Evaluating the effectiveness of an educational program on chemotherapy-induced peripheral neuropathy in enhancing competence among nurses in cancer care

Abstract

Introduction

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a significant side effect that profoundly affects patients’ quality of life (QOL). Nurses play a critical role to enhance CIPN care through assessments, patient education and symptom management This study aimed to evaluate the effectiveness of an educational program on CIPN in improving the competency of nurses in managing CIPN at Kenyatta National Hospital (KNH) in Kenya.

Methodology

Ethical approvals were obtained from the institutions’ ethics and research committees. A pretest-posttest quasi-experimental design was utilized, involving 43 nurses at the Cancer Treatment Centre (CTC). Structured self-administered questionnaires were used for data collection in April 2023 (baseline) to February 2024 (6-month follow-up). A two-day training program was conducted in July/August 2023. Descriptive statistics and paired sample t-test were used for analysis. These findings yielded a comparison of an overall competency score with p < 0.005 as significant.

Results

There were 43 participants, of which 67.4% were females, 62.8% held diplomas in nursing, 27.9% had a Bachelor of Science in Nursing (BScN) degree. More than half (58.1%) had 5 years or less of oncology experience, and 83.7% lacked formal oncology training. Awareness of risk factors for CIPN significantly improved after the educational program, with knowledge of older patient age rising from 67.4% to 97.4% (P = 0.0005) and recognition of a history of smoking increasing from 60.5% to 92.3% (P = 0.0003). Knowledge of specific chemotherapy agents associated with CIPN surged from 16.3% to 56.4% (P = 0.0006). For knowledge about symptoms, muscle weakness awareness improved from 62.8% to 94.9% (P = 0.0008). Regarding treatment awareness, knowledge of duloxetine’s effectiveness increased from 60.5% to 100% (P = 0.0001). For nurses’ practices, responses for screening at baseline of “Never” decreased from 9.3% to 0%, and “Frequently” increased from 4.7% to 69.2%. Overall, the mean score for frequency of CIPN screening rose from 4.1 (standard deviation [SD] = 2.0) to 6.8 (SD = 1.4) (P = 0.0000). Both the overall CIPN knowledge score (p < 0 .0001) and practice scores (p < 0.0001) increased significantly. The overall competency score rose from a mean of 32.5 (SD = 7.8) to 46.1 (SD = 5.6) (p < 0.0001).

Conclusion and recommendation

CIPN education program was effective in improving competencies of nurses. There is need to establish a continuous medical education program on CIPN and chemotherapy effects and staff mentorship for better care. Additionally, the CIPN training needs to be integrated into the Ministry of Health’s educational program.

INTRODUCTION

Chemotherapy is a key treatment modality for cancer, aimed at curing or controlling disease. However, some types can lead to chemotherapy-induced peripheral neuropathy (CIPN), a nerve-damaging side effect encompassing sensory, motor, and autonomic disturbances. The CIPN is associated with medications including taxanes, bortezomib, platinum compounds, and vinca alkaloids (Banach et al., 2016). This side effect can affect patients’ quality of life (QOL), leading to significant limitations in activities of daily living (ADL).

Nurses are crucial in assessing and educating patients about CIPN risk factors, screening and self-care practices. However, many nurses lack the required competence and confidence for this activity (Ferreira & Maclean, 2018). Discussions about CIPN with patients are often limited compared to discussions about other side effects, reflecting inadequate training and awareness among nursing staff (Katzung & Trevor, 2015). To manage CIPN effectively, and teach patients, nurses must be knowledgeable about its symptoms, risk factors, and treatment options (Asiri et al., 2020). This study sought to determine the effectiveness of an educational intervention in improving nurses’ competence in the care of patients receiving neurotoxic chemotherapy at Kenyatta National Hospital (KNH) Cancer Treatment Centre (CTC) Kenya.

