الفهرس 
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Abstract
Hepatocellular carcinoma is a cancer that starts in the liver. It’s different from secondary liver cancers, which have spread to the liver from other organs. It can be cured with surgery or transplant. In more advanced cases it can’t be cured, but treatment and support can help patient live longer and better. It’s important to remember that the patient and caregivers still have control over the decisions they make about the treatment. Hepatocellular carcinoma is the most common type of primary liver cancer (Llovet, et al., 2021).
Hepatocellular carcinoma occurs most often in people with chronic liver diseases such as cirrhosis caused by hepatitis B or hepatitis C infection. Hepatocellular carcinoma significantly reduces lifestyle, even in the absence of cirrhosis, and that successful treatment of HCC is associated with an improvement in lifestyle (Kulik, & El-Serag, 2019).
Aim of the study:
The current study aimed to assess caregivers’ awareness toward health care of their patients with hepatocellular through:
1. Assessing knowledge of caregiver about hepatocellular carcinoma.
2. Assessing practices of caregiver during care of patient with hepatocellular carcinoma.
3. Assessing attitude of caregiver toward patient with hepatocellular carcinoma
Research design
A descriptive correlation research design was used to achieve the aim of the current study.
Setting
The current study was conducted at outpatient clinic in liver tumor clinic in Ain Shams University Specialized Hospital in Cairo Governorate assisted To El-Abaseya, Elweili, Kobri El Qobba, Hadaeq Al Qubbah, Alf Maskan, Ezbet El Nakhl, El-Khalifa El-Maamoun, and service include (liver tumor clinic, oncology clinic, hemodialysis unit, physiotherapy and rehabilitation, operation rooms, postoperative intensive care unit, liver-kidney transplantation intensive care unit, diagnostic, intervention radiation includes chest x ray, CT, MRI, Doppler, Mammogram, atomic scanning, ultrasound waves, thermal frequency and providing all health service to the community.
Subjects
Purposive sample of 130 caregivers of patients with hepatocellular carcinoma out of 200 caregivers who attended the outpatient liver tumor clinic, Ain Shams Specialized Hospital at 2018-2019.
Data collection tools
Two tools were used to achieve the aim of this study
First tool: An interviewing questionnaire was used. It was designed by the research investigator based on reviewing the current and related literature review it was written in Arabic language. It consists of three parts:
Part I (A) Demographic characteristics of caregivers, as age, gender, marital status, educational level, occupation, income and place of residence. question No (1-7).
(B) Demographic characteristics of patients with hepatocellular carcinoma, as age, sex and marital status, educational level, occupation, place of residence. Question No (8-13)
(C) Medical history of the patients as suffering from previous hepatic disease, method of discovering disease, duration of hepatocellular carcinoma, place of receiving treatment, type of treatment, receiving of health education, frequency of physician visits. Question No (14-20).
Part II: Caregiver knowledge regarding hepatocellular carcinoma as definition, causes, risk factors, symptoms, diagnosis, complications, treatment, prevention, definition of chemotherapy, goal of chemotherapy, types of chemotherapy, method of administration chemotherapy, complication of chemotherapy, goals of radiotherapy, side effects of radiotherapy, method of administration radiotherapy, palliative of therapy, sources of knowledge. Question No (21-38).
Scoring system:
Total knowledge questions included (17) and scored (34) degree. Caregiver’s responses were scored as correct=2, incomplete correct=1, incorrect=zero. The scores of the items were summed up and the total divided by the number of items, these scores were converted to percent score. Total score of caregivers’ knowledge considered satisfactory if total percent score was 50% or more representing (17-34) and unsatisfactory if the total percent score was less than 50% representing (0-16) (Khallaf, 2019). The source of knowledge question was excluded from the scoring system
Part III: Reported practices of caregivers
This tool was adopted from (Hansen, 2017) and modified by investigator and aims to collect data about caregiver’s practices of patients with hepatocellular carcinoma including, person hygiene includes (5 statements), medication administration includes (8 statements), Pain management include (5 statements), Nutrition includes (16 statements), Elimination includes (5 statements), Transferring includes (6 statements), rest and sleep, sport includes (9 statements).
Scoring system:
Total practice questions included (54) and scored (54 degree). The responses scored as done=1, not done=zero.
The scores of the items were summed up and the total divided by the number of items. These scores were converted to percent score. Total score of caregivers’ reported practices considered adequate 60% or more representing (32-54) and inadequate if the total percent score was less than 60% representing (31) (Ebrahem, 2015).
The second tool: Caregiver’s attitudes regarding patients with hepatocellular carcinoma Likert scale
Scoring system:
Total attitude question included (33) and scored (66)
Responses of the caregivers were ”never” or ”sometimes” or “always” which scored zero, one, and two respectively. The scores of the items were summed up and the total divided by the number of items. These scores were converted to percent score. Total score of caregivers’ attitudes considered positive if total percent score was 60% or more representing (39-66) and negative if the total percent score was less than 60% representing (38) (Ebrahem, 2015).
Field work:
Data collection of the study was started at the beginning of January 2021, and completed by the end of March 2021. The research investigator attended at outpatient clinic in liver tumor clinic in Ain Shams University Specialized Hospital in Cairo Governorate. Three days per week (Sunday, Tuesday, and Thursday) from 8am to 12pm meet the caregivers in the break area of clinic, clinic work days (Sunday, Tuesday, Thursday).
The research investigator first explained the aim of the study to the caregiver’s patients and reassures them that information collected will be treated confidentiality and that used only for the purpose of the research. The research investigator met caregiver’s patients at outpatient clinic in liver tumor clinic in Ain Shams University Specialized Hospital, the research investigator takes 30 minutes for each tool to complete the sheet with caregiver’s patient.
The present study revealed the following main results:
• 60.7 % of caregiver’s age ranged from 35 to 40 years.
• 75.4% of them were female. 66.2% of them were married.
• 68.5% of them had adequate income.
• 54.6% of the caregivers had satisfactory knowledge while 45.4% of them had unsatisfactory total knowledge.
• 91.5% of the caregivers had adequate reported practices while 8.5% of them had inadequate reported practices.
• 73.1% of the caregivers had positive attitude while 26.9% of them had negative attitude.
• There is a highly statistically significant relation between caregivers’ total knowledge and their educational level and their wok.
• There is no statistically significant relation between caregivers’ total knowledge and their ages, gender, marital status and income
• There is a highly statistically significant relation between caregivers’ total practice and their ages, and educational level.
• There is a highly statistically significant relation between caregivers’ total attitude and their ages, gender, educational level, and their work.
• There is a highly statistically significant relation between caregivers’ total level of knowledge and their total practices.
• There is no statistically significant relation between caregivers’ total level of knowledge and their total attitude.
• There is a statistically significant relation between caregivers’ total attitude and their total practices.
Conclusion:
The current study concluded that, more than half of the caregivers had satisfactory knowledge while majority of the caregivers had adequate reported practices while and nearly three quarters of the caregivers had positive attitude Also, there is a highly statistically significant relation between caregivers’ total practice and their ages, and educational level there is a highly statistically significant relation between caregivers’ total attitude and their ages, gender, educational level, and their work. Moreover, there is a highly statistically significant relation between caregivers’ total level of knowledge and their total practices; there is no statistically significant relation between caregivers’ total level of knowledge and their total attitude. Also, there is a statistically significant relation between caregivers’ total attitude and their total practices.