Share this article on:

Cancer Nursing Research Output in Africa 2005 to 2014: An Integrative Review

Maree, Johanna Elizabeth DCur; Herbert, Vivien MSN; Huiskamp, Agnes Alice MSN

doi: 10.1097/NCC.0000000000000334
Articles: Online Only

Background: This study is the first review of African cancer nursing research as only 1 review focusing on South Africa was conducted in the past decade.

Objective: The aim of this study was to identify, summarize, and synthesize the findings from previous independent studies conducted by nurses in Africa.

Methods: The terms cancer nursing and oncology nursing and Africa were used to search PubMed, CINAHL, Web of Science, SA e-publications, and Scopus. Studies reporting research conducted in an African setting, coauthored by a nurse affiliated with an African institution and published between January 1, 2005, and December 31, 2014, in English were included. A data extraction sheet captured the data.

Results: A potential 536 articles for possible inclusion were identified. Fifty met the inclusion requirements. Cancer in women (78%; n = 39) and prevention and early detection (62%; n = 31) were most commonly investigated. The work was primarily quantitative and collected data on some knowledge aspect from women in the community. Most of the studies (96%; n = 48) did not meet the criteria of high-quality work.

Conclusions: Africa’s nurses have improved their research output in the field of cancer nursing considerably. Research focusing on the most prevalent cancers, the treatment, the patient living with cancer, the family, extended family, and community is lacking, as is work focusing on pain and other symptoms.

Implications for Nursing Practice: Nurses in practice should assist nurse researchers to address the identified knowledge gaps to develop cancer nursing science and practice tailored to meet the unique needs of Africa.

Author Affiliation: Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Johanna Elizabeth Maree, DCur, Department of Nursing Education, University of the Witwatersrand, 7 York Rd, Parktown, 2193, Johannesburg, South Africa (Lize.maree@wits.ac.za).

Accepted for publication November 14, 2015.

The significance of this study is related to the fact that this is the first review of cancer nursing research conducted on the African continent. Only 1 review focusing on South African cancer nursing was conducted in Africa in the past decade.1 As evident by the 1994 to 2003 world review of cancer nursing research output conducted by Molassiotis and colleagues,2 the majority of cancer nursing research originated from the developed world, and only 4 of the 619 (0.7%) articles included in the world review originated from Africa: 3 from South Africa and 1 from Egypt. It is quite possible that Africa’s cancer nurses can be informed by research conducted in the developed world; however, there is a strong possibility that the evidence might not be applicable to Africa with its limited resources, distinctive healthcare challenges,1 and specific disease profiles. In addition, 9 years have lapsed since the publication of the world review, and there was some development in cancer treatment and care in Africa the past decade that necessitates the identification of key trends and gaps in nursing research and giving directions for future research.

According to the World Population Review,3 Africa, the second largest and second most populated continent on earth, consists of 56 countries with people of various ethnicities. In 2013, Africa had a population of 1033 billion, with more than half being younger than 25 years. The life expectancy in many countries is less than 50 years3; however, it is estimated that between 2010 and 2030 the number of people reaching the age 60 years or older would increase by 90%.4 Africa is still developing, and the majority of the 20 poorest nations in the world reside on this continent.5

Cancer is a public health problem in Africa, and the burden of cancer is increasing because of the growth of the population as well as aging. In addition, factors such as reproductive behaviors, smoking, obesity, and physical inactivity related to economic transition increase the risk prevalence.4 According to the 2012 Globocan statistics,6 an estimated 847 000 people living in Africa will receive new diagnosis of cancer each year, whereas 591 200 would die of this group of diseases. The most common cancers in men living in Africa are prostate and liver cancer, Kaposi sarcoma, lung cancer, and colorectal cancer, whereas breast, cervical, liver, colorectal, and ovary cancers are the most common cancers in Africa’s women.7

Unfortunately, cancer control in Africa faces various challenges. Lack of political will, limited resources, and other competing interests, such as controlling the spread of human immunodeficiency virus, tuberculosis, and malaria, result in cancer receiving a relatively low public health priority.4,8 Lack of cancer surveillance; inadequate cancer advocacy; underfinanced and fragmented healthcare services; lack of diagnostic and treatment capacities; weak referral systems; lack of knowledge, awareness, and capacity among healthcare practitioners; and lack of effective cancer medicines that can be easily administered without hospitalization are only some of the factors that add to the challenges.8,9 In addition, adequate equipment needed to diagnose and treat cancer is scarce and poorly maintained.10

