Rajiv Gandhi university of health sciences,

bangalore, karnataka

proforma for registration of subject for dissertation

1. / name of the candidate and address / Mr. BASKARAN. B
goutham college of nursing, manjunath nagar, west of chord road, rajajinagar, bangalore 560010.
2. / Name of the institute / goutham college of nursing, manjunath nagar, west of chord road, rajajinagar, bangalore 560010.
3. / course of study and subject / M.SC. nursing 1 year,
MEDICAL SURGICAL nursing
4. / Date of admission to course / 25/09/2010
5. / title of the topic / “A STUDY TO EVALUVATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWELDGE REGARDING cancer patients SUICIDAL EVALUATION AND PREVENTION AMONG STAFF NURSES WORKING IN SELECTED CANCER HOSPITAL AT BANGALORE”
6 / BRIEF RESUME OF THE INTENDED STUDY
6.1 / NEED FOR STUDY:
Cancer, a dreadful disease, has a relentless, very painful and debilitating course and if not treated properly in time, results in death. Cancer is one of the second largest killer diseases next to the heart disease. With great exposure to pollution and changing life style, the incidence of cancer has increased alarmingly. (1)
Approximately 10 million new cancer cases are seen each year worldwide, 4.7 million are in the more developed countries and nearly 5.5 million are in the less developed countries. Although the disease has often been regarded principally as a problem of the developed world, more than half of all cancers occur in the developing countries. In developed countries cancer is the second most common cause of death and epidemiological evidence points to the emergence of a similar trend in developing countries (2).
Currently cancer causes 12% of all deaths worldwide. An approximately 20 year’s time, the Number of cancer deaths annually will increase from about 6 million to 10 million. The principal factors contributing to this projected increase are the increasing proportion of elderly people in the world an overall increase in deaths from Cancer resulting from tobacco use (3)
World Health Organization reported that one in 12 urban women develops cancer in her lifetime. Approximately 40 percent of new cases of cancer affect women. Every three minutes a woman is diagnosed with breast cancer. Once in every 13 minutes, a woman dies of breast cancer. In fact the disease accounts for 20 percent of the total cancer related diseases in India. Presently 75,000 new cases occur in Indian women every year. cancer is a leading cause of death around the world. It also estimated that 84 million people will die from cancer between 2005 and 2015 without intervention? (4, 3)
Cancer prevalence in India is estimated to be around 2.5 million, with over 8,00,000 new cases and5,50,000 deaths occurring each year due to this disease in the country (5).
World health organization in the year 2007 reported that India has highest cancer rates in the world. The survey includes more than 200 000 patients with histopathologically confirmed cancers. The incidence of gall bladder cancer in women in New Delhi was10.6 per 100 000 of the population .the world’s highest rate for women for this cancer. Districts in central, south, and northeast India had the world’s highest incidence of cancers associated with tobacco, which is chewed as well as smoked in India. Aizawl district in the northeastern state of Mizoram has the world’s highest incidence of cancers in men of the lower pharynx (11.5 per 100000 people) and tongue (7.6 per 100 000 people). The district also has the country’s highest rate of stomach cancer among men. Wardha has the highest incidence of mouth cancer in the world. The incidence of mouth cancer among men in Pondicherry was 8.9 per 100 000, one of the highest rates in the world for men. Rates of stomach cancer were high among men in Bangalore and Chennai. The survey also detected a “belt of thyroid cancer” in women in coastal districts of Kerala, Karnataka, and Goa. The survey also reported that breast cancer has replaced by cervical cancer as the leading site of cancer among women in Indian cities and lung cancer is the most common cancer in men in Calcutta, Mumbai and New Delhi. (6)
Department of epidemiology and biostatistics Kidwai memorial institute of Oncology Dr. K. Ramachandra Reddy reported that about 9 million new cancer cases are diagnosed every year and over 4.5 million people die from cancer each year in the world. The estimated number of new cancers in India per year is about 7 lakhs and over 3.5 lakhs people die of cancer each year. Out of these 7 lakhs new cancers about 2.3 lakhs (33%) cancers are tobacco related. There would be about 1.5 lakhs cancer cases at any given time in Karnataka and about 35,000 new cancer cases are added to this pool each year(7) .
