Most of the population of the United States, in their lifetime, will have cancer, know a loved one or acquaintance who has cancer, or be affected by the economic impact of the disease on the community.
Medical and cancer knowledge and technology are developing at phenomenal rates. The increasing knowledge base increases the amount of information with which an individual is presented at the time of illness or diagnosis of cancer. At such a crucial time in an individual's life, the emotional, physical, and financial impact of the disease makes it difficult to understand the information presented. The highly technical information and the impact of the disease affects the individual's ability to be adequately informed. It makes it difficult for individuals with cancer to become effective members of the health care team who can make informed decisions regarding care and the future.
At Brigham Young University (BYU) College of Nursing, the Honora Oncology Course titled Learning to Live with Cancer was designed to teach cancer principles to nursing and non-nursing undergraduate students. The overall objectives of the course were to provide knowledge about cancer to students, upgrading their understanding of the disease and dispelling misinformation and myths prior to being involved in a cancer situation. It was hoped this would assist students to be better cancer health care consumers. A search of the literature demonstrated that no course providing such educational experiences or opportunities had been reported.
There is some nursing literature discussing the teaching of cancer content to undergraduate nursing students. The Oncology Nursing Society sponsored a study in 1982 conducted by Brown, Johnson, and Groenwald (1983) to obtain information about cancer content taught in the undergraduate curriculum of nursing schools throughout the United States. The study was repeated in 1991. The studies showed minimal time in content presentation and in clinical experiences given to undergraduate nursing students nationwide. Pierce (1992) noted that undergraduate nursing content had been presented in variety of ways including group projects, independent study courses, and oncology électives. In 1993, PostWhite, Carter, and Anglim evaluated the impact of an educational workshop on the attitudes of nursing students in the area of cancer prevention and early detection. They found that such a workshop may increase the number of people practicing recommendations of cancer prevention and early detection. In 1997, a 6-week, 3credit hour nursing elective consisting of 3 hours of didactic and 15 hours of clinical experience per week was taught at BYU.
There is a great deal of literature available for the lay public produced by organizations such as the American Cancer Society (Atlanta, GA); national cancer centers such as University of Texas M.D. Anderson Cancer Center (Houston, TX), and Sloan-Kettering Cancer Center (New York, NY); and many community cancer centers and hospitals. The literature usually is available at all times for patient and family education, and it usually is written clearly at the fifth-grade level. However, much of this literature is not available in the public realm until an individual has been diagnosed and is coping with the cancer situation.
A computerized search of MEDLINE and Educational Resources Information Center (ERICI revealed no examples of cancer content actually being taught to college or university undergraduate nonnursing students. Maurer (1997) discusses the possible use of a peer education model for teaching breast self-examination to undergraduate college women, but no actual teaching appears to have been performed. In a study performed with medical students. Peters, Schimpfhauser, Cheng, DaIy, and Koatyniak (1987) evaluated whether a course in cancer prevention which increased the knowledge of disease prevention principles would result in more positive attitudes toward cancer prevention and treatment. They also evaluated whether such a course would produce more frequent use of disease prevention techniques in clinical settings. The study showed the couree increased the knowledge base of medical students regarding cancer but did not make a difference in attitudes or practice.
Philosophy and Purpose. Education is the key to dispelling myths and misconceptions and allowing the public to understand and demand appropriate cancer care. The Honors Oncology Course shares important information in an effort to accomplish the following goals:
* To provide students with the opportunity to gain current and accurate knowledge about cancer.
* To apply learned knowledge in community service.
* To become better consumers of cancer health care.
At the end of the course, students were to be able to achieve the following objectives:
* Discuss basic principles of pathophysiology, carcinogenesis, and etiology of cancer.
* Explain the standard modes of treatment for cancer.
* Discuss appropriate management of symptoms associated with cancer.
* Apply concepts to increase quality of life for both themselves and cancer patients.
This course waa an honors course because of the community clinics] component, the discussion and critical thinking concerning sensitive and controversial issues, and the increased time spent in accomplishing more comprehensive assignments.
The Honors Oncology Course was a 3credit hour seminar taught during a Gweek block (a block is one half of a semester). Three hours per week (1.5 credit hours) were held in classroom seminar. Clinical experience consisted of 15 hours per week (2.6 credit hours). These hours were performed in the community setting.
Seminar. The Table shows the material presented during the 6 weeks of seminar, Some material was presented in a didactic fashion. Most of the material was covered in active discussion among students and faculty or guest lecturers. Guest lecturers were enlisted to speak on specialty subjects (e.g., living wills, medical power of attorney, insurance issues, nutrition, organ transplant). Students were encouraged to ask as many questions as they would like te ask. Questions regarding the students' clinical experience or individual needs were entertained immediately, even if not related directly to the day's content. The faculty's desire for class discussion was to encourage students to ask questions to supplement their own knowledge base.
Clinical Experience. Home Experience. The students went, in pairs, to visit with the cancer patients and their families. Students visited in pairs as a safeguard for studente, patients, and families. The students were to visit the patients at least four times during the block. This was to provide the students with an opportunity to interact with patients and the families in a home situation on a one-on-one basis.
The first visit was used as an opportunity to become acquainted with the patients, families, home environments, and the superficial history of the cancer and its treatment. During this visit, the students established that the patients were willing to have them visit and explained what would occur in following visita.
The second visit was to determine what questions or concerns the individuals with cancer and the families had regarding cancer, its treatment, and any problems in coping with the illness or treatment.
During the third visit, students were prepared with answers to the patients' questions and possible solutions to problems which the patients or the students observed. This visit was not intended to take control away from the patients in their ability to solve their own problems but to provide resources or new options that patients may not have been aware existed.
