in children with leukemia. other supplements are glutamine, vitamin E, colostrums, probiotics may help reduces gastro-intestinal toxicities of chemotherapy and radiation.

Section???E : Reviews related to infection control measures of children with cancer.

Livodiotti S; et al (2012) conducted a national wide survey to evaluate the management and prophylaxis of febrile neutropenia in pediatric clients admitted to hematology, oncology and hematopoietic stem cell transplant units. Out of 40 centers 34 (63%) prescribed anti-bacterial and anti-myotic prophylaxis in low risk subjects 78 and 94% in transplant patients .Half of the centres prescribe a combination of antibiotic regimen in low risk patients. when initial empirical therapy fails after 7 days,63% of the centers add empirical anti-myotic therapy in low and 8% in high risk patients. preventive nursing procedures are in accordance with international guidelines.

Schmidt WP ; et al (2009)63 conducted a cross sectional study survey in 800 household in Kenya to explore cultural constraints that limit better hygiene. A total of 5182 critical opportunities for hand washing were observed . The results revealed that 25% wash hands with soap. About 32% practiced hand washing after fecal content. There was strong association with media exposure and hygiene promotion.

Curtis VA; et al(2009)84 reviewed the results of formative research studies from 11 countries to understand motivating factors in hand washing.17% of child care takers washed hand with soap after the toilet. Hand washing were not inculcated at an early age. Key motivations for hand washing were disgust, nurture, comfort and affiliation .''Plan'' involving hand washing included to improve health to teach children good manners.

Kotch JB ; et al (2007)67 conducted a study to determine whether hand washing reduces transmission of infections agents in reducing the rate of diarrheal illness among children 23 pairs of child care centers were matched on size and star-rated licenses level of intervention agents in reducing diarrheal illness among children.

Anderson ME, et al;(2012) conducted a study to evaluate the effectiveness of hand hygiene practices and the impact of hand hygiene interventions. Hand hygiene compliance was 58% (340/583).Verbal hand hygiene reminders had significant positive association with hand hygiene compliance. Findings suggest that active, rather than passive interventions are more effective for increasing compliance.

CHAPTER ??? III

RESEARCH METHODOLOGY

It includes the research design, variables, setting of the study, population of the study, sample size, sampling technique, criteria for selection of samples, description of the tool, procedure for data collection and plan for data analysis.

RESEARCH APPROACH

Quantitative Research approach was used for this study.

RESEARCH DESIGN

The research design adopted for this study was Pre-Experimental, One Group Pretest And Posttest design. The rationale for adopting this design that was control and homogeneity cannot be maintained among the selected samples.

According to Polit and Beck (2011) the schematic representation of Pre-experimental study is shown below.

GROUP

PRE-TEST

INTERVENTION

POST ??? TEST

Caregivers of children with cancer

Assess the existing level of knowledge and attitude regarding homecare management for cancer among caregivers of children with cancer using structured knowledge questionnaire and attitude scale.

Multimedia Package:

Diet therapy, Physical activity, Side-effects of various therapies and Infection control measures for children with cancer which is communicated using Lecture & Pamphlets.

Infection control measures and Diet therapy for children with cancer is educated using Video clipping.

Physical activity for children with cancer is demonstrated by the investigator.

Assess the post test level of knowledge and attitude regarding homecare management for cancer among caregivers of children with cancer using knowledge questionnaire and attitude scale.

VARIABLES

Independent Variable

The independent variable for this study was Multimedia package on home care management prepared by the investigator, which comprises of lectures, video clipping, pamphlet and demonstration.

Dependent Variable

The dependent variable for this study was Knowledge and Attitude regarding homecare management for cancer.

Extraneous Variable

Educational status, occupational status , food pattern, family history of cancer, family income, type of cancer, duration of illness, treatment modalities, source of information about cancer.

SETTING

The setting for the study was pediatric oncology ward of Kanchi Kamakoti Child Trust Hospital, Chennai, the oncology ward comprises of 35 beds and has an Inpatient of 50-60 per month.

SAMPLE

The study sample comprises of 40 caregivers of children with cancer who diagnosed with cancer and living with the disease for about 0-3 years.

CRITERIA FOR SAMPLE SELECTION

Inclusive Criteria

Children who were under 12 years of age diagnosed to have cancer for about 0- 3 years.

