Crc Capstone Blue 2

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This presentation holds the results of my Capstone Project research on colorectal cancer screening knowledge and behaviors.

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  • HBM — major conponents: perceived susceptibility, severity, benefits, barriers, motivation and modifying factors.
  • 66-item tool. Scored by the number of correct words from entire tool: 0 – 18 3rd grade or below, 19 – 44 4th to 6th grade, 45 – 60 7th to 8th grade, 61 – 66 9th grade or above
  • i.e. sample deficiencies, design problems,
  • 90% AA, 5%Cau, 1% Hisp, Asian, and Other, 2% no resp
  • 30 males, 82 females
  • M&M=Medicare and Medicaid
  • Women fared significantly better on both the pre- and post-test. As it relates to educational level, there was a strongly significant difference in performance on the tests and the REALM assessment.
  • Patients ARE able to learn.
  • Crc Capstone Blue 2

    1. 1. Colorectal Cancer: Patient Knowledge, Attitudes, and Screening Behaviors<br />Capstone Project Presentation<br />by<br />Sharon D. Brantley, RN, BSN<br />in partial fulfillment of the<br />Requirement for the Degree<br />MASTER OF SCIENCE IN NURSING<br />December 2, 2009<br />
    2. 2. Colorectal Cancer (CRC)<br />2nd leading cause of all cancer deaths (Bazensky, Shoobridge-Moran, & Yoder, 2007)<br />Ranks 3rd in prevalence of behind prostate and lung CA in men and breast and lung CA in females (Centers for Disease Control, 2007)<br />Affects men and women of all races equally (Bazensky et al., 2007)<br />Approximately 150,000 new cases each year (American Cancer Society, 2007)<br />Over 50,000 die from CRC each year (ACS, 2007)<br />
    3. 3. CRC: The Problem<br />Represents significant public health risk<br />Early detection and polyp removal could reduce mortality by 50% (Smith, Cokkinides, & Eyre, 2004)<br />Only about 50% of Americans received recommended screening (National Cancer Institute, 2007)<br />
    4. 4. Literature Review<br />Limited knowledge or low literacy is related to negative attitudes about CRC and CRC screening methods (Dolan et al., 2004)<br />377 male veterans in VA Medicine Clinic<br />Survey based on Health Belief Model (HBM)<br />Completed CRC questionnaire + REALM<br />Assessed ability to name or describe CRC screening tests: Fecal Occult Blood Test (FOBT), flexible sigmoidoscopy (flex sig), or colonoscopy<br />Felt FOBT was messy, inconvenient, and would not use FOBT kit if provided by MD <br />
    5. 5. Literature Review<br />Clients with limited literacy were less likely to be knowledgeable about CRC (Miller, Brownlee, McCoy, & Pignone, 2007).<br />Pilot study of 50 subjects at internal medicine clinic in teaching facility<br />Survey of 26 questions about CRC screening and personal learning methods about health topics + REALM assessment<br />Researchers explained screening tests and asked when subjects had last received: FOBT, flex sig, or colonoscopy<br />
    6. 6. Need for this Study<br />Current low screening rates are believed to result from fear of cancer and fear of the tests associated with screening for CRC (Ueland, Hornung, & Greenwald, 2006)<br />One-on-one education session produced significant change in beliefs about CRC prevention and CRC screening (Ueland, Hornung, & Greenwald, 2006). <br />
    7. 7. Theoretical Framework: Health Belief Model<br />Developed in the 1950’s by four psychologists: Hochbaum, Kegeles, Leventhal, and Rosenstock<br />US Public Health Service wanted to explain lack of participation in free disease prevention programs<br />
    8. 8. Conceptual Definitions<br />Education = the process of acquiring knowledge through engagement in the interdependent activities of teaching and learning. <br />Knowledge = what is known about CRC and CRC screening methods.<br />Compliance = adherence to the advisement or health guidelines provided by a healthcare practitioner. <br />