METHODS

Study design and participant recruitment

A quasi-experimental pretest-posttest design was used to evaluate effectiveness of a CIPN educational intervention. The study was conducted at KNH CTC, Kenya’s biggest cancer treatment centre. It provides outpatient and inpatient comprehensive and specialized cancer services to majority of the patients diagnosed with cancer countrywide. All qualified nurses working in the CTC were given an opportunity to participate. Ethical approval was granted by the joint KNH/University of Nairobi Ethics Committee. A permit was obtained from the National Commission for Science, Technology and Innovation (NACOSTI). Voluntary and informed consent was obtained from all participants.

Development of CIPN education guide

The researcher reviewed literature on CIPN to use as the basis for drafting the training content. Principles of adult learning were applied in designing the educational program. The four principles of the adult learning theory gave insights on developing the educational intervention guide and involving the nurses in the education process from planning to implementation and evaluation. The nurse participants were involved in identifying learning needs by answering questions from the questionnaire about their experiences in which they could assess their present level of knowledge and practice regarding CIPN. The same questionnaire was administered to the nurses both at the pre-intervention and post-intervention periods. By answering the questions, the gaps between the participants’ present knowledge and practice were determined.

The curriculum content draft was reviewed by a panel of multidisciplinary experts to validate it and the mode of training. The educational guide content validity test results were conducted by an independent team of 10 experts (one oncology lecturer/supervisor, four oncology nurses, one patient navigator, one clinical oncologist, two oncology pharmacists, and one biostatistician). The educational guide was cross-checked with experts and revised as needed.

The piloting of the research instruments for the CIPN study was carried out with a separate group of five nurses at the gynae-oncology unit to evaluate the reliability and validity of the questionnaires. Based on Lawshe’s table (Lawshe, 1975), a content validity ratio value of 0.7 was obtained (higher than acceptable value of 0.62 for evaluation).

Material and equipment for the training session

For training purposes, a meeting room fitting at least 23 participants (in consideration of the COVID-19 social-distancing rules) was procured within the hospital premises. For the training sessions, various teaching aids were utilized to enhance understanding of CIPN assessment. The LCD (liquid crystal display) projector and PowerPoint presentation provided a visual framework for the educational content, while flip charts facilitated interactive discussions. Participants engaged in role playing to strengthen their assessment and psychomotor skills.

During practical sessions, instructors used demonstration equipment, including pain scales for pain assessment, and conducted sensory assessments for neuropathy using cotton wool and sharp pins. Participants were taught how to use a numeric pain scale and to document the patients’ reported pain levels together with any changes observed. For sensory assessment, sharp/dull sensation were elicited using a pin. For use of cotton wool, participants applied light touch by gently stroking the skin with cotton wool in a randomized pattern while the eyes of the other colleague were closed. Then the colleague indicated when they felt the touch, which was then documented. Having learnt these techniques, nurses were expected to apply them in clinical settings when assessing patients for CIPN.

Implementation of educational intervention

A 2-day training program was conducted in July/August 2023, in two cohorts, 1 week apart. The CIPN educational intervention applied andragogy to enable the nurses to learn. The teaching was facilitated mainly by the researcher and assisted by two facilitators, all of whom were experts in the field of oncology nursing. The core intervention was capacity-building sessions for the nurses on all aspects of CIPN care, from introduction to CIPN, risk factors, assessment, and diagnosis (Table 2). The training included practical skills about initial screening, and assessing neuropathic pain, motor and autonomic nervous system. An overview of CIPN-associated drugs, pharmacological and non-pharmacological management, CIPN prevention and safety measures, performing CIPN patient health education, and assessment to increase suspicion index were also taught.

Table 2.