Caregiver of children with cancer who can understand Tami, English & Telegu.

Exclusive Criteria

Caregivers who were not willing to participate in the study.

Caregivers who are paid for the services are excluded.

SAMPLE SIZE

It consisted of 40 caregivers of children with cancer who diagnosed with cancer and living with the disease for about 0-3 years. Who fulfilled the sample selection criteria formed the samples for the study.

SAMPLING TECHNIQUE

Non-probability purposive sampling technique was used to select the samples for the study.

DEVELOPMENT AND DESCRIPTION OF THE TOOL:

I. DATA COLLECTION

After an extensive review of literature and consultation with expert???s opinion the tool was constructed to generate the data. Tool for the data collection consisted of three sections.

SECTION A: Demographic variables

Educational status, occupational status, food pattern, family history of cancer, family income, type of cancer, duration of illness, treatment modalities, source of information about cancer.

SECTION B: Knowledge questionnaire regarding homecare management

The knowledge questionnaire prepared by the investigator was divided into the following sections and total number of questions in each sections were given below.

Diet therapy

Physical activity

Side effects of various therapies &

Infection control measures

Diet therapy - 10 questions

Physical activity - 10 questions

Side-effects of various therapies - 10 questions

Infection control measures - 5 questions

Scoring key: The tool consisted of 35 questions.

Each correct response was awarded a score of ???1??? mark and wrong response was given a score ???0???

Score

Percentage

Level of knowledge

1- 9

10-15

16-20

< 50 %

50-75 %

>75 %

Inadequate

Moderately adequate

Adequate

SECTION C: Attitude scale regarding home care management

The attitude scale prepared by the investigator was divided into the following sections were given below.

Diet therapy

Physical activity

Side effects of various therapies

Infection control measures

A four point likert scale which consisted of 5 positive worded and 5 negative worded statements were used to assess the attitude regarding homecare management of caregivers of children with cancer.

Scoring key: The tool consisted of 10 questions with Maximum score of 80 and Minimum score of 20, divided into the following:

Positive statements- 10- score 4-3-2-1

Negative statements- 10- score 1-2-3-4

Positive statements: 1,3,5,7,9.

Negative statements: 2,4,6,8,10.

Score

Percentage (%)

Level of attitude

61-80

>75

Favorable attitude

40-60

50-75

Moderately favorable attitude

20-39

<50

Unfavorable attitude

.

II. INTERVENTION TOOL

The intervention tool prepared by the investigator consisted of the following :

Lecture method consisted details regarding diet therapy, side effects of various therapies was planned for 10 minutes. Video Clippings containing images related to infection control measures and diet therapy was planned for 10 minutes. Demonstration on physical activity was planned for 15 minutes and distribution of Pamphlets that contained details of home care management of diet therapy, physical activity, side effects of various therapies and infection control measures was planned for 10 minutes.

CONTENT VALIDITY

The content validity of the tool was obtained from 1 pediatrician, 3 pediatric nursing experts and 1oncologist. The content validity from the nutritionist and physiotherapist was obtained. The content validity for the translated tool in Tamil language was also obtained from a Tamil Pandit. As per the experts??? advice all the modifications were made and were incorporated in the final tool.

ETHICAL CONSIDERATION

Ethics is a system of moral values that is concerned with the degree to which the research procedures adhere to the professional, legal and social obligations to the study participants. Polit and Hungler (2011)

1. BENIFICIENCE

The investigator followed the fundamental ethical principle of beneficence (doing good) by adhering to

The right to freedom from harm and discomfort

The study will be beneficial for the participants as it enhances their knowledge and attitude of the caregivers of children with cancer regarding homecare management.

The right to protection from exploitation

The investigator explained the procedure and nature of the study to the participants and ensured that none of the participants will be exploited or denied fair treatment.

2. RESPECT FOR HUMAN DIGNITY

The investigator followed the second ethical principle with respect for human dignity. It includes the right to self determination and the right to self disclosure.

The Right to Self-determination.

The investigator gave full freedom to the participants to decide voluntarily whether to participate in the study, to withdraw from the study and the right to ask questions.

b) The Right to Full Disclosure.

