INTRODUCTION AND BACKGROUND "Education is the most powerful weapon which you can use to change the world." Nelson Mandela “When you know better you do better.†― Maya Angelou Acute myeloid leukemia (AML) is a hematopoietic stem cell disorder characterized by the proliferation and accumulation of immature hematopoietic cells in the bone marrow and blood. This malignant alteration in hematopoietic stem cells leads to a loss of normal hematopoietic function, which, if left untreated, typically leads to death within weeks to months of its clinical presentation. AML accounts for approximately 20% of acute leukemia in children and 80% of acute leukemia in adults. The incidence of AML progressively increases with age and in adults over the age of 65 years, the incidence is approximately 30 times the incidence of AML in children.AML is slightly more common among men than among women, but the average lifetime risk in both sexes is less than ½ of 1%.The overall five-year relative survival rate for leukemia has more than quadrupled since 1960As per the cancer statistics in US in the year 2017, the estimated new cases of AML are 21380 and the percentage of all new cases in 2017 is 1.3%. The estimated deaths in year 2017 are 10590, The percentage of surviving 5 years is 26.9 % Incidence in India- While the average rate of incidence in India is lower than that in the United States of America, population-based cancer registry shows an alarming rise in cases of blood cancer in Mumbai and Delhi. The figures in the rural areas, however, are still much lower For men, the deadliness of leukemia in India peaks at age 80+. At 13.9 deaths per 100,000 men in 2013, the peak mortality rate for men was higher than that of women, which were 10.1 per 100,000 women. The annual mortality rate per 100,000 people from leukemia in India has decreased by 4.6% since 1990, an average of 0.2% a year. In TMH yearly thousands of patients register but only 90 to 120 patients yearly gets admitted for treatment because of bed constraints The primary treatment modality for these hematological diseases requires a systemic treatment approach using chemotherapy, immunotherapy, and more recently targeted therapies Treatment of AML begins with induction chemotherapy, with the goal of achieving Complete Remission with a resolution of morphologically detectable disease and the restoration of normal blood counts. Both chemotherapy and HSCT have been utilized and each approach has a major role in the treatment of this disease. The goals of therapy- Normalization of hematopoiesis resolution of cytopenias or leukocytosis/lymphocytosis, Effective treatment of potential sanctuary sites or extramedullary disease, Elimination of minimal residual disease, Suppression of emerging resistant clones. Minimizing treatment related toxicities and Maintaining or improving quality of life is critical to effective treatment, Supportive care is an integral component of an effective Individualized cancer treatment plan that minimizes potential toxicities, maximizes therapeutic outcomes, and maintains optimal quality of life for the patient. NEED FOR THE STUDY In today’s era the knowledge is important. To empower the patients with the knowledge which is required during the management of disease over the long duration can help in better outcome Due to a weakened immune system and a highly decreased capacity of the body to fight infection, patient with acute myelocytic leukemia are vulnerable and in danger of developing a number of complications. These complications can be immediate and short-term or long-term or delayed It is important that patients treated with chemotherapy be educated about what to expect from their regimen and the correct use of supportive care medications at home. In addition to patient education, it is equally important to determine any barriers that may hinder their understanding of the education they are provided It is important that patients are educated about their chemotherapy and management of adverse effects prior to and during subsequent cycles of treatment to abate the anxiety and distress that may be associated with a lack of knowledge Patient education should include teaching about the potential for and consequences of neutropenia, Preventive measures to decrease the risk of infection, Reportable signs and symptoms of infection and what to do when signs and symptoms occur Patients coming for treatment of AML at Tata Hospital come from various socio cultural, and educational background which differentiates their level of understanding and knowledge. Due to the increase in the number of patients coming from various parts of India and despite giving instructions due to different level of understanding there can be a gap between the patient’s knowledge and understanding. Various research studies show that the planned education provided by the health-care providers had a positive effect on the symptom control of patients receiving chemotherapy Hence this study assesses the effectiveness of a structured teaching programme on the awareness of patients on chemo schedule and its management in acute myeloid leukemia he teaching programme would provide information about the disease, treatment and care related to acute myeloid leukemia REVIEW OF LITERATURE Mukaddar Molloglu & Gulyeter Erdogan, Turkey had conducted a performance of a planned education model in patients receiving chemotherapy can alleviate the side effects of chemotherapy and thus can increase the quality of the patients’ lives.