The experience of cancer pain in South African patients.

BACKGROUND: Most people with cancer experience pain caused by the disease and treatment. AIMS: To describe the experience of cancer pain of South African patients. METHODS: A qualitative descriptive design was used; 20 (n=20) participants were purposively selected and in-depth interviews were conducted. Inductive content analysis was used to analyse the data. FINDINGS: Two themes and five subthemes were identified. The themes were pain as a unique multi-dimensional experience, and that the unmet needs of the patient can influence their experience of pain. CONCLUSION: The participants experienced total pain. Emotional pain, enhanced by loneliness and unmet information needs was experienced, and this was felt by participants as the worst kind of pain. Pain was mediated by means of medication that did not work well for all, support, compassionate care and hope that God would cure them and take the pain away. RECOMMENDATION: A person-centred approach to pain management is needed, especially in diverse countries, such as South Africa, to better understand the complexity and influence of culture, language and education on the pain experience and to guide individual pain management.

Caring for cancer patients in acute cancer care settings: Voices of South African nurses.

Little is known about the experience of nurses in Africa caring for cancer patients. This study was undertaken to provide a straightforward description of the experiences of South African nurses caring for patients in acute cancer care settings. Purposive sampling selected 20 nurses with whom there were in-depth interviews. Most of the participants were female registered oncology nurses with more than five years' experience. Three themes were identified: defining the cancer nursing experience, the challenges experienced in caring for cancer patients, and challenges imposed by the healthcare system. Most of the participants believed they were called by God to care for cancer patients. However, the challenges they experienced led to guilt feelings and believing the care they provided was insufficient. They were subjected to workplace violence, missed the support from senior nursing management, and displayed signs of burnout. Addressing these challenges could limit their emotional distress and prevent burnout.

Knowledge, attitudes and practices of Zimbabwean men relating to prostate cancer.

BACKGROUND: Prostate cancer is one of the leading causes of death in Zimbabwe. However, screening for prostate cancer is opportunistic as population-based screening is not available. OBJECTIVES: This study aimed to describe the knowledge, attitudes and practices of men living in Harare, Zimbabwe relating to prostate cancer. METHOD: A door-to-door survey took place in Mufakose, Harare. Each household was included, and men, 40 years and older, were convenience sampled until realisation of the calculated sample size of 269 (n = 269). A researcher-administered questionnaire collected the data, analysis was performed with descriptive statistics, and Chi-square tested statistically significant differences between the variables. RESULTS: The majority of the sample (53.2; n = 143) was between 40 years old and 49 years old. Most (74.5%; n = 201) did not know what prostate cancer was, but the total sample (100%; n = 269) indicated that prostate cancer could lead to death. Only 50.6% (n = 136) were of the opinion that men should be screened; most (87.7%; n = 236) had never been screened. A Chi-square test of independence found a statistically significant difference between educational level and having had prostate cancer screening, χ2 (1) = 47.881, p 0.000. CONCLUSION: As confirmed by other studies, the respondents had limited knowledge of prostate cancer, but had a positive attitude towards the disease, as most were willing to go for screening. There had been only a small percentage screened previously, and less than half returned to learn the results.Contribution: The study emphasises the role of primary health clinics as it could be an ideal setting to teach men about prostate cancer and its screening, and provide screening services in Zimbabwe.

Paediatric oncology nursing education and training programmes: a scoping review protocol.

INTRODUCTION: The care of children with cancer is a highly specialised field which requires well-educated, trained and dedicated nurses to provide high-quality care. In low/middle-income countries, the survival rate of children with cancer is low as compared with that of high-income countries due to the limited number of specialised oncology healthcare professionals, especially nurses. To address this problem, a number of paediatric oncology education and training programmes have been developed for nurses. The objective of this scoping review is to describe the existing literature focusing on paediatric oncology nursing education and training programmes; to map the content, delivery methods, duration and mode of assessment. METHODS: The review will include articles published in English, from 2012 to 2022, that describe a paediatric oncology nursing education programme, from any setting. The review will follow Joanna Briggs Institute methodology for scoping reviews guidelines. A systematic search of literature will be performed in CINAHL, Dimensions, Embase, PubMed and Scopus. A two-stage standardised screening process will be employed to evaluate eligibility of the articles. All abstracts that will be considered relevant will be reviewed in full text form by the two reviewers independently. Conflicts will be resolved by consensus of all reviewers through a meeting. Data will be extracted by two independent reviewers using a developed data extraction tool. The results will be reported in extraction tables and diagrams with a narrative summary. ETHICS AND DISSEMINATION: This scoping review is part of the multiphase study which obtained ethical clearance from College of Medicine Research Ethics Committee in Malawi and Human Research Ethics Committee of the University of Witwatersrand, South Africa. The scoping review will be published in a peer reviewed journal. The findings will also be presented at national and international conferences. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/X3Q4H.