The majority of Africa’s cancer patients present with advanced disease, when cure is no longer possible.8 Not only are traditional healers extensively used, but also even people who seek healthcare early in the cancer trajectory are faced with the possibility of missed diagnosis as cancer is an underrecognized condition. Providing support to cancer patients and their families is also challenging because of transportation issues, the increasing dismantling of the extended family caused by migration, poverty, changes in lifestyle and urbanization, and lack of community support.10

The availability of surgical treatment is limited because of the lack of skilled health professionals and surgical equipment,4 and only approximately 5% of cancer patients receive chemotherapy.10 Radiotherapy treatment is also a challenge, as Barton et al11 found that Africa, in 2002, had only 18% of the megavoltage radiotherapy machines, either cobalt or linear accelerator, of the estimated need. Abdel-Wahab et al,12 in an International Atomic Energy Agency analyses of the radiotherapy resources in Africa, found that Africa was the world’s least developed region with regard to the provision of radiotherapy services. Only 23 of the 52 African countries included in the analysis had teletherapy machines, and the average capacity was less than 1 teletherapy machine per million people. In addition, the radiotherapy machines were primarily concentrated in South Africa and Egypt, which together hosts 60% of the radiotherapy equipment in Africa. Brachytherapy, either high-dose rate or low-dose rate, was available in only 20 countries—once again concentrated in the south and north of Africa with the exception of Nigeria. In addition, most radiotherapy centers in Africa deliver only simple curative treatment and provide primarily palliative services. On the positive side, radiotherapy machines have increased in number over the last 2 decades from 155 in 1998 to 277 in 2010, and the number of operational teletherapy machines increased in 17 African countries during the same period.

Providing palliative care to Africa’s cancer patients faces the same challenges as preventing and treating cancer, and similarly, the overwhelming majority of Africa’s patients needing palliative care do not have access to such care. In many African countries, drugs needed for effective management of pain and other symptoms are not available. In addition, in many countries, legislations restrict opioid prescription to medical practitioners, which cannot be afforded considering the low doctor-patient ratio and non–facility-based healthcare.13

Although cancer nursing is an established nursing specialty,2 little is known about the status of cancer nursing on the African continent as no literature explaining this issue seems to be available. Considering the development of cancer care in Africa, it can therefore only be assumed that cancer nursing is in a development stage and that despite the pressing shortage of nurses and midwifes14 nurses would be involved in the primary and secondary prevention of cancer, cancer treatment, and the provision of palliative care. In addition, the unique challenges facing Africa would necessitate nursing research as research enables nurses to develop new approaches to health problems, design new and innovative programs to improve the outcomes of cancer patients and their families, and provide the evidence base for cancer nursing practice.15,16

We selected an integrative review research method as we wished to identify, summarize, and synthesize the findings from previous independent studies17 conducted by nurses in Africa, in an attempt to advance the development of both cancer nursing science and practice18 on the continent. Specifically the study aimed to

  • quantify the publication output of cancer nursing conducted by nurses in Africa as from 2005 to 2014 and to describe the work in terms of the country of origin, authors and journals of publication and number of citations, the focus, participants, and methods used;
  • determine whether the studies were funded; and
  • assess the quality of the work.
Back to Top | Article Outline

Methods

We used the terms cancer nursing and oncology nursing and Africa for our search. In addition to the term Africa, we also searched the individual countries that, according to the International Atomic Energy Agency,12 have a teletherapy machine. Databases searched were PubMed, CINAHL, Web of Science, SA e-publications, and Scopus. Studies had to report findings of research conducted in an African setting and had to be coauthored by a nurse affiliated with an African institution. The work had to be published between January 1, 2005, and December 31, 2014, in English. In order to capture only the output of published research, we excluded literature reviews, dissertations, editorials and letters to the editor, conference abstracts, case reports, discussion papers, and gray literature. Articles of which the full texts could not be accessed through the South African interuniversity library system were also excluded.