World health organization 2010 has reported that every year almost one million people die from suicide; a "global" mortality rate of 16 per 100,000, or one death every 40 seconds. In the last 45 years suicide rates have increased by 60% worldwide. Suicide is of the third leading causes of death among those aged 15-44 years in some countries and the second leading cause of death in the 10-24 years age group. These figures do not include suicide attempts which are up to 20 times more frequent than completed suicide.(8)
The suicide rate in India is 10.3. In the last three decades the suicide rate has increased by 43% but the male female ratio has been stable at 1.4: 1. Majority (71%) of suicide in India are by persons below the age of 44 years which imposes a huge social, emotional and economic burden, Physical and mental illness, disturbed interpersonal relationships were the major reasons for suicide.(9)
West Delhi Press Trust of India reported that a 55 year old cancer patient committed suicide by setting fire himself. He was suffering from cancer last ten years. (10)
Mumbai Times of India reported that a 46 years old best employer upset with his cancer ailments hanged himself at his residence. ((11)
Kolkata India Asian News service reported that a terminally ill cancer patient committed suicide by jumping from second Floor as died. (12)
Kolkata Express News service reported that a newly wed couple allegedly committed suicide at their residence due to neck cancer. (13)
The study was contacted on the risk of suicide in cancer patients 39 articles were included in the review It reported that incidence of completed suicide in cancer patients ranged from standardized mortality ratio of 1 to 11. The reported percentages of suicidal ideation in non-psychiatric populations of cancer patients ranged from 0.8 to 71.4%, compared to a reported prevalence of suicidal ideation in the general population, of between 1.1 and 19.8%. Risk factors identified for completed suicide and suicidal ideation in cancer patients include mental health, socio-demographic and illness factors. Some of these risk factors extend to the general population; however, some are specific to cancer such as cancer site, physical functioning and prognosis. Despite the prevalence of suicidal ideation in a cancer population being comparable to the general population, the prevalence of completed suicide is elevated. Although suicidal ideation does not necessarily result in completed suicide, it is important that adequate training be provided for cancer professionals on the risk factors for suicide in cancer patients.(14)
The descriptive study was conducted on the prevalence of suicidal ideation among terminally ill cancer patients at Kasturba Hospital Manipal were Fifty-four terminally ill inpatients (27 men and 27 women) from the palliative care unit of the Oncology department were evaluated on various rating scales for depression, hopelessness and suicidal ideation, and the correlation of suicidal ideation with medical symptoms such as pain, as well as awareness of the diagnosis and understanding of the illness. Most patients (79.7%) denied having suicidal thoughts or wishing for an early death; only 9.2% had severe suicidal ideation. Two patients (3.8%) with severe suicidal ideation had a past history of major depression. Factors such as the presence of pain, awareness of the diagnosis and understanding of the illness contributed to depressive mood states. Suicidal ideation and a desire for death appear to be linked exclusively to the presence of a mental disorder. In addition, poor pain control and awareness of the diagnosis may also contribute to suicidal ideation. (15)
The prediction of cancer suicide remains a major challenge for health care professionals in inpatient settings. A clearer identification of factors specific to inpatient suicide is required to improve both practice and research within this area. Based on the above facts and literature the researcher felt that there is a need to educate the oncology nurses on suicidal evaluation and prevention of suicides to decrease the incidence of suicidal rate among cancer patients.
6.0
6.1
6.2
6.3 / REVIEW OF LITERATURE:
A review of literature refers to activities involved in identifying and searching for information on a topic, developing and understanding the state of knowledge on a topic. It is an extensive, systematic selection of potential sources of previous work, which acquaints the investigator with fact finding work after securitization. Polit & Hungle state that review of literature provides readers with a background for understanding the significant of the study.
The review of literature is divided in to following aspects
Studies Related To Incidence of Suicide among cancer Patients
Studies Related to Knowledge of staff Nurses on Suicidal Evaluation and Prevention of Suicide among cancer Patients.
Studies Related To Effectiveness of Structured Teaching Programme

