Prevent Colon Cancer Medical Presentation

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Colon Cancer Prevention Colleen Pucely, Kala Rudningen, Kathy Schulz, Anne Tuoy-Giel, Jamie Vetvick, & Abigail Yozamp
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Preventing Colon Cancer 80 % by 2018 Colorectal Cancer Awareness Month Dress in Blue Day Removing Barriers to Colorectal Screening Act How Can you help? For further information: https://nccrt.org/80-in-every-community/
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Save a Life Rack Card (excerpt) COLORECTAL CANCER IS the 2nd leading cause of cancer deaths for men and women combined in the U.S. The good news is that it’s PREVENTABLE. It is important to get screened.There are several different screening options. If you’re 45 years old or have a family history of colon or rectal cancer or polyps, it’s time to talk to your doctor about the best screening option for you Colorectal Cancer Facts & Figures: American Cancer Society 2017-2019. Cancer Stat Facts: Colorectal Cancer. National Cancer Institute.
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Population Presentation focus will be age 50-75, however it is noteworthy the suggested age of screening has changed. The American Cancer Society recommends cancer screening begin at age 45 in people with average risk. People with a life expectancy of greater than ten years and in good health should receive regular screening for colon cancer through the age of 75. The length of screening will vary with the type of test. American Cancer Society updates colorectal screening guide. Retrieved from https://www.cancer.org/latest-news/american-cancer-society-updates-colorectal-cancer-screening-guideline.html
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Background on Colon Cancer Prevention Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide. Second leading cause of cancer in the United States and worldwide. The vast majority of new cases of colorectal cancer (about 90%) occur in people who are 50 or older. Millions of people in the United States are not getting screened as recommended. Screening tests can find precancerous polyps and colorectal cancer early, when treatment works best.
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Public Policy The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. Multiple screening tests are used to detect colorectal cancer, including: Fecal occult blood test (FOBT) and fecal immunochemical test (FIT) Computed tomography (CT) colonography Sigmoidoscopy Colonoscopy To veiw Flyer https://www.cancer.gov/PublishedContent/Images/about-nci/organization/crchd/inp/screen-to-save/connect/screen-to-save-infographic.__v200213193.png The American Cancer Society states: People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45: A strong family history of colorectal cancer or certain types of polyps A personal history of colorectal cancer or certain types of polyps A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease) A known family history A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer
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Healthy People 2020 Healthy People 2020 calls for a 10% to 15% reduction in death rates from 2007 to 2020 for selected cancers. Trends in death rates can be used to predict progress toward meeting HP2020 targets. The target goal of adults aged 50-75 who receive colorectal screening is to increase to 70.5% by 2020 (2008 was 50.1% of adults who received screenings). National data predicts a decrease in colorectal cancer of about 33% over the decade due to the impact of screening measures. Colorectal Cancer Control Program
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Standards Affordable Care Act Federal incentive programs Center for Disease Control Insurance and Medicare Coverage
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The Health Promotion Model Nora Pender -1982 and revised 1996. Framework- integrating nursing and behavioral science perspective to predict health behaviors Health- positive dynamic not absence of disease Health promotion- increasing a client’s level of well being. Multidimensional nature of persons as they interact within their environment (Murdaugh, Parsons, & Pender, 2019)
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The Model Focuses on Three Areas Individual Characteristics and Experiences Prior related behavior Personal factors Behavior-specific Cognitions and Affect Perceived benefits of action Perceived barriers to action Perceived self-efficacy Activity-related affect Interpersonal influences Situational influences Commitment to a plan of action immediate completing demands and preferences Behavioral Outcomes Assumptions of the Health Promotion Model Individuals seek to actively regulate their own behavior Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span. Self-initiated reconfiguration of person-environment interactive patterns is essential ato behavior change. (Theoretical Foundations of Nursing, 2011)
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Assessment Risk Factors Physical inactivity Low-fiber, high-fat diet Smoking Heavy alcohol use Obesity Age African-American race History of colorectal polyps or colorectal cancer Genetics Family history of colon cancer Diabetes Radiation therapy for cancer Lifestyle Changes to Reduce your risk of Colon Cancer Eat a variety of fruits, vegetables, and whole grains Drink alcohol in moderation Stop smoking Exercise most days of the week Maintain a healthy weight The National Cancer Institute- Colorectal Cancer Risk Assessment Tool https://ccrisktool.cancer.gov/ (Mayo, 2019)
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Life course perspective from Ory et al., 2014
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Selected health risk Although, majority of colorectal cancer cases are diagnosed at age 50 or older, age by itself is not a risk factor. Age when used as a marker of time, represents the duration of the environmental exposure, the cumulative effects of the risk factors, and ongoing changes of the genomic instability and epigenetic alteration which explains the high incidence of cancer (White, et al. 2014) Although the ageing process cannot be changed, age related factors that contribute to increased risk for cancer can be changed.