We developed a data extraction sheet to document the required data. The data extraction sheet captured the year of publication; the title of the article; the name of the journal and its impact factor if applicable; number of citations on July 1, 2015, as per Google Scholar; the names and affiliations of all the authors including the countries they represent; the country/countries where the data were gathered; the settings; the cancer and populations under study; the focus of the study (for instance, primary and secondary prevention); purpose (for instance investigate knowledge); and the research methods used. Research methods included the design, sampling and sample size, and the data collection and analyses methods used. One section made judgements of the quality of the work, one indicated whether the study was funded and one indicated who the funding agencies were.

To assess the quality of the articles, we used the same grading system for qualitative and quantitative work described in the world review,2 which was also used in the South African review.19 Quantitative research was assessed using the 3-point grading scale developed by Mann,2 and qualitative work used the rating system developed by Cesario and colleagues.20 In addition, mixed-method studies were assessed using the criteria outlined by O’Cathain et al21 and case studies using Stake’s instrument outlined by Crowe et al.22 These instruments were also used in the South African review.19 The researchers used the same instruments, as it allowed comparison of the work using the same criteria and possibly simplifying future comparisons.

Data gathering commenced in October 2014, and regular searches continued until April 2015 to identify any new studies published that had to be added to the body of the current review. The lists of publications obtained from the databases were reviewed to exclude work that did not meet the inclusion criteria. The titles were first reviewed to determine whether the study investigated some aspect of cancer; abstracts were used where titles were unclear. Abstracts were used to investigate the authors and their affiliations and country where the study was conducted. Full texts were obtained, and the data extraction sheet captured the data that were individually reviewed by all 3 authors. Data on the number of times the article was cited was obtained from Google Scholar. We used content analyses23 to categorize the focus of the studies and to group the categories into themes and the Mann-Whitney U test24 to compare the differences of the various groups.

Back to Top | Article Outline

Results

A potential 536 articles for possible inclusion in this review were identified; most (36.1%) were found in PubMed, followed by Web of Science (27.1%), Scopus (20.9%), SA e-publications (13.2%), and CINAHL (6.7%). A total of 486 articles were excluded as they either did not meet the inclusion criteria, were duplicates, or lacked accessible full texts, resulting in 50 articles being included in this review (list available on request).

We could not find evidence of any article published in 2006, but noted an upward trend in publications (Figure 1). The work originated from 9 African countries (Table 1) in collaboration with 6 countries outside Africa that contributed to 4 articles.

Figure 1

Figure 1

Table 1

Table 1

The work was published in 21 journals with half published in African-based journals. The Africa Journal of Nursing and Midwifery published 8 (16%); Health SA Gesondheid, 7 (14%); and Curationis, 6 (12%). Five articles (10%) were published in the European Journal of Cancer Care, and 3 (6%) in the European Journal of Oncology Nursing, BMC Research Notes, and Cancer Nursing, respectively, and 2 (4%) in BMC Cancer. Thirteen journals published 1 article only (Table 2).

Table 2

Table 2

Journals used various indicators to communicate their impact that complicated comparisons. However, considering the journals publishing more than 1 article, none of the African-based journals (African Journal of Nursing and Midwifery, Health SA Gesondheid, and Curationis) have a Thomas Reuters impact factor,25 similar to that of BMC Research Notes.26 In contrast, the 2014 Thomas Reuters impact factor of the other 4 journals were higher than 1.4: BMC Cancer, 3.362; Cancer Nursing, 1.966; European Journal of Cancer Care, 1.564; and European Journal of Oncology Nursing, 1.426. The Thomas Reuters impact factors of the journals publishing a single article ranged from 0 to 2.711.27 Most of the articles (90%; n = 45) were cited, and the number of citations ranged from 0 to 54, with an average of 7.4 and median of 5. The highest number of articles (42%; n = 21) were cited 1 to 5 times; 13 (26%), 6 to 10 times; 6 (12%), 11 to 15 times; 3 (6%), 16 to 20 times; 1 (2%), more than 20; and 1 (2%), more than 50 times. Work published in journals with Thomas Reuters impact factors were cited more on average compared with those published in journals without these impact factors (11.2 vs 4.9 times). A Mann-Whitney U test indicated that the numbers of citations of the work published in journals with impact factors (median, 9.5) were significantly greater than those published in journals without an impact factor (median, 4.0), U = 186.5, P = .05. In addition, the articles (50%; n = 25) published in international journals were, on average, more cited than the articles (50%; n = 25) published in African-based journals (10.7 vs 4.2 times). A Mann-Whitney U test indicated that the numbers of citations of the work published in international journals (median, 10.68) were significantly greater than those published in African-based journals (median, 3.0), U = 168.0, P = .02.