The researcher has fully described the nature of the study, the person???s right to refuse participation and the researcher???s responsibilities based on which the informed consent both oral and written consent was obtained from the participants.

3. JUSTICE

The researcher adhered to the third ethical principle of justice, it includes participant???s right to fair treatment and right to privacy.

a) Right to Fair Treatment

The researcher selected the study participants based on the research requirements, no vulnerable or compromised candidates were selected as study participants.

b) Right to Privacy.

The researcher maintained the participant???s privacy throughout the study.

4. CONFIDENTIALITY:

The researcher maintained confidentiality of the data provided by the study participants.

PILOT STUDY

The pilot study was conducted at Kanchi Kamakoti Child Trust Hospital, Chennai for a period of one week after getting formal permission from the medical director. Informed consent was obtained from the study participants, the number of participant selected for the study were 10. After which pre-test was conducted using structured knowledge questionnaire and attitude scale along with the assessment of demographic variables, Intervention was administered using multimedia package comprising (video clippings, demonstration, lecture and pamphlet) on the same day. The post-test was conducted after one week by administering the same structured knowledge questionnaire and attitude scale. The results showed that, it was feasible and practicable to conduct the main study and the criterion measures were found to be effective. The plans for statistical analysis were also determined. Therefore the data collection for the main study was done in a same setting.

RELIABILITY

Tool reliability was checked by test-retest method and split half method. The reliability score was ???r???= 0.9 for knowledge questionnaire and ???r???=0.9 for attitude scale. This indicated that the tool was reliable.

PROCEDURE FOR DATA COLLECTION

A formal permission was obtained from the Principal, Omayal Achi College of Nursing. The main study was conducted at pediatric oncology ward of Kanchi Kamakoti Child Trust Hospital in Chennai. A formal permission was obtained from the medical director of the institution. The data was collected within the period of 4 weeks. The study participants were gathered at the time of the study in a seminar hall with help of the nursing staffs, administrative officer they were made to sit comfortably, with adequate lighting and ventilation. A formal introduction of self and to the topic was given to the study participants. The study participants were given the consent form along with the pre-test questionnaire consisting of demographic form, knowledge questionnaire and 4 point likert attitude scale, the participants took approximately 15- 20 minutes to fill the questionnaire. After the completion of the questionnaire, the investigator administered the intervention tool (multimedia package) for 45 minutes on the aspects of diet therapy, physical activity, side effects of various therapies and infection control measures. The session was concluded by clarifying the doubts of the participants and answering to their questions. The participants were given refreshment after the intervention. Post test was conducted after seven days by using the same knowledge questionnaire and attitude scale.

The instruction given to the participants were:

They can fill the questionnaire with frank and honest answers to the best of their ability.

All the responses will be treated confidential.

All questions should be answered.

Doubts can be clarified.

PLAN FOR DATA ANALYSIS

Descriptive Statistics

Frequency and percentage distribution was used to analyze the demographic variables.

Mean and standard deviation was used to compare the pre and post test level of knowledge and attitude.

Inferential Statistics

Paired ???t??? test was used to compare the pre and post test level of knowledge and attitude regarding home care management of caregivers of children with cancer.

Correlation coefficient (Karl Pearson Method) was used to find out the relationship between knowledge and attitude regarding home care management of caregivers of children with cancer.

Chi square to associate post level of knowledge score and attitude score with selected demographic variables of caregivers of children with cancer.

CHAPTER ??? IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with analysis and interpretation of data to study the effectiveness of multimedia package on knowledge and attitude regarding home care management among caregivers of children with cancer at selected hospital, Chennai. The data findings have been tabulated and interpreted according to plan for data analysis.

The data collected from 40 caregivers were grouped and analyzed using descriptive and inferential statistics, the results were presented under the following sections.

ORGANIZATION OF DATA

Section A : Description of Demographic variables of the caregivers.

Section B : Assessment of the pre test and post test level of knowledge and attitude on homecare management for cancer among caregivers of children with cancer.

Section C : Effectiveness of homecare management for cancer among caregivers of children with cancer.

Section D : Correlation of mean differed score in knowledge and attitude regarding homecare management for cancer among caregivers of children with cancer.

Section E : Association of the mean differed knowledge and attitude score on homecare management for cancer with selected demographic variables.

