The Translation Science Project
The current translation project focuses on colorectal cancer. The translation science project is a contribution to the efforts towards the improvement of the compliance with the screening protocol of colorectal cancer for Latin America patients aged between 50 and 70 years in a community health setting in Miami-Dade. The proposed project’s objective will help to determine how health care staff utilizes evidence-based practices (EBP) CRC screening protocol to improve compliance among Latin population aged 50 to 70 years old.
In this project, the population of interest will consist of Latin American patients aged between 50 to 70 years old from a community health clinic in Miami-Dade. Latin American individuals belong to the minorities in the United States. This population will include White Hispanics and non-White Hispanics, or Spanish-speaking Hispanics and English-speaking Hispanics. Moreover, the study will include a retrospective chart audit to compare the CRC study compliance with Latin American individuals who participated in the study during January to June 2015.
One of the most common causes of mortality in the United States is colorectal cancer (CRC). It is the fourth top cause of mortality in the category of non-cutaneous cancer and second in the category of cancer in general. The CRC screening is an effective way to reduce the increasing trend of prevalence and mortality of the disease (Brown, 2014). Patients and healthcare professionals have several screening options due to the presence of cheap and effective colorectal screening tests (Miller, et al., 2011). According to the American Cancer Society (2014), the likelihood of acquiring CRC increases with age. Statistically, it reveals that the elderly population comprises approximately 90% of new cases and 93% of deaths due to colorectal cancer.
Despite numerous studies that demonstrate the affectivity of screening in preventing the occurrence of CRC because its capacity to detect polyps, only 59% of elderly in the United States aged 50 years old and older report to have undergone the CRC screening. In 2010, the 47 % of Latin patients aged 50 years old and older had the CRC screening. Thus, the American Cancer Society already ranked CRC as a major priority (American Cancer Society, 2014).
Synthesis of Evidence
Various scholars have contributed to the understanding of the significant factors behind the low compliance with screening protocols for colorectal cancer. Miller et al,. (2011) are some of the scholars who have contributed to the knowledge and understanding of the reasons for low compliance with the screening protocols. The authors argue that one of the contributing factors is the low health literacy among the patients aged between 50 and 74 years. Low health literacy affects the decision-making ability of an individual (Schroy, Mylvaganam & Davidson, 2014). Low health literacy also affects the health seeking behaviors of individuals. Ignorance of the seriousness of certain diseases and the fact that early screening can improve the chances for a successful treatment affects the compliance with the screening protocols negatively. The analysis of the data collected shows that these factors are significant. For instance, the researchers found that 56% of the study population had low health literacy.
There is agreement across the board regarding the influence of low health literacy on the low compliance rates for screening for colorectal cancer. Daly, Xu & Levy (2014) highlights the low literacy levels of the progression of cancer from one stage to another. The low literacy levels affect the knowledge of the prognosis of the condition as well as the treatment options available at different stages. Given the importance of the timeliness of diagnosis to the successful treatment of cancer; the low healthy literacy rates not only undermine the compliance with screening protocols for colorectal cancer but also the probability for a successful treatment. For instance, Daly et al., (2014) find that the study population was uninformed about how an adenoma progressed to a carcinoma and the importance of appropriate testing in interrupting the sequence of progression.
The significance of health literacy in the compliance with screening protocols for colorectal cancer has been underscored by Miller et al,. (2011) and Daly et al., (2014). Other researchers also agree with this group of scholars. An article review by Garcia, Buylla, Nivolas-Perez & Quintero (2014) found that addressing low health literacy was important in improving the uptake of screening for colorectal cancer. While also highlighting the other factors that influence the compliance with the screening protocols, Garcia et al., (2014) emphasized the role of public awareness of the importance of screening and knowledge of colorectal cancer on the uptake of screening.
Garcia et al., (2014) also highlighted the positive correlation that exists between the knowledge of colorectal cancer, the perception of risks, and the attitudes of the public with an increased willingness to take up screening for colorectal cancer. The operational definition of the perception of risk was the perceived benefits of the screening for colorectal cancer and the barriers that prevent the uptake of screening (Garcia et al., 2014). This implies that any interventional programmes aimed at improving the compliance with the screening protocols for colorectal cancer should focus on the modification of attitudes and the improvement of the public knowledge about colorectal cancer and the important role that screening plays in its treatment (Yim et al., 2012). The modification of the attitudes is achieved by offering knowledge to neutralize the previously held beliefs. The findings by Garcia et al., (2014) mimic those by Miller et al,. (2011) and Daly et al., (2014). Collectively, the three groups of researchers, using empirical and theoretical perspectives, have found that the low health literacy is a significant deterrent to the compliance with the screening protocols for colorectal cancer.