Studies Related to Incidence of Suicide among cancer Patients

The retrospective cohort study was conducted on incidence of suicide in person with cancer. United states population served by the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed with cancer from 1973 to 2002. By the National Center for Health Statistics Among 3,594,750 SEER registry patients observed for 18,604,308 person-years, 5,838 suicides were identified, for an age-, sex-, and race-adjusted rate of 31.4/100,000 person per year. The suicide rate in the general US population was 16.7/100,000 person-years. Higher suicide rates were associated with male sex, white race, and older age at diagnosis. The study results revealed that highest suicide risks were observed in patients with cancers of the lung and bronchus (standardized mortality ratio [SMR] = 5.74; 95% CI, 5.30 to 6.22), stomach (SMR = 4.68; 95% CI, 3.81 to 5.70), oral cavity and pharynx (SMR = 3.66; 95% CI, 3.16 to 4.22), and larynx (SMR = 2.83; 95% CI, 2.31 to 3.44). SMRs were highest in the first 5 years after diagnosis with cancer. Patients with cancer in the United States have nearly twice the incidence of suicide of the general population. The study concluded that suicide rates vary among patients with cancers of different anatomic sites. (16)
A comparative study was conducted on suicide and cancer among the genders. A total of 265 female and 1307 male suicides were enumerated, reflecting 0.04% and 0.19% from each gender, and providing an overall hazard ratio for male suicide of 6.2 [95% confidence interval (CI) 5.4–7.1]. Females with colorectal (P = 0.01) and cervical (P < 0.0001) cancers showed decreased suicide rates. Males with head and neck cancers (P < 0.0001) and myeloma (P = 0.02) had increased rates, whereas rates were decreased in males with lung cancer (P = 0.01), liver (P = 0.01), brain tumors (P = 0.04), and leukemia (P = 0.007). The hazard ratio associated for male suicide with distant metastasis was 2.84 (95% CI 2.49–3.24); for married status, 0.46 (95% CI 0.39–0.54); and for African-American ancestry, 0.24 (95% CI 0.17–0.34)—comparable ratios were seen here for female suicides. In head and neck cancers, with both genders analyzed together, the suicide hazard was increased if surgery was contraindicated (3.0, 95% CI 1.3–6.8), but not if refused. The high-risk patient was male, with head and neck cancer or myeloma, advanced disease, little social or cultural support, and limited treatment options. The study concluded that Oncologists and allied health professionals should be aware of the potential for suicide in cancer patients and their associated risk factors.(17)
A descriptive survey was conducted on Better off Dead Suicidal Thoughts in Cancer Patients at a regional cancer center in Edinburgh, United Kingdom Patients completed the Patient Health Questionnaire-9 (PHQ-9) which included 9 items related to patients thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Those who reported having had such thoughts for at least several days in this period were labeled as positive responders. Patients also completed the Hospital Anxiety and Depression Scale (HADS) and a pain scale. The participating patients cancer diagnoses and treatments were obtained from the cancer center clinical database Data were available on 2,924 patients, 7.8% (229 of 2,924; 95% CI, 6.9% to 8.9%) were positive responders. Clinically significant emotional distress, substantial pain, and—to a lesser extent—older age, were associated with a positive response. There was strong evidence of interactions between these effects and emotional distress played the most important role. The study concluded that A substantial number of cancer outpatients report thoughts that they would be better off dead or thoughts of hurting themselves Management of emotional distress and pain should be a central aspect of cancer care. (18)
Studies Related to Knowledge of staff Nurses on Suicidal Evaluation and Prevention of Suicide among cancer Patients.