SECTION A: DESCRIPTION OF DEMOGRAPHIC VARIABLES OF THE CAREGIVERS.

Table 1(a) :Frequency and percentage distribution of caregivers of children with cancer with respect to educational status, occupational status, family history, monthly income and location of residence.

n = 40

Demographic Variables

No.

%

Educational Status

??

??

No Formal Education

6

15.00

Primary Education

7

17.50

Secondary Education

9

22.50

High School

6

15.00

Higher Secondary

2

5.00

Under Graduate

7

17.50

Post Graduate

3

7.50

Occupational Status

??

??

Semi Skilled Worker

4

10.00

Skilled Worker

12

30.00

Self Employed

16

40.00

Professional

7

17.50

Home Worker

1

2.50

Family History

??

??

Yes

11

27.5

Paternal Relation

3

7.5

Maternal Relation

4

10.0

Sibling Relation

4

10.0

Uncertain

0

0.00

No

18

45

Monthly Income

??

??

<5000

7

17.50

5000-9000

15

37.50

9000-12000

9

22.50

>12000

9

22.50

The table 1(a) shows that majority 9(22.50%) had secondary level of education, 16(40%) were self employed, 29(72.50%) had no family history of cancer and 15(37.50%) had a monthly income of Rs.5000 ??? 9000.

Table 1(b) :Frequency and percentage distribution of caregivers of children with cancer with respect to food habits, type of cancer, duration of illness, treatment modalities and media.

n = 40

Demographic Variables

No.

%

Food Habits

??

??

Vegetarian

13

32.50

Non-Vegetarian

27

67.50

Type of Cancer

??

??

Leukemia

15

37.50

Lymphomas

14

35.00

Others

11

27.50

Duration of Illness

??

??

0-6 Month

3

7.50

6 Month -1Year

21

52.50

1 - 2 Year

8

20.00

2 - 3 Year

8

20.00

Treatment Modalities

??

??

Radiation Therapy

2

5.00

Surgical Treatment

15

37.50

Chemotherapy

23

57.50

Others

0

0.00

Media

??

??

Television

2

5.00

Internet

14

35.00

Health Care Members

13

32.50

News Paper

7

17.50

Peer Groups

4

10.00

The table 1(b) shows that majority 27(67.50%) were non-vegetarian, 15(37.50) had leukemia, 21(52.50%) had illness for 6 months ??? 1 year, 23(57.50%) were undergoing chemotherapy and 14(35%) had received information about cancer through internet.

SECTION B: ASSESSMENT OF THE PRETEST AND POST TEST LEVEL OF KNOWLEDGE AND ATTITUDE ON HOMECARE MANAGEMENT FOR CANCER AMONG CAREGIVERS OF CHILDREN WITH CANCER.

n = 40

Fig.1: Percentage distribution of pretest and post test level of knowledge regarding homecare management for cancer among caregivers of children with cancer

The figure 1 shows the percentage distribution of pretest and post test level of knowledge regarding home care management for cancer.

The figure shows that in the pretest, majority 25(62.5%) had moderately adequate knowledge regarding homecare management for cancer. In the post test, majority 37(92.5%) had adequate knowledge regarding home care management for cancer.

n = 40

Fig.2: Percentage distribution of pretest and post test level of attitude regarding homecare management for cancer among caregivers of children with cancer

The figure 2 shows the percentage distribution of pretest and post test level of attitude regarding homecare management for cancer.

The figure shows that in the pretest, majority 38(95%) had moderately favorable attitude regarding home care management for cancer. In the post test, majority 37(92.5%) had favorable attitude regarding home care management for cancer.

SECTION C : EFFECTIVENESS OF HOMECARE MANAGEMENT FOR CANCER AMONG CAREGIVERS OF CHILDREN WITH CANCER.

Table 2 : Comparison of pretest and post test level of knowledge regarding homecare management for cancer among caregivers of children with cancer.

n = 40

Knowledge

Mean

S.D

???t??? Value

Pretest

21.75

5.12

t = 11.340***

p = 0.001, S

Post Test

31.72

2.01

***p<0.001, S ??? Significant

The table 2 shows that in the pretest the mean score of knowledge was 21.75 with S.D 5.12 and the post test mean score was 31.72 with S.D 2.01. The calculated ???t??? value of t = 11.340 and was found to be statistically highly significant at p<0.001 level. This clearly showed that the intervention multimedia package on homecare management for cancer had significant improvement in the level of knowledge to the caregivers of children with cancer.