Growth and development of oncology nursing in Africa.

There is a growing recognition that oncology nurses are vitally important for an effective cancer control system. Although there is variation among countries, oncology nursing is being recognized as a specialty practice and seen as a priority for development in cancer control plans in many settings. Ministries of Health in many countries are beginning to acknowledge the role nurses play in achieving successful cancer control outcomes. Additionally, the need for access to relevant education for oncology nursing practice is being recognized by nursing and policy leaders. The purpose of this paper is to highlight the growth and development of oncology nursing in Africa. Several vignettes are presented by nurse leaders in cancer care from several African countries. Their descriptions offer brief illustrations regarding the leadership nurses are providing in cancer control education, clinical practice, and research in their respective countries. The illustrations offer insight into the urgent need, and the potential, for future development of oncology nursing as a specialty given the many challenges nurses face across the African continent. The illustrations may also provide encouragement and ideas for nurses in countries where there is little current development of the specialty about how to proceed to mobilize efforts aimed toward its growth.

Palliative Nursing in Africa: Scoping the Landscape of Evidence Focusing on Cancer Care.

AIM: The aim of this study was to describe the research output of African's nurses in the field of palliative care from January 1, 2012 to December 31, 2021. METHODS: A scoping review was conducted. The key words Africa and nursing in combination with palliative care, end of life, terminal care, hospice, and supportive care were used to search the databases Cumulative Index to Nursing and Allied Health Literature, PsychINFO, PubMed, Scopus, and Web of Science. Only studies authored by a nurse with an African affiliation focusing on issues related to advanced cancer were included. The data were captured onto an extraction sheet and analyzed by means of descriptive statistics and content analyses. RESULTS: Of the 522 articles identified, only 16 met the inclusion criteria. The work originated from eight African countries was primarily qualitative and focused on the family and caregivers. Pain was the only symptom investigated. CONCLUSIONS: Studies focusing on symptoms, psychosocial, spiritual, end of life care as well as studies testing nursing interventions are urgently needed. Interregional research could also assist with building the current evidence.

The experiences of caregivers of patients living with cancer admitted to a hospice in South Africa.

BACKGROUND: Caregivers share cancer experiences with patients, but little is known about their own experiences in the end-of-life phase, the most difficult phase in the caregiving journey. AIMS: To describe the experiences of caregivers of cancer patients admitted to a hospice in South Africa. METHODS: A qualitative design was used; 22 (n=22) participants were purposively selected and in-depth interviews were conducted. Analysis of the data was by qualitative content analysis. FINDINGS: A total of three themes arose from the data: emotional responses towards the caregiver role, personal cost of caregiving and spiritual issues relating to caregiving. CONCLUSION: Caring for cancer patients during the last phase of life was not easy. Responsibilities overwhelmed the participants and they were emotionally exhausted. They lacked knowledge of how to care and experienced a heavy financial burden. Despite the challenges that they faced, faith and religious practices served as a coping mechanism and kept some going.

Competencies for Nurses Regarding Psychosocial Care of Patients With Cancer in Africa: An Imperative for Action.

Psychosocial care is considered an important component of quality cancer care. Individuals treated for cancer can experience biologic or physical, emotional, spiritual, and practical consequences (eg, financial), which have an impact on their quality of living. With the establishment of cancer centers in Africa, there is growing advocacy regarding the need for psychosocial care, given the level of unmet supportive care needs and high emotional distress reported for patients. Nurses are in an ideal position to provide psychosocial care to patients with cancer and their families but must possess relevant knowledge and skills to do so. Across Africa, nurses are challenged in gaining the necessary education for psychosocial cancer care as programs vary in the amount of psychosocial content offered. This perspective article presents competencies regarding psychosocial care for nurses caring for patients with cancer in Africa. The competencies were adapted by expert consensus from existing evidenced-based competencies for oncology nurses. They are offered as a potential basis for educational program planning and curriculum development for cancer nursing in Africa. Recommendations are offered regarding use of these competencies by nursing and cancer program leaders to enhance the quality of care for African patients with cancer and their family members. The strategies emphasize building capacity of nurses to engage in effective delivery of psychosocial care for individuals with cancer and their family members.