CIPN Knowledge

	Baseline		Post-intervention		P-Value
	N = 43	Percent	N = 39	Percent
Knowledge of CIPN terminologies
Peripheral neuropathy refers to symptoms arising from damage to peripheral nerves	35	81.4	34	87.2	0.3173
CIPN is the injury, or degeneration of the peripheral nerve fibers	43	100.0	38	97.4	0.3173
Knowledge of CIPN risk factors
Patient age (higher risk in older patients)	29	67.4	38	97.4	0.0005
Pre-existing neuropathy (e.g., diabetic neuropathy)	39	90.7	38	97.4	0.1573
History of smoking	26	60.5	36	92.3	0.0003
Impaired renal function with reduced creatinine clearance; exposure to other neurotoxic chemotherapeutic agents	34	79.1	33	84.6	0.5271
Combination of neurotoxic chemotherapeutic agents	37	86	38	97.4	0.0253
Paclitaxel, cisplatin, vincrisine and bortezemib are commonly associated with CIPN	7	16.3	22	56.4	0.0006
Knowledge of symptoms and complications of CIPN
Tingling (“pins and needles”)	37	86	37	94.9	0.2188
Pain, which may be severe and constant, may come and go, or may feel like burning	32	74.4	34	87.2	0.1573
Decreased sensation (“legs feel like jelly”)	35	81.4	32	82.1	0.763
Increased sensitivity to touch, temperature, pressure, pain	17	39.5	16	41	1
Muscle weakness	27	62.8	37	94.9	0.0008
Symptoms can appear hours to days after chemotherapy and may reduce in intensity with time	39	90.7	38	97.4	0.375
Orthostatic hypotension may indicate autonomic CIPN	28	65.1	39	100	0.0002
Stocking glove distribution of sensory symptoms of CIPN refers to the paresthesia in the hands and feet	36	83.7	38	97.4	0.2188
The severity depends on both the duration of the regimen and the dose of the chemotherapeutic agents	29	67.4	35	89.7	0.0225
Pre-existing nerve damage and other neuropathic pain states increase the severity of CIPN symptoms	34	79.1	37	94.9	0.1797
Knowledge about CIPN diagnosis
Paresis, complete patient immobilization and severe disability is not a sensory symptom	28	65.1	33	84.6	0.1655
Numbness, tingling, altered touch sensation to warm or cold temperatures is a motor symptom not associated with CIPN	14	32.6	26	66.7	0.0047
Identifying numbness or tingling is critical in the clinical assessment of patients with CIPN	27	62.8	29	74.4	0.3173
Patient interview on the existence of CIPN symptoms essential first step in assessing CIPN	19	44.2	30	76.9	0.0027
Patients readily reports symptoms of peripheral neuropathy	27	62.8	10	25.6	0.0029
Knowledge of CIPN treatment modalities
Duloxetine has been shown to be efficacious for managing painful CIPN	26	60.5	39	100	0.0001
Topical treatments such as 8% capsaicin patches have been successfully used in managing symptoms of CIPN	28	65.1	34	87.2	0.0325
Spinal cord stimulation is being used successfully in the management of CIPN	21	48.8	18	46.2	0.7389
Localized cooling, if given during the chemotherapy treatment, would be successful in preventing CIPN	16	37.2	17	43.6	0.593

Note. CIPN = chemotherapy-induced peripheral neuropathy.

Data collection

Following the study approval by the UON/KNH Ethical Review Committee (ERC), baseline questionnaires were administered to the nurse participants to identify gaps in CIPN knowledge and practice. For the actual training, the participants were divided into two groups. The training was conducted over two sessions each lasting 2 days for each of the two separate groups. They were scheduled one week apart in July/August 2023 and included both theory and practical skills development. The hospital management granted permission to enable the release of the nurses from routine clinical work for 2 full days each.

The questionnaires were self-administered on hard copy by the participants. Responses were later entered into Research Electronic Data Capture (REDCap) by the researcher. REDCap is a secure, web-based application that facilitates the collection and management of research data through customizable online surveys and databases.

The educational intervention workshop started in the morning and participants were told to anticipate a post-test at the end of the training the following day. The post-interventional knowledge data were collected at the end of the two-day training in July and August 2023 respectively. The post-intervention practice data collection was done by the researcher 6 months later, in January and February 2024, to allow time for the participants to be able to incorporate the new learning into their daily practice.

Measurement of outcome variables

The total CIPN knowledge score was a sum of the number of correctly answered questions by participants in five areas. A series of questions in the Competency Assessment Questionnaire were used to gauge the nurses’ understanding of the different aspects of CIPN (e.g., awareness of the common neuropathic signs and symptoms; sensory, motor and autonomic, risk factors, and care). The nursing knowledge competency score was the number of correctly answered questions. This variable was collected before the training and at the completion of training. The possible range in the knowledge score was 0 to 27. A paired sample t-test was used to test whether the differences in nurse knowledge between the two periods was significant.

