NUR 590 Benchmark EBP Project PICOT Paper Essay
NUR 590 Benchmark EBP Project PICOT Paper Essay
NUR 590 Benchmark EBP Project PICOT Paper 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.
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.
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.
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
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.
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.
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