An Inquiry into Cancer-Related Knowledge, Understanding, and Health-Seeking Behavior of Men Living in South Africa.

In 2018, we conducted a survey among a convenience sample of men (n = 205) living in a resource-poor, semi-urban community in South Africa. We aimed to describe what they know about cancer by asking questions about cancer-related knowledge and understanding, and health-seeking behavior. We also investigated possible relationships between the variables. We used a researcher-administered questionnaire to collect the data and descriptive statistics and quantitative content analyses for the analysis. Chi-square was used to examine the relationships. The mean age of the sample was 35 years, and 49.8% (n = 102) attended 11 or 12 years of school. One-third (32.7%; n = 67) indicated they knew what cancer was, but only 28.8% (n = 59) gave an explanation: "very dangerous/a killer/worse than HIV" were the most common explanations. Only 24.9% (n = 51) were able to identify a possible warning sign, and "feeling very sick" was the most common. However, more than 60% considered six of the seven warning signs of cancer as serious. When suspecting they might have cancer, most (77%; n = 159) indicated they would tell the preferred person within 1 week, while 5.9% (n = 12) would tell "nobody." Although the majority (52.2%; n = 107) felt their partners and families motivated them to seek healthcare when sick, 28.3% (n = 58) needed permission to consult a professional. Educating the community about cancer in a culturally sensitive manner, irrespective of their educational level and perceived knowledge of cancer, could improve knowledge and understanding and lead to seeking healthcare timely.

"A lot of them have scary tears during childbirth " experiences of healthcare workers who care for genitally mutilated females.

Despite concerted efforts to curb Female Genital Mutilation/Cutting (FGM/C), it is still a contributor to the high morbidity and mortality rates among females in Africa. According to available literature, the experiences of healthcare workers who care for the genitally mutilated females in Nigeria have not been described, hindering efforts towards ending this procedure through evidence-based, community-led interventions. This qualitative study described the experiences of healthcare workers caring for the genitally mutilated females in South-Eastern Nigeria. In-depth interviews conducted with 17 participants resulted in two themes and five sub-themes. The participants faced major challenges in caring for these females as the complications of FGM/C resulted in situations requiring advanced skills for which they were ill-prepared. Irrespective of this complex situation, the participants believed FGM/C was an age-old cultural practice; some even supported its continuation. The solution to this problem is not simple. However, educational programmes involving all cadres of healthcare workers could assist with eradicating this practice. Also, enforcing the anti-FGMC law could enhance the eradication of this procedure.

Seeking Divine Intervention to Manage the Advanced Stages of Breast Cancer in Southwestern Nigeria.

BACKGROUND: The World Health Organization records indicate that breast cancer is the most common cancer in women both in developed and developing regions of the world. In developed countries, breast cancer is the second cause of cancer-related deaths, whereas in developing countries, breast cancer is the leading cause of cancer-related mortality in women. The empirical literature on Nigeria indicates that women present with advanced stages of the illness. OBJECTIVES: To explore the health-seeking behaviors of Southwestern Nigerian women with advanced breast cancer from the time they noticed a breast abnormality to their eventual presentation at the hospital for the management of the illness. METHODS: Thirty women with advanced stages of breast cancer in a large tertiary, referral, teaching, and university-affiliated Southwestern Nigeria Hospital were purposively selected for study participation. Participants completed a demographic information form and an in-depth face-to-face, one-on-one, semistructured interview guided by open-ended questions. Data analysis was inductive. RESULTS: Findings revealed that women sought divine interventions for the management of breast cancer. Prayer and spirituality were associated with high levels of optimism among the study participants. CONCLUSION: Nurses should provide information and counseling to women and the general public on the etiology and appropriate management of breast abnormalities and include the importance of a spiritual dimension of care. IMPLICATIONS FOR PRACTICE: Findings indicate the need to introduce a spiritual dimension to the care of women with advanced breast cancer. Findings also indicate the need for a comprehensive population-based breast health education.

The Experiences of Women Living With Cervical Cancer in Africa: A Metasynthesis of Qualitative Studies.

