Pediatric Oncology Nursing Research in Low- and Middle-Income Countries: Exemplars from Three Regions
Introduction
Over the past 50 years, pediatric oncology nursing research has generated evidence to support best practices in nursing care. Nurse researchers from high-income countries (HICs), such as the United Kingdom, United States, Australia, and Western European countries, have explored a wide range of nursing topics using both qualitative and quantitative methodologies. Results of their research have been disseminated in oncology-focused nursing journals such as the Journal of Pediatric Oncology Nursing (Association of Pediatric Hematology/Oncology Nurses), Cancer Nursing (International Society of Nurses in Cancer Care), and European Journal of Oncology Nursing (European Oncology Nursing Society), as well as other interdisciplinary journals. Nurses within the Children's Oncology Group in the United States, set a research blueprint in 2013, guided by a resilience-focused framework adapted from Haase's Resilience in Illness Model for patients, families, and cultures across the cancer continuum.1 The goal was that this framework would provide support for nurse-led research and evidence-based practice projects, particularly within the context of the care of children with cancer enrolled in clinical trials.
To evaluate the role of nurse-led research to provide direction for clinical practice, Gibson, et al2 published an analysis of all pediatric oncology nursing abstracts presented at the International Society of Paediatric Oncology (SIOP) conferences from 2003 to 2012. Although the numbers of abstracts addressing clinical practice issues and empirical family research were balanced, methodology was heavily weighted toward surveys. The authors also noted a dearth of abstracts from low- and middle-income countries (LMICs). A review of pediatric oncology nursing research in LMICs published in 2020, however, showed a significant upswing in publications from China and Brazil, both of which are upper-middle-income countries.3 Publications from Africa and Southeast Asia were sparse, indicating that support for nurse researchers in those areas is still sorely needed. Topics most frequently addressed by nurse researchers in LMICs included instrumentation translation and cultural adaption, parent coping, and nursing practices in supportive care, such as central venous catheter care, end-of-life care, pain management, and chemotherapy administration.
The purpose of this article is to highlight pediatric oncology nursing research challenges and to propose strategies for addressing those challenges in three LMICs in increasing income status by World Bank ranking.4, 5, 6 These countries include Ethiopia (low-income), Pakistan (lower-middle-income), and Argentina (upper-middle income) (Fig. 1). Table 1 summarizes the demographics and relevant health statistics for each country. By providing perspectives from each local pediatric oncology nurse, the reader can go beyond the tropes of lack of resources, time, or interest to learn the specific cultural and national context for conducting nursing research. It is our hope that a path will open for international collaboration and support for pediatric oncology nursing research in LMICs, particularly to advance beyond conference abstract presentations into publication in peer-reviewed journals. This is the only way that locally produced evidence for optimal pediatric oncology nursing care can be more widely disseminated and put into practice. Otherwise, the nurses in LMICs are doomed to continue to depend on imported evidence from HICs that may or may not be effective for children and adolescents whose cancer is biologically different from cancers in HICs, even with the same diagnosis, and whose responses to cancer treatment may likewise vary. It is now clear that cultural and regional distinctions in childhood cancer experiences are critical, including communication of diagnosis, hierarchies of family decision-making, financial out-of-pocket costs, and spiritual practices, to name only a few. Therefore, we must look to the expert nurses who care for these children, adolescents, and their families for the evidence of best practices in pediatric oncology nursing in their settings. Given global trends in migration today, nurses everywhere have much to learn from our colleagues in LMICs who can inform our pediatric oncology nursing practices as well.
Section snippets
Background
Ethiopia is a state on the Horn of Africa, lying entirely within tropical latitudes, and is the 10th largest and second-most populated country in Africa.7 There is a nursing shortage in Ethiopia (see Table 1), and pediatric oncology treatment has only recently become available in the capital and three other cities.
Becoming a professional nurse in Ethiopia requires a 4-year university training, and more than seven universities offer a bachelor degree program.10 Despite their strong academic
Pakistan
Pakistan, a lower-middle-income country in Asia (see Fig. 1), has the fifth-largest population in the world,6 a large percentage of which is younger than 15 years of age, and significant poverty across the country (see Table 1). Health care access is elusive, with limited health care centers for specialized care and a minimal number of health care providers. The increasing care burden with increase in the number of patients and reduction in the number of trained nurses makes safe and optimal
Argentina
Argentina is in the extreme south-southeast of South America (see Fig. 1). The distribution of childhood cancer in Argentina is similar to that of HICs in Europe and North America.38 Leukemias are the most common oncological disease in children, followed by central nervous system tumors and lymphomas.
In Argentina, treatment for pediatric cancers is centralized; however, 44% of the general population does not live near the capital. As a result, families of children with cancer often must migrate
Discussion
Three experienced pediatric oncology nurses from LMICs have described the current status of nursing research in their country and region. The results of three literature searches for pediatric oncology nurse investigations in a low-income (Ethiopia), lower-middle-income (Pakistan), and upper-middle-income country (Argentina) have demonstrated the paucity of literature published in English- and Spanish-language journals. These authors from LMICs also noted common challenges for pediatric
Conclusion
Nursing research in HICs has led to significantly improved patient outcomes and this includes pediatric oncology nursing. However, just as it took years for HIC nurses to achieve advanced education and specialization as well as institutional support and funding to conduct nursing research for evidence-based nursing practice, so too the road for nurses in LMICs to achieve the same is long. Fragile health care systems, a traditional focus on primary care, and infectious disease in settings with
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.