A nurse-led model of colorectal cancer surveillance has shown improved outcomes for patients, new research has found.
The study published in the Medical Journal of Australia showed improved compliance with guideline recommendations to 97%, a reduction in the number of unnecessary colonoscopies and a reduced number of cases progressing to cancer.
The early diagnosis of colorectal cancer (CRC) is vital and can be achieved with screening by faecal occult blood tests (FOBT) or colonoscopy, write the authors led by Dr Erin Symonds, senior scientist at the Flinders Centre for Innovation in Cancer (FCIC) at Bedford Park.
“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 researchers say in their report.
“Screening and surveillance guidelines aim to optimise the effectiveness of CRC prevention, with surveillance intervals generally ranging between one and five years.”
Compliance with those recommendations is poor, however, with as many as 89% 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”.
Dr Symonds joined fellow FCIC, SA Health and Flinders University College of Medicine and Public Health researchers Kalindra Simpson, Michelle Coats, Angela Chaplin, Karen Saxty, Jayne Sandford, Matthew Flinders Distinguished Professor and Global Gastrointestinal Health expert Emeritus Professor Graeme Young, Dr Charles Cock, Professor Robert Fraser and Dr Peter Bampton in the study.
It focused on two public hospitals and four private South Australian metropolitan hospitals where the SCOOP program has run for more than 10 years.
After early success (compliance by 2000 had increased from 46% to 96%), 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 three-month period.
In the nurse-led model compliance with surveillance guidelines was achieved in 97.1% of cases, and in the physician-led model, compliance reached 83%, 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 say.
“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.”