Eighty-six authors contributed to the work, of which 77 (89.5%) were affiliated to an African institution, 3 (3.5%) were affiliated to a Swedish institution, and 2 (2.9%) to institutions in the United Kingdom. Institutions in Kuwait, Oman, Canada, and Australia each provided 1 author (1.7%). Only 3 of the African authors (3.9%) were not affiliated with an academic institution. The majority of African authors (84.4%; n = 65) contributed to only 1 article, 8 to 2 (10.4%), 2 to 3 (2.6%), 1 to 11 (1.3%), and 1 to 21 articles (1.3%).

Cancer in women (78%; n = 39) was the most common diagnostic focus. More than half of the work (56%; n = 28) focused on cervical cancer, 18% (n = 9) focused on breast cancer, whereas 2 (4%) combined cervical cancer breast cancer. Seven articles (14%; n = 7) did not investigate a specific cancer, 1 (2%) focused on oral cancer, 1 (2%) on prostate cancer, and 2 (4%) on childhood cancers. Figure 2 presents the number of articles focusing on a specific cancer compared with the top 6 cancers in sub-Saharan African men and women.7

The work investigated 4 themes: prevention and early detection (58%; n = 29), cancer care (16%; n = 8), cancer experiences (14%; n = 7), and nurses and nursing practice (12%; n = 6). Table 3 provides the detail of the themes investigated. Women (66%; n = 33), specifically women from the community (46%; n = 23), were the most common participants in the studies, followed by women with cervical cancer (16%; n = 8) and nurses (14%; n = 7). Information about knowledge (awareness, understanding, perceptions, beliefs), attitudes, and practices was most collected (54%; n = 27), whereas only 9 (18%) of the work included some practice issue. A summary of the participants and the information obtained from the participants is presented in Table 4.

Table 3

Table 3

Table 4

Table 4

When investigating the research methods, it was found that not all the articles mentioned research designs. However, more quantitative findings (62% n = 31) were presented as opposed to qualitative findings (32%; n = 16). Similar to the research designs, sampling methods were missing from some of the studies. Convenience sampling was the most popular sampling method (28%; n = 14), and only 6 (17.6%) of the 34 studies with a quantitative component used a calculated sample size. Not all the work mentioned the sample size, but sample sizes ranged between 1 and 980. The sample size of the qualitative work ranged from 6 to 82, with an average of 19.4 and median of 15. The sample sizes of the quantitative work ranged from 22 to 980, with an average of 253.8 and median of 261. Interviews (72%; n = 36) collected most of the data, and questionnaires (46%; n = 23) were the most commonly used data-gathering instrument. The research designs and methods are outlined in Table 5.

Table 5

Table 5

Only 12 of the studies (24%) were funded; 7 (14%) were funded by the Tshwane University of Technology, South Africa, and 2 (4%) by the National Council for Science and Technology, Kenya; the Cancer Association of South Africa, the Institutional Collaboration Training Project, Zambia, and the Swedish Children’s Cancer Foundation in combination with the University of West England each funded 1 study.

Most of the studies (96%; n = 48) did not meet the criteria of high-quality work (Table 6). The quantitative work mostly lacked calculated sample sizes, and only 1 study (2%) had comparison groups. However, all the studies included clearly described outcomes measures. Most (75.0%; n = 16) of the qualitative work met the criteria to be regarded as fair quality. Procedural rigor scored the lowest, whereas heuristic relevance scored the highest.