The final visit was to terminate with the patients and their families. Students expressed appreciation to the patients and families for their time and willingness to participât« in the program and to assist the students in learning more about cancer.
The expectations were the same for nursing and non-nursing students. Students were encouraged to telephone the faculty for any problems encountered during the visits and for answers to questions the students were unable to answer. Students and faculty had frequent discussions about the patient visits concerning students' observations, relationships noted during the visits either between patients and families or between students and patients, questions about problems being experienced by the patients, and community resources available to the patients in solving problème or answering questions.
Each pair of studente visiting an individual with cancer and the family were asked to write a paper on the experience containing the following information:
* Pathophyeiology of the patient's cancer.
* Summary of the patient's medical therapy. Students were to comment on the surgery, radiation therapy, or chemotherapy the patient received or was receiving.
* A list of the patient's questions or problems which required solutions, together with the solutions devised by the studente.
* A discussion of an ethical, political, or health care issue which the patient was experiencing or had the potential to experience. This section was to include two current articles from the literature which discussed the chosen subject. It also was to include a discussion of the student's own personal feelings or experience with the chosen issue.
* A discussion concerning how the students felt about their home experience and what they learned about cancer and cancer care from the home experience.
Community Experience. Students selected some activity each week in which they provided community service or interacted with a community group working in the area of cancer. Students were free to explore as many different types of activities as possible. Students selected such activities as:
* Working with the American Cancer Society in assisting with projects of the Society's Utah division,
* Working with the Salt Lake City Cancer Wellness House's support groups or educational groups.
* Organizing group service projects to assist cancer patients with needed projects.
* Working with the Cancer Club at BYU to organize educational and service activities.
* Participating in cancer support groups sponsored by private therapists or local hospitals in the Wasatch Front, Utah area.
Professionalism Experience. To understand professional organizations involved in cancer care, students were encouraged to attend one meeting of an organization euch as the Intel-mountain Chapter of the Oncology Nursing Society (ICONS), the Utah Cancer Pain Initiative, Cancer Pain Free-Utah, ICONS' Fall Conference, or a local medical oncology conference.
Content for Honors Oncology Course*
Spirituality Experience, The faculty at BYU believe the spiritual aspect of life for the cancer patiente, the families, and the caregivers is a very important aspect of cancer care. At BYU, a weekly devotional is held where students can hear church leaders, community leaders, and BYU faculty speak on topics meant to uplift and improve students' lives. Students were asked to attend three of these devotional services.
Final Simulation. As a final examination, students were given a scenario with questions which they were to answer in written and presentation format. The questions addressed cancer pathophysiology; patient teaching; economic and financial problems; psychosocial, spiritual, and cultural aspects of cancer care; issues of providing terminal care; hospice; and stages of death and dying.
The results of teaching the Honors Oncology Course, Learning to Live with Cancer, was satisfying for both faculty and students. Studente were motivated to fill their clinical hours with positive learning experiences. They found their own patients to visit for their home experience. They generally spent more time than was required to meet the needs of the patients and their families. Many of the community experiences listed were the creative ideas of the students who actively searched for ways they could be of service. Students reported gaining new information and having preconceived ideas either validated or destroyed by their interactions with support groups. In writing their final scenarios, the students often were required to gather information about the health care system of which they previously had had only limited knowledge. One of the students, a history major, wrote his final simulation as a story about a fictional patient and the patient's situation which included all the aspects of care addressed by the scenario.
The interaction between the nursing and non-nursing students was interesting. The nursing students were able to provide a clinical perspective not experienced by non-nursing students. The non-nursing students were able to provide perspectives from their own backgrounds not previously experienced by nursing students. Nursing students continued to write and express themselves in clinical terms, which was sometimes rather inflexible. Nonnursing studente were more creative in their writing and discussion than nursing students. Non-nursing students also experienced the "aha" reaction more frequently because of lack of past experience with disease and cancer patients specifically.
Satisfaction for faculty came with the enthusiasm of the students. The studente were excited to learn information which was, in many cases, completely unrelated to their major at the university. They were in the class to become better-informed health care consumers, which was the purpose of the class. They bonded with each other and with their home patients quickly and felt the satisfaction of serving others. They seemed to feel free to ask questions, and it was apparent that previously incorrect information was clarified as a result of the class. One comment which exemplifies the enlightenment that resulted from this class follows. A male nonnursing student said:
I always thought that when you had breast cancer, you just lopped off the breast, and that was the end of that. Working with the women in the breast cancer support group has made me realize that this is not true and has made me much more sensitive to the needs of these women and other cancer patienta.
- American Cancer Society. (1998). Cancer facto and figures - 1998. Atlanta, GA: Author.
- Brown, J.K., Johnson, J.L., & Groenwald, S.L. (1983). Survey of cancer nursing content in U.S. schools of nursing, Oncology Nursing Forum, 10(4), 82-83.
- Maurer, P. (1997). A peer education model for teaching breaat Belf-eiamination to undergraduate college women. Cancer Nursing, 20(1),49-61.
- Petere, A.S., Schimpfhaueer, F.T., Cheng, J., DaIy, S.L., & Koetyniak, RJ. (1987). Effect of a course in cancer prevention on students' attitudes and clinical behavior Journal of Medical Education, 62, 692-600.
- Pierce, M. (1992!. Undergraduate preparation of the oncology nurse. Oncology Nursing Forum, 19(8), 1234-1237.
- Post-White, J., Carter, M., & Anglim, M.A. (1993). Cancer prevention and early detection: Nursing studente' knowledge, attitudes, personal practices, and teaching. Oncology Nursing Forum, 20(51, 743-749.
Content for Honors Oncology Course*