|Year : 2018 | Volume
| Issue : 1 | Page : 11-17
Association between psychological distress and unmet information needs among female cancer patients in two selected teaching hospitals in South-West Nigeria
Foluso O Ojewole, Amarachi Marie Madu, Chinomso Ugochukwu Nwozichi
Department of Adult Health Nursing, School of Nursing, Babcock University, Ogun State, Nigeria
|Date of Web Publication||12-Jan-2018|
Chinomso Ugochukwu Nwozichi
Department of Adult Health Nursing, School of Nursing, Babcock University, Ikenne, Ogun State
Source of Support: None, Conflict of Interest: None
Background: Cancer-related information is a major need among cancer patients. Existing data indicate that cancer patients who are anxious or depressed have poorer treatment outcomes. Aim: The aim of this study is to assess the association between psychological distress and unmet information needs among female cancer patients in two teaching hospitals in Southwest Nigeria. Materials and Methods: Using a descriptive-correlational design, 244 females in the oncology units of two selected Nigerian teaching hospitals were purposively selected to complete a modified psychological distress scale and a self-developed information need questionnaire. Data were analyzed using descriptive and inferential statistics P value set at 0.05. Results: Majority (76%) of the patients were psychologically distressed, 71.3% of the participants wanted specific information on their cancer disease. There is a correlation between cancer patients' level of psychological distress and their unmet information needs (P = 0.027; r = −0.142) and a correlation between cancer patients' information needs and duration of their illness (P = 0.034; r = −0.135). Conclusion: Cancer patients experience psychological distress to some extent. Furthermore, they are interested in finding out information about their cancer disease. Every unmet information needs impact on the psychological distress experienced by patients. It is, therefore, recommended that nurses and other healthcare professionals should endeavor to assess the specific information needs to provide required information and ease their psychological distress.
Keywords: Association, cancer patients, psychological distress, unmet information needs
|How to cite this article:|
Ojewole FO, Madu AM, Nwozichi CU. Association between psychological distress and unmet information needs among female cancer patients in two selected teaching hospitals in South-West Nigeria. CHRISMED J Health Res 2018;5:11-7
|How to cite this URL:|
Ojewole FO, Madu AM, Nwozichi CU. Association between psychological distress and unmet information needs among female cancer patients in two selected teaching hospitals in South-West Nigeria. CHRISMED J Health Res [serial online] 2018 [cited 2018 Jan 19];5:11-7. Available from: http://www.cjhr.org/text.asp?2018/5/1/11/223123
| Introduction|| |
Cancer is one of the leading causes of morbidity and mortality worldwide and it is recognized as a public health problem. It has also been estimated that by 2020, the number of new cases of cancer in the world will increase to more than 15 million, with deaths increasing to 12 million. In Nigeria, it is estimated that at least 80,000 Nigerians die from various forms of cancer annually and about 500,000 new cases of cancer diagnosed annually. A diagnosis of cancer may make patient experience uncertainty, fear, and loss which can be alleviated by information. Research shows some evidence that depression, anxiety, and psychological distress are associated with patients reporting greater unmet needs. Similarly, another study  reported that better emotional functioning was associated with higher satisfaction with provision of information. Little is known about the association between psychological distress and unmet information needs among cancer patients in Nigeria. This study will attempt to explore the association between psychological distress and unmet information need among cancer patients in Nigeria.
Cancer patients have reported the importance of adequate information and effective communication in helping them adjust and cope with the illness. ,,, Various studies have identified some categories of information needs for cancer patients among which are information about nature of the disease, cancer treatment, investigative tests, preventive, restorative, maintenance and physical care, etc. More recent research indicates that cancer patients, during their illness, have a variety of information sources available to obtain the information needed to learn, decide, adjust, and cope. Health service providers need to continuously assess whether each individual patient wants only limited information or whether external constraints such as a language barrier, clinic organization, or the attitudes of health professionals deny them access to the information they want.
Researchers have reported that adequate information assists patients in making decision and problem solving making it possible for patients to prepare for future events. This is due to the fact that information serves as a means whereby patients learn the skills needed for self-management. In some cases, information are provided by healthcare personnel, but the patients do not benefit adequately from those information due to the high speed with which the information are provided and excessive use of technical languages as observed. Findings revealed that satisfaction with information received was a significant predictor for all aspects of quality of life.
