Top

Supportive Care in Cancer

Published in:

01-11-2008 | Original Article

Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients

Authors: Li-Shan Ke, Tai-Yuan Chiu, Wen-Yu Hu, Su-Shun Lo

Published in: Supportive Care in Cancer | Issue 11/2008

Abstract

Introduction

This study aimed to investigate the effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions regarding supplying artificial nutrition and hydration (ANH) to terminal cancer patients.

Materials and methods

A quasi-experimental design was adopted. A structured questionnaire evaluated the effects of educational intervention. From April to June 2005, 88 nurses were enrolled in the gastroenterology, general surgery, and intensive care unit of Taipei Veterans General Hospital in Taiwan. The nurses were randomly assigned into experimental and control groups in equal numbers (44 nurses in each group). After the experimental and control groups completed the pretest, the experimental group participated in a 50-min lecture. Both groups received a post-test 2 weeks after the lecture.

Results

This study showed that prior to educational intervention, nurses have possessed experiences of ANH use in routine caring for terminal cancer patients. However, due to the lack of knowledge about supplying ANH to terminal cancer patients, the nurses trended toward the negative behavioral intention, although they realized the burdens of ANH in these patients. After educational intervention, mean scores of knowledge, attitudes and behavioral intentions of the experimental group increased significantly (z = −5.255, p < 0.001; t = −5.191, p < 0.001; z = −3.274, p ≦ 0.001). Mean score changes of knowledge and attitude between these two groups reached significant differences (t = −7.306, p < 0.001; t = −4.165, p < 0.001), but no significant difference was observed in the mean score change of behavioral intention (z = −1.943, p > 0.05).

Conclusion

The educational intervention remarkably improved nurses’ knowledge and attitudes regarding supplying terminal cancer patients with ANH. As for the changes in the behavioral intentions, it requires long-term moral and ethical training and communication. The results of this research emphasized the importance of educational interventions, which should be considered seriously in future reference nursing education program.

Andrews MR, Levine AM (1989) Dehydration in the terminal patient: perception of hospice nurses. Am J Hosp Care 6:31–34PubMedCrossRef

Asch DA, Christakis NA (1996) What do physicians prefer to withdraw some forms of life support over others? Intrinsic attributes of life-sustaining treatments are associated with physicians’ preferences. Med Care 34:103–111PubMedCrossRef

Bruera E, Franco JJ, Maltoni M, Watanabe S, Suarez-Almazor M (1995) Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation. J Pain Symptom Manage 10:287–291PubMedCrossRef

Burge FI, King DB, Willison D (1990) Intravenous fluids and the hospitalized dying: a medical last rite? Can Fam Physician 36:883–886

Chang HH, Hu WY, Chiu TY et al (2003) An interventional study assessing palliative care learning amongst junior medical students undertaking the course “the human side of medicine”. J Med Educ 7:150–160

Chiu TY, Hu WY, Chuang RB et al (2004) Terminal cancer patients’ wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan. J Pain Symptom Manage 27:206–214PubMedCrossRef

Chiu TY, Hu WY, Chuang RB, Chen CY (2002) Nutrition and hydration for terminal cancer patients in Taiwan. Support Care Cancer 10:630–636PubMedCrossRef

Department of Health, Executive Yuan, Taiwan, R.O.C. 2006 Statistical summary of the main causes of death in Taiwan. Available at http://www.doh.gov.tw/statistic/index.htm. Accessed Sep 23, 2007

Ellershaw JE, Sutcliffe JM, Saunders CM (1995) Dehydration and the dying patient. J Pain Symptom Manage 10:192–197PubMedCrossRef

10.

Fainsinger R, Miller MJ, Bruera E, Hanson J, Maceachern T (1991) Symptom control during the last week of life on a palliative care unit. J Palliat Care 7:5–11

11.

Fainsinger RL, Bruera E (1997) When to treat dehydration in a terminally ill patient? Support Care Cancer 5:205–211PubMedCrossRef

12.

Hu WY, Tseng CN, Wang Y, Ueng RS (2004) The effects of clinical practice program toward palliative care for nursing students’ education in school of nursing. Taiwan J Hosp Palliat Care 9:1–20

13.