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Selected health risk To understand the risk factors, we have to look at the adults in midlife ages 45 to 64 years since cancer of the colon takes almost 10 years to develop. Adults between ages 45 and 64 years old have the following characteristics: Host immunity begins to decline New responsibilities with ageing family members Peak careers Competing obligations balancing work, family and personal interests Unaware of the recommended preventative services Do not consider themselves at risk
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Selected risk factor 2010 BRFSS data indicates that middle aged adults were more sedentary than younger adults (White et al, 2014) 25.5% of adults aged 45 -64 years did report not exercising in the last 30 days compared to 17.7% of adults aged 18-24 years, and 21.8% for adults aged 25 -44 years. (White et al, 2014)
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Health Promotion Plan Goal: Get at least 150 minutes of moderate-intensity aerobic activity per week These minutes could be spread throughout the week. Examples of moderate-intensity aerobic activities include: Brisk walking (at least 2.5 miles per hour) Water aerobics Dancing (ballroom or social) Gardening Tennis Biking (slower than 10 miles per hour)
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Healthy People 2020 Physical Activity goals: PA -1: Reduce the proportion of adults who engage in no leisure time physical activity PA-2: Increase the proportion of adults who meet current federal physical activity guidelines for aerobic physical activities PA-2.1: Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for at least 150 minutes/week
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Suggested Evidence-based Nursing Intervention Goal: Identify a patient's unique personal characteristics and experiences that affect subsequent actions. Pre Visit planning updates EHR and health maintenance to be able to provide provider reminders for one-one discussion with patient on colorectal screening. Review and work health maintenance report Identify and reduced out‐of‐pocket expense (financial support). One on one screening can identify these patients that fall in this category. Focus on specific population with identified financial barrier
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Evaluation of Intervention 1 Intervention 1: Provider reminder and recall systems Outcome that is measurable: An increased percentage of the general population who’s recommended to receive colo-rectal cancer screenings who are offered the appropriate colo-rectal cancer screening based on current guidelines by the Centers for Disease Control and Prevention Measure the percentage of the stated population - age 45 and older for this measurement purpose (any specific/outlier recommendations who fall under the age of 45 likely due to strong family history will not be included/tracked in this study/intervention) who have been offered colo-rectal cancer screenings (including any recommended screenings based on current recommendations, i.e colonoscopies and fit tests) at current clinics who do not have a provider reminder and/or recall systems. This is measured by doing chart reviews of every patient within the stated population age 45 and older at current clinics for the year 2018. Once the chart reviews are complete and percentages are obtained, the implementation of a provider reminder/recall system will be initiated.
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Evaluation of Intervention 1 Continued The initiation of the provider reminder/recall system will be in place for one year. Once this year is up, patient charts will again be audited and a percentage will be obtained seeing what percentage of the stated population based on current guidelines and recommendations for colo-rectal screening cancer (Assuming they are unchanged from the previous year of audits completed prior to the implementation of the recall system) has received and has not received the appropriate colo-rectal cancer screening. The percentage will then be compared pre and post intervention to see if implementing a provider reminder/recall system was effective in getting the stated population the opportunity to receive the appropriate colo-rectal cancer screening
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Evaluation of Intervention 2 Intervention 2: Identify and reduce out‐of‐pocket expense (financial support). Outcome that is measurable: An increased percentage of the general population who’s recommended to receive colo-rectal cancer screenings based on current guidelines by the Centers for Disease Control and Prevention who are offered the appropriate colo-rectal cancer screening. Measure the percentage of the stated population - age 45 and older for this measurement purpose (any specific/outlier recommendations who fall under the age of 45 likely due to strong family history will not be included/tracked in this study/intervention) who have been offered colo-rectal cancer screenings (including any recommended screening based on current recommendations, i.e colonoscopy and fit test) at current clinics who do NOT offer financial support or incentive to receive appropriate colo-rectal cancer screening based on current recommended guidelines per The Center For DIsease Control and Prevention. This is measured by doing chart reviews of every patient within the stated population at specific clinics for the year 2018. Once the chart reviews are complete and percentages are obtained, the implementation of a financial support/incentive program is implemented.