BACKGROUND: Cervical cancer is the fourth most common cancer in women worldwide. However, developing countries bear 85% of the burden, with Africa sharing the highest incidence with Melanesia. OBJECTIVES: The aims of this study were to explore the experiences of women living with cervical cancer in Africa and to inform others of the extent of the work done in this field of study by synthesizing the findings of qualitative research. METHODS: The work of Sandelowski and Barroso guided the study, and 6 databases were searched to identify relevant studies using the key words Africa, cervical cancer, and experiences. RESULTS: A total of 13 studies (n = 13) met the inclusion criteria, and their findings were synthesized. The studies originated primarily from South Africa and focused on the period from diagnosis to 1 year after completing curative treatment. One overarching core theme living a life of suffering, 2 main themes, architects of suffering and mediators of suffering, and 9 subthemes were identified. CONCLUSION: Women living with cervical cancer in Africa live a life of suffering, which starts when they experience the first symptom of cervical cancer and continues well after completing treatment. The facilitators of suffering outweighed the mediators and could not be guaranteed, as it did not relieve the suffering of all. IMPLICATIONS FOR PRACTICE: Nurses practicing in Africa should be acutely aware of cervical cancer and do their utmost within their limited resources to prevent and detect the disease in its earliest stage. Religious and support interventions could be used to lessen the suffering of these women.

Experiences of Girls Who Underwent Female Genital Mutilation/Cutting.

Objective To describe the experiences of girls who have undergone FGM/C, so that efforts toward ending this practice can be scaled up using evidence-based interventions. Method: A qualitative descriptive design with in-depth interviews conducted with 16 genitally mutilated girls, aged between 12 and 19 years. Results: Four themes and 10 sub-themes were identified. The themes were: it is the right thing to do; the cold circumcision morning; life after FGM/C; FGM/C is ongoing. They experienced fear, uncertainty, pain, and helplessness due to the practice. Conclusion: The FGM/C experiences of these girls could serve as evidence to scale up efforts toward ending FGM/C.

Experiences of young women who underwent female genital mutilation/cutting.

AIM AND OBJECTIVES: To describe the FGM/C experiences of young women living in Nigeria. BACKGROUND: Globally, several activities have been targeted at ending female genital mutilation/cutting (FGM/C). However, the practice is ongoing, especially in countries such as Nigeria, which is reported to be having a population boom. Therefore, there is a need to investigate the FGM/C experiences of young women in such countries so that efforts towards ending it can be accelerated using evidence-based, community-led interventions. DESIGN: A qualitative descriptive design. METHODS: The study took place in two states of south-eastern Nigeria with a high prevalence of FGM/C. The snowball sampling method was used to recruit 22 women, aged 20-40, who had undergone FGM/C. Participant's experiences were explored through semi-structured interviews, and the qualitative content analysis was used for data analysis. The consolidated checklist for reporting of qualitative studies guided the reporting of this study. FINDINGS: Three themes and seven subthemes emerged from the data. The themes were as follows: cultural issues, life as a circumcised woman and the future with FGM/C. Half of the participants could not recall their experiences on the day of their circumcision, as they were circumcised at infancy. However, those who were older when circumcised experienced it as a painful, traumatic experience forced upon them. Some of the participants experienced sexual and childbirth problems due to this procedure, and this was of great concern to them. CONCLUSION: Female genital mutilation/cutting was a traumatic experience forced on the participants. They felt helpless as they could not choose and had to do the "right thing." Despite the trauma and complications caused by the cutting, some still supported the continuation of the practice. RELEVANCE TO CLINICAL PRACTICE: Understanding the experiences of genitally mutilated women could assist healthcare practitioners in rendering quality, and contextualised services to these women.

Knowledge and Practices of Cervical Cancer and Its Prevention Among Malawian Women.