Psychological distress is largely defined as a state of emotional suffering characterized by symptoms of depression (e.g., lost interest; sadness; and hopelessness) and anxiety (e.g., restlessness; feeling tense. In particular, tenants of the stress-distress model posit that the defining features of psychological distress are the exposure to a stressful event that threatens the physical or mental health, the inability to cope effectively with this stressor, and the emotional turmoil that results from this ineffective coping., They argue that psychological distress vanishes when the stressor disappears or when an individual comes to cope effectively with this stressor. Psychological distress is a serious problem faced by many cancer patients, especially when adequate information is not provided. An understanding of the concept of psychological distress will help nurses ameliorate this problem in patients living with cancer. It is, therefore, very imperative to assess areas of unmet information needs and to find out whether psychological distress among cancer patients is associated with their unmet information needs.
| Materials and Methods|| |
This descriptive-correlational study was conducted in the oncology units of two teaching hospitals in Southwest Nigeria. The two teaching hospitals were selected for the availability of diverse and sufficient participants. Purposive sampling technique was utilized to select 244 participants. Ethical Clearance was obtained from both hospitals as well as from Babcock University Ethical Committee. The tool for data collection consisted of a modified psychological distress scale developed by Kessler and a self-developed, structured questionnaire to assess the information needs yielding a validity value of 0.87 reliability using the Spearman-Brown prophecy formula. The first section of the Questionnaire included demographic variables of the respondents, the second section was a standardized tool developed by Kessler. This measured the level of psychological distress with items constructed on a scale of 1 (none of the time) to 5 (All the time). Study participants were informed about the purpose of the study. Participants were assured of confidentiality as well as their right to withdraw from the study at any time without consequences. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (Chicago IL, USA). Data analyzed were presented in tables reporting frequency, counts, and percentages. Pearson product moment correlational coefficient was used to determine relationship between cancer patient's level of psychological distress and unmet information needs at 0.05 level of significance.
| Results|| |
A total of 244 females with cancer participated in this study. [Table 1] shows that majority of the participants (40/6%) were between the ages of 35–44 years, 35.2% were married, 45.9% had tertiary education, 25.4% were self-employed, 44.7% were Muslims, 44.7% were Yoruba, and 46.7% had breast cancer. Nearly 29.9% of the participants have battled with their ailment for duration of 9–12 months and 50.8% consented that they had a family history of cancer. [Table 2] shows information need that would be required by these patients. Among all the categories identified, 71.3% of the participants wanted information on cancer disease. It should be noted also that the participants rated information on waiting time, check-up, sexuality, and physical rehabilitation plan including management of complications very low.
[Table 3] shows the level of psychological distress experienced by cancer patients. The mean score was 28.873 (76%), which shows that majority of the patients were psychologically distressed. This is because the minimal level of psychological distress experienced by cancer patients was even rated at 63.2%.
[Table 4] result summarized below shows the sources of cancer related information. Findings revealed that a majority (36.9%) of the information was gotten from health care and the least source of information (15.2%) was from books and printed materials.
[Table 5] shows the association between psychological distress and unmet information needs The results in [Table 5] revealed a significant perfect but inverse relationship between cancer patients' level of psychological distress and their unmet information needs (r = −0.142; P < 0.05).
|Table 5: Pearson product moment correlation coefficients of the relationship between cancer patients' level of psychological and unmet information needs|
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[Table 6] shows the association between information needs and the duration of illness since their diagnosis. The results revealed a significant perfect but inverse relationship between cancer patients' information needs and duration of illness (r = −0.135; P < 0.05).
|Table 6: Pearson product moment correlation coefficients of the relationship between cancer patients' information needs and illness duration|
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| Discussion|| |
The study findings revealed that majority (76%) of the patients were psychologically distressed. This result is consistent with the findings  that receiving a diagnosis of cancer has been linked with a reduction in psychological well-being, quality of life, interpersonal relationships, and optimism. There are also data indicating that cancer patients who are anxious or depressed have poorer treatment outcomes, perhaps through lower compliance with medication.
Findings of this study reveal that majority (71.3%) of the participants want information on cancer disease which is synonymous with the findings of previous studies., The highest source of information was from health care, (28.3%). This is consistent with the findings of Therefore, findings of this study is consistent with the study.