Table 6

Table 6

Back to Top | Article Outline

Discussion

The study provided evidence of 50 studies conducted in Africa by nurses affiliated with an African institution in the field of cancer nursing from 2005 to 2014; a more than 10-fold increase since the publication of the world review published in 2006.2 In addition to the increase in publications, it was positive to find 7 countries who were not featured in the world review published some of the work included in the current review. Unfortunately, we lost 1 country since the world review as we could not find evidence of any publication originating from this specific country. Most of the work originated from South Africa, which is not unique in the African context. Adejumo and Lekalakala-Mokgele28 when describing the studies concerning nursing in Africa from 1986 to 2006, as well as Sun and Larson1 when scoping clinical nursing and midwifery research in African countries between 2004 and 2014, found the same trend. Sun and Larson1 found 79.5% of the work included in their study originated from South Africa, whereas Adejumo and Lekalakala-Mokgele28 indicated that 67.3% of the work included in their study originated from Southern Africa particularly South Africa. Adejumo and Lekalakala-Mokgele28 explain the distribution of the work by stating that nursing education has been long established in these countries.

How the growth in publications compares to the research output of the rest of the developing world and even the developed world is unknown, and we would have to wait for an updated world review before we could draw conclusions. However, the world review included 3 developing countries outside Africa, Brazil, Iran, and Korea, which published 2 and 1 article each, respectively. When comparing African cancer nursing research output with those of nursing and midwifery research in general, cancer nursing is not high on the agenda. Topics related to primary healthcare and community health nursing, midwifery, child nursing, nursing education issues, human immunodeficiency virus and AIDS, and professional issues are the most common research focus.1,28 Sun and Larson1 found that funding was one of the major drivers of the research priorities and research topics in Africa. This would influence cancer nursing research, as Africa spends approximately 80% of the limited amount allocated to healthcare on acute communicable diseases, which have also been the overwhelming focus of donors,9 whereas cancer is not a donor priority.29

Adewole and colleagues30 identified the African environment, inadequate research infrastructure, and lack of funding and other resources as barriers to rigorous cancer research in Africa. Klopper and Uys,31 when describing the state of nursing and nursing education in Africa, highlighted various educational factors that could influence the quality of research including lack of access to higher education (where the search for external funding has become a crucial responsibility), university’s challenges in terms of shortage of faculty, lack of development, weak research and innovation capacity, brain drain, and poor facilities and infrastructure. These facors could have added to the low quality of the articles reported in the current review but cannot be the sole reasons, as Molassiotis et al2 regarded the quality of the studies in the world review, dominated by the developed world, “disappointing.” Although Africa’s nurses did not produce clinical trials, prospective studies with comparison groups, or retrospective studies with controls, the quality of both the quantitative and qualitative work did not compare poorly with what was found in the world review. However, it was noted that, similar to the findings of the world review, essential information was not reported, and inaccuracies and inconsistencies were noted in the study designs. Molassiotis and colleagues2 warn that cancer nursing would only be taken seriously by our interdisciplinary colleagues if the quality of our work was of high standard. Africa’s nurses might face an additional challenge as Imbayarwo, a Zimbabwean scientist, stated, “Anything from Africa has always been looked down upon.”32

It was positive to find that most of the work was cited, even if not published in journals with an impact factor. To urge Africa’s cancer nurses to publish only in journals with impact factors, which leads to a significantly higher citation rate, might not be reasonable. It might be more appropriate for Africa’s cancer nursing scholars to conduct focused research and build a body of knowledge to inform cancer nursing science and practice on the continent instead of striving to publish a few articles with high citation rates. This, however, does not mean that quality could be compromised. Imbayarwo is of the opinion that Africa’s researchers do not publish work in local journals because it is of a low standard, but because of the subject matter and time pressures.32 Also, Adejumo and Lekalakala-Mokgele28 related the increase in Africa’s nursing publications to the presence of nursing journals based in Africa. However, the visibility and availability of the work published in some of these journals are hindered by limited access, not only to full texts but also titles and abstracts of the work. Fortunately, during the period of the review, 2 of the African-based journals have changed to an open-access system, and Africa welcomed a new open-access international nursing journal focusing on nursing and midwifery in general. It would be interesting to see how the improved visibility and availability would influence the number of citations as well as the quality and quantity of cancer nursing publications.

