Studies plot colorectal roles
Research suggests nurses can lead the charge when it comes to tracking colorectal cancer.
A nurse-led model of colorectal cancer surveillance has improved compliance with guideline recommendations to 97 per cent, reduced the number of unnecessary colonoscopies and reduced the number of cases progressing to cancer, according to research published in the Medical Journal of Australia.
The early diagnosis of colorectal cancer (CRC) is vital and can be achieved with screening by faecal occult blood tests (FOBT) or colonoscopy, wrote the authors, led by Dr Erin Symonds from Flinders University.
“A family of CRC or a personal history of adenoma can increase a person’s risk of CRC as much as fourfold, and such individuals are advised to undergo regular surveillance colonoscopy,” Dr Symonds and colleagues wrote.
“Screening and surveillance guidelines aim to optimise the effectiveness of CRC prevention, with surveillance intervals generally ranging between one and 5 years.”
Compliance with those recommendations is poor, however, with as many as 89 per cent of patients receiving inappropriate surveillance, usually a colonoscopy before the recommended date.
The Southern Co-operative Program for the Prevention of Colorectal Cancer (SCOOP) was established in 1999 to “improve surveillance rates to match the Australian National Health and Medical Research Council guidelines on CRC prevention”.
After early success (compliance by 2000 had increased from 46 per cent to 96 per cent), SCOOP was expanded to use two models: one nurse-led in public academic hospitals, where nurses make recommendations based on NHMRC guidelines, which are then confirmed by a physician; and the other, physician-led in private non-academic hospitals where the specialist physician manages the entire process.
In the latest research, both models were audited over a 3-month period. In the nurse-led model compliance with surveillance guidelines was achieved in 97.1 per cent of cases, and in the physician-led model, compliance reached 83 per cent, a statistically significant difference.
“Having a process in place that allows for long term compliance with surveillance guidelines will promote optimal health care, as procedures performed to frequently can increase risks to patients, are expensive, and lengthen waiting lists,” Dr Symonds and colleagues wrote.
“Continuous monitoring of and education about colonoscopy surveillance intervals for patients at elevated risk of CRC promotes adherence to recall guidelines and efficient use of limited endoscopy resources.”