NUR 590 Colorectal cancer (CRC) Essay

Colorectal cancer (CRC) mostly begins as a polyp, a noncancerous growth that develops in the mucosal layer of the colon or rectum. The characteristic slow growth from a precancerous polyp to invasive cancer to advanced-stage cancer offers an opportunity to prevent and early detection of CRC (Robertson et al., 2017). Screening can prevent cancer by detecting and removing precancerous growths at an early stage when treatment is more successful. This paper seeks to describe the population demographics of CRC, discuss my proposed intervention, and explore factors that may influence health management for the population.

The wellness of a population’s health using improved patient safety protocols implores healthcare workers (HCWs) especially nurses, to develop evidence-based practice interventions to reduce and prevent occurrence of adverse events like hospital acquired infections (HAIs) and medication administration errors (MAEs) among others. These adverse events lead to poor patient outcomes, increase the overall cost of care and disease burden, and lowers the quality of care delivered by healthcare professionals. Hospital acquired infections are some of the leading healthcare concerns that affect patient safety and quality of care. Many patients suffer from these infections that result into lengthened stays in hospitals, increased cost of care, and in extreme circumstances death.

Population’s Demographics and Health Concerns

CRC is the third most common cancer diagnosed in both males and females annually in the U.S, excluding skin cancers. The American Cancer Society (ACS) estimates that 149,500 adults in the U.S will be diagnosed with colorectal cancer. These include 104,270 new cases of colon cancer, 52,590 males and 51,680 females, and 45,230 new cases of rectal cancer, 26,930 males and 18,300 females (ACS, 2020). The lifetime risk of developing CRC is 4.3% for males and 4.0% for females. The 2018 ACS CRC screening guideline recommends that adults aged 45 years and older have regular CRC screening with a high-sensitivity stool-based test or visual examination (ACS, 2020). The ACS lowered the age to begin CRC screening from 50 to 45 years because occurrence rates are increasing in younger populations. Modeling studies reveal that the balance of benefit to harm is more favorable for beginning screening at age 45 than at 50.

Proposed Evidence-Based Intervention

The proposed evidence-based intervention is performing annual CRC screening using a fecal immunochemical test (FIT). FIT uses antibodies against hemoglobin to detect human blood in the stool (Robertson et al., 2017). It is about twice as likely as most guaiac-based fecal occult blood test (gFOBT) products to detect both advanced adenomas and cancer. Mannucci et al. (2019) state that CRC screening should be recommended before 50 years or as early as 40 years in persons with average risk. Annual CRC screening supports Healthy People 2020 goal of reducing the number of new cancer cases and morbidity, disability, and death caused by cancer (Health.Gov, 2020). It is in line with the objective C-16 by increasing the number of adults who receive a CRC screening per the most recent guidelines (Health.Gov, 2020). It also supports objective C-18.3 by increasing the number of adults counseled by their providers about CRC screening.

Comparison of the Intervention to Previous Practice or Research

Colonoscopy is the most widely CRC screening method in the U.S. It has the longest rescreening interval compared to other test options, 10 years for average-risk persons with normal results. Colonoscopy is considered the most sensitive test for the early detection of colorectal neoplasia (ACS, 2020). However, it has higher screening costs, requires adequate bowel preparation, and increases the risk of adverse events since it is an invasive test (Zhong et al., 2020). These cons contribute to moderately low participation rates in colonoscopy-based screening programs. FIT has inferior one-time performance for neoplastic detection compared with colonoscopy but higher participation rates. Zhong et al. (2020) found that FIT may be comparable to one-time colonoscopy in the detection rate of CRC, even though it has lower detection rates of any adenoma and advanced adenoma than one-time colonoscopy. Besides, annual or biennial FIT seems to be very cost-effective compared with 10-yearly colonoscopy. FIT appears to be non-inferior to colonoscopy in the average-risk population.

Expected Outcome for the Intervention

The expected outcome of CRC screening is early detection and removal of polyps before they develop into cancer. Mannucci et al. (2019) explain that CRC screening can help detect and remove adenomas and diagnose CRC earlier. The FIT screening will thus help identify and remove the polyps early before they develop into cancer.

Time for Implementation and Evaluation of the Outcome

The intervention will be implemented over one year. Average-risk adults 45 years and older will be screened for CRC using FIT. The outcome will be evaluated after one year of implementation. It will entail comparing the number of patients detected to have polyps through the FIT screening compared to the previous two years.

Synthesis of Nursing Science, Determinants of Health, and Epidemiologic, Genomic, and Genetic Data in the Management of Population Health

Nursing science can be applied in supporting individuals with an average risk of CRC by identifying these persons and recommending screening. Nurses can apply their knowledge on CRC to identify patients with risk factors and recommending annual screening (Ylitalo et al., 2019). Social determinants of health, including lack of access to healthcare, inadequate insurance coverage, transportation options, and lack of knowledge, may hinder individuals from accessing screening services (Ylitalo et al., 2019). These can be incorporated in supporting this population by identifying strategies to address these barriers and increase screening rates.