    9. 9. Hypotheses<br />#1: The knowledge level of patients participating in an educational session on colorectal cancer screening will change upon completion of the class.<br />#2: The colorectal cancer screening compliance behaviors in patients who participate in an educational session on colorectal cancer screening will change upon completion of the class.<br />
    10. 10. Research Design<br />Descriptive, pretest-posttest design<br />After consent was given, subjects completed demographic form and pretest.<br />After class, posttest given and REALM assessment completed.<br />
    11. 11. Sampling<br />Convenience sampling of clients at a large metropolitan hospital serving a disproportionately indigent population through use of flyers and investigator recruitment<br />Potential subjects were scheduled to attend a class on CRC and CRC screening methods<br />
    12. 12. RAPID ESTIMATE OF ADULT LITERACY IN MEDICINE (REALM)©Terry Davis, PhD ∙ Michael Crouch, MD ∙ Sandy Long, PhD (1991)<br />Sample Tool:<br />
    13. 13. CRC Class Content<br />Colon cancer: incidence, risk factors, development, symptoms<br />CRC screening: FOBT, sigmoidoscopy, colonoscopy<br />Colonoscopy in detail<br />DECISION to make appt<br />Prep instructions<br />Day of procedure: sequence of events<br />
    14. 14. Assumptions<br />Subjects provide accurate self-reported information.<br />Subjects honestly report their beliefs and opinions and make a valid attempt to answer questions correctly.<br />Subjects retain knowledge over time.<br />
    15. 15. Limitations<br />Small sample size (n=112)<br />Localization of the sample<br />Learning environment—room size, technical difficulties<br />Quasi-experiment design—no control group<br />Homogeneity of population<br />
    16. 16. Data Collection<br />Data collected<br />Tests graded and REALM assessments scored<br />Data coded and entered into SPSS file for analysis<br />
    17. 17. Sample by Age<br />
    18. 18. Sample by Ethnicity<br />
    19. 19. Sample by Gender & Marital Status<br />
    20. 20. Sample by Educational Level<br />
    21. 21. Sample by Household Income<br />
    22. 22. Sample by Insurance Status <br />M&M = Medicare & Medicaid<br />Comm = Commercial<br />
    23. 23. Sample by REALM Score<br />
    24. 24. Data Analysis: Descriptives<br />
    25. 25. Data Analysis: Findings<br />Paired t-Test<br />
    26. 26. Data Analysis: Spearman ρ Correlations<br />** Correlation significant at 0.01 level (2-tailed)<br /> * Correlation significant at 0.05 level (2-tailed)<br />
    27. 27. Data Analysis: Spearman ρ Correlations<br />** Correlation significant at 0.01 level (2-tailed)<br /> * Correlation significant at 0.05 level (2-tailed)<br />
    28. 28. FINDINGS: Hypotheses<br />SUPPORTED – Significant change in knowledge<br />#1: The knowledge level of patients participating in an educational session on colorectal cancer screening will change upon completion of the class.<br />UNABLE TO ASSESS – Colonoscopy appointments were several months after class.<br />#2: The colorectal cancer screening compliance behaviors in patients who participate in an educational session on colorectal cancer screening will change upon completion of the class. <br />
    29. 29. Implications for Nursing<br />Knowledge regarding current CRC screening guidelines<br />Diverse and interactive teaching and learning methods<br />Establish cues to identify low literacy clients<br />Tailor educational activities and patient education materials to meet lower literacy levels<br />
    30. 30. Recommendations for Future Study<br />Replication on a larger scale with diverse populations<br />Follow-through on actual subject compliance with screening<br />Longitudinal studies to examine long-range compliance and knowledge retention<br />Investigation of different teaching modalities and media<br />
    31. 31. ACKNOWLEDGMENTS<br />Dr. Linda Streit—Capstone Project Advisor<br />Dr. Linda Kimble—Statistical Analysis Support<br />Greta Baldwin-Mason, RN, MSN—Data Coding<br />Dr. Henry Olejeme—Physician Sponsor<br />Gertrude Dunlap, LPN—Research Assistant<br />

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