The Efficacy of Colonoscopy for Colorectal Cancer
The PICO question on this evidence-based practice (EBP) study proposal states: for male adults of 49 years of age and below with colorectal cancer, is colonoscopy compared to other tests more accurate in diagnosing colorectal cancer? The purpose of the study is to determine whether a colonoscopy is effective in diagnosing colorectal cancer in male individuals under 45 years and whether the measure is more effective than other tests. The non-experimental design study will feature 40 health workers tasked with answering a survey questionnaire on their use of colonoscopy as a diagnostic tool for colorectal cancer. The survey will also seek to understand how effective health workers find colonoscopy compared to other tests. Comparative screening methods will include the Fecal Immunochemical Test (FIT), among others.
Colorectal cancer screening is viewed as an effective preventive health measure that requires outreach and education. Health workers are encouraged to conduct opportunistic testing when a patient visits the hospital (U.S. Preventive Services Task Force, 2008). The health workers also contact patients due for screening as part of their outreach activities. Therefore, practitioners are at the forefront of encouraging individuals to have colorectal cancer screening (Cairns, 2002). They are also responsible for conducting the screening, which makes them a suitable sample choice as they select the type of testing to use since they are aware of the efficacy of their preferred method.
In experimental designs, the nature of the participants, the data collection instruments, and the settings are particularly relevant to the study. For the proposed research, the subjects will be 40 health workers in different health care settings. The survey approach was selected due to its versatility, cost-effectiveness, generalizability, and efficiency. The points of data collection will be at each health care facility where subjects will have been successfully recruited. The data collection is projected to take approximately two months considering that only a few participants will be found at each health care facility.
Survey questionnaires will be used to determine, among other things, the experience of the practitioner with colorectal cancer screening, experience with colonoscopy as a screening method for colorectal cancer, the method used in the most recent surveillance, the approximate number of times they have used the colonoscopy to investigate the presence of colorectal cancer, and their perceived level of efficacy of the colonoscopy compared to other alternatives. Most non-experimental studies are usually retrospective, also known as ex-post facto since they investigate a phenomenon that has already occurred (Thompson, 2007). As a result, such studies have no control of the settings, which makes it a challenge to restrict erroneous variables that may have been introduced, which creates the possibility of bias in the findings.
Issues of data validity often overwhelm quantitative studio. The study will seek to improve the external validity, which Shadish and Cook (2005) described as the degree to which the causal relationship holds in differences between subjects, study settings, outcomes, and interventions. In essence, external validity will endeavor to determine the presence of conceptually similar relationships across time, places, and people among others.
Enhanced external validity will demonstrate that the findings of the research will be generalizable to other populations with similar characteristics. Hence, to achieve this outcome, the researcher will ensure that the research settings are comparable to standard real-life settings. The diverse healthcare settings in which the data will be collected will ensure that they are similar to real-life contexts. Internal validity will also be applied to determine the quality of the findings by evaluating the difference between the outcome of the tests and other types of screening.
Just as the tradition descriptive designs, the proposed study will seek to understand the status of the subject, which is the use and efficacy of colonoscopies as surveillance measures of colorectal cancer. Thompson (2007) stated that non-experimental studies are typically observational or purely descriptive. With this knowledge, the proposed study will be analyzed using descriptive statistics. In this regard, data from the surveys will be analyzed using the statistical software, SPSS. Non-experimental studies being mostly extrapolative or descriptive are not interested in finding causality between variables.
The goals and nature of variables determine the most appropriate analytical and evaluation process to be employed. While causality analysis is not recommended, the study will apply correlation methods. This analysis will enable the identification of the initial relationship between the variables. For instance, the demographic parameter of years of practice of a health worker will be correlated with the choice of a screening method to determine if the experience is interrelated to using the colonoscopy.
Analyzing the data using correlation investigation is highly recommended because the variables being investigated will have already occurred or in the process of unfolding. The focus, therefore, will be on establishing the impact of one variable’s measures on another. The correlation coefficient numerical value will determine the strength of the relationship and its directionality (+ or -) (Thompson, 2007). Thompson (2007) avers that the absence of any relationship will be indicated by the correlation coefficient 0 and the range is usually +1.0 to 0 and then to -1.0. A positive correlation coefficient will reveal the presence of a relationship.
For instance, a score of + 1.0 between a health worker’s preference for colonoscopy and the number of times used previously will indicate a strong relationship. The interpretation would be that the two variables are likely to occur together (Thompson, 2007). In the case of a negative score, the implication will reveal that as the number of times the colonoscopy has been used in the past decreases, the same practitioner is also likely to pick a different procedure other than a colonoscopy.
