Promotion of the Structured Instructional Program on Self-Management Knowledge for Patients Undergoing Chemotherapy Toward Physical Activity and Exercise

Background: Chemotherapy is a cancer medicine, mostly used to treat solid tumours and malignancies. It is one of the main medications for cancer. It is primarily used to treat systemic disease and may extend the life of critical conditions. 

Objectives: To assess the Promotion of the structured instructional program on self-management Knowledge for patients undergoing chemo-drugs. 

Methodology: The quantitative study with the quasi-experimental design was conducted in the Middle Euphrates Oncology Center at Al-Najaf Alshraf City to achieve instructional Promotion program self-management knowledge for patients with chemo-drugs. The study sample is selected according to the specific attribute that restricts the study population from the worth criteria, which involves (28) participants in the experimental group and (27) participants in the control group. Content validity of the educational program and the questionnaire, which was distributed among (15) experts who are not less than (5) years of experience in the field, instrument stability of (test-retest) was determined after the pilot study on (10) patients, with the reliability of (r = 0. 96), which is statistically acceptable. There are two pre-tests and two post-tests collected by the participants to evaluate the Promotion of the structured instructional program on self-management Knowledge for patients undergoing chemo-drugs. 

Results: The result shows the distribution of demographic characteristics of the higher percentage of 13 (43%) and 12 (40%) of the study participants, the age group from (20-35) years was the highest frequency, and the sample was between the age group (20-35), related to marital status the most of the sample were married (73.3%) in many experimental groups and (83.3%) in the control group.

Conclusion: The study concludes that the pre-test shows that chemotherapy patients suffer from poor self-care management. The structured instructional program increased the participants' knowledge level regarding self-care toward chemotherapy in the experimental group compared with the control group.

In the world, cancer is the leading cause of morbidity and mortality, placing a considerable load on the systems of the people's health and their families and also on society as a whole, mostly in growing and developed nations. The latest universal cancer estimate by the International Research Agency involves (18.1) million cases of cancer recently and nearly (9.6) million cancer cases linked to dying in 2018 [1]. Patients undergoing chemotherapy often face numerous challenges, including fatigue, weakness, and a diminished quality of life. Recognizing the potential benefits of physical activity during chemotherapy, a structured instructional pro-gram on self-management knowledge has emerged as a promising avenue to improve patients' well-being [2].

Chemotherapy is cancer medicine, mostly applied in treating most solid tumours and malignancies, like leukaemia, lymphoma, and myeloma, with the use of antineoplastic agents that target fast-growing. In addition to the benefit of cytotoxic agents, such as inhibiting the growth of infectious agents and killing malignant cells, they can also damage normal cells and abnormal cells, leading to many physical problems.  Chemotherapy's side effect survey found that( 43) percent of patients suffered from headache, ( 90) percent from fatigue, ( 95) percent from weakness, hair loss( 76) percent, nausea (77) percent, (75) percent from vomiting, diarrhoea (31) percent, stomach cramps 40 percent, (47) percent from mouth sores, dry mouth (74) percent,  However, these adverse effects depend on many variables, like the form and dosage of chemotherapy medication, the patient condition of health, and the cancer stage [3]. Exercise has been consistently reported as effective in minimizing fatigue; a strategy clients may not often utilize. This strategy is assisted by the theoretical mechanism that exercise could normalize the physical performance and efficiency damaged during chemomedication. The present study aims to explore key strategies for promoting and implementing such programs, focusing on enhancing physical activity and exercise and assessing the Promotion of the structured instructional program on self-management Knowledge for patients undergoing chemotherapy.

This quantitative study with a quasi-experimental design was carried out in the Middle Euphrates Oncology Center at Al-Najaf AL-Ashraf City in order to achieve the promotion of an instructional program on self-management knowledge for patients with chemo-drugs from the period 4 October 2020 to 22 June 2021. Non-probability purposive sample was selected from the patients who received chemotherapy sessions. The sample was chosen from the target population meeting the specific criteria during a specific time interval. The sample consists of (85) patients who attend on a regular schedule to receive chemotherapy, who have previously been diagnosed with cancer and have regular visits to the center for handling and consultation and who are undergoing scheduled chemotherapy. Ten patients chose to assess the needs of the patient for this program, another ten patients selected to act in the pilot study, while (60) chemotherapy recipients were assigned to participate in the original study sample, divided into two groups: (30) patient was assigned as (experimental group), and another (30) patient was selected as (control group). (5) Patients were dropped out from the original sample distributed as two patients who refused to complete the post-test from the experimental group and one patient who refused to complete the post-test from the control group. Furthermore, two patients from the control group were referred to another oncology center. Then, the final study sample that completed the study steps consisted of (28) patients in the experimental group and (27) patients in the control group. A total sample of (85) patients who received chemotherapy agreed to participate and met the criteria during the study period. The instructional program was designed to provide the patients with information about physical activity and exercise.

