Peer-reviewed article

Self-Efficacy and Knowledge in Cardiotoxicity Management Among Pediatric Oncology Nurses: A Cross-Sectional Mediation Analysis.

Akdeniz Kudubeş A, Semerci Şahin R, Savaş EH, Ay A · 21 Sept 2026

Abstract

Background Cardiotoxicity is a serious adverse effect of cancer treatment in children and can be reversible or irreversible, with irreversible forms involving permanent loss of cardiac muscle cells. Objective This study aimed to examine pediatric oncology nurses' self-efficacy and knowledge levels regarding the management of cancer treatment-related cardiotoxicity, to identify the sociodemographic and professional factors associated with self-efficacy, and to test whether knowledge functions as a mediator in the association between cardiotoxicity-related training and self-efficacy. Methods In this descriptive, cross-sectional study, 122 nurses working in pediatric oncology units for at least 6 months (July 2024 to February 2025) completed the Information Form, the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Induced Cardiotoxicity (NSS-CTC), and the Cardiotoxicity Knowledge Level Form for Pediatric Oncology Nurses (CKLF-PON). Data were analyzed with descriptive statistics, t tests, 1-way ANOVA, and hierarchical multiple linear regression. Three simple mediation models then tested whether CKLF-PON knowledge mediated the effects of training, literature engagement, and postgraduate education on NSS-CTC self-efficacy, with 95% bias-corrected accelerated confidence intervals from 5000 bootstrap resamples. Results The hierarchical model explained 72.0% of the variance in self-efficacy. Female sex (β=0.172, P=0.003), years of experience in pediatric oncology (β=0.139, P=0.030), cardiotoxicity-specific training (β=0.209, P=0.003), engagement with current literature (β=0.315, P<0.001), and CKLF-PON knowledge (β=0.336, P<0.001) were independent correlates. Knowledge partially mediated the effects of cardiotoxicity-specific training and literature engagement, but not of postgraduate pediatric-nursing education. Conclusions Clinical experience alone does not guarantee effective cardiotoxicity management. Structured, content-specific education and continuous professional development improve self-efficacy partly by enhancing objective knowledge. Clinical relevance Among pediatric oncology nurses, self-efficacy for managing cancer treatment-related cardiotoxicity was associated not with accumulated clinical experience but with 2 modifiable behaviors: participation in cardiotoxicity-specific training and regular engagement with the current literature, both of which operated partly through objectively measured knowledge.