NURS FPX 6614 Assessment 1 Defining a Gap in Practice – Executive Summary

This summary will analyze clinical priorities for fecal immunochemical testing (FIT) in comparison to colonoscopy for routine colon cancer screening for adults over fifty years of age. FIT testing is less invasive than a colonoscopy and requires no bowel preparation, which is a deterrent for many people in scheduling this important screening method.

Clinical Priorities for FIT Testing

Colorectal cancer (CRC) is the second most common cause of cancer death in the United States (Siegel et al., 2020). Colon cancer typically starts as small polyps on the surface of the colon (Harvard Health Publishing, 2019). It takes ten to fifteen years for polyps to develop into colorectal cancer (American Cancer Society, 2020). Therefore, regular preventative screening is the most effective means of preventing colorectal cancer development. Care coordination is needed to ensure scheduling and follow-up with this population is of utmost importance and improve communication between primary care and oncology providers (Hershey & Given, 2020). The use of care coordinators will also help to ensure access to screening methods (Siegel et al., 2020).

Colonoscopy is often avoided due to the invasive nature of the procedure as well as the bowel preparation, which is considered by many to be worse than the colonoscopy itself (Harvard Health Publishing, 2019). Any polyps seen during the colonoscopy can be easily removed, but there are other less invasive methods available for screening.

There have been many clinical trials that show screening using fecal occult blood testing (FOBT), or FIT reduces colorectal mortality by 13-33% (VA Office of Research and Development, 2021). These tests are inexpensive and non-invasive.

NURS FPX 6614 Assessment 1 Defining a Gap in Practice – Executive Summary

PICOT Question

In adults with no family history of colorectal cancer, is fecal testing sufficient for annual colorectal screening? A suitable nursing diagnosis for this would be altered health maintenance related to a lack of knowledge about preventative screenings required for adults, as evidenced by being past due for colorectal cancer screening. The expected outcome for this would be to have Increased awareness of preventative health screenings required for the age group. Another outcome would be to complete fecal testing for colorectal screening within one month. The assessment portion would include determining readiness for learning and determining what the patient already knows about health care prevention. Interventions for this diagnosis would include learning the patient’s habits and discussing adhesion to health maintenance in the past, such as having annual physicals and being up to date on routine vaccinations. Another intervention Will be to determine if there are any barriers, such as transportation and health care costs. Lastly, the care coordinator should provide education and assess learning by asking open-ended questions to determine the level of understanding. The coordinator should instruct the patient and go through the fecal testing kit with the patient. The education should be documented, and arrangements be made to discuss results when available.

A study performed called “Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality from Colorectal Cancer (CONFIRM) is the largest clinical trial performed at Veterans Affairs Medical Centers in the United States (VA Office of Research and Development, 2021). The study was set to include 50,000 patients nationally that were randomly assigned to receive either annual FIT or colonoscopy per current standard of care for ten years and followed by study staff to ensure compliance.

Services and Resources Available for Care Coordination with the Selected Population

Many facilities have care teams comprised of a nurse and a physician. The nurse functioning as the care coordinator can review patient records to determine if colorectal cancer screening is due, verify with the patient the screening has not been done at another facility, and arrange for the fecal immunochemical testing kit to be sent out to the patient. The care coordinator can follow the panel of patients assigned to ensure the patient received the kit, returned the kit, and initiated any follow-up required if the kit is positive for blood in the stool.

NURS FPX 6614 Assessment 1 Defining a Gap in Practice – Executive Summary

Intervention Plan and Expected Outcomes

Care teams are supposed to be reviewing the status of other screenings and vaccinations at appointments, so this task will not add a significant amount of workload. The kits can be kept in the clinic for patients seen in person and ordered to be shipped out by nursing staff. Reviewing telephone appointments and sending the kits to patients also eliminates unnecessary trips to the facility. The expectation is that all patients will be compliant with annual colorectal screening, and those with positive fecal tests will be scheduled for follow-up with the colorectal clinic. If there are any polyps removed during a colonoscopy found in a colorectal clinic, the necessary consultation can be made with medical oncology to discuss treatment. This plan will assist the nurse with the delivery of care in the practice setting and across care settings by ensuring appropriate referrals and follow-up of the patient’s status during the screening process. This process will also promote wellness by ensuring appropriate screenings are completed on a timely basis.

Conclusion

This paper summarized the use of fecal immunochemical testing as a way of gaining compliance with preventative colorectal screening for adult patients with no family history of colorectal cancer. The process uses existing methods and streamlines the process, ensuring education, ease of procedure for the patient, and reducing procedure costs for patients considered low risk for colorectal cancer.

References

American Cancer Society. (2020, June 8). Can Colorectal Cancer Be Prevented? Cancer.org; American Cancer Society. https://www.cancer.org/cancer/colon-rectal-cancer/causes- risks-prevention/prevention.html

Harvard Health Publishing. (2019, August 21). The prep is worse than the procedure. Harvard Health. https://www.health.harvard.edu/newsletter_article/the-prep-is-worse-than-the- procedure

Hershey, D. S., & Given, B. A. (2020). Improving Care Coordination for Comorbidity and Cancer. Cancer Nursing, 43(1), 86–87. https://doi.org/10.1097/ncc.0000000000000780

Siegel, R. L., Miller, K. D., Goding Sauer, A., Fedewa, S. A., Butterly, L. F., Anderson, J. C., Cercek, A., Smith, R. A., & Jemal, A. (2020). Colorectal cancer statistics, 2020. CA: A Cancer Journal for Clinicians, 70(3). https://doi.org/10.3322/caac.21601

VA Office of Research and Development. (2021, March 15). CSP #577 – Colonoscopy vs. Fecal Immunochemical Testing in Reducing Mortality From Colorectal Cancer. Clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT01239082

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Question

Develop a PICOT question that defines a gap in practice and write a 2-3 page executive summary presenting the key elements that decision-makers will need to make decisions.