What is of great concern is that Africa lacks a dedicated cadre of cancer nursing researchers as most of the authors contributed to only 1 article. Without dedicated cancer nurse researchers, we would not be able to move away from collecting baseline data and conduct more sophisticated research to build a body of knowledge to inform African cancer nursing science and practice and improve outcomes in terms of the prevention and early detection of cancer and the outcomes of patients, caregivers, and families living with cancer. The reasons for this situation are not clear; however, it seems as if the shortage of faculty at Africa’s universities forces faculty to supervise postgraduate students across nursing fields, hindering them from building and focusing on their specialist field. For instance, van Rooyen et al33 found that only 4 of the 105 doctor of philosophy degree–prepared nursing faculty at South African universities held a National Research Foundation rating that calls for scholarly work with a definite research focus. It might also be possible that some of the authors were not interested in research, but conducted research because it was required of them28,34 and therefore did not continue their work. This is, however, mere possibility and should be investigated to draw definite conclusions. In addition, it seems as if nurses practicing in cancer care settings do not conduct research, as only 3 of the African authors were not affiliated with an academic institution. Roxburgh,35 in a study conducted in Scotland, found that clinical nurses were generally receptive to conducting research but were challenged by their knowledge and skills to conduct research, which, bearing in mind the educational challenges of nurses in Africa, might also be applicable to the African setting.

As seen in Figure 2, the research conducted is inconsistent to the cancer profile of Africa. Cervical cancer and breast cancer received the most attention, and other prevalent cancers such as liver cancer, prostate cancer, non-Hodgkin lymphoma, colon and rectum cancer, esophageal cancer, Kaposi sarcoma, and lung, stomach, and bladder cancers were not investigated.36 In addition, work focusing on the patient with cancer, symptoms, treatment-related issues, and supportive care lacks foundation. Whether the lack of diagnostic and treatment opportunities faced by Africa’s cancer patients played a role in this deficit is quite possible. Considering the lack of infrastructure, high disease burden, and advanced stage at presentation, it was interesting to find that palliative care received so little attention. In addition, patients living with pain and pain management were not investigated, which is a serious gap in our research as pain is a major problem for people living with cancer in Africa, while morphine is either not available or not accessible in most African countries.37,38 It was also interesting to find that the family, caregiver, and the community living with people with cancer were not included in the work presented in this review. Researching these topics is especially important because in most of Africa, the philosophy of interconnectedness, called Ubuntu in South Africa (“I am because you are”), the family, extended family, and community, plays an important role in the life of a person.

Figure 2

Figure 2

Most of the work (62%) used a quantitative approach, whereas mixed-methods and case studies produced single articles. Molassiotis et al,2 in the world review of cancer nursing research outputs, found a similar trend, with 60.2% of the articles quantitative, which is supported by Adejumo and Lekalakala-Mokgele,28 who found that 64.3% of the general nursing research output of Africa was quantitative. This is in contrast with the study of Sun and Larson,1 who found the opposite with 41.1% of the work being quantitative. Whether this is positive or negative is debatable. The advantages of qualitative research are well known, and it is also well known that qualitative and quantitative methods can complement each other and can be used sequentially or in tandem. However, one of the major advantages of qualitative research is the fact that it gives voice to the voiceless,39 which would be an important starting point when we advocate for affordable accessible screening opportunities, diagnostic facilities, affordable treatment, and the availability of essential palliative drugs such as morphine. It comes as no surprise that interviews were the most commonly used method for data collection, as 40% of Africa’s population are still unable to read and write.40

The majority of the work included in the current review collected data from people living in the community. This is a positive trend and in constrast to the work presented in the world review,2 where most of the studies focused on nurses and other healthcare professionals. In addition, focusing on cancer prevention is the appropriate approach for Africa’s cancer nurses and adhered to “the 10 priorities and actions for cancer research and control in Africa.”36(p248) Sylla and Wild36 support the prioritization of research on the causes of cancer and cancer prevention, promotion of primary prevention, introduction of screening and early detection, access to basic diagnostic services and affordable treatment, and international collaborations. This calls for more sophisticated work than exploring and describing some knowledge aspect of cancer and should include intervention studies allowing us to develop, test, and refine ways to prevent cancer; mobilize people to make use of screening opportunities; provide cancer screening opportunities; establish basic diagnostic services; and advocate for affordable treatment and essential palliative drugs. International collaboration is indeed needed to strengthen these attempts. Considering the challenges we face and the information we most commonly obtained from participants, it is quite reasonable to conclude that the field knowledge, attitudes, and practices have reached maturity and would only call for additional work in extraordinary circumstances.