Table 3: Comparison of pretest and post test level of attitude regarding home care management among caregivers of children with cancer.

n = 40

Attitude

Mean

S.D

???t??? Value

Pretest

24.22

2.68

t = 23.104***

p = 0.000, S

Post Test

35.97

2.56

***p<0.001, S ??? Significant

The table 3 shows that in the pretest the mean score of attitude was 24.22 with S.D 2.68 and the post test mean score was 35.97 with S.D 2.56. The calculated ???t??? value of t = 23.104 was found to be statistically highly significant at p<0.001 level. This clearly showed that the intervention multimedia package on homecare management for cancer had significant improvement in the level of attitude to the caregivers of children with cancer.

SECTION D : CORRELATION OF MEAN DIFFERED SCORE IN KNOWLEDGE AND ATTITUDE REGARDING HOMECARE MANAGEMENT FOR CANCER AMONG CAREGIVERS OF CHILDREN WITH CANCER.

Table 4 : Correlation between mean differed score in knowledge and attitude regarding homecare management for cancer among caregivers of children with cancer.

n = 40

Variables

Mean

S.D

???r??? Value

Knowledge

9.97

5.56

r = 0.338*

Attitude

11.75

3.22

*p<0.05, S ??? Significant

The table 4 shows that the mean differed knowledge score was 9.97 with mean differed S.D 5.56 and the mean differed attitude score was 11.75 with mean differed S.D 3.22. The calculated ???r??? value of r = 0.338 was found that there was a moderate significant correlation of knowledge with attitude. This clearly showed that there is a moderate positive correlation between the mean differed knowledge and attitude score which indicates that when the level of knowledge of caregivers increases their attitude level on homecare management for cancer also increases.

SECTION E : ASSOCIATION OF THE MEAN DIFFERED SCORE IN THE KNOWLEDGE AND ATTITUDE ON HOMECARE MANAGEMENT FOR CANCER AMONG CAREGIVERS OF CHILDREN WITH CANCER WITH THEIR SELECTED DEMOGRAPHIC VARIABLES.

Table 5 : Association of mean differed score in the knowledge regarding homecare management for cancer among caregivers of children with cancer with their selected demographic variables.

n = 40

Demographic Variables

Pre test

Post test

No.

%

No.

%

Educational Status

No Formal Education

2

5.0

3

7.5

Primary Education

2

5.0

5

12.5

Secondary Education

6

15.0

3

7.5

High School

5

12.5

2

5.0

Higher Secondary

1

2.5

1

2.5

Under Graduate

4

10.0

3

7.5

Post Graduate

0

0

3

7.5

Occupational Status

Semi Skilled Worker

1

2.5

3

7.5

Skilled Worker

7

17.5

5

12.5

Self Employed

7

17.5

9

22.5

Professional

5

12.5

2

5.0

Home Worker

0

0

1

2.5

Family History

Yes

5

12.5

6

15.0

No

15

37.5

14

35.0

Monthly Income

<5000

3

7.5

4

10.0

5000-9000

10

25.0

5

12.5

9000-12000

3

7.5

6

15.0

>12000

4

10.0

5

12.5

N.S ??? Not Significant

The above table 5 shows that none of the demographic variables had shown statistically significant association with the mean differed knowledge score of caregivers on home care management for cancer

Table 6: Association of mean differed score in attitude regarding homecare management for cancer among caregivers of children with cancer with their selected demographic variables.

n = 40

Demographic Variables

Pre test

Post test

No.

%

No.

%

Occupational Status

Semi Skilled Worker

4

10.0

0

0

Skilled Worker

4

10.0

8

20.0

Self Employed

4

10.0

12

30.0

Professional

5

12.5

2

5.0

Home Worker

3

7.5

0

0

Duration of Illness

0-6 Month

3

7.5

0

0

6 Month -1Year

7

17.5

14

35.0

1 - 2 Year

3

7.5

6

15.0

2 - 3 Year

7

17.5

0

0

*p<0.05, S ??? Significant

The above table 6 shows that demographic variables occupational status and duration of illness had shown statistically significant association with the mean differed attitude score of caregivers on homecare management for cancer of children with cancer and other variable did not have any significant association.

