Cancer Nursing Research in Africa: Scoping the Landscape

Sunday, 30 July 2017: 10:15 AM

Lize Maree, DCur
Vivien Herbert, MSc (Nsg)
Agnes A. Huiskamp, MA (Nsg)
Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa

Purpose: The purpose of the study was to perform a scoping review of existing literature on studies conducted in Africa by a nurses and midwives affiliated to an African institution over the past decade, to identify and describe the work completed, identify gaps and define priorities for future research.

Methods:  We used a scoping review for our study and used the terms Africa + cancer nursing and Africa + oncology nursing to search PubMed, CINAHL, Web of Science, Scopus and SA e-publications for literature published between 1 January 2006 to 31 December 2015. Articles were included if it was conducted in an African country with a nurse/midwife affiliated to an African institution as one of the authors. The work also had to be written in English, peer reviewed, have an abstract with a full text available through the university’s electronic data bases or interlibrary system. A data extraction sheet was developed to record the name of the journal, the year of the study, the country where the study was conducted, the names of the Africa nurse/midwife author, the study design, the cancers and topics investigated. The titles and abstracts were individually reviewed for inclusion by the authors. All the authors analyzed work which was confirmed through a consensus meeting.

Results: Our search produced 529 articles of which we excluded 427 for either being duplicates or not meeting the inclusion criteria; 57 papers were included in the review. The work was conducted in 8 of the 54 countries in Africa with more than 60% (n=36) in South Africa. The studies were published in 28 journals of which 9 are based in Africa. More than 50% of the articles (n=30) was published in international journals. The number of authors ranged from 1 to 11 (median 4.5) and 17.5% (n=10) of the work had a single author. Eighty four nurses/midwives from Africa authored/co-authored the articles with most (82.1%; n=69) contributing to only 1 article. Only 2 (2.4%) authors contributed to more than 3 papers. The studies were primarily quantitative (36.8%; n=21) while 17 (29.8%) were qualitative and 11 (19.3%) have non-specific designs. Only a small percentage (8.8%; n=5) were intervention and outcomes studies. Cervical cancer was the focus of the majority of studies (57.9%; n=33) followed by breast cancer (17.5%; n=10) with prostate cancer the focus on only one study. Six topics were investigated; primary and secondary prevention of cancer, cancer care, experiences of patients living with cancer, access to cancer care, nurses and nursing practice issues. More than 50% (n=33) of the studies investigated an aspect of primary and secondary prevention with 27 (47.4%) exploring knowledge/awareness/practices. The 12 studies (21.1%) addressing nursing practice mainly investigated cervical cancer screening programs.

Conclusion: In a 10 year review of the cancer nursing research conducted in Africa by Africa nurses/midwives, 57 articles were found. Considering the fact that Africa consists of 54 countries, 57 articles in 10 years seem to be a very low research output. However, the number of studies compare favorable to the 73 found in a review on clinical nursing and midwifery research in African countries conducted over a 10 year period ending in 2014. It was positive to find that most of the work was published in international journals. What is of concern is the large percentage of authors involved in only one study supporting evidence that Africa lacks dedicated cancer nurse scientists and that Africa’s nurses contributes poorly to global scientific publications. The cancers investigated do not match the cancer disease profile of Africa. Breast and prostate cancer, the most common cancers in women and men in Africa received little attention whilst cervical cancer, the second most common cancer in women, were the most investigated, possibly because it can be prevented. Other common cancers in both men and women such as liver and colorectal cancer and cancer of the esophagus were not investigated. Studies focusing on symptom management and the family and care giver of the patient also lack. Although studies on knowledge, attitudes and practices can provide baseline data, this field of study is over exhausted and we need to move forward and prioritize developing and testing innovative ways to prevent and detect cancer early. It was positive to find some work focused on nursing practice which would enable us to start developing evidence for Africa specific cancer nursing practice.