Ke LS, Chiu TY, Lo SS, Hu WY (2007) Knowledge, attitudes, and behavioral intentions of nurses toward providing artificial nutrition and hydration for terminal cancer patients in Taiwan. Cancer Nurs 31:67–76CrossRef

14.

Lai YL (2004) Hospice palliative care in Taiwan. Formosan J Med 8:653–656

15.

Lynn J, Childress JF (1983) Must patients always be given food and water? Hastings Cent Rep 13:17–21PubMed

16.

Mc Inerney F (1992) Provision of food and fluids in terminal care: a sociological analysis. Soc Sci Med 34:1271–1276CrossRef

17.

Micetich KC, Steinecker PH, Thomasma DC (1983) Are intravenous fluids morally required for a dying patient? Arch Intern Med 143:975–978PubMedCrossRef

18.

Morita T, Hyodo I, Yoshimi T et al (2005) Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies. Ann Oncol 16:640–647PubMedCrossRef

19.

Morita T, Shima Y, Adachi I (2002) Attitudes of Japanese physicians toward terminal dehydration: a nationwide survey. J Clin Oncol 20:4699–4704PubMedCrossRef

20.

Morita T, Tei Y, Inoue S, Suga A, Chihara S (2002) Fluid status of terminally ill cancer patients with intestinal obstruction: an exploratory observational study. Support Care Cancer 10:474–479PubMedCrossRef

21.

Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S (2001) Determinants of the sensation of thirst in terminally ill cancer patients. Support Care Cancer 9:177–186PubMedCrossRef

22.

Morita T, Tsunoda J, Inoue S, Chihara S (1999) Perceptions and decision-making on rehydration of terminally ill cancer patients and family members. Am J Hosp Palliat Care 16:509–516PubMedCrossRef

23.

Musgrave CF, Bartal N, Opstad J (1995) The sensation of thirst in dying patients receiving i.v. hydration. J Palliat Care 11:17–21PubMed

24.

Musgrave CF, Bartal N, Opstad J (1996) Intravenous hydration for terminal patients: what are the attitudes of Israeli terminal patients, their families, and their health professionals? J Pain Symptom Manage 12:47–51PubMedCrossRef

25.

Philip J, Depczynski B (1997) The role of total parenteral nutrition for patients with irreversible bowel obstruction secondary to gynecological malignancy. J Pain Symptom Manage 13:104–111PubMedCrossRef

26.

Printz LA (1988) Is withholding hydration a valid comfort measure in the terminally ill? Geriatrics 43:84–88PubMed

27.

Smith SA (1997) Controversies in hydrating the terminally ill patient. J Intraven Nurs 20:193–200PubMed

28.

Solomon MZ, O’Donnell L, Jennings B et al (1993) Decisions near the end of life: professional views on life-sustaining treatments. Am J Public Health 83:14–23PubMed

29.

Tsai PJ (2004) The ethical dilemma and social work ethical justification for terminal medical communication. Taiwan J Hosp Palliat Care 9:141–152

30.

Tsai SL, Hu WY, Chiu TY et al (2004) The knowledge of palliative care amongst senior medical students undertaking the course “family, society and medicine”. Formosan J Med 8:313–322

31.

Weissman DE, Ambuel B, Norton AJ, Wang-Cheng R, Schiedermayer D (1998) A survey of competencies and concerns in end-of-life care for physician trainees. J Pain Symptom Manage 15:82–90PubMedCrossRef

32.

Wurzbach ME (1995) Long-term care nurses’ moral convictions. J Adv Nurs 21:1059–1064PubMedCrossRef

33.

Zerwekh JV (1983) The dehydration question. Nursing 13:47–51PubMed

Title: Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients
Authors: Li-Shan Ke
Tai-Yuan Chiu
Wen-Yu Hu
Su-Shun Lo
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 11/2008
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-008-0426-0

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2008

Noncancer life stresses in newly diagnosed cancer

Osteonecrosis of the jaw (ONJ) in cancer patients treated with Bisphosphonates: how the knowledge of a phenomenon can change its evolution

A review of patient self-report tools for chemotherapy-induced nausea and vomiting

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

Maintenance of effects of a home-based physical activity program among breast cancer survivors

Neutropenia occurrence and predictors of reduced chemotherapy delivery: results from the INC-EU prospective observational European neutropenia study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer