Effectiveness of Planned Teaching Programme on Side Effects ofRadiation Therapy Among Oral Cancer Patients

INTRODUCTION

Cancer is a group of disease involving abnormal cell growth with the potential to invade to other parts of the body. The common types of cancer are Breast cancer, prostate cancer, lung cancer, pancreas cancer, colon cancer, head and neck cancer1 .Oral cancer is among the top three types of cancers in India and it occurs due to severe alcoholism, use of tobacco in the form of cigarettes, chewing betel nut, human papilloma virus (HPV), poor dental care and poor diet².

The treatment for cancer includes chemotherapy, radiation therapy and surgery. The radiation therapy is used to shrink tumours and kill cancer cells.³ The common side effects of radiation therapy include dry mouth, red and sore mouth, trouble swallowing, damaged taste buds, tiredness, skin irritation and teeth erosion or cavities⁴ .The side effects of radiation therapy can interfere with patient quality of life and day to day functioning. 

An effectiveness of easy-to-read pamphlets on knowledge regarding self-care management on side-effects of radiation therapy was conducted at urban oncology clinic, Canada. The results revealed that pamphlet was effective in increasing knowledge scores among literacy patients. Thestudy concluded that, oncology nurses should use innovative teaching strategies to improve patient understanding and self-care behaviours to manage side effects of radiation therapy⁵.

The present study aimed to evaluate the effectiveness of planned teaching programme on knowledge regarding self care management on side effects of radiation therapy among oral cancer patients at Indian setting.

METHODOLOGY

This study was based on Ludwig VonBertalanff’s general system theory. A quasi experimental two group pre-test – post- test design was used. Based on objectives of the study, a structured knowledge questionnaire and lesson plan on self-care management on side effects of radiation therapy was prepared in English and then it was translated to Kannada since the study participants communication and understanding were only in Kannada. The tool and teaching plan were validated by research and subject expertsfor its adequacy and appropriateness. After obtaining an ethical clearance from an institutional ethical committee, a written permission was obtained from Medical Superintendent of R.L. Jalappa Hospital and Research centre, Tamaka, Kolar. Using purposive sampling technique, 60 oral cancer patients were selected. Of the total, 30 were allotted to experimental and 30 were allotted to control group with an inclusion criteria of oral cancer patients who were undergoing for radiation therapy, willing to participate in the study and able to understand and communicate in Kannada or English language. Written consent was obtained from all study participants. The pre-test was conducted to both groups oforal cancer patients through interview schedule on one to one basis to assess their knowledge on self -care management on side effects of radiation therapy followed by a planned teaching program on management on side effects of radiation therapy only to the experimental group in Kannada by using power point presentation, charts, pamphlets and flash cards. After one month, post-test was donefor both experimental and control group by using same questionnaire. 

RESULTS

I. Socio-demographic variables of oral cancer patients

Majority (53% in experimental and 33% in control group) of oral cancer patients were belonged to the age group 55 to 64 years, most ( 50% in experimental and 63% in control group) of them were females, majority (90% in experimental and 96% in control group) of them were Hindus, most (70% in experimental and 63% in control group) of them were illiterates, 73% of them in both groups were farmers, 57% in experimental and 60% in control group were belongs to low income group, majority (77 % in experimental and 57% in control group) were from joint family and 90% of them in experimental and 85% in control groupwere from rural area. 

I. Pre-test knowledge score of oral cancer patients

The knowledge score was grouped under an adequate knowledge (above 75%), moderately adequate knowledge (50-75%) and inadequate knowledge (score less than 50%) and presented in figure 1, which shows that majority (63% in experimental group and 76% in control group) of oral cancer patients had inadequate knowledge, 37% in the experimental group and 24% in control group had moderately adequate knowledge and none of them either in the experimental group or control group had adequate knowledge. 

III. Effectiveness of planned teaching programme on knowledge on side effects of radiation therapy among oral cancer patients

Difference of overall pre and post-test mean knowledge score of oral cancer patients within the group was done. The overall mean pre-test knowledge score was 13.5 and in post-test it was 27.1. The paired “t” test value (15.62, p=0.000) was found to be significant. In control group the overall mean pre-test knowledge score was 12.7 and in post-testit was 12.9. The unpaired “t” test value was 0.26 indicating that there was no significant difference between pre and post test knowledge scores in the control group. This indicates that structure teaching programme was effective in improving the knowledge score in experimental group than the control group and the same is presented in table-1.

There was no significant difference in the overall mean pre-test knowledge score in experimental group (mean=13.5) and the control group (mean=12.7). The unpaired paired “t” test value was 0.83 which was not significant. This indicates that the groups were homogenous in terms of their pretest knowledge scores.

The overall post- test mean knowledge score in experimental group was apparently higher (mean=27.1) than the control group (mean=12.9). The student “t” test value wasstatistically (20.8, p<0.001) indicating that, there wasa significant difference between experimental and control group scores which were statistically significant at 0.001level. (Table-2)

IV. Association of knowledge score with sociodemographic variables of in experimental group and control group

The association of knowledge score with its sociodemographic variables revealed that there was no significant association between age, gender, religion, educational status, occupation, family income, type of family and place of residencewith knowledge score in experimental group. 

Similarly there was no significant difference between the knowledge score and its sociodemographic variables such as age, gender, religion, educational status, occupation, family income, type of family and place of residence in the control group.

DISCUSSION

The present study was intended to assess the effectiveness of planned teaching program on Knowledge regarding Self-care management on side effects of radiation therapy among oral cancer patients receiving Radiation therapy at Kolar. The findings on socio-demographic variables of oral cancer patients revealed that majority of study participants belonged to the age group of 55- 64 years, most of them were females, illiterates, belongs to joint family with low socio-economic back ground and also farmers. It was supported by the study on Socio Demographic profile on oral cancer patients residing in Tamilnadu- A Hospital based study showed that majority of the study subjects belonged to the illiterates with low socioeconomic classes⁶ .

The overall mean pre-test knowledge score of experimental group was slightly higher (mean=13.5) than the control group (mean=12.7) the t value of pretest knowledge score was 0.130 The overall post-test mean knowledge score of experimental group was apparently higher (mean=27.1) than the control group (mean=12.9) the t value of post-testknowledge was 0.00. This indicates that structure teaching programme was effective in improving the knowledge score in experimental group than the control group. This finding is supported by the study conducted on Knowledge, attitude and Practices among women with oral cancer patients receiving radiation therapy in India revealed that planned teaching program was effective in improving the knowledge score among women with oral cancer⁷ .