Our study has various limitations. It is unlikely this review presented the total body of work done in Africa by nurses affiliated to an African institution in the field of cancer nursing, as we focused on peer-reviewed literature available by means of selected databases. In addition, we acknowledge that some articles meeting the inclusion criteria could have been missed because of the uncertainty whether the authors were nurses affiliated with an African institution.The key words selected for the study and including only the individual countries in possession of radiotherapy machines in addition to “Africa” could also be limitations. Using the term “nursing” could have resulted in not including multidisciplinary work in which nurses participated. Furthermore, the number of citations was assessed 6 months after the end of the review cycle, which could have influenced the number of citations positively. Yet, the researchers believe that the work included in this review provides a good representation of the work done in the field of cancer nursing in Africa by Africa’s nurses from 2005 to 2014. It would be helpful for future reviews if authors could indicate their nursing status by adding a recognizable acronym, such as RN, to their names.

Back to Top | Article Outline

Conclusion

Africa’s nurses have improved their research output in the field of cancer nursing significantly and should celebrate this achievement. In addition, we added to the body of knowledge in terms of primary and secondary cancer prevention; however, the field of knowledge, attitudes, and practices has now definitely reached maturity. Research focusing on the most prevalent cancers, the treatment, the patient living with cancer, the family, extended family, and community is lacking, as is work focusing on palliative care and pain and other symptoms. There is an urgent need for multidisciplinary innovative and influential collaborative work to improve the availability of screening opportunities, improve screening uptake, and improve cancer outcomes throughout the trajectory of the disease.

Back to Top | Article Outline

Implications for Nursing Practice

Africa’s nurses practicing in disease prevention, cancer care, primary healthcare, and palliative care should join forces with nurse researchers to address the identified knowledge gaps, which would assist with the development of cancer nursing science and practice tailored to meet the unique needs of Africa.

Back to Top | Article Outline

ACKNOWLEDGMENT

The authors thank Mr C. Maree for his assistance with the database searches.