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Evaluation of Intervention 2 Continued The initiation of the financial support/incentive program will be in place for one year. Once this year is up, patient charts will again be audited and a percentage will be obtained seeing what percentage of the stated population based on current guidelines and recommendations for colo-rectal screening cancer (Assuming they are unchanged from the previous year of audits completed prior to the implementation of the financial support/incentive program) has received and has not received the appropriate colo-rectal screening. The percentage will then be compared pre and post intervention to see if implementing financial support/incentive program was effective in getting the stated population the opportunity to receive the appropriate colo-rectal cancer screening
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References American Cancer Society. (2019). American Cancer Society Guideline for Colorectal Cancer Screening. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html Baron, R. C., Melillo, S., Rimer, B. K., Coates, R. J., Kerner, J., Habarta, N., . . . Leeks, K. J. (2010). Intervention to Increase Recommendation and Delivery of Screening for Breast, Cervical, and Colorectal Cancers by Healthcare Providers. American Journal of Preventive Medicine, 38(1), 110-117. doi:10.1016/j.amepre.2009.09.031 Blumenthal, D. S., Smith, S. A., Majett, C. D., & Alema-Mensah, E. (2010). A trial of 3 interventions to promote colorectal cancer screening in African Americans. Cancer, 116(4), 922-929. doi:10.1002/cncr.24824 Center for Disease Control (2019). What is CDC doing about Colorectal Cancer. Retrieved from https://www.cdc.gov/cancer/colorectal/what_cdc_is_doing/index.htm Center for Disease Control. (2019). What Should I Know About Screening? Retrieved from https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm
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Coronado, G. D., Petrik, A. F., Bartelmann, S. E., Coyner, L. A., & Coury, J. (2015). Health Policy to Promote Colorectal Cancer Screening: Improving Access and Aligning Federal and State Incentives. Clinical researcher (Alexandria, Va.), 29(1), 50–55. doi:10.14524/CR-14-0044. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4847543/ Fight Colorectal Cancer: Get behind a cure. Retrieved from https://fightcolorectalcancer.org/ Healthypeople.gov. (2019). Adults receiving colorectal cancer screening based on the most recent guidelines. Retrieved from https://www.healthypeople.gov/2020/data/Chart/4054?category=1&by=Total&fips=-1 Healthypeople.gov. (2019). Clinical Preventive Service. Retreived from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Clinical-Preventive-Services Healthy People 2020. Healthy People 2020 Progress Review: Cancer and Genomics. Retrieved from https://www.healthypeople.gov/sites/default/files/HP2020_Cancer_and_Genomics_Progress_Review_Slides.pdf Healthypeople.gov. (2019). Reduce Invasive Colorectal Cancer. Retreived from https://www.healthypeople.gov/node/4075/data_details Issa, I. A., & Noureddine, M. (2017). Colorectal cancer screening: An updated review of the available options. World journal of gastroenterology, 23(28), 5086–5096. doi:10.3748/wjg.v23.i28.5086 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537177/
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Mayo Clinic. (2019). Colon cancer. Retrieved from https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669 Murdaugh, C. L., Parsons, M. A. & Pender, N. J. (2019). Health promotion in nursing practice. (8th ed). New Your, NY: Pearson. National Cancer Institute. (2019). Colorectal Cancer Screening. Retrieved from https://progressreport.cancer.gov/detection/colorectal_cancer National Colorectal Cancer Roundtable (NCCRT) (2019). Retrieved from https://nccrt.org/crc-news-february-28-2019/ Ory, M. G., Anderson, L. A., Friedman, D. B., Pulczinski, J. C., Eugene, N., & Satariano, W. A. (2014). Cancer prevention among adults aged 45-64 years: setting the stage. American journal of preventive medicine, 46(3 Suppl 1), S1–S6. doi:10.1016/j.amepre.2013.10.027 Sakraida, T. J. (2017). Health promotion model. Retrieved from https://nursekey.com/21-health-promotion-model/
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Save a life Rack Card (2018). Retrieved from https://fightcolorectalcancer.org/fight/library/save-life-rack-card/ Staroselsky, M., Volk, L. A., Tsurikova, R., Pizziferri, L., Lippincott, M., Wald, J., & Bates, D. W. (2006). Improving electronic health record (EHR) accuracy and increasing compliance with health maintenance clinical guidelines through patient access and input. International Journal of Medical Informatics, 75(10-11), 693-700. doi:10.1016/j.ijmedinf.2005.10.004 Theoretical Foundations of Nursing. (2011). Nola Pender: The Health Promotion Model. Retrieved from https://nursingtheories.weebly.com/nola-pender.html White, M. C., Holman, D. M., Boehm, J. E., Peipins, L. A., Grossman, M., & Henley, S. J. (2014). Age and cancer risk: a potentially modifiable relationship. American journal of preventive medicine, 46(3 Suppl 1), S7–S15. doi:10.1016/j.amepre.2013.10.029 Wolf, A., Fontham, E.T.H., Church, T.R., Flowers, C.R., Guerra, C.A.,LaMonte, S.J.,... Smith,R. (2018). Colorectal screening for average risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians, 69(3), 184-210. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21457