Student Directed Projects in Cancer Education: Eight Years Experience in California

Lee H. Hilborne, Melanie I. Wolf-Greenberg

ABSTRACT

A student directed cancer education project was developed in conjunction with the California Division of the American Cancer Society. This program has shown to be cost effective in providing cancer information to the community from a university setting.

INTRODUCTION Despite overwhelming evidence that cancer is largely

preventable or curable if treated early, fears and mis- conceptions about cancer prevent individuals from seeking prompt and potentially lifesaving medical inter- vention. ’ Current medical techniques cannot aid the majority of cancer patients when they consult their doctor; in fact, two out of three cancer patients will die from their disease. The American Cancer Society (ACS) estimated that 134,000 people with cancer, who might have been saved by earlier diagnosis and prompt medical treatment, would die in 1981 .‘

Furthermore, many cancers can be prevented. The most notable example is lung cancer. During the last 25 years the age adjusted death rate from lung cancer has in- creased 184.8% in men and 238.8% in women.2 The majority (75%) of lung cancers is directly attributable to cigarette smoking.’.2

Education, then, is currently the most powerful weapon in the fight against cancer. Educating individuals about cancer, how it may be prevented, and how it may be detected earlier is the basis of the program described herein.

BACKGROUND The “Biology of Cancer” course was introduced in

1973 at the University of California at Santa Cruz by Steven Leib, MD, then an undergraduate at the univer- sity. Based on the success of this course, attracting 500 students from this relatively small campus, it was clear an audience that wanted basic cancer education existed. The California Division of the American Cancer Society elected to sponsor the course and provide financial support on a statewide level. The course has grown

steadily and in 1981 was presented at 27 colleges and universities throughout California. The concept has been acknowledged by the National Office of the American Cancer Society and is now promoted nation- ally. The American Cancer Society has published pam- phlets to assist colleges and local ACS units organize student directed C O U ~ S ~ S . ~ . ~

THE PROGRAM The course introduces students to cancer’s multidi-

mensional nature during one school quarter or semester. Guest lecturers are invited each session to discuss topics on which they have particular expertise (e.g., smoking and lung cancer, biological aspects of cancer, unproven methods of cancer treatment and psychosocial issues and cancer). Special presentations are made by a panel of patients and families of cancer patients who share their personal experiences.

All courses cover the epidemiological, biological, clinical and psychosocial aspects of cancer. However, the emphasis and difficulty of the course depends on the audience the course is directed toward and on the department and instructor sponsoring the course. To encourage an audience with diversified interests, many courses have no prerequisites and presume little or no background in medicine, biology or cancer. Courses presented in life science departments generally stress the biological aspects of the disease, whereas those in social science departments emphasize the psychosocial, social and political implications of cancer.

The most important underlying theme in these courses, and a major factor in their success, is that they are student directed. Students are responsible for selecting speakers and topics, contacting speakers and arranging presentations, preparing and administering examinations and recruiting new student volunteers to repeat this process for subsequent program years. The student coordinating committee, consisting of 2- 15 students, works closely with a faculty adviser and the local ACS unit.

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Student planning committee members have a unique opportunity. In addition to expanding their knowledge of cancer, they learn about the teaching process, course organization and examination preparation. These indi- viduals meet well-known and respected community leaders, providing a chance to discuss particular interests and career goals with persons in the health and social sciences.

In the past eight years, the cost of operating these programs has decreased. The use of “learning hours” was developed to provide a more accurate assessment of time and funds invested in student directed programs in cancer education. (Table 1) Funding for the courses has traditionally come from a diversified number of sources. The most frequent funding source in California is the California Division of the American Cancer Society. This is an important resource in light of budget cutbacks in the public sector. The sponsoring depart- ment also supplies financial support, meeting space, faculty time and administrative resources. Additional support has come from local cancer centers and organi- zations.

EXPANSION OF STUDENT DIRECTED PROGRAMS

In addition to providing courses on basic cancer in- formation to various undergraduate audiences, the

“student directed programs” philosophy has been applied to professional (e.g., nursing, medical, and public health students) and community audiences. The concept acknowledges the fact that special groups know best what information they desire on a particular sub- ject, in this case, cancer.

Biology of Cancer I1 is a pilot course offered through the University of California, Los Angeles, School of Public Health. It is primarily for students completing the introductory cancer course (Biology of Cancer I) at UCLA. Biology of Cancer I1 is a two-quarter sequence. The first quarter introduces students to the process of cancer and health education, concentrating on practical issues such as reaching special populations (e.g., high school students, the elderly and minorities) and tech- niques of program development, implementation and evaluation. The quarter culminates in a cancer educa- tion project proposal for the second quarter. The second quarter is devoted to implementation and evalu- ation of the proposed project.