For practice, the frequency of screening for CIPN was assessed by combining the questions about the participants’ frequency of checking at baseline for the presence of peripheral neuropathy prior to initiation of the first chemotherapy, eliciting patients’ symptoms related to CIPN, and assessing patients for other risk factors associated with peripheral neuropathy. The responses resulted in a score with a range of 0 to 9. CIPN practice scores were created by assigning 0 whenever the nurse participant said they never performed an expected practice, 1 if it was rarely done, 2 for doing it occasionally, and 3 whenever the expected practice was always done. A practice score was created by summing the assigned scores to the answers’ questions in a segment. The overall practice competency consisted of the frequency of CIPN screening; for baseline presence of neuropathy, to elicit patients’ symptoms related to CIPN, as well as to assess CIPN risk factors, frequency of performing CIPN assessment, and frequency of providing CIPN education.

The questions on nursing assessment of CIPN prior to each infusion of neurotoxic chemotherapy and patients’ ability to perform fine motor skills, assessment of deep tendon reflexes and muscle strength on patients receiving neurotoxic chemotherapy, performance of objective motor function assessment skills, and documenting CIPN assessment data if the patient is receiving neurotoxic chemotherapy informed the frequency of performing CIPN. The responses resulted in a score ranging from 0 to 18.

Data management and analysis

Data validation on paper and digitized tools was enforced through verification of ranges and skip patterns, as well as close supervision and review of questionnaires by the researcher. The data entry tablet used for REDcap data entry was password-protected, while paper questionnaires were kept under lock-and-key by the researcher, thereby controlling data access to only those with the need and right to access them.

The study used Stata 18 quantitative analysis. Frequencies were calculated for participant characteristics, including demographics (sex, age, level of education), work (type of employment, current position, related training and years of experience), and self-identified training needs. Knowledge and practice scores were calculated by summing respective question responses. A composite competency score was constructed by combining the knowledge and practice scores. The analysis compared the competency scores across participants’ demographic and work characteristics using Kruskal-Wallis test while the competency scores between pre-intervention and post-intervention periods were compared using Wilcoxon signed-rank sum test due to the paired nature of responses from the same participants.

RESULTS

The total population of eligible nurses working in the CTC was 45. Consenting nurses at baseline were 43 nurses who participated in the study and all of them returned the questionnaires representing a 100% response rate at the baseline. Thirty-nine nurses completed the educational program and responded to the final questionnaire (90.69 %) response rate post-intervention.

Demographic and work characteristics of nursing respondents

Two-thirds of the 43 nurses were females and almost a third (32.5%) were between 40 and 50 years, while just more than a quarter were less than 30 years (25.6%). The diploma cadre of nurses formed the majority of the respondents (62.8%), with the proportion decreasing for bachelor’s and master’s degree holders (Table 1). Senior positions were held by 27.9% who had 21–30 years of experience. The majority (83.7%) lacked formal oncology training.

Table 1.

Demographics and Work Characteristics of the Nurses

	N = 43	Percent
Sex
Male	14	32.6
Female	29	67.4
Age in years
Less than 30	11	25.6
30–39	11	25.6
40–49	14	32.5
50–59	7	16.3
Highest level of education
Diploma	27	62.8
Bachelors	12	27.9
Masters	3	7
Other	1	2.3
Current position
Assistant Chief Nurse	4	9.3
Senior Nursing Officer	15	34.9
Nursing Officer I	4	9.3
Nursing Officer II	5	11.6
Nursing Officer III	14	32.6
Senior Enrolled Nurse	1	2.3
Type of employment
Contract	12	27.9
Permanent	31	72.1
Received oncology training
No	36	83.7
Yes	7	16.3
Years of nursing practice
Less than 5	11	25.6
5–10	9	20.9
11–20	8	18.6
21–30	12	27.9
More than 30	3	7
Years of oncology nursing practice
None	5	11.6
5 years or less	25	58.1
6–10 years	9	20.9
11–20 years	2	4.7
21–30 years	2	4.7
31–40 years	0	0
Specialist oncology nursing training	N = 7	Percent
Masters	1	14.3
Short courses	5	71.4
Other	1	14.3