According to the findings, female cancer patients experience psychological distress, and their unmet information needs have a correlation with their level of psychological distress. This study is in line with the findings  that found out that more than half (53%) cancer patients experienced “prevalent” nervousness, worries, fears, and sadness. Although these authors did not report formal diagnostic and statistical manual of mental disorders-Fourth edition Text Revision) disorders, they raised the important point that many (in this case over half) of their sample of cancer patients were significantly psychologically distressed by their diagnosis and treatment. In this study, based on the percentage of patients having the same information need, one can be deduced that those information are important to them. If the need is not meant, then could lead to psychological distress.
The higher prevalence of psychological distress indicates that cancer and its related treatment may have greater negative effects on the psychological well-being of participants. This finding provides useful information for nurses to identify the etiology of psychological distress in these patients population. Because psychological distress is a common symptom among females with cancer, it is vital to incorporate measurement of psychological distress into nursing assessment procedures. Cancer care has been found to have several stressors both to patients and even the care-givers.
This study suggests that a correlation exists between psychological distress and unmet information needs.It is possible that these cancer patients may not have enough information, their psychological distress may also be related to other needs such as financial burden of cancer treatment or lack of support care from family and loved ones. This study is in contrast with the findings  that reported that depression, anxiety, and psychological distress are associated with patients reporting greater unmet needs. In recent literature, however, the effect of unmet information needs on psychological distress have been weak, some studies have substantiated this relationship between unmet information needs and psychological distress while some have not found unmet information need related to psychological distress.
Findings of this study revealed a significant correlation between cancer patients level of psychological distress and their unmet information need. Thus, the higher duration of illness, the lower the information need of these patients. It is possible that this can also be attributed to the fact that cancer patients who are newly diagnosed may wish to have more information about the course of their care, possibly to prepare for issues such as self-care during recovery while on the other hand, those with a higher the duration of their illness have these information already and have been coping with their self-care. Evidence from literature has shown that information needs may differ at different stages of a patient's cancer journey  and time since diagnosis.
Although some studies have attempted to evaluate how information needs change during the cancer journey, their value is limited, as time as diagnosis tends to be crudely dichotomized in analyses. Researchers have found out in their study that there were significant correlations between time since diagnosis and mean scores for the prognosis, treatment, and body image and sexuality domains as well as all the items collectively., However, all of the correlations were negative, indicating that as the time since diagnosis increases, information needs scores tend to decrease. Health information is an effective tool in cancer care.
This study is limited by the small sample size of the cancer patients in the hospitals which represents just a small fraction of cancer patients. Furthermore, this study focused on a particular region in Nigeria which will limit generalization of results obtained. The results of this study may have been influenced by the gender bias wherein only women were involved.
| Conclusion and Recommendation|| |
It has been revealed by the outcome of this study that cancer patients experience psychological distress due to the lack of adequate information. However, the psychosocial adjustment and counseling for terminal disease patients should not just start when the patients start receiving treatment but should begin from the period of testing to diagnosis to prognosis.
It is therefore recommended that no assumptions should be made about the needs of any woman, there should be regular monitoring of the patients' needs and quality of life, medical practitioner must pay greater attention to unmet needs and provide appropriate services and resources. However, given the magnitude of unmet needs among these patients, multifaceted interventions targeting various domains of unmet needs should be developed and tested to decrease the psychological distress of these patients.
Our profound gratitude goes to all the participants who willingly devoted their time to participate in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Solanke TF, Adebamowo CA, editors. Report of a workshop on state of the art in oncology in Ibadan and Ife. Ibadan: National Headquarters of Cancer Registries in Nigeria; 1996. p. 7-12.
Hodgkinson K, Butow P, Fuchs A, Hunt GE, Stenlake A, Hobbs KM, et al.
Long-term survival from gynecologic cancer: Psychosocial outcomes, supportive care needs and positive outcomes. Gynecol Oncol 2007;104:381-9.
Snyder CF, Dy SM, Hendricks DE, Brahmer JR, Carducci MA, Wolff AC, et al.
Asking the right questions: Investigating needs assessments and health-related quality-of-life questionnaires for use in oncology clinical practice. Support Care Cancer 2007;15:1075-85.
Douma KF, Koning CC, Zandbelt LC, de Haes HC, Smets EM. Do patients' information needs decrease over the course of radiotherapy? Support Care Cancer 2012;20:2167-76.