The questionnaires were constructed and composed of two parts. Part 1: Demographic Characteristics: This consisted of (5) items, which included age, gender, marital status, level of education, and residence. Part II: knowledge of patients about self-care management: First domain: Self-care knowledge related to nutrition consisted of (7) items. Second domain: Self-care knowledge related to physical activity and exercise consisted of (5) items. Third domain: Self-care knowledge related to maintaining social relationships consisted of (5) items. Fourth domain: Self-care knowledge of chemotherapy complications related to body systems consisted of (29) items.

Table 1: Distribution of Demographical Characteristics

(SD, ̅X, N)

Table (1) shows the distribution of demographic characteristics of the higher percentage 13 (43%) and 12 (40%) of the study participants; the age group from (20-35) years was the highest frequency, and the sample was between the age group (20-35). The higher percentage within the study (43.3) and control (40%) groups. While, females among the participants were female in both groups 15 (50%) and (51.7%) gender was slightly more than male among them (50%) and (53.3%). Related to marital status, most of the sample were married (73.3%) in many experimental groups and (83.3%) in the control group. Recorded intermediate school graduates (20%) for the study group and (26.7%) for the control group. The participants from urban areas were similar to those from rural areas in residency (50%) to the experimental group and (50%) to the control group.

Table 2: Responses of both group members related to their Self-care management knowledge regarding physical activity and exercise

P= 0.05 (P= probability, SD= Standard Deviation)

The current table (2) demonstrates Self-care knowledge related to physical activity and exercise. The statistical results found that the general mean for the experimental group for the Pre-test was (1.20± 0.128), and the first Post-test recorded (1.66± 0.066). While the second Post-test was (1.59± 0.037).

Figure 1: Progression of Patient's Self - Management knowledge Related to complications of the Body System

Fig (1) presented the progress in the experimental group member's knowledge during post-test after attending educational program sessions, in which no change appears upon patient knowledge in the control group.

In terms of age, which is presented in Table 1, the information analysis and allocation of demographic characteristics shows that the majority of the patients (41.7 %) were in the age group (20-35), indicating that they were mostly young. This result is consistent with Van den et al. (2013) [4], who reported that the majority of patients (70%) were under the age of 40, which is consistent with the findings of this study. Regarding gender, the current study found that the majority of patients (61%) were female. This indicates that women outnumbered men. According to the gender findings of Aslam et al., (2014), [5] he reported that his study sample was female (79 %) and (21 %) was male; the current study finding shares this result. Related to (marital status), the current study found that the majority of patients (78.3%) were married. Haryani et al., (2017), [6] found that the bulk of the population was married, accounting for (92.5 %), while Davoodi, et al., (2015), [7] found that (51 %) of the patients were married. The findings of the previous studies affirm and agree with those of the current study. Concerning educational attainment, the current study found that (23.3 %) of the included patients had completed intermediate school, which is consistent with Abdel-Razaq et al., (2017), [8] who found that the majority of patients (25 %) had completed intermediate school.

Physical activity choice has been identified as a significant component in long-term exercise participation. Patients in other trials preferred inclining activities, like walking, swimming, or mindfulness exercise. Life situations, personal experiences, and capacities can all have an impact on motivation, thus it's critical to keep a personalized approach to standardized exercise programs. This outcome is consistent with the findings of the current investigation Crane-Okada et al., (2012). However, patients gained the knowledge after receiving the educational program. Chokroverty and Sahota, (2011) stated that the majority of participants in their study suffer from breast cancer (60%) in stages II and III (49%), were diagnosed over five months ago and received multiple cycles of chemotherapy. Breast cancer patients who receive chemotherapy following an operation report greater exhaustion, a decline in daily activities, an increase in daytime sleeping, and an increase in periods of wakefulness during the night throughout chemotherapy, when the patients obtain the recorded tips from nurses showing comprehensive information about all physical activities which act effectively to increase the knowledge of participants.

Promoting a structured instructional program on self-management knowledge for patients undergoing chemotherapy, emphasizing physical activity and exercise, holds great promise for improving overall well-being. By combining educational approaches, interactive components, technology, and collaboration with healthcare providers, this comprehensive strategy addresses patients' multifaceted challenges, empowering them to actively participate in their care and enhance their quality of life during chemotherapy. Continuous evaluation and refinement of such programs will contribute to ongoing advancements in supportive care for individuals navigating the intersection of cancer treatment and physical activity.

The study recommended that an informational office should be established in the hospitals and oncology centers to support patients with any information concerning self-management, which may be carried out post-chemotherapy sessions. Specialist nursing staff training may be established to improve the role of nurses as educators.

Ethical considerations

Permission was granted from Al-Najaf Health Direction and the district hospitals’ research committees to conduct the study. Participation was voluntary, and informed consent was obtained from each participant. All participants were assigned a code number, and the same numbers were maintained during the assessment. Data were kept in a safe place, and only the researcher had access to the data. Furthermore, only the questionnaire number and the anonymous codes were captured and separated from the main data during the analysis.

Funding

There are no sources of funding to declare.

Conflicts of interest

The authors declare no conflict of interest to declare for publication

Acknowledgement

The authors would like to express their appreciation to the nursing staff working at Al Sadder Hospital in Najaf City for their cooperation and help in the study conduction.