Knowledge of CIPN risk factors

The knowledge domains included terminologies, risk factors, symptoms, diagnosis, and treatment modalities while practice was evaluated regarding screening, assessment, and patient education frequency. The nurses’ knowledge on CIPN risk factors shifted following the educational program. Awareness of patient’s age as a risk factor increased from 67.4% at baseline to 97.4% post-intervention (P = 0.0005). Recognition of a history of smoking as a risk factor increased from 60.5% to 92.3% (P = 0.0003), while understanding about the impact of impaired renal function improved slightly from 79.1% to 84.6% (P = 0.5271). Knowledge of the combination of neurotoxic agents rose from 86% to 97.4% (P = 0.0253). Notably, awareness of specific agents associated with CIPN surged from 16.3% to 56.4% (P = 0.0006). Knowledge of pre-existing neuropathy remained high, rising from 90.7% to 97.4% (P = 0.1573). (See Table 2.)

Knowledge of CPIN symptoms and complications

The knowledge of CIPN symptoms and complications showed significant improvements from baseline to post-intervention, regarding muscle weakness awareness, which significantly increased from 62.8% to 94.9% (P = 0.0008). Knowledge of other symptoms showed higher percents following education, but were not statistically significant. Most were high prior to the session. At baseline, 86% of participants recognized tingling (“pins and needles”), which increased to 94.9% at post intervention (P = 0.2188). Awareness of severe and fluctuating pain rose from 74.4% to 87.2% (P = 0.1573), while knowledge of decreased sensation remained stable at approximately 81.4% and 82.1% (P = 0.763). Recognition of increased sensitivity to touch showed no change, with 39.5% at baseline and 41% at post-intervention (P = 1.000). Knowledge that symptoms can appear hours to days after chemotherapy increased from 90.7% to 97.4% (P = 0.375).

The understanding that orthostatic hypotension may indicate autonomic CIPN rose from 65.1% to 100% (P = 0.0002) and awareness of the severity of symptoms related to chemotherapy duration and dosage improved significantly from 67.4% to 89.7% (P = 0.0225). Although recognition of stocking-glove distribution of sensory symptoms increased from 83.7% to 97.4% (P = 0.2188), and knowledge that pre-existing nerve damage exacerbates CIPN symptoms increased from 79.1% to 94.9% (P = 0.1797), neither were statistically significant. Overall, these findings indicate an enhancement in nurses’ understanding of CIPN following the intervention (See Table 2).

Knowledge of CIPN treatment modalities

The knowledge of treatment modalities for CIPN also indicated significant improvements following the education. Awareness that duloxetine is effective for managing painful CIPN increased from 60.5% at baseline to 100% at post intervention (P = 0.0001). Knowledge of topical treatments, such as 8% capsaicin patches, rose from 65.1% to 87.2% (P = 0.0325). However, understanding of spinal cord stimulation’s effectiveness remained stable, with 48.8% at baseline and 46.2% at post intervention (P = 0.7389). Similarly, awareness that localized cooling can prevent CIPN showed minimal change, increasing from 37.2% to 43.6% (P = 0.593).

Overall knowledge

The mean score for knowledge of CIPN terminologies remained stable at 1.8 (SD = 0.4) for both pre- and post-assessments (P = 1.0000). However, knowledge of risk factors increased from a baseline mean of 4.0 (SD = 1.4) to 5.3 (SD = 1.1) at post intervention (P = 0.0000). Knowledge of CIPN symptoms and complications improved from 7.3 (SD = 1.8) to 8.8 (SD = 1.3) (P = 0.0000). Additionally, understanding of diagnosis rose from 2.7 (SD = 1.2) to 3.3 (SD = 1.2) (P = 0.0284), and knowledge of treatment modalities increased from 2.1 (SD = 1.1) to 2.8 (SD = 0.8) (P = 0.0034). The overall CIPN knowledge score also showed a significant increase, rising from 17.9 (SD = 4.1) at baseline to 21.9 (SD = 2.9) at post intervention (P = 0.0000). These findings highlight an enhancement in nurses’ overall knowledge of CIPN following the intervention.

