Demographic details of study subjects

Study instrument

A structured pretested questionnaire was administered to the study subjects. The questionnaires were coded and information on personal details were not included. The structured questions were very simple, basic and were aimed to test the basic awareness rather than very advanced aspects of cancer.

The questionnaire assessed knowledge of cancer awareness in the following areas:

1. General cancer awareness

2. Warning signs and symptoms of cancer

3. Causative factors of cancer

4. Myths and facts (cancer statistics)

5. Knowledge of cancer prevention

6. General aspects of cancer treatment

7. Decision-making in cancer treatment.

The questionnaire comprised gradient answers such as ?yes,? ?no.? ?don?t know.? The questionnaire was uploaded on hospital intranet and the link was shared with all the hospital staff. The questionnaires were also distributed manually. The heads of each department were requested to encourage the staff to fill the questionnaire within a span of 1 month. As part of follow up formal and informal efforts were carried out at the individual level to fill the forms. Follow-up through E-mails, telephone calls and personal request were carried out.

Cancer awareness score

To warrant an effective measure of study outcomes, a Cancer Awareness Score (CAS) was developed. CAS of individual participants was achieved by dividing the total average score of each subject by ten. Also, the total average score of nurses was divided by ten to arrive at average CAS. The score was used to evaluate the level of awareness amongst the study population. Those who scored <4>

Data entry and analysis

The questionnaires filled electronically were directly entered in the central data base and maintained. The questionnaires filled manually were entered in the computer by the data operator in central data base. Accuracy of the data was checked by the next level of supervision. Data was transported to the SPSS version 16.0 software and the data was analyzed using the same software.

Results

A total of 244 nurses (53.3%) out of 458 employed were surveyed. One hundred and forty six forms were filled manually and 78 forms were completed electronically. The return rate was 65.5%. The completion rate was 100% and the rejection rate was zero [Table 2]. Of these 223 were females and 21 were males. The study subjects were in the age range of 19?56 years.

Participation of study subjects

General awareness

Out of the 244 nurses, 75.81% were aware about general aspects of cancer [Table 3]. 77.5% of the nurses acknowledged that cancer is a serious health problem in India, and 79.9% were aware of the increasing incidence of cancer. 66.4% subjects knew that cancer is a lifestyle disease. 75.4% were aware that cancer is preventable, and 78.7% agreed that early detection is possible. 23?lieved that all lumps are cancerous.

General cancer awareness amongst nurses. (a) Answers of the participants. (b) Group average score

Warning symptoms of cancer

Almost 75% of the study subjects were aware about warning symptoms of cancer [Table 4], with a majority of them were aware of the all the warning symptoms of cancer and rest were aware of some of the symptoms.

Awareness of warning symptoms of cancer amongst nurses. (a) Answers of the participants. (b) Group average score

Causative factors

About 90% of them were aware about all the causative factors [Table 5], 8.8% were not aware and 1.2% did not know about the causes.

Awareness of causative factors of cancer amongst nurses. (a) Answers of the participants. (b) Group average score

Myths of cancer

In this study, 21% of nurses were observed to have one or more myths about cancer during the survey, while 77.8% did not carry myths about cancer [Table 6]. Surprisingly, 23.4?lieved that cancer is contagious, 25% of the study subjects believed that cancer is familial, 13.9?lieved that cancer is due to God?s curse! Another alarming observation is that they believe that procedures such as biopsy (17%) or surgery (21.7%) can spread cancer! [Table 6]. It is vital to work on removing these myths.

Myths of cancer amongst nurses. (a) Answers of the participants. (b) Group average score

Cancer statistics

More than 65% of the participants were unaware about Cancer statistics in India. More than half subjects were unaware of the most common cancerin men and women, the cancer incidence and deaths. However, 33% of the study subjects had knowledge on cancer statistics in India [Table 7]. It is important to empower nurses with the information on increasing burden of cancer in India and common cancers in men and women. Cancer statistics help in strengthening the cancer awareness program.

Awareness amongst nurses on cancer statistics. (a) Answers of the participants. (b) Group average score

General aspects of cancer treatment: It was encouraging to observe that 75?lieved that cancer is curable (75%) especially in early stages (77.9%), while 18% thought that there is no treatment for cancer and 20.5?lieved that cancer always recurs and kills. Regarding the pain, 37?lieved that cancer treatment is painful, 38.9%.

Believed that pain is sign of advanced cancer and 45.1% shared the view that all cancer patients experience pain. Almost 75% of study subjects possessed optimal knowledge on general aspects of cancer treatment with <25 href="https://www.thieme-connect.com/products/ejournals/html/10.4103/ijmpo.ijmpo_159_17#TB_8" xss=removed>Table 8].

