Pharmacovigilance Interventions on Awareness, Attitude and Practices of Nurses Regarding Chemotherapy Administration

Cancer remains one of the leading causes of morbidity and mortality worldwide and continues to pose a major public health challenge due to its increasing burden. Chemotherapy is a cornerstone of cancer management and has significantly improved survival rates and quality of life; however, its cytotoxic nature and narrow therapeutic index make patients highly vulnerable to adverse drug reactions (ADRs). According to the World Health Organization, ADRs are harmful and unintended responses occurring at normal drug doses and contribute substantially to hospital admissions, morbidity, and mortality, yet remain underreported (Fatima et al., 2021). The recognition of ADRs led to the development of pharmacovigilance, defined as the science of detecting, assessing, understanding, and preventing adverse drug effects, which is particularly crucial in high-risk settings such as oncology (WHO).

Pharmacovigilance is especially important in chemotherapy administration, where nurses play a pivotal role in drug preparation, administration, monitoring, and early detection of ADRs. Nurses’ knowledge, attitudes, and practices directly influence patient safety, reporting of ADRs, and overall treatment outcomes. Despite this critical role, studies from developing countries highlight gaps in nurses’ training, awareness, and reporting practices related to chemotherapy safety (Wahb et al., 2020; Mousa et al., 2021). Educational interventions have been shown to significantly improve nurses’ knowledge and attitudes, emphasizing the need for continuous and structured training in pharmacovigilance and safe chemotherapy practices (Matta & Karam, 2022).

The burden of cancer is particularly high in low- and middle-income countries, including Pakistan, where late-stage diagnoses and limited resources further complicate treatment outcomes (Mattiussi & Lippi, 2020; Tufail & Wu, 2023). Oncology nurses in Pakistan are frequently exposed to chemotherapy-related risks due to inadequate training and inconsistent adherence to safety protocols (Hosen et al., 2019). Strengthening nurses’ competencies through pharmacovigilance-based educational interventions is therefore essential to enhance safe chemotherapy administration, reduce medication-related risks, and improve patient outcomes while fostering a positive safety culture in oncology care (Coyne et al., 2019; Mamdouh et al., 2022).

Table 1: Demographic Characteristics of Respondents (n = 115)

Table 1 presents the demographic characteristics of the 115 participants. Most respondents were female (65.2%) and nearly half were married (49.6%). The majority were aged 25–30 years (63.5%), held an undergraduate degree (59.1%), and had 5–10 years of professional experience (50.4%). Overall, the sample comprised predominantly young, well-qualified nurses with moderate clinical experience.

Table 3 presents the descriptive statistics of nurses’ awareness, attitude, and practices regarding chemotherapy administration before and after the intervention (n = 115). Significant improvements were observed across all domains following the pharmacovigilance intervention. Mean awareness scores increased from 1.67 ± 0.26 to 3.59 ± 0.79, attitude scores from 1.72 ± 0.33 to 3.32 ± 0.99, and practice scores from 1.18 ± 0.16 to 3.92 ± 0.46. Median values supported these findings, indicating consistent improvement, while post-test variability suggested differing levels of individual response. Overall, the results confirm the effectiveness of the pharmacovigilance intervention in enhancing nurses’ chemotherapy-related knowledge, attitudes, and practices.

Table 2. Descriptive statistics for Pre and post data values of Awareness, Attitude and practices of Nurses in Chemotherapy Administration (n=115)

^{IQR= Interquartile Range}

Table 3. Overall Awareness, Attitude and practices of Nurses in Chemotherapy Administration (n=115)

Table 3 shows results comparing pre- and post-test scores of nurses’ awareness, attitude, and practices regarding chemotherapy administration (n = 115). Statistically significant improvements were observed across all domains following the pharmacovigilance intervention (p < .001). Mean scores increased for awareness (1.67 ± 0.26 to 3.59 ± 0.79; Z = −9.31), attitude (1.72 ± 0.33 to 3.32 ± 0.99; Z = −9.23), and practice (1.83 ± 0.17 to 3.92 ± 0.46; Z = −9.31). These findings confirm the strong effectiveness of the intervention in enhancing nurses’ chemotherapy-related knowledge, attitudes, and practices.

The findings of this study demonstrate a significant positive effect of pharmacovigilance-based educational interventions on nurses’ awareness, attitudes, and practices related to chemotherapy administration across all demographic and professional groups. Both descriptive statistics and the Wilcoxon Signed Ranks Test confirmed marked improvements in all domains following the intervention (p < .001), indicating enhanced knowledge, positive attitudinal shifts, and improved clinical practices. These results highlight the effectiveness of structured training programs in strengthening nursing competencies and promoting patient safety in oncology settings.

Subgroup analysis revealed that improvements were evident among both male and female nurses, with slightly greater gains among females. Younger nurses (25–30 years), those with undergraduate education, and nurses with 5–10 years of experience showed the greatest improvements, suggesting that early- and mid-career professionals may be particularly receptive to pharmacovigilance training. These findings underscore the value of targeting actively practicing nurses to maximize the impact of educational interventions.

The results are consistent with previous studies reporting significant gaps in pharmacovigilance knowledge and ADR reporting due to inadequate training and systemic barriers (Bankar et al., 2023; Kassa et al., 2025). Similar to findings by Manasa et al. (2023) and Alkofide et al. (2024), this study supports the role of continuous education in bridging the gap between knowledge and practice. Overall, the findings reinforce the need for sustained, structured pharmacovigilance training to enhance safe chemotherapy administration and improve reporting practices in oncology care.

The results demonstrate that to increase the knowledge, attitudes, and practices of nurses involved in the administration of chemotherapy, systematic educational interventions are necessary. The high rates of improvement noted after the interventions by all age groups, education level, work experience proves that continuous professional growth is very essential in supporting high standards of clinical practice. The findings also indicate that increasing knowledge and the positive attitude can make people adhere to the rules of safety better and feel more secure when receiving chemotherapy. Therefore, one can promote good treatment and reduce risks involved in taking medicine in healthcare practices through capacity-building programs aimed at education.

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