Student directed projects also have been piloted suc- cessfully in secondary schools. The courses have been presented as part of the health instruction portion of secondary school curricula. These classes generally have been organized in the “mini-series” format with 5-10 sessions devoted to selected topics of interest to high school students (e.g., smoking and health, sun exposure

PROGRAM YEAR

1973- 1974

1974-1975

1975-1976

1976-1977

1977-1978

1978-1979

1979-1980

1980- 1981

Table 1 Student Directed Cancer Education Programs

Eight Years Experience in the California Division, Inc. American Cancer Society

NUMBER OF TOTAL TOTAL NUMBER OF DIRECT ACS TOTAL # OF TOTAL OF” COST PER COST PER PROGRAMS ENROLLMENT LEARNING HOURSC SUBSIDY VOLUNTEERS* VOLUNTEER HOURS LEARNING HOUR PROGRAM

1 500 30.000 s 1,000 2 480 3.36 s 1.000

4 1,175 82,463 s 8,000 20 1,550 9.76 s 2,000

10 2,895 179,505 $ 7,500 54 4,110 4.26 $ 750

12 2,720 180,855 S 6.000 58 4,144 3.36 $ 500

16 2,770 180,767 f 9,000 102 8,173 5.06 S 562

19 3,645 238,096 f 8,555 129 9,653 3.66 f 450

21 2,889 187,555 $ 9,050 125 9,722 4.86 S 431

27 3,775 234,863 S 10.500 131 9,823 4.46 s 389

OVERALL TOTALS 110 20,369 1,314,104 $ 59.605 621 47,655 4.56 s 542

* number o f student coordinators *‘ estimated nunber o f in-class and out o f c lass studying hours

estimated nuntrer o f hours spent by coordinators i n planning and inplementing cancer education courses

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and skin cancer and basic cancer epidemiology). Studies have shown that secondary school health education pro- grams are most effective when students are most in- v ~ l v e d . ~ - ~ It is essential to direct peer pressure away from negative health habits and toward positive health habits.’ Since the teen-age years are a period when individuals develop health practices, it is hoped this series will encourage students to embark on a lifetime program to reduce their incidence and mortality from cancer.

The National Association of School Nurses will hold its annual meeting and conference June 26-30 at the Madison Hotel in Seattle. The theme of the conference will be “Soaring to Wellness in Washington.”

Plans are being made for this to be a participatory conference with Day 1 being “determining one’s own wellness level.” Day 2 will be “learning daily coping strategies” and Day 3 will be “previewing existing programs that promote wellness.”

More information can be obtained by contacting the NASN headquarters, 7395 S. Krameria St., Englewood, CO 801 12.

1

CONCLUSION Student directed programs in cancer education are

an effective way to provide many sectors of the popula- tion (i.e., secondary school students, college and university students and community members) with essential cancer information. Course evaluations by the more than 20,000 college students completing the course during its eight years in California suggest a public desire for such educational program‘s. More than 1.3 million learning hours have been invested by California students during the last eight years.

It is important to remember that “Biology of Cancer” is a flexible program. The course can be adapted to meet the needs of most any audience. We have found that student involvement, the underlying philosophy of all our programs, is a most essential element for a successful program.

Information regarding development and implementa-

tion of a student directed cancer education program is available through most local units and state divisions of the American Cancer Society.

References

1 . Prescott DM, Flexer AS: Cancer-The Misguided Cell. Sunderland, MA: Sinauer Associates Inc, pp 261-277, 1982.

2. 1983 Cancer Facts and Figures. American Cancer Society Pub. No. 5008-LE New York: National Headquarters, American Cancer Society Inc, 1983.

3. Biology of Cancer: A Planning Guide. American Cancer Society Pub. No. 2057-PE. New York: National Headquarters, American Cancer Society Inc, 1981.

4. Developing a “Biology of Cancer” Course in Your Unit . American Cancer Society Pub. No. 2622-LE. New York: National Headquarters, American Cancer Society Inc, 1981.

5. Morison JB, et al: Health education and cigarette smoking: a report on a three-year program in the Winnipeg school division (1960-1963). Canad Med Assn J 91:49-56, 1964.

6. Bartlett EE: The contribution of school health education to community health promotion: what can we reasonably expect? Am J Public Health 71:1384-1391, 1981.

7. Pederson LL, et al: Change in smoking status among school- aged youth: impact of a smoking-awareness curriculum, attitudes, knowledge and environmental factors. Am J Public Health 71:1401-1404, 1981.

Lee H. Hilborne, MD, is a Resident in Pathology at the UCLA Hospital and Clinics, Los Angeles, CA 90024. Melanie Wov-Greenberg, MPH, is a Health Planner with the Orange County Health Planning Council, 202 Fashion Lane, Suite 219, Tustin. CA 92680.

1 NASN conference to boost Wellness in Washington

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