Practice

The results indicated significant improvements in nurses’ practices related to CIPN from baseline to six-month post intervention. For the action of screening for peripheral neuropathy at baseline, “Never” responses decreased from 9.3% to 0%, while “Frequently” increased from 4.7% to 69.2%. In eliciting CIPN symptoms, “Never” responses fell from 2.3% to 0%, and “Frequently” rose from 23.3% to 59%. Additionally, the “Never” responses for assessment of other risk factors dropped from 14.0% to 0%, with “Frequently” increasing from 14.0% to 53.9%. Overall, these findings demonstrate a marked enhancement in nursing practices regarding CIPN following the intervention (see Table 3).

Table 3.

CIPN Practice

	Never (Percent)		Occasionally (Percent)		Frequently (Percent)		Always (Percent)
	Baseline (N = 43)	Post-intervention (N = 39)	Baseline (N = 43)	Post-intervention (N = 39)	Baseline (N = 43)	Post-intervention (N = 39)	Baseline (N = 43)	Post-intervention (N = 39)
Performing CIPN screening
Screening patients for baseline presence of peripheral neuropathy prior to initiation of the first chemotherapy	9.3	0.0	67.4	5.1*	4.7	69.2*	18.6	25.6
Elicit patient’s symptoms related to CIPN	2.3	0.0	55.8	7.7*	23.3	59*	18.6	33.3
Assessing patients for other risk factors associated with peripheral neuropathy	14.0	0*	62.8	5.1*	14.0	53.9*	9.3	41*
Performing CIPN assessment
Performing nursing assessment of CIPN prior to each infusion of neurotoxic chemotherapy	7.0	0.0	48.8	10.3*	25.6	56.4*	18.6	33.3
Assessing patients’ ability to perform fine motor skills	16.3	0.0*	46.5	7.7*	20.9	74.4*	16.3	18.0
Assessing deep tendon reflexes on patients receiving neurotoxic chemotherapy	27.9	0.0*	60.5	38.5*	4.7	41.0*	7.0	20.5
Assessing muscle strength in patients receiving neurotoxic chemotherapy	18.6	0.0*	58.1	30.8*	14.0	51.3*	9.3	18.0*
Performing objective motor function assessment skills (muscle strength, gait assessment)	18.6	0.0*	55.8	20.5*	14.0	59.0*	11.6	20.5
Documenting CIPN assessment data if the patient is receiving neurotoxic chemotherapy	20.9	0.0*	46.5	7.7*	20.9	61.5*	11.6	30.8
CIPN counselling/education
Teaching patients about CIPN self-assessment of symptoms and when to contact the health professionals	14.0	0.0*	39.5	2.6*	27.9	48.7	18.6	48.7*
Educating patients about safety precautions used to avoid injuries associated with CIPN	7.0	0.0*	41.9	2.6*	37.2	33.3	14.0	64.1*

Note. CIPN = chemotherapy-induced peripheral neuropathy.

Table 4.