CHAPER ??? V

DISCUSSION

This chapter discusses in detail the findings of the study based on the interpretation from statistical analysis. The findings are discussed in pertinence to the objectives of the study. The findings are supported by the review of literature related to the phenomena of the study.

The purpose of the study was to assess the effectiveness of multimedia package on knowledge and attitude regarding homecare management for cancer among caregivers of children with cancer at selected hospital, Chennai.

The first objective was to assess the pre and post level of knowledge and attitude regarding homecare management for cancer among caregiver of children with cancer.

The analysis revealed that in the pretest, majority 25(62.5%) had moderately adequate knowledge regarding homecare management for cancer among caregivers of children with cancer. In the post test, majority 37(92.5%) clearly showed that the intervention multimedia package on homecare management for cancer had significant improvement in the level of knowledge to the caregivers of children with cancer.

The analysis also revealed that in the pretest, majority 38(95%) had moderately favorable attitude regarding homecare management for cancer among caregivers of children with cancer. In the post test, majority 37(92.5%) This clearly showed that the intervention multimedia package on homecare management for cancer had significant improvement in the level of attitude to the caregivers of children with cancer.

The findings were supported by the study conducted by Schimiegelow (2010) effectiveness of home care program in the families of children with cancer among 30 parents from selected hospital was assessed and it was found that overall knowledge was improved from 17% to 72% in the post test and also revealed that hospital based home care program enhanced their quality of life during the child's cancer trajectory.

The second objective was to evaluate the effectiveness of homecare management for cancer on level of knowledge and attitude among caregiver of children with cancer.

The analysis portrayed in table 2 shows that in the pretest the mean score of knowledge was 21.75 with S.D 5.12 and the post test mean score was 31.72 with S.D 2.01. The calculated ???t??? value of t = 11.340 was found to be statistically highly significant at p<0.001 level. This clearly showed that the intervention multimedia package on homecare management for cancer had significant improvement in the level of knowledge to the caregivers of children with cancer.

The results of the analysis in table 3 shows that in the pretest the mean score of attitude was 24.22 with S.D 2.68 and the post test mean score was 35.97 with S.D 2.56. The calculated ???t??? value of t = 23.104 was found to be statistically highly significant at p<0.001 level. This clearly showed that the intervention multimedia package on homecare management for cancer had significant improvement in the level of attitude to the caregivers of children with cancer.

Hence the null hypothesis NH1 stated earlier that ???there is no significant difference in the pre & post test level of knowledge and attitude regarding homecare management for cancer among caregiver of children with cancer??? was rejected.

The third objective was to correlate the mean difference knowledge score with attitude score regarding homecare management for cancer among caregiver of children with cancer.

The results of the correlation analysis in table 4 shows that the mean differed knowledge score was 9.97 with mean differed S.D 5.56 and the mean differed attitude score was 11.75 with mean differed S.D 3.22. The calculated ???r??? value of r = 0.338 was found to be statistically significant at p<0.05 level.

The result showed that there was a positive correlation between the mean differed knowledge and attitude score which indicated that when the level of knowledge of caregivers increases their attitude level on home care management for cancer also increases.

Hence the null hypothesis NH2stated earlier that ???There is no significant relationship between pre and post test level of knowledge with attitude regarding homecare management for cancer among caregiver of children with cancer??? was rejected.

The fourth objective was to associate the mean difference level of knowledge and attitude score with selected demographic variables.

The results portrayed in table 5 showed that none of the demographic variables had shown statistically significant association with the mean differed knowledge score of caregivers on homecare management for cancer of children with cancer.

The results portrayed in table 6 showed that the demographic variables occupational status and duration of illness had shown statistically significant association with the mean differed attitude score of caregivers on homecare management for cancer of children and other variable did not have any significant association.

Hence the null hypothesis NH3stated earlier that ???There is no significant association of the mean differed knowledge score with selected demographic variables and for the attitude score , variables such as occupational status and duration of illness was rejected and the hypothesis for the other variables was accepted.

CHAPTER ??? VI

SUMMARY, CONCLUSION, IMPLICATIONS, RECOMMENDATIONS AND LIMITATIONS

This chapter presents the summary, conclusion, implications, recommendations and limitations of the study based on the objectives selected.

