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

1. Colorectal Cancer: Patient Knowledge, Attitudes, and Screening Behaviors Capstone Project Presentation by Sharon D. Brantley, RN, BSN in partial fulfillment of the Requirement for the Degree MASTER OF SCIENCE IN NURSING December 2, 2009

2. Colorectal Cancer (CRC) 2nd leading cause of all cancer deaths (Bazensky, Shoobridge-Moran, & Yoder, 2007) Ranks 3rd in prevalence of behind prostate and lung CA in men and breast and lung CA in females (Centers for Disease Control, 2007) Affects men and women of all races equally (Bazensky et al., 2007) Approximately 150,000 new cases each year (American Cancer Society, 2007) Over 50,000 die from CRC each year (ACS, 2007)

3. CRC: The Problem Represents significant public health risk Early detection and polyp removal could reduce mortality by 50% (Smith, Cokkinides, & Eyre, 2004) Only about 50% of Americans received recommended screening (National Cancer Institute, 2007)

4. Literature Review Limited knowledge or low literacy is related to negative attitudes about CRC and CRC screening methods (Dolan et al., 2004) 377 male veterans in VA Medicine Clinic Survey based on Health Belief Model (HBM) Completed CRC questionnaire + REALM Assessed ability to name or describe CRC screening tests: Fecal Occult Blood Test (FOBT), flexible sigmoidoscopy (flex sig), or colonoscopy Felt FOBT was messy, inconvenient, and would not use FOBT kit if provided by MD

5. Literature Review Clients with limited literacy were less likely to be knowledgeable about CRC (Miller, Brownlee, McCoy, & Pignone, 2007). Pilot study of 50 subjects at internal medicine clinic in teaching facility Survey of 26 questions about CRC screening and personal learning methods about health topics + REALM assessment Researchers explained screening tests and asked when subjects had last received: FOBT, flex sig, or colonoscopy

6. Need for this Study 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) One-on-one education session produced significant change in beliefs about CRC prevention and CRC screening (Ueland, Hornung, & Greenwald, 2006).

7. Theoretical Framework: Health Belief Model Developed in the 1950’s by four psychologists: Hochbaum, Kegeles, Leventhal, and Rosenstock US Public Health Service wanted to explain lack of participation in free disease prevention programs

8. Conceptual Definitions Education = the process of acquiring knowledge through engagement in the interdependent activities of teaching and learning. Knowledge = what is known about CRC and CRC screening methods. Compliance = adherence to the advisement or health guidelines provided by a healthcare practitioner.

9. Hypotheses #1: The knowledge level of patients participating in an educational session on colorectal cancer screening will change upon completion of the class. #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.

10. Research Design Descriptive, pretest-posttest design After consent was given, subjects completed demographic form and pretest. After class, posttest given and REALM assessment completed.

11. Sampling Convenience sampling of clients at a large metropolitan hospital serving a disproportionately indigent population through use of flyers and investigator recruitment Potential subjects were scheduled to attend a class on CRC and CRC screening methods

12. RAPID ESTIMATE OF ADULT LITERACY IN MEDICINE (REALM)©Terry Davis, PhD ∙ Michael Crouch, MD ∙ Sandy Long, PhD (1991) Sample Tool:

13. CRC Class Content Colon cancer: incidence, risk factors, development, symptoms CRC screening: FOBT, sigmoidoscopy, colonoscopy Colonoscopy in detail DECISION to make appt Prep instructions Day of procedure: sequence of events

14. Assumptions Subjects provide accurate self-reported information. Subjects honestly report their beliefs and opinions and make a valid attempt to answer questions correctly. Subjects retain knowledge over time.

15. Limitations Small sample size (n=112) Localization of the sample Learning environment—room size, technical difficulties Quasi-experiment design—no control group Homogeneity of population

16. Data Collection Data collected Tests graded and REALM assessments scored Data coded and entered into SPSS file for analysis

17. Sample by Age

18. Sample by Ethnicity

19. Sample by Gender & Marital Status

20. Sample by Educational Level

21. Sample by Household Income

22. Sample by Insurance Status M&M = Medicare & Medicaid Comm = Commercial

23. Sample by REALM Score

24. Data Analysis: Descriptives

25. Data Analysis: Findings Paired t-Test

26. Data Analysis: Spearman ρ Correlations ** Correlation significant at 0.01 level (2-tailed) * Correlation significant at 0.05 level (2-tailed)

27. Data Analysis: Spearman ρ Correlations ** Correlation significant at 0.01 level (2-tailed) * Correlation significant at 0.05 level (2-tailed)

28. FINDINGS: Hypotheses SUPPORTED – Significant change in knowledge #1: The knowledge level of patients participating in an educational session on colorectal cancer screening will change upon completion of the class. UNABLE TO ASSESS – Colonoscopy appointments were several months after class. #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.

29. Implications for Nursing Knowledge regarding current CRC screening guidelines Diverse and interactive teaching and learning methods Establish cues to identify low literacy clients Tailor educational activities and patient education materials to meet lower literacy levels

30. Recommendations for Future Study Replication on a larger scale with diverse populations Follow-through on actual subject compliance with screening Longitudinal studies to examine long-range compliance and knowledge retention Investigation of different teaching modalities and media

31. ACKNOWLEDGMENTS Dr. Linda Streit—Capstone Project Advisor Dr. Linda Kimble—Statistical Analysis Support Greta Baldwin-Mason, RN, MSN—Data Coding Dr. Henry Olejeme—Physician Sponsor Gertrude Dunlap, LPN—Research Assistant