Table Showing Overall CIPN Competency Consisting of Knowledge and Practice

	N	Mean	SD	Median	P-Value
Knowledge
Knowledge of CIPN terminologies (0–2)
Baseline	43	1.8	0.4	2.0	1.0000
Post-intervention	39	1.8	0.4	2.0
Knowledge of risk factors (0–6)
Baseline	43	4.0	1.4	4.0	0.0000
Post-intervention	39	5.3	1.1	6.0
Knowledge of CIPN symptoms and complications (0–10)
Baseline	43	7.3	1.8	8.0	0.0000
Post-intervention	39	8.8	1.3	9.0
Knowledge of diagnosis (0–5)
Baseline	43	2.7	1.2	3.0	0.0284
Post-intervention	39	3.3	1.2	4.0
Knowledge of treatment modalities (0–4)
Baseline	43	2.1	1.1	2.0	0.0034
Post-intervention	39	2.8	0.8	3.0
Overall CIPN knowledge score (0–27)
Baseline	43	17.9	4.1	18.0	0.0000
Post-intervention	39	21.9	2.9	23.0
Practice
Frequency of CIPN screening (0–9)
Baseline	43	4.1	2.0	3.0	0.0000
Post-intervention	39	6.8	1.4	7.0
Frequency of CIPN assessment (0–18)
Baseline	43	7.4	4.1	8.0	0.0000
Post-intervention	39	12.3	2.9	12.0
Frequency of providing CIPN education (0–6)
Baseline	43	3.1	1.6	3.0	0.0000
Post-intervention	39	5.1	1.0	5.0
Overall CIPN practice (0–33)
Baseline	43	14.6	6.8	14.0	0.0000
Post-intervention	39	24.2	4.7	23.0
Overall CIPN competency (0–60)
Baseline	43	32.5	7.8	31.0	0.0000
Post-intervention	39	46.1	5.6	46.0

Note. CIPN = chemotherapy-induced peripheral neuropathy.

Regarding frequency of patient counselling/education on CIPN, there was improvement. For teaching patients about CIPN self-assessment and when to contact health professionals, “Never” responses decreased from 14.0% to 0%, while “Always” responses increased from 18.6% to 48.7%. For educating patients about safety precautions to avoid CIPN-related injuries, “Never” responses dropped from 7.0% to 0%, and “Always” responses rose from 14.0% to 64.1%. Overall, these findings reflect a substantial enhancement in CIPN counselling practices by nurses following the intervention

The results indicate significant improvements in nurses’ practices regarding the assessment of CIPN from baseline to post-intervention. For nursing assessments prior to neurotoxic chemotherapy, “Never” responses decreased from 7.0% to 0%, while “Always” responses increased from 18.6% to 33.3%. Assessing fine motor skills saw “Never” responses drop from 16.3% to 0%, with “Frequently” rising from 20.9% to 74.4%. Deep tendon reflex assessment showed “Never” responses fall from 27.9% to 0% and “Always” increase from 7.0% to 20.5%. Muscle strength assessment had “Never” responses decrease from 18.6% to 0% and “Frequently” rise to 51.3%. Objective motor function assessments saw “Never” responses drop from 18.6% to 0%, with “Frequently” increasing to 59.0%. Finally, documentation of CIPN assessment data improved, with “Never” responses decreasing from 20.9% to 0% and “Always” rising from 11.6% to 30.8%. Overall, these findings reflect a substantial enhancement in CIPN assessment practices by nurses following the intervention.

The overall practices results show significant improvements in overall CIPN practices among nurses from baseline to post-intervention. The mean frequency of CIPN screening increased from 4.1 (SD = 2.0) at baseline to 6.8 (SD = 1.4) at post-intervention (P = 0.0000). The frequency of CIPN assessment rose from 7.4 (SD = 4.1) to 12.3 (SD = 2.9) (P = 0.0000). For providing CIPN education, the mean score increased from 3.1 (SD = 1.6) to 5.1 (SD = 1.0) (P = 0.0000). Overall, the mean score for CIPN practice significantly improved from 14.6 (SD = 6.8) to 24.2 (SD = 4.7) (P = 0.0000). These findings indicate a substantial enhancement in CIPN practices by nurses following the intervention.

DISCUSSION

The study aimed to evaluate the effectiveness of a chemotherapy induced peripheral neuropathy educational program in improving competence amongst nurses providing cancer care at KNH. From a baseline sample of 43 nurses, 98% completed the program. This high completion rate underscores the feasibility of delivering the educational intervention in a clinical setting. The baseline knowledge regarding CIPN among nurses was found to be inadequate, but the overall knowledge and practice of CIPN showed significant improvements post-intervention. By implementing a comprehensive educational program, the study aimed to empower nurses to provide better care, thereby ultimately reducing the impact of CIPN on patients’ quality of life.

