Provider’s Adherence to Current G uidelines for Colorectal C ancer Screening

1. Provider’s Adherence to Current Guidelines for Colorectal Cancer Screening

2. GRADUATE STUDENTS Haley Hyde Jessica Fordham Jena Hamm

3. BACKGROUND • Colorectal cancer is a leading cause of cancer related deaths every year. • 150,000 Americans will be diagnosed with Colorectal cancer each year. • 75% of those diagnosed will have NO risk factors. • The direct medical cost of Colorectal cancer was estimated by the CDC to be $20 billion by the year 2020.

4. Purpose • The purpose of our research was to ascertain healthcare provider’s adherence with the current guidelines for Colorectal Cancer Screening (CRCS) by the American Gastroenterological Association (AGA).

5. Research Questions • Are providers adhering to AGA guidelines regarding CRCS? • Are providers consistent with AGA guidelines for CRCS? (NP’s/Physicians) • Are patients being offered education at age 50-75 for CRCS?

6. Definition of Terms • Providers Theoretical. The nurse practitioner, physician’s assistant, or physician whom first addressed a patient and identified a problem in his or her health (Taber’s Cyclopedic Medical, 2009). Operational. Nurse practitioners or physicians who educate, perform, or refer patients for CRCS. • American Gastroenterological Association Guidelines Theoretical. Early detection of CRC and adenomatous polyps for asymptomatic and average risk adults age 50-75 by the utilization of FOBT annually, flexible sigmoidoscopy every five years optionally if patients declines a colonoscopy, or colonoscopy every 10 years (AGA, 2008). Operational. Set of guidelines developed by the AGA for CRCS. • Education Theoretical. AGA guidelines that providers offer to patients about screening options for CRCS. Operational. Documentation noted of options, risk, and benefits in regard to CRCS guidelines.

7. Theoretical Framework • The theoretical framework for this research is Nola Pender’s Health Promotion Model (HPM). The graduate students used the HPM in the research study on CRCS adherence rates by primary care providers. The HPM is important in promoting healthy lifestyles by allowing individuals to actively regulate their own behavior. The HPM was an important part in our research in promoting early detection and prevention (Pender & Pender, 1980)

8. Supporting Literature • According to Shokar et al. (2010), minority groups have a higher than average incidence and mortality of colorectal cancer and a lower rate of screening (Shokar, Carlson, & Weller, 2010). • Both provider types NP/physician need improvement in FOBT practices. The desired choice of CRCS was colonoscopy, yet FOBT were the most commonly used screening method during in-office digital rectal exams (Menees et al., 2009). • Menees et al. (2009) discovered gynecologists routinely ordered or performed CRCS compared to nurse practitioners. Most providers acknowledged the use of CRCS but many were not compliant with the current guidelines. • Colonoscopy has become the number one recommended screening study for CRCS. Information was based on physician reports of their recommendations and practices with no validation on their self-reported data (Klabunde et al., 2009). • Providers need to increase options for screening to make the patients more compliant and to facilitate a better strategy to prepare patients for their preferred screening procedure (McQueen et al., 2009).

9. Correlation between Findings and Review of Literature Differences • Decrease in compliance rates among physicians compared to nurse practitioners in accordance with AGA guidelines. • The older patient population received more education or documentation of education by the primary health care provider. • Lack of use of FOBT as a screening option for CRCS. Similarities • African Americans are least likely to be screened for Colorectal Cancer screening. • Lack of patient education and screening regarding CRCS guidelines documented in the primary care offices. • Colonoscopy was the most commonly used screening option for CRCS.

10. Methodology Design: A cross-sectional retrospective chart review Setting: Three clinics located in the rural southeastern U.S. Population: 300 medical records (charts) Sample: Patient’s ages 50-75 who presented in the clinic for an annual well care visit or related screening. The first 100 most recent charts in each clinic were selected by the medical records staff using the ICD 9 code for annual well exam. No chart was selected dated earlier than the year 2008.

11. Data Sheet Collection • Demographics– Age, Gender, Race • Provider Type– Nurse Practitioner, Physician • Sample-Patients age 50-75 • Documentation of screening test done • FOBT • Sigmoidoscopy • Colonoscopy • Documentation of education, referral ,or refusal.

12. Age groups were identified to show a pattern of consistency in education

13. Out of 300 patients that had a test performed or results documented in the chart, colonoscopy was documented in 36% (108) patients. The no test category represented refusal, referral, or education not documented by the provider. Test Categories

14. In the data collected, 70.4% were physician visits 29.6% were nurse practitioner visits. With one degree of freedom, the Chi- square test statistic is 38.07 while the Chi Square critical value is 6.36 at the 1% level. Since the test statistic is greater that the critical value we reject the hypothesis that Physicians and Nurse Practitioners offer the same education.

15. Nurse Practitioner’s documented education of CRCS on 70% of patient visits.

16. Physician Adherence Physicians documented education for CRCS out of 31% of patient visits

17. Patient Education by Age Groups Of records examined, 43% (128) were educated. The graph shows that as age increases, documentation of education on CRCS guidelines also increase.

18. . Outcomes based on findings • The outcomes of the research shows that the physicians documented education based on CRCS guidelines on 31% of the patient visits and nurse practitioners documented education on 70% of the patient visits • Of the ages 70-75, 67% were educated. This incidental finding led the graduate students to believe that as the age of the patient increases so does the importance of education/documentation of CRCS for that patient.

19. Importance of NP role • To identify screening needs of our patients in order to promote health and well-being. • Educate our patients on the importance of screenings. • Offer available resources to our patients based on their individual health screening needs.

20. Recommendations • As a recommendation for further research, it is advised to not only address CRCS status, but to look into adherence by the patient after the initial recommendation was made by the provider. • Research should also be conducted utilizing a larger sample size so the population could be sufficiently represented. • It is also advised in future research to conduct an equal amount of investigation between NP’s and the Physician.