Malawi has the highest incidence of cervical cancer in the world. Due to various challenges the country faces in terms of cervical cancer control, women have a poor chance to survive this disease. The purpose of our study was to describe the knowledge and practices of cervical cancer and its screening as well as the educational preferences of women living in a rural community in the Chiradzulu District. We conducted a survey among women between the ages 30 and 45, used convenience sampling, a calculated sample size (n = 282) and structured interviews to collect the data. A questionnaire adapted from a previous study served as data collection instrument. The data were analysed in Microsoft Excel and chi-square (p < .05) was used to investigate the relationships between the variables. Content analyses analysed the open-ended questions. The mean age of the sample was 36.1 (SD ± 5.1) and the highest percentage (37.4%; n = 98) belonged to the Yao ethnic group. The majority attended primary school (66.0%; n = 173), were married (74.4%; n = 195) and depended on a small business as source of income (55.7%; n = 146). Most of the women (93.4%; n = 247) had heard of cervical cancer and the visual inspection with acetic acid (VIA) screening programme (67.9%; n = 178) but only 22.9% (n = 60) indicated they had been screened. Lack of knowledge of the screening programme was the most common reason for not being screened. Having a demonstration of the VIA procedure was the most popular educational method (92.0%; n = 241) which gives a fresh approach to educational programmes aimed at preventing cervical cancer.

Living with cancer of the head and neck: A qualitative inquiry into the experiences of South African patients.

OBJECTIVE: To describe the experiences of South African patients living with head and neck cancer. METHODS: We used a qualitative descriptive design and conducted unstructured interviews with 18 (n = 18) purposive selected participants. Data saturation determined the sample size. Qualitative content analysis was used to analyse the data. RESULTS: The majority of the sample were Black males; on average, 50.8 years (SD ± 13.6) old. Two themes and eight subthemes arose from the data. The themes were living with the consequences of the illness and treatment, and coping with a changed life. The lives the participants knew before becoming sick changed and became a living hell; pain was a major problem as was eating and for some, communicating. The participants were stigmatised, ridiculed and rejected which added to their suffering. Receiving support from family and friends and their faith in God assisted them to cope with their changed lives. CONCLUSION: Our study poses various challenges to clinical practice. Pain management is of the utmost importance; the nutritional status of these patients should be monitored and best practices in terms of management applied. Raising awareness of cancer and its complications could improve knowledge and decrease blame, stigmatisation and rejection and improve patient outcomes.

Holding conversations with cancer patients about sexuality: Perspectives from Canadian and African healthcare professionals.

Cancer treatment can have a significant impact on an individual's sexuality. However, cancer survivors are reporting that very few healthcare professionals are talking with them about the topic. This work was undertaken to gain an increased understanding about the dialogue between cancer care professionals and cancer patients regarding the topic of sexuality. It was anticipated the effort would allow the identification of barriers that could limit dialogue between patients and healthcare providers, as well as offer insight regarding how to overcome such barriers in busy clinical settings. A Canadian sample of 34 healthcare professionals were interviewed and 27 African nurses engaged in a focus group discussion. A content analysis revealed similarities in terms of personal discomfort with the topic and feeling unprepared to discuss it with patients. There were notable differences between the two samples in terms of the barriers related to culture and tradition. African nurses reported significant cultural barriers, stigma and discrimination influencing conversations about sexuality with cancer patients in contrast to their Canadian counterparts.

An exploration into the quality of life of women treated for cervical cancer.

BACKGROUND:  Cervical cancer mainly occurs among women from the developing world, and women face unique challenges in terms of their disease and treatment. Most women present with advanced cervical cancer and receive the standard curative treatment with external beam radiotherapy and brachytherapy with or without chemotherapy. OBJECTIVES:  To describe the quality of life (QOL) of women treated for cervical cancer during treatment (M0), at 6 months after completing treatment (M6) and at 12 months after treatment (M12). METHODS:  A cross-sectional design, calculated sample size (n = 153) and convenience sampling were used. Data were collected through structured interviews, and the EORTC QLQ-C30 and EORTC QLQ CX24 served as data collection instruments. Descriptive statistics were used to analyse the data, and the Kruskal-Wallis H test was used to compare the mean responses across the groups (p ≤ 0.05). RESULTS:  The mean age of the respondents was 50.6 years (standard deviation [SD] 11.9). The global health status improved significantly in contrast with the functional scores. Financial difficulties were rampant, especially during the treatment phase. Insomnia and urinary frequency were the most cumbersome problems and remained so even after treatment. CONCLUSIONS:  Despite an improvement in the global health, cervical cancer and its treatment had a negative influence on the QOL in all domains of lives of these women. Assessing the QOL of patients during treatment and follow-up visits would allow nurses to develop interventions to address distressing problems timeously. In addition, Africa's nurses should assess social functioning and develop programmes to prevent social dysfunction.