(5) T. Elumelu et al had conducted a study at university college hospital Ibadan Nigeria where a questionnaire was used to assess the knowledge and experience of patients with cancers and it showed that (98%) had prior information about chemotherapy and possible side effects. 95% of these patients expressed satisfaction with the chemotherapy treatment received and coped with the side effects because they were well prepared.(6) A study was conducted to know the effectiveness of a Nursing Intervention Protocol for Chemotherapy Induced Neutropenia and the result shows that patients undergoing myelosuppressive chemotherapy are at risk of developing neutropenia which may lead to lifethreatening infections that may quickly lead to sepsis, and death Severe neutropenia and febrile neutropenia are therefore major causes of morbidity, treatment interruptions and dose reductions in patients undergoing chemotherapy In addition to clinical impact, the economic impact of neutropenia is considerable. Myelo-suppressive chemotherapy is commonly associated with neutropenia, resulting in severe infections, treatment delays and, ultimately, adversely affecting patients’ outcome (7) PROBLEM STATEMENT “A Study to assess the effect of Structured teaching programme on knowledge of patients with Acute Myeloid Leukemia on Chemotherapy schedule , its Side effects and Management at a tertiary cancer center.†Key words -Structured teaching programme, Acute myeloid leukemia, Chemotherapy schedule, side effects Aim-To assess the effect of structured teaching on knowledge of patients with Acute Myeloid Leukemia on Chemotherapy schedule, Side effects and its Management. OBJECTIVES OF THE STUDY 1. To assess the knowledge regarding chemotherapy, its side effects and its management in patients with Acute Myeloid Leukemia in experimental and control group 2. To assess the effect of structured teaching programme on chemotherapy, its side effects and its management in patients with AML in experimental and control group 3. To find the association between knowledge scores and selected demographic variables of patients with Acute Myeloid leukemia ASSUMPTIONS 1. All participants receiving cytarabine and daunomycine chemotherapy treatment are at risk of developing side effects. 2. Structured teaching programme is accepted method of teaching. 3. Structured teaching programme may improve the knowledge scores. 4. Knowledge will vary from person to person. HYPOTHESIS H0- There will be no significant difference in knowledge score related to chemo schedule and its management in acute myeloid leukemia patients post structured teaching programme. The finding of the study will highlight the existing knowledge of patients with AML receiving chemotherapy Structured teaching programme on AMl Chemotherapy schedule, side effects and its management could be used to educate the patients.
RESEARCH METHODOLOGY In this study the researcher is going to assess the knowledge of patients related to AML chemotherapy protocol its side effects and its management. The subjects would be adult AML patients those are receiving chemotherapy in TMH, there would be 2 groups experimental and control group. After assessment of patients if those are meeting the inclusion criteria after consent Pre test will be taken for the patients from the both the groups. The structured teaching will be provided to the experimental group samples at the same day. The post test will be conducted for the both the groups on 7 th day in the same setting. I-Research Aproach- Quantitative approach. II- Design of the study -Nonrandomized trial (quasi-experiment) 2 group pre test - post test. III- Setting – Tertiary cancer center in Mumbai TMH- OPD and Inpatients. IV- Research variables Independent variable – structured teaching programme. Dependent variables – Knowledge of patients on chemotherapy schedule, side effects and its management. Demographic variables- In this study the demographic variables are Age, Gender, Educational status, Family income, Diagnosis, and informant
V-Target population – Patients diagnosed and receiving treatment for AML
VI- Sample - patients planned and receiving Chemotherapy for AML who fulfills the inclusion criteria
VII- Sample size – 60 30 each will be in control and Experimental group.
VIII - Sampling technique – Convenient Sampling
IX- Duration- 6 months
X-Criteria for Sample Selection: Inclusion criteria – Age above 18 years & diagnosed with AML Patients Planned for 3+7 protocol chemotherapy Patients receiving 3+7 protocol chemotherapy Patients able to read, write Hindi/ English or Marathi. Registered with TMH. Exclusion criteria – Relapsed AML Paediatric patients Patients those are not willing to participate. Patient on maintenance Palliative patients
Tool & Technique: Tool: 1. Structured knowledge questionnaire 3. Structured teaching programme Technique:. Self Report technique using questionnaire Data collection time – Six weeks at Tata Memorial Hospital Description of the tool- Investigator will prepare a questionnaire according to the objectives Section A- Patient information- Demographic profile like, Age,Gender, Education, Family income, Occupation, diagnosis, Chemotherapy and Informant. Section B – (I)Knowledge regarding AML (II)Knowledge regarding chemotherapy Schedule in AML (III)Knowledge regarding side effects and its management |