How to quote
Fernández Landa MJ. Enfermeras en la prevención y control del cáncer colorrectal, de la teoría a la práctica. Metas Enferm mar 2021; 24(2):3-6. Doi: https://doi.org/10.35667/MetasEnf.2021.24.1003081713
Mª José Fernández Landa
Enfermera. Doctora en Salud Pública (UPV/EHU). Osakidetza-SVS.
Contact email: firstname.lastname@example.org
Versión en Español
Colorectal cancer is the term used for those tumours which originate in the colon or rectum. Its natural history shows that it usually starts like a small polyp which, on some occasions, becomes malignant. Prevention of this type of cancer must always be directed to cover all levels, starting by Primary Prevention. Besides, currently we have effective screening procedures for this type of cancer in our setting, allowing its detection at early stages, as well as pre-malignant lesions which, when removed early, will reduce its progression to invasive cancer (1). In this sense, the objective of the Colorectal Cancer Screening Program of the Basque Country (2) is to reduce both the incidence and the mortality due to this type of cancer, offering its participants a quality test that protects their safety. Although it is necessary to point out that screening not only has beneficial effects, such as those described previously; but also shows adverse effects, such as false positive results, false negative results, and complications derived of invasive tests; the latter are irreversible, in some cases (3). This screening is targeted to 50-to-69-year-old women and men, living in the Basque Country; and the screening test used is Fecal Occult Blood Testing (FOBT) performed every two years, followed by a colonoscopy for diagnostic confirmation, in case the test shows a positive result (2).
After years of implementing the screening tests in Spain, it is worth asking about the position of nurses, because we are the only professionals accompanying patients throughout this process. We nurses are actively involved in the colorectal cancer screening, both in Primary Care and in the Endoscopy Units, allowing an improvement of the results obtained in the screening, as well as satisfaction among participants.
On one hand, we Primary Care nurses are responsible, after the medical consultation, to provide information on aspects such as a reinforcement of the medical information received, clarification of doubts, and information about the diet required, the preparation before colonoscopy, and potential post-colonoscopy complications. This is conducted in a specific visit for those persons with positive results in FOBT who will undergo colonoscopy for diagnostic confirmation. This process of care is relevant for the quality of the procedure, because all the information relative to the test and colonic preparation is provided in our visit, and it will be highly important in terms of the final quality of the colonoscopy. For this reason, we must have the adequate tools and training. All the information materials provided by nurses can be accessed through the digital clinical record, but it is not possible to conduct a systematic record of all aspects covered in this specific visit; therefore, regardless of our willingness to inform and conduct this visit in a structured manner, there is no current specific protocol. Likewise, this specific consultation enables the screening of asymptomatic population, allowing to conduct the preventive activities included in the PAPPs (Preventive Activities and Health Promotion Program) (4). This visit is considered adequate to perform the preventive activities that are also associated with colonoscopy quality and results, such as weight and height control, toxic habits, lifestyle, and medication control. Moreover, we community nurses have the advantage of closeness to persons and families, and therefore our advice and recommendations can have a higher impact on their follow-up.
On the other hand, we play an important role in Endoscopy Units in terms of the quality of the procedure, developing different activities under protocol before, during and after the procedure, such as checking all aspects regarding patient identification and safety, providing assistance in the endoscopy process, and post-colonoscopy care (5,6). We must mention that in other European Union countries, we nurses have been authorized for many years now to perform colonoscopies under the supervision of Gastroenterologists; this is an extraordinary fact, through which we have demonstrated that we are able to conduct these procedures independently, obtaining adequate results in terms of the quality standards from the Clinical Practice Guidelines, and a high level of satisfaction among participants (7-9).
After some improvement interventions associated with the quality of screening colonoscopy, we know that the active participation of nurses throughout the process allows to improve the results obtained, achieving a major proportion of adequate colonic preparations, and guaranteeing care before, during and after the colonoscopy, thus reducing complications and improving the satisfaction of those persons undergoing the test (10). For this reason, it is essential to empower nurses for leading interventions that will allow to improve significant aspects of the quality of screening colonoscopy. It is important to carry out actions that will allow us to make changes and improvements in this regard, because we are essential professionals in the entire screening care process, from the recommendations provided in our visits targeted to Primary Care, going through colonoscopy preparation, and finally offering care at Endoscopy Units.
Even so, we must highlight that, overall, this process of care has not been developed sufficiently, allowing us to keep, among other aspects, a record of activities that can contribute to better information among people, and optimal colonoscopy results; likewise, this would allow a reduction in variability, the standardization of procedures, and the evaluation of their effectiveness.
As a final reflection, it is worth remembering that we nurses are the only professionals involved in the entire screening process from its start, even before screening begins, with recommendations on Primary Prevention, until the end, after the colonoscopy has been performed. Therefore, we must think about everything that is still left for us to do in other aspects of health and people care; although for this, training and research will be essential, that is to say, evidence-based practice.
- Quintero E, Alarcón-Fernández O, Jover R. Controles de calidad de la colonoscopia como requisito de las campañas de cribado del cáncer colorrectal. Gastroenterol Hepatol 2013; 36(9):597-605.
- Programa de Cribado de Cáncer Colorrectal de la CAPV. Programa de cribado de cáncer colorrectal [internet]. 2016 [citado 8 nov 2020]. Disponible en: https://www.osakidetza.euskadi.eus/programa-de-prevencion-del-cancer-colorrectal/ab84-oescacon/es/
- Barrett BP, McKenna PJ. Communicating benefits and risks of screening for prostate, colon, and breast cancer. Fam Med 2011; 43(4):248-53.
- SemFYC-PAPPS. Programa de actividades preventivas y de promoción de la salud [internet]. [citado 8 nov 2020]. Disponible en: http://papps.es/
- Jover R, Alarcón O, Brullet E, Bujanda L, Bustamante L, Campo R. Guía de práctica clínica de calidad en la colonoscopia de cribado del cáncer colorrectal. Madrid: EDIMSA; 2011.
- Rodríguez M, Delgado R. Actuación de enfermería en la colonoscopia y polipectomía endoscópica. AEGASTRO 2005.
- Maule WF. Screening for Colorectal Cancer by Nurse Endoscopists. N Engl J Med 1994; 330(3):183-7.
- Schoenfeld PS, Cash B, Kita J, Piorkowski M, Cruess D, Ransohoff D. Effectiveness and patient satisfaction with screening flexible sigmoidoscopy performed by registered nurses. Gastrointest Endosc 1999; 49(2):158-62.
- Putten PG van, Borg F ter, Adang RPR, Koornstra JJ, Romberg-Camps MJL, Timmer R, et al. Nurse endoscopists perform colonoscopies according to the international standard and with high patient satisfaction. Endoscopy 2012; 44(12):1127-32.
- Fernández Landa MJ, Portillo Villares MI, Bilbao Iturribarria MI, Idígoras Rubio MI, Regulez Campo V, Martínez Indart L. Impacto de una intervención en las consultas de Enfermería de Atención Primaria para la mejora de la calidad de la colonoscopia de cribado. Metas Enferm mar 2020; 23(2):16-22.