CRC has a higher prevalence in older age groups and among males compared to females. Males 45 years and older should thus be highly recommended to have CRC screening. Individuals with a family history of CRC are considered a high-risk group. For instance, 5% of persons with CRC have an inherited gene mutation associated with high-risk hereditary conditions (ACS, 2020). The genetic data can be applied by recommending that persons with a family history begin screening before 45 years and have regular rescreening intervals.

Conclusion

CRC is the third most common cancer and is more prevalent in men. Guidelines recommend initiation of screening from 45 years with high-sensitivity tests or visual examination. Annual CRC screening at 45 years is a robust screening option and a potentially conservative one. My proposed intervention is annual CRC screening with FIT to increase early detection and removal of polyps. Although FIT is inferior to colonoscopy, its increased participation rates may counterbalance its fairly poor detection capacity in population screening. Nursing science can be incorporated in identifying individuals at risk of CRC and recommending screening. Besides, screening should be emphasized in males and persons with family history since they are at a high risk of developing CRC.

References

American Cancer Society. (2020). Colorectal Cancer Facts & Figures 2020-2022. Atlanta: American Cancer Society.

Mannucci, A., Zuppardo, R. A., Rosati, R., Leo, M. D., Perea, J., & Cavestro, G. M. (2019). Colorectal cancer screening from 45 years of age: Thesis, antithesis, and synthesis. World journal of gastroenterology, 25(21), 2565–2580. https://doi.org/10.3748/wjg.v25.i21.2565

Health.Gov. (2020). Cancer | Healthy people 2020. Healthy People 2030 | health.gov. https://www.healthypeople.gov/2020/topics-objectives/topic/cancer

Robertson, D. J., Lee, J. K., Boland, C. R., Dominitz, J. A., Giardiello, F. M., Johnson, D. A., … & Rex, D. K. (2017). Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 152(5), 1217-1237. https://doi.org/10.1053/j.gastro.2016.08.053

Ylitalo, K. R., Camp, B. G., Meyer, M. R. U., Barron, L. A., Benavidez, G., Hess, B., … & Griggs, J. O. (2019). Barriers and facilitators of colorectal cancer screening in a federally qualified health center (FQHC). The Journal of the American Board of Family Medicine, 32(2), 180-190. https://doi.org/10.3122/jabfm.2019.02.180205

Zhong, G. C., Sun, W. P., Wan, L., Hu, J. J., & Hao, F. B. (2020). Efficacy and cost-effectiveness of fecal immunochemical test versus colonoscopy in colorectal cancer screening: a systematic review and meta-analysis. Gastrointestinal endoscopy, 91(3), 684-697. https://doi.org/10.1016/j.gie.2019.11.035

Description:

Refer to the PICOT you developed for your evidence-based practice project proposal. If your PICOT required revision, include those revisions in this assignment. You will use your PICOT paper for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.

Write a 750-1,000-word paper that describes your PICOT.

Describe the population’s demographics and health concerns.
2. Describe the proposed evidence-based intervention and explain how your proposed intervention incorporates health policies and goals that support health care equity for the population of focus.
3. Compare your intervention to previous practice or research.4. Explain what the expected outcome is for the intervention.
5. Describe the time for implementing the intervention and evaluating the outcome.
6. Explain how nursing science, social determinants of health, and epidemiologic, genomic, and genetic data are applied or synthesized to support population health management for the selected population.
7. Create an Appendix for your paper and attach the PICOT. Be sure to review feedback from your previous submission and revise your PICOT accordingly.
8. Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper.

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Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite at least four to six peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

BA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

MS Nursing: Public Health MS Nursing: Education
MS Nursing: Acute Care Nurse Practitioner MS Nursing: Family Nurse Practitioner
MS Nursing: Health Care Quality and Patient Safety

4.1: Synthesize nursing science, determinants of health, and epidemiologic, genomic, and genetic data in the management of population health.

Trauma occurs when individuals are overwhelmed by circumstances or events and counters them with extreme horror, fear, and helplessness. Excessive stress overwhelms an individual’s coping capacity. Trauma can stem from exposure to abuse, discrimination, neglect, violence, and accidents (Shalaby & Agyapong, 2020). This paper seeks to describe populations with traumatic experiences and an intervention to address the concern and discuss factors that influence health management.

Population’s Demographics and Health Concerns

According to the National Council for Behavioral Health (NCBH), 70% of adults in the U.S. have experienced a traumatic event at least once. Almost all children who observe a parental homicide or sexual assault will develop Post Traumatic Stress Disorder (PTSD). Likewise, 90% of sexually abused children, 77% who school shootings, and 35% of youths exposed to community violence develop PTSD (NCBH, 2020). Trauma is associated with adverse effects on physical and mental health as well as social and occupational functioning. Physical effects include headaches, excessive sweating, palpitations, altered bowel patterns, and being easily startled. Mental impact includes fear, anxiety, depression, emotional swings, increased alcohol and drug use, and sleeping difficulties (Mikhail et al., 2018). Furthermore, individuals socially isolate themselves due and have diminished interest in activities.