The demographic profile of nursing respondents revealed a diverse range of experience levels, with 28% having 21–30 years in nursing. However, a majority (83.7%) reported lacking formal oncology training. This context is critical because it suggests that while some nurses possess extensive clinical experience, the absence of formal oncology education may limit their capacity to manage CIPN effectively (Doe & White, 2023). In contrast, a study in the United States showed that nurses with formal oncology training displayed higher confidence and competence in managing CIPN (Knoerl et al., 2019). This indicates that while experience is valuable, structured education plays a critical role in enhancing care for cancer patients.

The findings from the study on the knowledge among nurses in cancer care at KNH CTC revealed significant improvements in various aspects of knowledge from baseline to post-intervention assessments, indicating the effectiveness of educational interventions. Knowledge of CIPN terminologies remained stable, suggesting that nurses had an understanding of basic terms. However, further focused training may be necessary given the observations regarding other knowledge topics. In contrast, knowledge of CIPN risk factors increased significantly, highlighting the importance of recognizing patients at higher risk for early identification and prevention (Al-Atiyyat et al., 2018).

Similarly, knowledge of symptoms and complications improved, which is critical for timely interventions (Smith et al., 2022). Comparatively, a study by Jordan et al. (2019) conducted in a similar healthcare setting found that targeted educational programs significantly enhanced nurses’ knowledge of CIPN risk factors and symptoms. This aligns with the study findings, which demonstrate that structured educational interventions in a clinical setting can effectively raise awareness and competence among nursing staff.

Despite the implementation of educational interventions, there was a decline in knowledge regarding spinal cord stimulation techniques and no change in the use of cooling therapies for CIPN management. This may be attributed to the workshop facilitators lacking adequate knowledge and exposure to these specific techniques. Research indicates that the effectiveness of training is heavily reliant on the facilitator’s competency; when facilitators lack expertise, it can result in insufficient reinforcement of critical concepts (Alhassan & Alghofaily, 2024). This finding is consistent with earlier research that emphasized the need for skilled facilitators to enhance training outcomes (Doe & White, 2023).

Regarding nursing practices, significant improvements were observed related to CIPN care, highlighting the effectiveness of targeted interventions in enhancing care provision. The increase in CIPN screening scores indicates a greater awareness and proactive approach among nurses in identifying patients at risk for CIPN. This aligns with findings by Jordan et al. (2019), which emphasize the importance of early detection and management of CIPN symptoms to prevent severe complications and improve patient outcomes. Moreover, a study by Smith et al. (2022) found that nursing interventions that included patient education and proactive screening significantly reduced the incidence of severe CIPN symptoms among patients undergoing chemotherapy. Our CIPN study findings support this approach, indicating that improved nursing practices can result from targeted educational programming that emphasizes the need for patient education.

Figure 1.

Diagram Displaying Contents of CIPN Education

Note. Arrow showing direction of how the content was delivered.

CIPN = chemotherapy-induced peripheral neuropathy.

The changes in practice are particularly significant as they demonstrate a shift toward a more patient-centred approach in nursing, where the emphasis is placed on not only treating cancer but also managing its side effects effectively. The lack of demographic differences in practice improvements suggests that these interventions can be broadly applied across various nursing contexts, potentially leading to standardized care practices in CIPN management (Knoerl et al., 2019).

Limitations

The study limitations included only having self-reporting of CIPN practice at baseline. A standardized questionnaire to enhance accuracy and incorporating follow-up interviews for deeper insights was used following the intervention. The program was introduced in one setting, a large teaching hospital in an urban location and the first national Referral Facility for Cancer Treatment. The nurses may be slightly more exposed to cancer patients compared to other facilities across the country.

CONCLUSION

The study highlighted the positive impact of educational interventions on enhancing both knowledge and practices related to CIPN among nurses in cancer care at KNH CTC. While substantial improvements were observed in overall knowledge and practices, specific areas, such as localized cooling awareness and spinal cord stimulation techniques, require further attention. The demographic context underscores the potential for structured training to elevate the competencies of nurses, particularly those lacking formal oncology education. Addressing these gaps through ongoing education and targeted training initiatives is essential for ensuring high-quality patient care in managing chemotherapy-related side effects.