The theme of low healthy literacy and its influence on the compliance with the screening protocols is central to the study by Sentell, Tsoh, Davis, Davis & Braun (2015). Sentell et al., (2015) found that low health literacy was correlated with low uptake of cancer screening. Even though the study population on which Sentell et al., (2015) focused was different, the researchers based their study on the background knowledge that applies across different population groups. Their study is important because it allows the comparison of trends in the Latin American population and the Chinese American population to determine the significance of low health literacy as a factor in the compliance with screening protocols for colorectal cancer.
The researchers performed an observational study where the data was collected using population-based surveys and interviews (Sentell et al., 2015). The researchers measured low health literacy and low English proficiency as some of the variables. They found that the compliance with screening for colorectal cancer was at 47.9% for the males in the population and 54.2% of the females in the population (Sentell et al., 2015). The researchers also found that the presence of low health literacy and low English proficiency was associated with a reduced likelihood of compliance with screening protocols for colorectal cancer at an odds ratio of 0.49 when compared with the people who did not have language barriers (Sentell et al., 2015).
The researchers conclude that low health literacy and low English proficiency were significantly and negatively associated with the low compliance with the screening protocols for colorectal cancer. The other factor that was highlighted was the access barriers to physicians (Sentell et al., 2015). Consequently, the researchers concluded that the most approach to improving the compliance with the screening protocols for colorectal cancer was to address the low health literacy (Sentell et al., 2015). This requires the use of education on colorectal cancer, the importance of screening, and the role of screening in the early detection and subsequent treatment of the disease.
The Proposed Management Approaches
The low compliance with the screening protocols for colorectal cancer despite the benefits can be managed through some approaches. The proposed approaches are derived from evidence from empirical studies. For instance, following the empirical study performed by Miller et al,. (2011), the scholars proposed the use web-based patient decision aids. The rationale for the proposal of this management approach is based on the knowledge that low health literacy among the patients aged between 50 and 70 years contributed significantly to the underutilization of colorectal cancer screening.
The randomized control trial performed by Miller et al,. (2011) showed that this management approach was effective. When compared with the people in the control group, more of the participants who were assigned to the experimental groups (84%) than those in the control group (55%) showed a higher preference for colorectal cancer screening. Additionally, more of the participants in the experimental group (52%) compared to the participants in the control group (20%) recorded increased readiness to comply with the screening protocols for colorectal cancer. Miller et al,. (2011) also found the participants who used the decision aid (experimental group) (30%) compared with control group (21) ordered for the screening tests for colorectal cancer and 19% of the participants who used the decision aid compared to 14% of the patients in the control group used completed the tests.
The education model proposed by Miller et al,. (2011) is also supported by other researchers with the aim of improving the compliance to the screening protocols for colorectal cancer. Even though the mode of delivery might differ from one scholar to another, there is a general agreement that health education will help increase health literacy, which will, in turn, improve the compliance with the screening protocols for colorectal cancer. Daly et al., (2014) tested a model for educating the patients on the progression sequence of adenoma to carcinoma and the importance of appropriate testing in interrupting the progression sequence.
The three-dimensional model of the colon with polyps and cancer was given to physicians. The response from the participants was that the three-dimensional models of the colon were very appropriate for patient education on the need for periodic screening for colorectal cancer (Daly et al., 2014). 44% of the physicians who were provided with the model reported using the model in patient education. The model was also beneficial in education the staff in the physician offices to promote the willingness of the patients to undergo colonoscopies. The model was also used to demonstrate to the patients and staff the need to undergo screening for colorectal cancer screening (Daly et al., 2014).
Informatics plays a significant role in improving the compliance with the screening protocols for colorectal cancer. This was demonstrated adequately by Mitsutake, Shibata, Ishii & Oka (2012). Mitsutake et al., (2012) acknowledged the importance of the internet in societies which are increasingly developed. Mitsutake et al., (2012) also acknowledged the association between low health literacy with low compliance with the screening protocols for colorectal cancer. Mitsutake et al., (2012) reported the paucity of knowledge regarding the relationship between eHealth literacy and the compliance with screening practice and knowledge about colorectal cancer.