Coulter A. Evidence based patient information. Is important, so there needs to be a national strategy to ensure it. BMJ 1998;317:225-6.
Cassileth BR, Volckmar D, Goodman RL. The effect of experience on radiation therapy patients' desire for information. Int J Radiat 2008;9:21-3.
Iconomou G, Viha A, Koutras A, Vagenakis AG, Kalofonos HP. Information needs and awareness of diagnosis in patients with cancer receiving chemotherapy: A report from greece. Palliat Med 2002;16:315-21.
Galloway S, Graydon J, Harrison D, Evans-Boyden B, Palmer-Wickham S, Burlein-Hall S, et al.
Informational needs of women with a recent diagnosis of breast cancer: Development and initial testing of a tool. J Adv Nurs 1997;25:1175-83.
Mills ME, Davidson R. Cancer patients' sources of information: Use and quality issues. Psychooncology 2002;11:371-8.
Boudioni M, McPherson K, Moynihan C, Melia J, Boulton M, Leydon G, et al.
Do men with prostate or colorectal cancer seek different information and support from women with cancer? Br J Cancer 2001;85:641-8.
Friis LS, Elverdam B, Schmidt KG. The patient's perspective: A qualitative study of acute myeloid leukaemia patients' need for information and their information-seeking behaviour. Support Care Cancer 2003;11:162-70.
Mirowsky J, Ross CE. Selecting outcomes for the sociology of mental health: Issues of measurement and dimensionality. J Health Soc Behav 2002;(43):152-70.
Horwitz AV. Distinguishing distress from disorder as psychological outcomes of stressful social arrangements. Health (London) 2007;11:273-89.
Ridner SH. Psychological distress: Concept analysis. J Adv Nurs 2004;45:536-45.
Vasoontara Y, Matthew K, Benjawan T. Kessler Psychological Distress Scale. Encyclopedia of Quality of Life and Well-Being Research 2014;2014:3469-70.
Kunkel LS, Baker B, Myers SD, Oyesanmi GO, Gomella KG. The patient's perspective: A qualitative study of acute myeloma leukemia patient's need for information and their info seeking behavior. Support Cancer Care 2013;11:162-70.
Somerset W, Stout SC, Miller AH, Musselman D. Breast cancer and depression. Oncology 2008;18:1021-34.
Sanson-Fisher R, Carey M, Paul C. Measuring the unmet needs of those with cancer: A critical overview. Cancer Forum 2010;33:200-3.
McDowell ME, Occhipinti S, Ferguson M, Dunn J, Chambers SK. Predictors of change in unmet supportive care needs in cancer. Psychooncology 2010;19:508-16.
Bugel JM, Butow PN, Tattersall MN. The needs of terminally ill cancer patients versus those of caregivers for information regarding prognosis and end of life issues. Cancer Support Care Cancer 2014;103:1957-64.
Mehnert A, Lehmann C, Schulte T, Koch U. Presence of symptom distress and prostate cancer-related anxiety in patients at the beginning of cancer rehabilitation. Onkologie 2007;30:551-6.
Nwozichi CU, Ojewole FO. Potential stressors in cancer care: Perceptions of oncology nurses in selected teaching hospitals in Southwest Nigeria. Afr J Med Health Sci 2015;14:130. [Full text]
Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Wain G, et al.
Breast cancer survivors' supportive care needs 2-10 years after diagnosis. Support Care Cancer 2007;15:515-23.
Rutten LJ, Arora NK, Bakos AD, Aziz N, Rowland J. Information needs and sources of information among cancer patients: A systematic review of research (1980-2003). Patient Educ Couns 2005;57:250-61.
Liekweg A, Eckhardt M, Taylor SC, Erdfelder E, Jaehde U. Psychometric assessment and application of a questionnaire measuring patient: Satisfaction with information on cancer treatment. Pharm World Sci 2005;27:96-103.
Sainio C, Eriksson E. Keeping cancer patients informed: A challenge for nursing. Eur J Oncol Nurs 2003;7:39-49.
Mistry A, Wilson S, Priestman T, Damery S, Haque M. How do the information needs of cancer patients differ at different stages of the cancer journey? A cross-sectional survey. JRSM Short Rep 2010;1:30.
Nwozichi CU. Effect of video-based teaching module on knowledge about testicular cancer and testicular self-examination among male undergraduate students. Arch Med Health Sci 2015;3:215-26. [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]