Back to Top | Article Outline

References

1. Sun C, Larson E. Clinical nursing and midwifery research in African countries: a scoping review. Int J Nurs Stud. 2015;52(5):1011–1016.
2. Molassiotis A, Gibson F, Kelly D, et al. A systematic review of worldwide cancer nursing research: 1994 to 2003. Cancer Nurs. 2006;29(6):431–440.
3. World Population Review. Africa Population 2015. http://worldpopulationreview.com/continents/africa-population/. Accessed June 9, 2015.
4. Jemal A, Bray F, Forman D, et al. Cancer burden in Africa and opportunities for prevention. Cancer. 2012;118(18):4372–4384.
5. Business Insider. Here Are The 20 Poorest Nations In The World. http://www.businessinsider.com/poorest-countries-in-the-world-2010-8?op=1#ixzz3cZMj0sV3. Accessed June 9, 2015.
6. International Agency for Research on Cancer and World Health Organization. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. Accessed January 7, 2014.
7. Sitas F, Parkin M, Chirenje Z, Stein L, Mqoqi N, Wabinga H. Cancers. In: Jamison D, Feachem R, Makgoba M, et al. eds. Disease and Mortality in Sub-Saharan Africa. 2nd ed, Washington, DC: World Bank; 2006.
8. Lingwood RJ, Boyle P, Milburn A, et al. The challenge of cancer control in Africa. Nat Rev Cancer. 2008;8(5):398–403.
9. Morhason-Bello IO, Odedina F, Rebbeck TR, et al. Challenges and opportunities in cancer control in Africa: a perspective from the African Organisation for Research and Training in Cancer. Lancet Oncol. 2013;14(4):e142–e151.
10. Vento S. Cancer control in Africa: which priorities? Lancet Oncol. 2013;14(4):277–279.
11. Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol. 2006;7(7):584–595.
12. Abdel-Wahab M, Bourque J-M, Pynda Y, et al. Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol. 2013;14(4):e168–e175.
13. African Palliative Care Association. Palliative care in Africa: delivery. http://www.africanpalliativecare.org/awareness/palliative-care-in-africa-delivery/. Accessed June 12, 2015.
14. Kinfu Y, Dal Poz MR, Mercer H, Evans DB. The health worker shortage in Africa: are enough physicians and nurses being trained? Bull World Health Organ. 2009;87(3):225–230.
15. LoBiondo-Wood G, Haber J. Integrating the process of research and evidence based practice. In: LoBiondo-Wood G, Harber J, eds. Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St Louis, MO: Mosby; 2010:5–26.
16. Mcilfatrick SJ, Keeney S. Identifying cancer nursing research priorities using the Delphi technique. J Adv Nurs. 2003;42(6):629–636.
17. Burns N, Grove S. The Practice of Nursing Research. Appraisal, Synthesis and Generation of Evidence. 6th ed. St Louis, MO: Saunders; 2009.
18. Kirkevold M. Integrative nursing research—an important strategy to further the development of nursing science and nursing practice. J Adv Nurs. 1997;25(5):977–984.
19. Maree J, Schmollgruber S. An integrative review of the South African cancer nursing research 2002–2012. Curationis. 2014;37(1):E1–E10.
20. Cesario S, Morin K, Santa-Donato A. Evaluating the level of evidence of qualitative research. J Obstet Gynecol Neonatal Nurs. 2002;31(6):708–714.
21. O’Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Health Serv Res Policy. 2008;13(2):92–98.
22. Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11:100.
23. Grove S, Bruns N, Gray J. The Practice of Nursing Research. Appraisal, Synthesis and Generation of Evidence. 7th ed. St Louis: Elsevier; 2013.
24. Marusteri M, Bacarea V. Comparing groups for statistical differences: how to choose the right statistical test? Biochem Med. 2010;20(1):15–32.
25. Department of Higher Education and Training. List of Approved South African Journals (January 2012). http://www.ais.up.ac.za/journals/accredited_journals.pdf. Accessed June 15, 2015.
26. Research Gate. BMC Research Notes (BMC Res Notes). https://www.researchgate.net/journal/1756-0500_BMC_Research_Notes. Accessed June 15, 2015.
28. Adejumo O, Lekalakala-Mokgele E. A 2-decade appraisal of African nursing scholarship: 1986–2006. J Nurs Scholarsh. 2009;41(1):64–69.
29. Omondi E. A call for the humane treatment of cancer patients in Africa. http://www.gacd.org/media/interact/focus-stories/africa/cancer-patients-africa. Accessed August 21, 2014.
30. Adewole I, Martin DN, Williams MJ, et al. Building capacity for sustainable research programmes for cancer in Africa. Nat Rev Clin Oncol. 2014;11(5):251–259.
31. Klopper H, Uys L. The State of Nursing and Nursing Education in Africa. A Country-by-Country Review 2013. Indianapolis, IN: Sigma Theta Tau International Honor Society of Nursing; 2013.
32. Nordling L. Africa analysis: quality in research. SciDevNet. http://www.scidev.net/global/policy/analysis-blog/africa-analysis-quality-in-research-1.html. Accessed August 23, 2015.
33. van Rooyen D, Ricks E, Morton D. Status of research-related activities of South Africa’s university nursing schools. Trends Nurs. 2012;1(1). FUNDISA. Pretoria.
34. Ofi B, Sowunmi L, Edet D, Anarado N. Professional nurses’ opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. Int J Nurs Pract. 2008;14(3):243–255.
35. Roxburgh M. An exploration of factors which constrain nurses from research participation. J Clin Nurs. 2006;15(5):535–545.
36. Sylla BS, Wild CP. A million Africans a year dying from cancer by 2030: what can cancer research and control offer to the continent? Int J Cancer. 2012;130(2):245–250.
37. Soyannwo O. Cancer pain—progress and ongoing issues in Africa. Pain Res Manag. 2009;14(5):349.
38. Cleary J, Powell RA, Munene G, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013;24(suppl 11):xi14–xi23.
39. Sofaer S. Qualitative methods: what are they and why use them? Health Serv Res. 1999;34(5 pt 2):1101.
40. Omolewa M. Adult literacy in Africa: the push and pull factors. Int Rev Educ. 2008;54(5–6):697–711.
Keywords:

Africa; Integrative review; Nursing research output

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved