Nurses’ Knowledge About Cancer-Related Cognitive Impairment: A Cross-Sectional Study

Nurses’ Knowledge About Cancer-Related Cognitive Impairment: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nurses’ Knowledge About Cancer-Related Cognitive Impairment: A Cross-Sectional Study loai ABU SHAROUR, Mohammad Qutishat This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8323200/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Cancer-related cognitive impairment (CRCI) is a common complication of cancer and its treatment. Nurses play a role in early identification, assessment, and management of CRCI; however, limited knowledge may hinder optimal patient care. This study aimed to assess nurses’ knowledge of CRCI and examine its relationship with sociodemographic and professional characteristics. Methods A cross-sectional descriptive study was conducted among 140 nurses. Data were collected using a structured questionnaire assessing demographic and professional characteristics, prior CRCI education/training, and knowledge of CRCI across six domains: definition, symptoms, assessment methods, causes, risk factors, and management. Descriptive statistics, t-tests, ANOVA, and Pearson correlation were used to analyze the data. Results Overall, nurses demonstrated limited knowledge of CRCI (mean total score = 13.9 ± 5.1, 46% correct). Domain-specific scores were lowest for risk factors (42%) and causes (45%), and slightly higher for management (50%) and symptoms (48%). Significant predictors of higher knowledge included advanced academic degree (F = 4.11, p = 0.02), more years of experience (F = 3.02, p = 0.05), prior CRCI education (t = 6.15, p < 0.001), previous training (t = 5.88, p < 0.001), and direct experience caring for cancer patients (t = 3.41, p = 0.001). Conclusions Targeted educational interventions, including structured training and hands-on exposure to oncology patients, are needed to enhance nurses’ competence in recognizing and managing CRCI. Cancer-related cognitive impairment CRCI nurses’ knowledge oncology nursing education training Introduction Cancer remains a major global health threat, accounting for nearly 10 million deaths worldwide in 2020 [ 1 ]. While advancements in chemotherapy, radiotherapy, hormonal therapy, and targeted treatments have improved survival, these therapies often produce long-lasting side effects. Among the most troubling is cancer-related cognitive impairment (CRCI) commonly called chemo brain or chemo fog [ 2 ]. CRCI encompasses persistent difficulties in attention, memory, executive functioning, processing speed, and concentration [ 3 ]. These deficits compromise patients’ ability to manage daily tasks, maintain employment, and carry out social responsibilities, ultimately reducing their quality of life [ 4 ]. Globally, CRCI has been documented in patients with both central and non-central nervous system cancers, with reported prevalence ranging between 21% and 75%. Approximately 44–58% of survivors endorse noticeable cognitive decline [ 5 ]. Although early research focused heavily on breast cancer, CRCI is now recognized across diverse cancer populations. In Jordan, the burden of cancer continues to rise. According to the Jordan Cancer Registry (JCR), 7,594 new cancer cases were reported among Jordanians in 2019 across all age groups, including children an increase of more than 50% from 4,865 cases a decade earlier. This growing incidence underscores the importance of understanding survivorship issues such as CRCI within Jordan’s healthcare context [ 6 ]. Chemotherapy was initially believed to be the primary driver of CRCI. Studies reported cognitive decline in about 23% of breast cancer patients receiving common regimens such as Doxorubicin, Cyclophosphamide, or Taxane-based therapies. Chemotherapeutic agents may have direct neurotoxic effects or act indirectly by increasing inflammatory cytokines (e.g., IL-6, IL-8, IL-10), inducing DNA damage, and accelerating gray and white matter loss in critical cognitive regions like the frontal lobes and hippocampus [ 1 , 7 ]. However, CRCI is now understood as a multifactorial condition. Hormonal treatments particularly anti-estrogen therapies used in breast cancer can impair cognition since estrogen is vital for neuronal growth and synaptic function [ 8 ]. Targeted therapies and radiation therapies have also been associated with deficits in memory, learning, and executive function [ 9 ]. Radiation may contribute to CRCI by triggering immune dysregulation, chronic oxidative stress, and inflammation [ 10 ]. Importantly, cognitive difficulties may emerge before treatment, influenced by factors such as aging, comorbid medical conditions, psychological distress, and systemic inflammation [ 11 ]. Consequently, distinguishing whether CRCI results from cancer itself, treatment modalities, or preexisting vulnerabilities remains challenging. CRCI presentation varies widely among patients. Symptoms may appear immediately after treatment begins, months or years later, or not at all. They may be subtle or severe, temporary or persistent [ 12 ]. Complicating detection, CRCI often overlaps with other cancer-related issues such as fatigue, anxiety, depression, and sleep disturbances. Early recognition and timely communication between patients and healthcare providers are essential for symptom management and patient support [ 13 ]. Despite CRCI’s impact, few studies have investigated healthcare professionals’—especially nurses’—knowledge, perceptions, and clinical practices regarding CRCI [ 14 ]. Nurses are central to patient education, symptom assessment, and emotional support; therefore, their understanding of CRCI is critical for early detection, patient counseling, and appropriate referral to specialized services. Clinical psychologists also play an important role in addressing psychological distress that may coexist with or be exacerbated by CRCI. Overall, CRCI represents a significant, multifaceted survivorship challenge with major implications for daily functioning and well-being. Given the rising cancer burden in Jordan and globally, understanding nurses’ knowledge and perceptions is essential for improving patient care, early recognition, and supportive interventions for those affected by CRCI. Therefore, this study was conducted to expand our exited literature and assess the oncology nurses’ knowledge regarding CRCI and identify the relationship between nurses’ knowledge and sociodemographic variables. Materials and Methods A non-experimental, observational study design was used to evaluate nurses’ knowledge of cancer-related cognitive impairment (CRCI), including their understanding of its definition, symptoms, assessment methods, causes, risk factors, and management strategies. Participants were recruited from various oncology units, medical, surgical, hematology, and pediatric using a non-probability convenience sampling approach. Sample size determination was based on a power analysis, which indicated that 120 participants were adequate to detect a moderate effect size (0.5) at a significance level of 0.05 with 80% power (Faul et al., 2007). Ethical approval was obtained from the institutional review board (MOH\2025\HNR-19), and written informed consent was obtained from all participants. Eligibility criteria required nurses to have at least six months of experience in an oncology setting and direct involvement in the care of cancer patients. Study announcements were posted in clinical areas to describe the study purpose and invite participation. A trained research assistant with a Bachelor of Science in Nursing and experience in research data collection distributed the questionnaires and collected them once completed. A total of 140 nurses completed the survey, while 20 declined participations without specifying their role, resulting in an 87.5% response rate. All participants received a detailed explanation of the study procedures prior to providing consent. Instruments and Procedures Demographic and professional data were collected, including age, gender, position, academic rank, years of experience, prior education on CRCI, previous training, interest in further education, and experience working with cancer patients. Knowledge Assessment: Nurses’ Knowledge of CRCI (30 items) Nurses’ knowledge of cancer-related cognitive impairment was measured using a 30-item structured test developed by the researcher. The items were constructed after a thorough review of empirical studies, clinical guidelines, and CRCI assessment recommendations [ 15 ]. The test assessed multiple domains, including definition, symptoms, assessment methods, causes, risk factors, and management strategies. Each item offered two response options (True/False), with one correct answer. Correct responses were scored as 1, and incorrect answers or “don’t know” responses were scored as 0. Total scores could range from 0 to 30. The instrument underwent expert review by five specialists in oncology nursing, neurocognitive assessment, and nursing education. Face and content validity were established, with all items meeting acceptable CVI thresholds (I-CVI ≥ 0.78; S-CVI/Ave > 0.90). Internal consistency reliability will be assessed using the Kuder–Richardson Formula (KR-20), and test–retest reliability will be evaluated with a two-week interval in a subsample of participants. The knowledge test has six domains including domain 1 Definition (4 items), domain 2: symptoms (5 items), domain 3: assessment methods (6 items), domain 4: Causes (4 items), domain 5: risk factors (5 items), and domain 6: management (6 items). The total possible score is 30 and distributed as; 0–9: poor knowledge, 10–19: moderate knowledge, and 20–30: good knowledge. Statistical Analysis Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Descriptive statistics—including means, standard deviations, frequencies, and percentages were used to summarize the study variables. To compare differences in the variables across educational qualifications and job titles, a one-way analysis of variance (ANOVA) was performed. Furthermore, Pearson’s correlation coefficient was applied to explore the relationships among the key study variables. Results Sample characteristics The sample consisted of 140 participants with an average age of 34.7 years (SD = 7.9). Most were females, staff nurses (62.9%), and held a bachelor’s degree (67.1%). The majority had between 5 and 10 years of experience (44.3%). Notably, most participants had no prior education or training on CRCI (77.1%), although interest in further education was high. Detailed frequencies and percentages for all variables are presented in Table 1 . Table 1 Demographic and Professional Characteristics of Participants (N = 140) Variable Category / Values n (%) / Mean ± SD Age (years) — 34.7 ± 7.9 Gender Male 52 (37.1) Female 88 (62.9) Position Staff nurse 104 (74.3) Charge nurse 22 (15.7) Clinical instructor 14 (10.0) Academic Rank / Degree Bachelor’s 94 (67.1) Master’s 38 (27.1) PhD 8 (5.7) Years of Experience 10 years 38 (27.1) Prior Education on CRCI Yes 32 (22.9) No 108 (77.1) Previous Training on CRCI Yes 28 (20.0) No 112 (80.0) Interest in Further Education Yes 118 (84.3) No 22 (15.7) Experience Working with Cancer Patients Yes 56 (40.0) No 84 (60.0) Nurses’ Knowledge of CRCI by Domain Overall, nurses demonstrated limited knowledge of CRCI (mean = 13.9 ± 5.1, 46% correct). Knowledge gaps were evident across most domains, particularly in risk factors (42%), causes (45%), and definition (48%), whereas slightly higher scores were seen in management (50%). Detailed domain-specific results are presented in Table 2 . These findings highlight the need for targeted educational interventions to improve nurses’ understanding of CRCI, especially regarding its causes, risk factors, and clinical definition. Table 2 Nurses’ Knowledge of CRCI by Domain (N = 140) Domain Items Possible Score Mean ± SD % Correct (Mean / Max) Definition 4 0–4 1.9 ± 1.0 48% Symptoms 5 0–5 2.4 ± 1.2 48% Assessment Methods 6 0–6 2.9 ± 1.5 48% Causes 4 0–4 1.8 ± 1.1 45% Risk Factors 5 0–5 2.1 ± 1.2 42% Management 6 0–6 3.0 ± 1.3 50% Total Knowledge 30 0–30 13.9 ± 5.1 46% Relationship Between Sociodemographic Variables and CRCI Knowledge Scores Significant associations with nurses’ knowledge of CRCI were observed for academic rank, years of experience, prior education, previous training, and experience working with cancer patients. The results showed that nurses with higher academic degrees had higher knowledge scores (Bachelor’s: 13.2 ± 5.2; Master’s: 15.1 ± 4.6; PhD: 16.0 ± 3.8; F = 4.11, p = 0.02). Years of experience were positively associated with knowledge (F = 3.02, p = 0.05), with scores increasing from 12.9 ± 5.0 ( 10 years). Nurses with prior education on CRCI scored higher than those without (17.2 ± 3.8 vs 12.7 ± 4.9; t = 6.15, p < 0.001). Previous training on CRCI was associated with higher scores (17.0 ± 4.0 vs 13.0 ± 5.0; t = 5.88, p < 0.001). Finally, nurses with experience caring for cancer patients had higher knowledge (15.0 ± 4.8) than those without (12.9 ± 5.0; t = 3.41, p = 0.001). All other variables (age, gender, position, interest in further education) were not significantly associated with knowledge. Detailed results for all variables are presented in Table 3 . Table 3 Relationship Between Sociodemographic Variables and CRCI Knowledge Scores (N = 140) Variable Category Mean Knowledge ± SD Test Statistic p-value Age (years) — — r = 0.12 0.16 Gender Male 14.5 ± 5.0 t = 1.85 0.07 Female 13.6 ± 5.2 Position Staff nurse 13.5 ± 5.1 F = 2.43 0.09 Charge nurse 14.8 ± 4.7 Clinical instructor 15.2 ± 5.0 Academic Rank / Degree Bachelor’s 13.2 ± 5.2 F = 4.11 0.02* Master’s 15.1 ± 4.6 PhD 16.0 ± 3.8 Years of Experience 10 years 15.0 ± 5.0 Prior Education on CRCI Yes 17.2 ± 3.8 t = 6.15 < 0.001* No 12.7 ± 4.9 Previous Training on CRCI Yes 17.0 ± 4.0 t = 5.88 < 0.001* No 13.0 ± 5.0 Interest in Further Education Yes 14.1 ± 4.9 t = 1.12 0.26 No 13.3 ± 5.5 Experience with Cancer Patients Yes 15.0 ± 4.8 t = 3.41 0.001* No 12.9 ± 5.0 Discussions The current study was conducted to assess the oncology nurses’ knowledge of cancer-related cognitive impairment (CRCI) and examined its relationship with sociodemographic and professional characteristics. Overall, limited knowledge of CRCI was determined among the nurses. This indicates that the nurses are not fully aware and equipped to diagnose, assess, and manage the patients with CRCI, which may affect the quality of care provided negatively. The results indicated that the nurses scored lowest in risk factors and causes domains, while slightly higher scores were observed in management and symptoms domains. These results indicate that while nurses may be somewhat aware of symptom recognition and management strategies, they lack understanding of underlying causes and predisposing factors. Such gaps are concerning because knowledge of risk factors and etiology is crucial for early identification and preventive interventions. These findings are consistent with previous research indicating that nurses generally have limited knowledge of CRCI, particularly regarding pathophysiology and risk factors [ 16 ]. Studies have shown that nurses often focus on symptom management but may underestimate the multifactorial causes of CRCI, including chemotherapy, radiation, psychological stress, and comorbidities[ 17 ]. These findings could be related to limited previous training of and limited prior education about CRCI, in the current study many of the participants did not receive previous training or education about CRCI. In line with prior studies, academic rank, years of experience, prior education/training, and direct clinical exposure to cancer patients were significantly associated with higher knowledge scores. Nurses with higher academic degrees demonstrated superior understanding of CRCI, which aligns with evidence that advanced education enhances nurses’ clinical reasoning and familiarity with complex conditions [ 18 ]. Similarly, nurses with more years of experience and those with prior education or training scored significantly higher, supporting the role of both formal education and continuing professional development in improving knowledge [ 19 , 20 ]. Clinical exposure to patients with cancer also significantly influenced knowledge. Nurses with experience caring for oncology patients scored higher than those without, which is consistent with literature highlighting the importance of hands-on experience in recognizing and managing cancer-related complications [ 21 , 22 ]. Direct interaction with patients allows nurses to apply theoretical knowledge in practice, reinforcing learning and increasing awareness of condition-specific issues such as CRCI. Interestingly, other factors such as age, gender, position, and interest in further education were not significantly associated with knowledge. This suggests that formal qualifications, training, and practical experience are stronger determinants of CRCI knowledge than demographic characteristics or expressed interest, emphasizing the need for structured educational programs. The findings underscore a critical need for targeted educational interventions to address knowledge gaps in CRCI. Structured training programs focusing on etiology, risk factors, assessment tools, and evidence-based management strategies could enhance nurses’ competence in this area. Improving nurses’ knowledge may lead to earlier detection of CRCI, better patient education, and more effective interventions to support cognitive function during and after cancer treatment. This study has several strengths, including the provision of a comprehensive, domain-specific assessment of nurses’ knowledge of CRCI, which allowed identification of specific areas of deficiency. The relatively large sample size enhances the reliability of the findings and enabled analysis of associations with multiple sociodemographic and professional variables. Moreover, the identification of significant predictors, such as academic education, years of experience, prior training, and clinical exposure, offers actionable insights for the design of targeted educational interventions. However, several limitations should be considered. The study relied on self-administered knowledge tests, which may not fully reflect actual clinical competence, and participants were recruited from a single geographic region or institution, potentially limiting generalizability. Cross-sectional design prevents causal inference between predictors and knowledge, highlighting the need for longitudinal studies to evaluate the impact of education and training over time. In addition, the use of self-reported prior education and training may have introduced recall bias. Conclusion The findings of this study indicate that nurses’ knowledge of cancer-related cognitive impairment (CRCI) is generally limited, particularly regarding risk factors, causes, and clinical definitions, while slightly better understanding was observed in symptom recognition and management. Higher knowledge levels were significantly associated with advanced academic education, more years of experience, prior CRCI education or training, and direct clinical exposure to cancer patients. These results highlight the urgent need for targeted educational interventions and structured training programs to enhance nurses’ competence in identifying, assessing, and managing CRCI. Improving nurses’ knowledge in this area is essential to ensure early recognition, effective patient education, and the delivery of high-quality care for individuals affected by CRCI. Declarations Conflict of Interest “No potential conflict of interest relevant to this article was reported”. Funding No Fund is attached to this project. Author Contribution The authors LS and MQ contributed to the study’s conception, design, data collection, analysis, and interpretation. All authors reviewed and approved the final manuscript Acknowledgement The authors would like to thank the study participants for their time and contribution. References Alregaibah, R., Y. Almogbel, and A. Alhowail, Associations of healthcare providers' awareness, perception, and knowledge of chemotherapy-induced cognitive impairment and their intentions to provide information about it to patients . European Review for Medical & Pharmacological Sciences, 2021. 25(21). DOI: 10.26355/eurrev_202111_27113 Zeng, Y., et al., The use of immersive virtual reality for cancer-related cognitive impairment assessment and rehabilitation: a clinical feasibility study . Asia-Pacific Journal of Oncology Nursing, 2022. 9(12): p. 100079. 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DOI: 10.1188/08.CJON.725-729 Watheeq, H.H. and I.A. AI-Ashour, Nurse's knowledge toward oncology patients during chemotherapy management . International journal of health sciences, 2022. 6(S8): p. 1063–1076. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8323200","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":557996656,"identity":"ab2e66c7-7bdb-445a-b25c-66ecb415509d","order_by":0,"name":"loai ABU SHAROUR","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACPgh1gMEATFcwQBl4ABuqljMka2FsI0aLRPIzCYY/d+TNpQ8fk66cd1jenL35AMOPim14tKSZSTC2PTPc2ZeWJnl222HDnT3HEhh7ztzGoyUBqKXhMOOGMzxmko3bgIwbOQbMjG34tKR/AzrssD1Eyxwgg7CWHDMJBrbDiRAtDUAGQS08b4otGNsOJ284w5Zs2XAsHcg4lnAQn1/42dM33gA6zHbDGeaDNxtqrG03HG8++OBHBW4tQMAi/QfBaQaTB/CpBwLmD0icOgKKR8EoGAWjYCQCAATdWWVp+u5PAAAAAElFTkSuQmCC","orcid":"","institution":"Al Ain University","correspondingAuthor":true,"prefix":"","firstName":"loai","middleName":"ABU","lastName":"SHAROUR","suffix":""},{"id":557996657,"identity":"a23d8ba8-40d9-4ffa-a7d8-315ac14738e6","order_by":1,"name":"Mohammad Qutishat","email":"","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Qutishat","suffix":""}],"badges":[],"createdAt":"2025-12-10 05:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8323200/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8323200/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98425615,"identity":"2043cb21-e498-4899-8c82-96e2796c8611","added_by":"auto","created_at":"2025-12-17 16:34:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40007,"visible":true,"origin":"","legend":"","description":"","filename":"MainTextBlind.docx","url":"https://assets-eu.researchsquare.com/files/rs-8323200/v1/6c916eff305fbfa87ddc5844.docx"},{"id":98015392,"identity":"5c519b0e-ecc5-41da-9782-d4f5ea6b5675","added_by":"auto","created_at":"2025-12-11 20:38:02","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4290,"visible":true,"origin":"","legend":"","description":"","filename":"132871592dff4060885da30b1a5d5989.json","url":"https://assets-eu.researchsquare.com/files/rs-8323200/v1/c8883c7cef3a834022f10835.json"},{"id":98015394,"identity":"1de72263-59e9-40d4-bd14-b99524e33929","added_by":"auto","created_at":"2025-12-11 20:38:02","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75231,"visible":true,"origin":"","legend":"","description":"","filename":"132871592dff4060885da30b1a5d59891enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8323200/v1/6b544a81d3d0732ea34550fe.xml"},{"id":98015397,"identity":"8c6863e4-392f-4793-ae42-7e8d6c1ce03d","added_by":"auto","created_at":"2025-12-11 20:38:03","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73247,"visible":true,"origin":"","legend":"","description":"","filename":"132871592dff4060885da30b1a5d59891structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8323200/v1/99d44a96c80b283cd6516793.xml"},{"id":98424773,"identity":"16c5ed51-9fa5-4a54-a59b-6115a208733f","added_by":"auto","created_at":"2025-12-17 16:33:49","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79887,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8323200/v1/c07e714e050debd542d31b0b.html"},{"id":99253001,"identity":"d1f72d34-a841-422f-844e-3b3a05b13799","added_by":"auto","created_at":"2025-12-30 19:53:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":814383,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8323200/v1/3a337e0f-f784-4f4d-83ac-67acf1f90c05.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nurses’ Knowledge About Cancer-Related Cognitive Impairment: A Cross-Sectional Study ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer remains a major global health threat, accounting for nearly 10\u0026nbsp;million deaths worldwide in 2020 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While advancements in chemotherapy, radiotherapy, hormonal therapy, and targeted treatments have improved survival, these therapies often produce long-lasting side effects. Among the most troubling is cancer-related cognitive impairment (CRCI) commonly called chemo brain or chemo fog [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. CRCI encompasses persistent difficulties in attention, memory, executive functioning, processing speed, and concentration [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These deficits compromise patients\u0026rsquo; ability to manage daily tasks, maintain employment, and carry out social responsibilities, ultimately reducing their quality of life [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Globally, CRCI has been documented in patients with both central and non-central nervous system cancers, with reported prevalence ranging between 21% and 75%. Approximately 44\u0026ndash;58% of survivors endorse noticeable cognitive decline [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although early research focused heavily on breast cancer, CRCI is now recognized across diverse cancer populations. In Jordan, the burden of cancer continues to rise. According to the Jordan Cancer Registry (JCR), 7,594 new cancer cases were reported among Jordanians in 2019 across all age groups, including children an increase of more than 50% from 4,865 cases a decade earlier. This growing incidence underscores the importance of understanding survivorship issues such as CRCI within Jordan\u0026rsquo;s healthcare context [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eChemotherapy was initially believed to be the primary driver of CRCI. Studies reported cognitive decline in about 23% of breast cancer patients receiving common regimens such as Doxorubicin, Cyclophosphamide, or Taxane-based therapies. Chemotherapeutic agents may have direct neurotoxic effects or act indirectly by increasing inflammatory cytokines (e.g., IL-6, IL-8, IL-10), inducing DNA damage, and accelerating gray and white matter loss in critical cognitive regions like the frontal lobes and hippocampus [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, CRCI is now understood as a multifactorial condition. Hormonal treatments particularly anti-estrogen therapies used in breast cancer can impair cognition since estrogen is vital for neuronal growth and synaptic function [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Targeted therapies and radiation therapies have also been associated with deficits in memory, learning, and executive function [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Radiation may contribute to CRCI by triggering immune dysregulation, chronic oxidative stress, and inflammation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Importantly, cognitive difficulties may emerge before treatment, influenced by factors such as aging, comorbid medical conditions, psychological distress, and systemic inflammation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Consequently, distinguishing whether CRCI results from cancer itself, treatment modalities, or preexisting vulnerabilities remains challenging. CRCI presentation varies widely among patients. Symptoms may appear immediately after treatment begins, months or years later, or not at all. They may be subtle or severe, temporary or persistent [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Complicating detection, CRCI often overlaps with other cancer-related issues such as fatigue, anxiety, depression, and sleep disturbances. Early recognition and timely communication between patients and healthcare providers are essential for symptom management and patient support [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite CRCI\u0026rsquo;s impact, few studies have investigated healthcare professionals\u0026rsquo;\u0026mdash;especially nurses\u0026rsquo;\u0026mdash;knowledge, perceptions, and clinical practices regarding CRCI [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nurses are central to patient education, symptom assessment, and emotional support; therefore, their understanding of CRCI is critical for early detection, patient counseling, and appropriate referral to specialized services. Clinical psychologists also play an important role in addressing psychological distress that may coexist with or be exacerbated by CRCI. Overall, CRCI represents a significant, multifaceted survivorship challenge with major implications for daily functioning and well-being. Given the rising cancer burden in Jordan and globally, understanding nurses\u0026rsquo; knowledge and perceptions is essential for improving patient care, early recognition, and supportive interventions for those affected by CRCI. Therefore, this study was conducted to expand our exited literature and assess the oncology nurses\u0026rsquo; knowledge regarding CRCI and identify the relationship between nurses\u0026rsquo; knowledge and sociodemographic variables.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA non-experimental, observational study design was used to evaluate nurses\u0026rsquo; knowledge of cancer-related cognitive impairment (CRCI), including their understanding of its definition, symptoms, assessment methods, causes, risk factors, and management strategies. Participants were recruited from various oncology units, medical, surgical, hematology, and pediatric using a non-probability convenience sampling approach. Sample size determination was based on a power analysis, which indicated that 120 participants were adequate to detect a moderate effect size (0.5) at a significance level of 0.05 with 80% power (Faul et al., 2007). Ethical approval was obtained from the institutional review board (MOH\\2025\\HNR-19), and written informed consent was obtained from all participants.\u003c/p\u003e\u003cp\u003eEligibility criteria required nurses to have at least six months of experience in an oncology setting and direct involvement in the care of cancer patients. Study announcements were posted in clinical areas to describe the study purpose and invite participation. A trained research assistant with a Bachelor of Science in Nursing and experience in research data collection distributed the questionnaires and collected them once completed. A total of 140 nurses completed the survey, while 20 declined participations without specifying their role, resulting in an 87.5% response rate. All participants received a detailed explanation of the study procedures prior to providing consent.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eInstruments and Procedures\u003c/h2\u003e\u003cp\u003eDemographic and professional data were collected, including age, gender, position, academic rank, years of experience, prior education on CRCI, previous training, interest in further education, and experience working with cancer patients.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eKnowledge Assessment: Nurses’ Knowledge of CRCI (30 items)\u003c/h3\u003e\n\u003cp\u003eNurses\u0026rsquo; knowledge of cancer-related cognitive impairment was measured using a 30-item structured test developed by the researcher. The items were constructed after a thorough review of empirical studies, clinical guidelines, and CRCI assessment recommendations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The test assessed multiple domains, including definition, symptoms, assessment methods, causes, risk factors, and management strategies. Each item offered two response options (True/False), with one correct answer. Correct responses were scored as 1, and incorrect answers or \u0026ldquo;don\u0026rsquo;t know\u0026rdquo; responses were scored as 0. Total scores could range from 0 to 30. The instrument underwent expert review by five specialists in oncology nursing, neurocognitive assessment, and nursing education. Face and content validity were established, with all items meeting acceptable CVI thresholds (I-CVI\u0026thinsp;\u0026ge;\u0026thinsp;0.78; S-CVI/Ave\u0026thinsp;\u0026gt;\u0026thinsp;0.90). Internal consistency reliability will be assessed using the Kuder\u0026ndash;Richardson Formula (KR-20), and test\u0026ndash;retest reliability will be evaluated with a two-week interval in a subsample of participants. The knowledge test has six domains including domain 1 Definition (4 items), domain 2: symptoms (5 items), domain 3: assessment methods (6 items), domain 4: Causes (4 items), domain 5: risk factors (5 items), and domain 6: management (6 items). The total possible score is 30 and distributed as; 0\u0026ndash;9: poor knowledge, 10\u0026ndash;19: moderate knowledge, and 20\u0026ndash;30: good knowledge.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Descriptive statistics\u0026mdash;including means, standard deviations, frequencies, and percentages were used to summarize the study variables. To compare differences in the variables across educational qualifications and job titles, a one-way analysis of variance (ANOVA) was performed. Furthermore, Pearson\u0026rsquo;s correlation coefficient was applied to explore the relationships among the key study variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eSample characteristics\u003c/h2\u003e\u003cp\u003eThe sample consisted of 140 participants with an average age of 34.7 years (SD\u0026thinsp;=\u0026thinsp;7.9). Most were females, staff nurses (62.9%), and held a bachelor\u0026rsquo;s degree (67.1%). The majority had between 5 and 10 years of experience (44.3%). Notably, most participants had no prior education or training on CRCI (77.1%), although interest in further education was high. Detailed frequencies and percentages for all variables are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and Professional Characteristics of Participants (N\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory / Values\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%) / Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e34.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (37.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88 (62.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePosition\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaff nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104 (74.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCharge nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (15.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical instructor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcademic Rank / Degree\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (67.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (27.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (5.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of Experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (28.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (44.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (27.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrior Education on CRCI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (22.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (77.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrevious Training on CRCI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (80.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInterest in Further Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118 (84.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (15.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperience Working with Cancer Patients\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (40.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (60.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eNurses\u0026rsquo; Knowledge of CRCI by Domain\u003c/h2\u003e\u003cp\u003eOverall, nurses demonstrated limited knowledge of CRCI (mean\u0026thinsp;=\u0026thinsp;13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1, 46% correct). Knowledge gaps were evident across most domains, particularly in risk factors (42%), causes (45%), and definition (48%), whereas slightly higher scores were seen in management (50%). Detailed domain-specific results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. These findings highlight the need for targeted educational interventions to improve nurses\u0026rsquo; understanding of CRCI, especially regarding its causes, risk factors, and clinical definition.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNurses\u0026rsquo; Knowledge of CRCI by Domain (N\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDomain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePossible Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e% Correct (Mean / Max)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDefinition\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSymptoms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAssessment Methods\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCauses\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRisk Factors\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManagement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Knowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRelationship Between Sociodemographic Variables and CRCI Knowledge Scores\u003c/h3\u003e\n\u003cp\u003eSignificant associations with nurses\u0026rsquo; knowledge of CRCI were observed for academic rank, years of experience, prior education, previous training, and experience working with cancer patients. The results showed that nurses with higher academic degrees had higher knowledge scores (Bachelor\u0026rsquo;s: 13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2; Master\u0026rsquo;s: 15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6; PhD: 16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8; F\u0026thinsp;=\u0026thinsp;4.11, p\u0026thinsp;=\u0026thinsp;0.02). Years of experience were positively associated with knowledge (F\u0026thinsp;=\u0026thinsp;3.02, p\u0026thinsp;=\u0026thinsp;0.05), with scores increasing from 12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 (\u0026lt;\u0026thinsp;5 years) to 15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 (\u0026gt;\u0026thinsp;10 years). Nurses with prior education on CRCI scored higher than those without (17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 vs 12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9; t\u0026thinsp;=\u0026thinsp;6.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Previous training on CRCI was associated with higher scores (17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 vs 13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0; t\u0026thinsp;=\u0026thinsp;5.88, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Finally, nurses with experience caring for cancer patients had higher knowledge (15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8) than those without (12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0; t\u0026thinsp;=\u0026thinsp;3.41, p\u0026thinsp;=\u0026thinsp;0.001). All other variables (age, gender, position, interest in further education) were not significantly associated with knowledge. Detailed results for all variables are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationship Between Sociodemographic Variables and CRCI Knowledge Scores (N\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean Knowledge\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003er\u0026thinsp;=\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePosition\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaff nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCharge nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical instructor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcademic Rank / Degree\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.02*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of Experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.05*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrior Education on CRCI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;6.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrevious Training on CRCI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;5.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInterest in Further Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperience with Cancer Patients\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eThe current study was conducted to assess the oncology nurses\u0026rsquo; knowledge of cancer-related cognitive impairment (CRCI) and examined its relationship with sociodemographic and professional characteristics. Overall, limited knowledge of CRCI was determined among the nurses. This indicates that the nurses are not fully aware and equipped to diagnose, assess, and manage the patients with CRCI, which may affect the quality of care provided negatively. The results indicated that the nurses scored lowest in risk factors and causes domains, while slightly higher scores were observed in management and symptoms domains. These results indicate that while nurses may be somewhat aware of symptom recognition and management strategies, they lack understanding of underlying causes and predisposing factors. Such gaps are concerning because knowledge of risk factors and etiology is crucial for early identification and preventive interventions. These findings are consistent with previous research indicating that nurses generally have limited knowledge of CRCI, particularly regarding pathophysiology and risk factors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies have shown that nurses often focus on symptom management but may underestimate the multifactorial causes of CRCI, including chemotherapy, radiation, psychological stress, and comorbidities[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These findings could be related to limited previous training of and limited prior education about CRCI, in the current study many of the participants did not receive previous training or education about CRCI.\u003c/p\u003e\u003cp\u003eIn line with prior studies, academic rank, years of experience, prior education/training, and direct clinical exposure to cancer patients were significantly associated with higher knowledge scores. Nurses with higher academic degrees demonstrated superior understanding of CRCI, which aligns with evidence that advanced education enhances nurses\u0026rsquo; clinical reasoning and familiarity with complex conditions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Similarly, nurses with more years of experience and those with prior education or training scored significantly higher, supporting the role of both formal education and continuing professional development in improving knowledge [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Clinical exposure to patients with cancer also significantly influenced knowledge. Nurses with experience caring for oncology patients scored higher than those without, which is consistent with literature highlighting the importance of hands-on experience in recognizing and managing cancer-related complications [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Direct interaction with patients allows nurses to apply theoretical knowledge in practice, reinforcing learning and increasing awareness of condition-specific issues such as CRCI.\u003c/p\u003e\u003cp\u003eInterestingly, other factors such as age, gender, position, and interest in further education were not significantly associated with knowledge. This suggests that formal qualifications, training, and practical experience are stronger determinants of CRCI knowledge than demographic characteristics or expressed interest, emphasizing the need for structured educational programs. The findings underscore a critical need for targeted educational interventions to address knowledge gaps in CRCI. Structured training programs focusing on etiology, risk factors, assessment tools, and evidence-based management strategies could enhance nurses\u0026rsquo; competence in this area. Improving nurses\u0026rsquo; knowledge may lead to earlier detection of CRCI, better patient education, and more effective interventions to support cognitive function during and after cancer treatment.\u003c/p\u003e\u003cp\u003eThis study has several strengths, including the provision of a comprehensive, domain-specific assessment of nurses\u0026rsquo; knowledge of CRCI, which allowed identification of specific areas of deficiency. The relatively large sample size enhances the reliability of the findings and enabled analysis of associations with multiple sociodemographic and professional variables. Moreover, the identification of significant predictors, such as academic education, years of experience, prior training, and clinical exposure, offers actionable insights for the design of targeted educational interventions. However, several limitations should be considered. The study relied on self-administered knowledge tests, which may not fully reflect actual clinical competence, and participants were recruited from a single geographic region or institution, potentially limiting generalizability. Cross-sectional design prevents causal inference between predictors and knowledge, highlighting the need for longitudinal studies to evaluate the impact of education and training over time. In addition, the use of self-reported prior education and training may have introduced recall bias.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicate that nurses\u0026rsquo; knowledge of cancer-related cognitive impairment (CRCI) is generally limited, particularly regarding risk factors, causes, and clinical definitions, while slightly better understanding was observed in symptom recognition and management. Higher knowledge levels were significantly associated with advanced academic education, more years of experience, prior CRCI education or training, and direct clinical exposure to cancer patients. These results highlight the urgent need for targeted educational interventions and structured training programs to enhance nurses\u0026rsquo; competence in identifying, assessing, and managing CRCI. Improving nurses\u0026rsquo; knowledge in this area is essential to ensure early recognition, effective patient education, and the delivery of high-quality care for individuals affected by CRCI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of Interest\u003c/h2\u003e\u003cp\u003e\u0026ldquo;No potential conflict of interest relevant to this article was reported\u0026rdquo;.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo Fund is attached to this project.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe authors LS and MQ contributed to the study\u0026rsquo;s conception, design, data collection, analysis, and interpretation. All authors reviewed and approved the final manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the study participants for their time and contribution.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlregaibah, R., Y. Almogbel, and A. Alhowail, \u003cem\u003eAssociations of healthcare providers' awareness, perception, and knowledge of chemotherapy-induced cognitive impairment and their intentions to provide information about it to patients\u003c/em\u003e. European Review for Medical \u0026amp; Pharmacological Sciences, 2021. 25(21). 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DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1188/08.CJON.725-729\u003c/span\u003e\u003cspan address=\"10.1188/08.CJON.725-729\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWatheeq, H.H. and I.A. AI-Ashour, \u003cem\u003eNurse's knowledge toward oncology patients during chemotherapy management\u003c/em\u003e. International journal of health sciences, 2022. 6(S8): p. 1063\u0026ndash;1076.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cancer-related cognitive impairment, CRCI, nurses’ knowledge, oncology nursing, education, training","lastPublishedDoi":"10.21203/rs.3.rs-8323200/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8323200/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eCancer-related cognitive impairment (CRCI) is a common complication of cancer and its treatment. Nurses play a role in early identification, assessment, and management of CRCI; however, limited knowledge may hinder optimal patient care. This study aimed to assess nurses\u0026rsquo; knowledge of CRCI and examine its relationship with sociodemographic and professional characteristics.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional descriptive study was conducted among 140 nurses. Data were collected using a structured questionnaire assessing demographic and professional characteristics, prior CRCI education/training, and knowledge of CRCI across six domains: definition, symptoms, assessment methods, causes, risk factors, and management. Descriptive statistics, t-tests, ANOVA, and Pearson correlation were used to analyze the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOverall, nurses demonstrated limited knowledge of CRCI (mean total score\u0026thinsp;=\u0026thinsp;13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1, 46% correct). Domain-specific scores were lowest for risk factors (42%) and causes (45%), and slightly higher for management (50%) and symptoms (48%). Significant predictors of higher knowledge included advanced academic degree (F\u0026thinsp;=\u0026thinsp;4.11, p\u0026thinsp;=\u0026thinsp;0.02), more years of experience (F\u0026thinsp;=\u0026thinsp;3.02, p\u0026thinsp;=\u0026thinsp;0.05), prior CRCI education (t\u0026thinsp;=\u0026thinsp;6.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), previous training (t\u0026thinsp;=\u0026thinsp;5.88, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and direct experience caring for cancer patients (t\u0026thinsp;=\u0026thinsp;3.41, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eTargeted educational interventions, including structured training and hands-on exposure to oncology patients, are needed to enhance nurses\u0026rsquo; competence in recognizing and managing CRCI.\u003c/p\u003e","manuscriptTitle":"Nurses’ Knowledge About Cancer-Related Cognitive Impairment: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 20:37:58","doi":"10.21203/rs.3.rs-8323200/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f01287aa-7507-42e0-8872-10bb2738145c","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T19:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 20:37:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8323200","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8323200","identity":"rs-8323200","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}