Clinical guidelines have become commonplace in medical practice; many professional organizations have already published such guidelines. Most well-designed clinical guidelines are developed using the specified method, which incorporates the principles of evidence-based medicine and consensus recommendations of a panel of experts. Although clinical guidelines may describe the standard practice, they do not, by themselves, set a standard of care for a particular patient. Most clinical guidelines are based on prior research on a clinical question. In this assignment, I will formulate a PICOT question and review the literature to help me answer it.
A Clinical Question
To formulate my question, I chose the topic of colorectal cancer prevention in the elderly. I determined this population because the risk of colon cancer increases with age. The disease, which is quite rare before the age of 40, is more common in people between the ages of 60 and 75, regardless of gender. About one in three patients already have liver metastases at the time of diagnosis. Symptoms are pretty varied and depend on various factors, such as the location of the tumor, its diameter, and the presence or absence of obstruction or bleeding. This means that cancer manifestations will have similarities with those of many other diseases of the abdomen or intestine. On this basis, the disease is hazardous and difficult to define in its early stages. This is why patients who are at risk should have regular preventive examinations. The primary method of diagnosing colorectal cancer is through instrumental examination methods, such as recto-romanoscopy, colonoscopy, and rhinoscopy.
Endoscopic methods allow for detailed examination of the state of the intestinal wall mucosa and existing tumors and biopsy for subsequent histological and cytological examination. Diagnosis of rectal cancer is made only based on cancer cell detection at the cytological examination of a biopsy specimen. In my clinical question, I would like to elaborate on the effectiveness of colonoscopy for the prevention of the disease in question. Therefore, my clinical question is formulated as “Is colonoscopy an effective diagnostic measure to prevent colorectal cancer in the elderly?” According to the PICOT system, there are several components to my clinical question. The patients, in my case, are adults 60 years of age or older. The intervention is a diagnostic colonoscopy for preventive purposes. The comparison refers to not performing a diagnostic colonoscopy in these patients. The result would be a reduction in the incidence of colorectal cancer in the study group. Finally, the time frame for the study would be one year. Thus, it will be possible to study the fictitiousness of the proposed method for reducing the incidence in the long term.
My clinical problem is primarily because cancer is a disease that is very difficult to put into remission. The earlier it is diagnosed, the better the patient’s chances of recovery. Therefore, the scientific community is actively studying treatment methods and effective methods of diagnosing colorectal cancer. This is confirmed by numerous articles on this topic, some of which I have included in my literature review. I would like to review the first article “Colon cancer: A clinician’s perspective in 2019” by Ahmed Monjur. This article talks about the different treatments and diagnoses of colon cancer. In addition, the article focuses on lowering the age of the risk group for the disease. Although the central part is still people over the age of 50, an increasing proportion of the population in their forties is affected by the disease. The author singles out colonoscopy as “the gold standard of colon cancer screening” (Monjur, 2020). He establishes that this procedure is most effective not only for monitoring cancer symptoms but also for detecting adenomas in the colon.
Second, I would like to review the article “Effectiveness of screening colonoscopy in reducing the risk of death from the right and left colon cancer: a large community-based study” by Doubeni et al. It is a large-scale study of the efficacy of colonoscopy in reducing the risk of death from colorectal cancer. The article focuses on the incidence of right-sided colon cancer because colonoscopy in this area is controversial in the scientific community. The study compared cancer incidence in people with and without a colonoscopy and corresponded these results with patients who had already died from the disease. The result showed that colonoscopy reduced the risk of colorectal cancer mortality by 67% (Doubeni et al., 2018). Screening the right half of the colon reduced the risk of morbidity by 65%. Because of this, we can conclude that colonoscopy is an effective method of reducing the risk of cancer for both halves of the colon.
The article “Colorectal cancer and nutrition,” written by Kannan Thanikachalam and Gazala Khan, also focuses on rejuvenating the age of people susceptible to colorectal cancer. The authors aimed to identify the leading causes and methods of diagnosing this disease. Thus, the article highlights patient nutrition as one of the leading causes of cancer development. “Nutrition may play both a causal and protective role in the development of colon cancer” (Thanikachalam & Khan, 2019). Consumption of certain foods is directly involved in the pathogenesis of colon cancer. The authors also call coloscopy the most effective diagnostic tool because it detects any pathological changes in the early stages.
An interesting study is presented in the article “Race and gender differences in awareness of colorectal cancer screening tests and guidelines among recently diagnosed colon cancer patients in an urban setting”. Leslie Carnahan et al. questioned whether people with already diagnosed colon cancer are aware of screening methods. In addition, the researchers sought to find out whether awareness was related to the way cancer was detected. According to the results, patient awareness was relatively low – only 20% of patients knew the guidelines for colonoscopy (Carnahan, 2021). Thus, one can conclude that patients have very little awareness of the need for preventive measures, increasing morbidity risk.
The final study I would like to review is “An overview of 25 years of incidence, treatment, and outcome of colorectal cancer patients” by Brouwer et al. It summarizes the dynamics of change in colorectal cancer treatment, incidence, and diagnosis. According to its results, the incidence of colorectal cancer was found to have increased. However, the 5-year relative survival rate increased significantly from 53% to 62% (Brouwer et al., 2018). This is due to constant innovations in the diagnosis and treatment of this disease, including the active use of colonoscopy.
Identification of the Beds Supportive Article
The article that best supports my nursing interventions is “Effectiveness of screening colonoscopy in reducing the risk of death from the right and left colon cancer: a large community-based study” by Doubeni et al. It is helpful in that it provides an extensive description of the use of colonoscopy in diagnosis and discusses its pros and cons. Unlike the other four articles, it provides quantitative statistical data specifically on the use of diagnostic colonoscopy. The other articles do not focus as much on the procedure and provide broader data, such as decreased or increased incidence. That is why this article is the most supportive and informative for my research.
Brouwer, N., Bos, A., Lemmens, V., Tanis, P., Hugen, N., Nagtegaal, I., Wilt, J., & Verhoeven, R. (2018). An overview of 25 years of the incidence, treatment, and outcome of colorectal cancer patients. International journal of cancer, 143(11), 2758-2766. Web.
Carnahan, L. R., Jones, L., Brewer, K. C. et al. (2021). Race and gender differences in awareness of colorectal cancer screening tests and guidelines among recently diagnosed colon cancer patients in an urban setting. Journal of Cancer Education, 36(1), 567–575. Web.
Doubeni, C. A., Corley, D. A., Quinn, V. P., et al. (2018). Effectiveness of screening colonoscopy in reducing the risk of death from the right and left colon cancer: a large community-based study Gut, 67(2), 291-298. Web.
Monjur, A. (2020). Colon cancer: A clinician’s perspective in 2019. Gastroenterology research, 13(1), 1–10. Web.
Thanikachalam, K., & Khan, G. (2019). Colorectal cancer and nutrition. Nutrients, 11(1), 164. Web.