Nurses improve compliance with cancer surveillance

A nurse-led model of colorectal cancer surveillance has led to more compliance with current guidelines and has proved more successful than its physician-led counterpart, new research has found.

The study, published in the Medical Journal of Australia, showed the model also brought about a reduction in the number of unnecessary colonoscopies and a reduced number of cases progressing to cancer.

Early diagnosis has a major impact on survival and can be achieved by screening with faecal occult blood tests or colonoscopy, the researchers said. But they added as many as 89 per cent of patients receive inappropriate surveillance, in most cases colonoscopy before the recommended date.

For the study, the reseachers focused on two public hospitals and four private South Australian metropolitan hospitals where the Southern Co-operative Program for the Prevention of Colorectal Cancer (SCOOP) program has run for more than 10 years.

Prior to the introduction of the nurse-led model in public academic hospitals in 2000, adherence to guidelines was 46 per cent, but had jumped to 96 per cent by 2002.

The study audited the nurse-led model in public academic hospitals, in which nurses make recommendations based on NHMRC guidelines that are then confirmed by a physician, and another model in private hospitals in which the specialist physician manages the entire process.

The team found that the nurse-led model achieved a better rate of compliance with surveillance guidelines than that physician-led model, with rates of 97.1 per cent and 83 per cent respectively.

Study lead Dr Erin Symonds from the Flinders Centre for Innovation in Cancer and her colleagues said: “Having a process in place that allows for long-term compliance with surveillance guidelines will promote optimal health care, as procedures performed too frequently can increase risks to patients, are expensive, and lengthen waiting lists.

“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.”