Therefore, the stronger the relationship, the more accurate the predictions will be. For the proposed study, it will demonstrate that a strong correlation between the past colonoscopy use will predict the most recent choice of the procedure. Shadish, Cook, and Campbell (2002) noted that correlations between variables could be effectively used to make predictions about their behavior. In addition, understanding participants’ choice in the past will predict what they will choose in the future. The prediction about the future choice can be made accurately without errors (Thompson, 2007). However, the absence of variables’ manipulation, random assignment, and controls in non-experimental studies imply that the correlation should not be taken as causality.
For the proposed study, a positive relationship will suggest that the choice of the past causes the subsequent decision or vice versa. A significant advantage in the correlation of the research is that it will be easy to predict the choice of colorectal cancer screening procedure by other practitioners based on the findings. Hence, this knowledge can be used to take appropriate action that would increase the probability of choosing the desired method of screening.
The key stakeholders that are likely to benefit from this study include researchers, practitioners, trainers, and patients. Providing preliminary data upon which other researchers can base their future studies will significantly expand knowledge in this area. Researchers will seek to confirm or dispute the findings by replicating the study in different settings (Locke, Silverman & Waneen, 2004). Therefore, the findings will enrich the academic discipline, especially nursing. Importantly, the correlation findings will enable researchers to establish whether the variables should be pursued further.
To demonstrate, if no relationship is found between past choice and future choice of a screening procedure, the researcher will conclude that there is no need to study causality. However, if a strong relationship is found, the researchers can extend the study further to investigate which of the two variables influence the other (Locke, Silverman & Waneen, 2004). On their part, practitioners will find the information highly relevant to their work. The professionals will benefit by having an evidence-based approach, which will inform their choice of cancer investigation method. Using the findings of the proposed study, health care workers will also establish elements that should influence their choices as well as which other options exist.
Patients will also derive significant benefits from the descriptive and correlational findings of the proposed study. Studies have unequivocally established that timely diagnosis is a prerequisite for better outcomes in the treatment of cancer patients (Cairns et al., 2010). Results are further improved when the risks of disease are found before an individual becomes asymptomatic. Achieving this goal largely depends on how effective a diagnostic method is in detecting potential vulnerabilities or symptoms as they are about to emerge. By establishing the use and efficacy of the colonoscopy in achieving this outcome, patients will benefit by the assurance that the cancer examination received has some potential in guaranteeing that the findings will be accurate so that the right course of action will be recommended.
Another benefit for patients is that they will avoid undergoing unnecessary tests for the same purpose when a single test would have been effective. For instance, the FIT test might be used as the first examination. Then a colonoscopy would follow if some factors are detected that could potentially develop into cancer (Cairns, 2010). However, if a colonoscopy is found effective in identifying predisposition risks and confirming the presence or absence of colorectal cancer, then it will be less invasive to use only the latter as it yields the required information in one test.
For the administration, the findings of this study could potentially generate substantial cost savings for the establishment. Using one test that achieves a wide array of information is significantly more cost-effective than performing a range of separate tests to obtain the same data (Quintero, Castells, Bujanda, Cubiella, Salas and Lanas, 2012). The resources saved will be used for mitigation initiatives, purchase and maintenance of multiple sets of equipment, and training practitioners on the use of tests, among other aspects. The extra resources would enable the facility to use such funds in other urgent areas.
The field of nursing training will also benefit from the study. To impart students with knowledge of the most relevant clinical practice, instructors in nursing education will have the most recent data on the performance of colonoscopies for colorectal cancer examination. Continuous improvement through evidence-based approach is a fundamental aspect that supports health care practice (U.S. Preventive Services Task Force, 2008). Besides becoming aware of what practitioners are doing in the real world context, they will also have data to compare with past and future evidence to keep their training curriculum updated.
Dissemination of Results
Various channels will be considered to disseminate the findings. Hence, to benefit the stakeholders, the study’s significant conclusions will be relayed through accessible mediums. Seminars and workshops where trainers are informed about the latest evidence will be considered, such as will magazines, newspapers, journals, and other periodicals that are oriented towards healthcare. Other platforms will include blogs and online news channels that are intended for the healthcare audience. Focusing on these platforms will ensure that the findings reach as many stakeholders as possible.
The preceding sections have discussed the research process, data collection, analysis, evaluation, and dissemination of the findings to the relevant stakeholders. The survey questionnaire has been established as a suitable data collection instrument while descriptive and correlation analyses were identified as the most appropriate for the non-experimental research. The correlations will be used in making predictions while the descriptive findings will provide information about the efficacy of the colonoscopy in screening for colorectal cancer. The results will benefit the stakeholders, including researchers, patients, trainers, and the administration of health care settings. Various strategies for disseminating the results were also suggested, which include seminars and workshops, published magazines and journals, as well as news channels dedicated to healthcare.