Proposed Evidence-Based Intervention

The proposed intervention incorporates peer support in trauma-informed care to accelerate the recovery process. Peer support involves having persons from diverse backgrounds sharing common trauma experiences (Shalaby & Agyapong, 2020). The intervention uses peer support workers, individuals with lived trauma experiences, and who have received special training to be part of the care team. Based on their similar experiences and the shared understanding, patients may trust their peer support worker and be more willing to engage in treatment.

Incorporating peer support supports Healthy People 2020 goal of improving mental health through prevention and ensuring access to appropriate, quality mental health services. The intervention will improve the mental health outcomes of persons with trauma experiences. It will help prevent mental health issues such as anxiety, PTSD, depression, and alcohol and substance use disorders.

Comparison of the Intervention to Previous Practice or Research

Previous practice in trauma-informed care entailed using behavioral health counselors. Crisanti et al. (2019) compared cognitive behavioral therapy intervention groups guided by certified peer support workers with groups led by behavioral health counselors for trauma survivors with PTSD. At six months after baseline, persons in the peer-led sessions had a higher therapeutic alliance and stronger connection than those in the counselor-led sessions. The study shows that peer support can increase patient engagement and ultimately accelerate the recovery process.

Expected Outcome for the Intervention

Incorporating peer support is expected to increase patients’ engagement in treatment and thus accelerating their recovery. Since patients will share their trauma experiences with peer support workers who have experienced similar experiences, it will promote a shared understanding and increase patients’ trust (Shalaby & Agyapong, 2020). Peer support is expected to help patients overcome social isolation caused by trust issues by creating trust between patients and the peer workers.

Time for Implementation and Evaluation of the Outcome

The intervention will be implemented within six months. Patients will be randomly assigned to an intervention or a control group. The intervention group will be assigned to a peer support worker, while the control group will be provided the usual trauma-informed care without peer support. Evaluation will be conducted six months after the implementation of the peer support care. The recovery scores of patients in the intervention group will be compared to those of the control group to evaluate the difference in recovery and outcomes.

Synthesis of Nursing Science, Determinants of Health, and Epidemiologic, Genomic, and Genetic Data in the Management of Population Health

Nursing science is applied to support patients with trauma experiences in line with the principles of safety, respect, and trust. Nursing science is also applied in delivering patient-centered care to improve patient engagement and the quality of trauma-informed care (Fleishman et al., 2019). Social determinants such as living in under-resourced or racially segregated neighborhoods and experiencing food insecurity can result in toxic stress. Social determinants that should be considered in trauma screening include poverty, neighborhood crime and violence, and racism (Mikhail et al., 2018). Health providers should increase protective factors to mitigate exposure to trauma and environmental factors that contribute to it.

Trauma mainly affects minority racial groups, children, adolescents, and older adults. The data can be applied in trauma-informed care by emphasizing screening for trauma experiences among high-risk populations. Youssef et al. (2018) found that trauma exposure can be passed to offspring transgenerationally via the epigenetic inheritance mechanism of DNA methylation alterations. The genetic data can be synthesized in trauma-informed care by emphasizing trauma screening to persons whose close relatives were exposed to trauma.

Conclusion

More than 70% of the U.S population has encountered traumatic events such as homicide, sexual assault, shooting, and community violence. Trauma is associated with adverse effects on physical and mental health and impairments in social and occupational functioning. My proposed intervention is to incorporate peer support in trauma-informed care. Peers work together with patients to create relationships where they share their strengths and support each other’s healing. Peer support is expected to increase patient engagement and accelerate recovery. The intervention will be implemented over six months using an intervention and control group.

References

Crisanti, A., Murray-Krezan, C., & Reno, J. (2019). Are treatment groups led by peers as effective as groups led by counselors for treating posttraumatic stress disorder and substance use disorder? https://doi.org/10.25302/5.2019.ce.12114484

Fleishman, J., Kamsky, H., & Sundborg, S. (2019). Trauma-informed nursing practice. OJIN: The Online Journal of Issues in Nursing, 24(2). https://doi.org/10.3912/OJIN.Vol24No02Man03

Mikhail, J. N., Nemeth, L. S., Mueller, M., Pope, C., & NeSmith, E. G. (2018). The social determinants of trauma: a trauma disparities scoping review and framework. Journal of Trauma Nursing| JTN, 25(5), 266-281.

National Council for Behavioral Health. (2020, July 17). Trauma Infographic. National Council. https://www.thenationalcouncil.org/

Shalaby, R., & Agyapong, V. (2020). Peer support in mental health: Literature review. JMIR mental health, 7(6), e15572. https://doi.org/10.2196/15572

Youssef, N. A., Lockwood, L., Su, S., Hao, G., & Rutten, B. (2018). The Effects of Trauma, with or without PTSD, on the Transgenerational DNA Methylation Alterations in Human Offsprings. Brain sciences, 8(5), 83. https://doi.org/10.3390/brainsci8050083