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

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.