Awareness amongst nurses on general aspects of cancer treatment. (a) Answers of the participants. (b) Group average score

Cancer prevention

Majority of subjects (83.2%) believed that cancer is preventable and 82?lieved that screening is the best way of early detection. Knowledge of prevention of cancer by Hepatitis B vaccine (86.5%) and HPV vaccine (74.6%) was observed. Surprisingly the obesity as a risk factor for cancer was recognised by 47.1% subjects. In all, more than 66% of study subjects had adequate knowledge about cancer prevention and <3 href="https://www.thieme-connect.com/products/ejournals/html/10.4103/ijmpo.ijmpo_159_17#TB_9" xss=removed>Table 9].

Awareness amongst nurses on cancer prevention. (a) Answers of the participants. (b) Group average score

Decision making of treatment

More than 80% of the patients believed that diagnosis of cancer, prognosis, treatment details should be discussed with patients and caregivers. Regarding the decision makers, they believed that patients (48.4%) or caregivers (28.3%) should take the treatment decision while 17.2?lieved that doctor should decide the treatment. While more than 80% of the study subjects believed that patient and caregivers should participate in decision-making, whereas <15 href="https://www.thieme-connect.com/products/ejournals/html/10.4103/ijmpo.ijmpo_159_17#TB_10" xss=removed>Table 10a]. The total average score of nurses was 84.72 for appropriate responses and 14.1 for inappropriate responses [Table 10b].

Awareness amongst nurses on decision making of treatment. (a) Answers of the participants. (b) Awareness amongst nurses on decision making of treatment. Answers of the participants. (c) Group average score\

To get an objective view of the quantum of cancer awareness amongst the nurses, CAS was applied. CAS was calculated as a group and on individual basis to measure the level of cancer awareness. The group CAS of the study subjects was 7.2/10 and as per the scale the findings revealed a need for improvement on cancer awareness [Table 11]. Only 4% of nurses had desirable level with a score of above 8, while 54.5% had score of 6?7, 18.8% had average and 22.5?low average. In all 95% required training and improvement in their level of knowledge

Average CAS of participated nurses and its interpretation: Needs improvement

Discussion

The important immediate solution to rising cancer incidence and mortality in India early diagnosis, is increasing cancer awareness through all possible means. Nurses and other staff in the hospital coming in constant and direct contact with patients and care givers. Thus, it is essential for the nursing staff to have sufficient cancer knowledge so that they can impart the appropriate awareness. On the contrary, inappropriate knowledge or presence of myths not only cannot achieve the purpose but also can lead to undesirable consequences. This study conducted with sole purpose of measuring basic aspects of cancer awareness among nurses reveals some important observations. Satisfactory aspects were in general awareness (75%), warning symptoms (75%) causations (80%), prevention (78%), treatment (68%) decision-making (83%) [Table 10c]. Unsatisfactory were knowledge of cancer statistics in India (26%). An observation of concern was existence of myths in 30% nurses. While group average CAS was 72% needing improvement, only 4% nurses had adequate knowledge and rest needed improvement of varying degrees.

The situation in other parts of world and India is varying. Shahriary?et al.[6] also reported a low level of awareness among nursing staff on cancer pain management. In another study conducted in Ethiopia also reported similar results.[7] A similar study conducted in South Africa [8] revealed that awareness of oral cancer risk factors and clinical signs amongst the nurses was poor. Several other studies reported a low awareness of breast cancer risk factors among nurses.[9] [10] [11] Knowledge about cancer cervix, screening and practice of Pap smear was reported to be low among nursing staff in Sikkim, India.[12]

Several myths are prevalent in general public and the questionnaire consisting these myths revealed interesting observations. Prevalence of cancer related myths amongst nurses such as God?s curse (13%), spread with biopsy (17%) or surgery (22%) or contagiousness (24%) as observed in this study can be disastrous. These are not unique to India. In a hospital-based study witchcraft and karma were perceived as reasons for suffering from cancer,[13] and in another, patients believed ?bad karma? was the reason for their illness.[14] Myths related to cancer, present major challenges to cancer prevention and control and hence should be addressed.[15] [16] Display of posters in their work areas will help them to remove these myths.

More studies are required to ascertain the level of cancer awareness amongst nurses in other parts of the country and understand the need to revise the nursing curriculum.

Meanwhile, there is an immediate need for the hospitals and oncologists to commence short training modules for nurses to improve the level of cancer awareness.

Conclusion

Authors perceive that the study subjects lack adequate knowledge about cancer. The total average score of the study subjects is <75>

Repeated training of nurses on cancer awareness is warranted. Nursing staff is the backbone of healthcare and play a vital role in promoting cancer screening and healthcare seeking practices. They are regularly assisting patients with cancer [6] and hence patients look up to them for information and advice. If well equipped with knowledge on cancer, they can further impart information to patients, care givers and other hospital staff.

Conflict of Interest

There are no conflicts of interest.

• References