The researchers sought to fill this gap in information by performing study where they established the correlation between eHealth literacy and the knowledge of colorectal cancer, and the compliance with the screening protocols for colorectal cancer (Mitsutake et al., 2012). The researchers found a positive correlation between eHealth literacy and the knowledge of colorectal cancer. The implication of this finding from an interventional perspective is that informatics plays a key role in improving awareness of colorectal cancer (Mitsutake et al., 2012). This further implies that the Internet can be used effectively to disseminate information, especially considering the increase in the significance of the internet in this technological era. The researchers also controlled the findings for the sociodemographic factors because the regression model showed that they significantly influenced the eHealth literacy and the screening practices for colorectal cancer (Mitsutake et al., 2012). Following the control of the confounding variables, the researchers found that that the eHealth literacy increased the likelihood for an individual to order and complete the screening for colorectal cancer by 1.03 times (Mitsutake et al., 2012).
These findings led to the conclusion that high eHealth literacy among the internet users increased the likelihood that the users will comply with the screening protocols for colorectal cancer. The researchers also conclude that the high eHealth literacy among the internet users is associated with increased knowledge of colorectal cancer when compared to individuals with low eHealth literacy among the internet users (Mitsutake et al., 2012). The findings by Mitsutake et al., (2012) complement those by Miller et al,. (2011). They both point towards the use of informatics-based models to increase the health literacy of the public.
Conclusion
The fact that colorectal cancer is a significant contributor of the morbidities and mortalities in the American public is not for debate. The statistics adduced in the paper show a high rate of morbidity and mortality due to colorectal cancer. The role of early detection in the treatment of all cancers has also been highlighted for emphasis by the scholars cited in the paper. However, the low utilization of screening among the study population is worrisome from a public health perspective. This is because the screening for colorectal cancer leads to the early detection. Early detection and diagnosis increase the chances of the successful treatment.
The synthesis of evidence has highlighted the low health literacy as a stumbling block to the compliance with the screening protocols for colorectal cancer. There is agreement across different scholars using both theoretical and empirical approaches that low health literacy contributes to the low utilization of screening for colorectal cancer. Following these findings, the researchers recommend the use of interventional approaches that address the issue of low health literacy among the public. The review of evidence from empirical research has shown that the use of informatics-based models to address the issue of low health literacy has shown to be effective.
The informatics-based models help increase the awareness of the public on the importance of screening for colorectal cancer. In addition to the increase in knowledge, these approaches also help modify the attitudes that also influence the compliance with the screening protocols for colorectal cancer.
References
American Cancer Society. (2014). Colorectal Cancer Facts & Figures 2014-2016. Atlanta: American Cancer Society.
Brown, C. G. (2014). The Iowa Model of Evidence-Based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing. Clinical Journal of Oncology Nursing, 8 (2), 157-159. doi: 10.1188/14.
Daly, J. M., Xu, Y., & Levy, B. B.T. (2014). Colon polyp model use for educating about colorectal cancer screening in Iowa Research Network. Journal of Cancer Education: The Official Journal of the American Association for Cancer education 29 (2): 401-406. doi: 10.1007/s13187-014-0637-7
Garcua, A., Buylla N., Nivolas-Perez, D. and Quintero, E. (2014). Public Awareness of Colorectal Cancer Screening: Knowledge, Attitudes, and Interventions for Increasing Screening Uptake. International Scholarly Research Notices: Oncology. http://dx.doi.org/10.1155/2014/425787
Miller, D.P., Spangler, J.G., Case, L.D., Goff, D.C. & Pignone, M.P. (2011). Effectiveness of a Web-Based Colorectal Cancer Screening Patient Decision Aid: A Randomized Controlled Trial in a Mixed-Literacy Population. American Journal of Preventive Medicine, 40(6), 608-615. Doi: 10.1016/j.amepre.2011.02.019.
Mitsutake, S., Shibata, A., Ishii, K. and Oka, K. (2012). Association of eHealth Literacy With Colorectal Cancer Knowledge and Screening Practice Among Internet Users in Japan. Journal of Medical Internet Research. 14(6):e153. DOI: 10.2196/jmir.1927
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27-35. doi:10.1111/j.1369-7625.2011.00730.x
Sentell, T., Tsoh, J., Davis T., Davis, J., and Braun, K. (2015). Low health literacy and cancer screening among Chinese Americans in California: a cross-sectional analysis. BMJ Open. 5:e006104 doi:10.1136/bmjopen-2014-006104
Smith, S. A., & Blumenthal, D. S. (2013). Efficacy to effectiveness transition of an Educational Program to Increase Colorectal Cancer Screening (EPICS): study protocol of a cluster randomized controlled trial. Implementation Science, 8(1), 1-11. doi:10.1186/1748-5908-8-86
Yim, M., Butterly, L., Goodrich, M., Weiss, J., & Onega, T. (2012). Perception of Colonoscopy Benefits: A Gap in Patient Knowledge? Journal of Community Health, 37(3), 719-724. doi:10.1007/s10900-011-9506-z