SUMMARY

In India, approximately 45,000 children are diagnosed with cancer every year and it ranks 2nd leading cause of death. survival rate of cancer has increased significantly compared to previous years with all the advanced treatment modalities. hence, home care management of cancer children plays an important role to sustain the effects of therapy. so investigator identified the need to educate caregivers of children with cancer about home care management.

The home care management also help health professionals to monitor and guide care that is given at home. The home care management in this multimedia package deals with diet therapy, physical activity, side effects of various therapy and infection control measures. the professionals knows that caregivers are following the procedures recommended at home. Care giving can have important benefits preventing complications, ensuring growth and development and enhance the quality of life. Caring for someone can give you a sense of satisfaction and confidence. Families who give care often feel closer to each other and to the young children who is ill.

The purpose of the study was to assess the effectiveness of multimedia package on knowledge and attitude regarding homecare management among caregivers of children with cancer

The objectives of the study were

To assess the pre test level of knowledge and attitude regarding homecare management among caregiver of children with cancer.

To evaluate the effectiveness of homecare management on level of knowledge and attitude among caregiver of children with cancer.

To correlate the mean difference knowledge score with attitude score regarding homecare management among caregiver of children with cancer.

To associate the mean difference level of knowledge and attitude score with selected demographic variables.

The study was based on the assumptions that

Caregiver of children with cancer may have some knowledge regarding home care management.

Multimedia package may enhance adequate knowledge and attitude regarding homecare management among caregiver of children with cancer.

The null hypotheses formulated were

NH1 There is no significant difference in pre and post intervention level of knowledge and attitude regarding homecare management among caregiver of children with cancer at p<0.001.

NH2 There is no relationship between mean difference knowledge score and attitude score at p< 0.05.

NH3 There is no significant association of mean difference level of knowledge and attitude with selected demographic variables at p<0.05

The review of literature was derived from primary and secondary sources, along with professional experience and expert???s guidance from the field of child health nursing provided a strong foundation for the selection of problem. It also strengthened the ideas for conceptual framework, aided to design the methodology and develop the tool for data collection.

In view of explaining and relating various aspects of the study, the investigator had adopted J.W Kenny's open system model to conceptualize the research.

The researcher adopted pre-experimental one group pre test and post design to assess the effectiveness of multimedia package on knowledge and attitude regarding homecare management among 40 caregivers of children with cancer. The study was conducted in the pediatric oncology ward comprises 35 beds and has an in patients of 50-60 per month at Kanchi Kamakoti Child Trust Hospital, who fulfilled the inclusive criteria of the study and were assigned by non probability purposive sampling.

The tool for data collection had 3 sections. Section A: Demographic data to collect information on Educational status, occupational status ,food pattern, family history of cancer, family income, type of cancer, duration of illness, treatment modalities, source of information about cancer. Section B: Knowledge questionnaire regarding homecare management which includes diet therapy, physical activity, side effects of various therapies, infection control measures to assess the effectiveness of multimedia package on knowledge level among caregiver of children with cancer. Section C: Attitude scale regarding home care management to assess the effectiveness of multimedia package on attitude level among caregiver of children with cancer which consists of diet therapy, physical activity, side effects of various therapies, infection control measures.

The Medical and Nursing experts validated the tool. The pilot study was conducted at Kanchi Kamakoti Child Trust Hospital, Nungambakam, Chennai and it was found practicable and feasible to proceed with the main study. The reliability of the tool was established by split half method, ???r??? = 0.9 by using Karl Pearson correlation coefficient method. The findings showed that the tool was found to be highly reliable to proceed with the main study.

The ethical aspect of research was maintained throughout the study by obtaining ethical clearance certificate from the International Centre for Collaborative Research (ICCR), formal permission from the respective authorities and consent from the participant???s parents and concerned staff nurse. Privacy and confidentiality was maintained throughout the data collection period and collected data was used only for the research purpose.

The main study was conducted for a period of 4 weeks. the collected was analyzed using SPSS version 13.

Main findings of the study were

The data collected was analyzed using descriptive and inferential statistics. Interpretation and discussion was done based on the objectives of the study, null hypotheses, conceptual framework and research studies from liter