Developing evidence-based care practices for patients requires setting the right clinical question and conducting an extensive literature search. The PICOT framework, which stands for a population of interest, intervention, comparison, outcome, and time, can be applied to formulate the question correctly (Boswell & Cannon, 2015). Colon cancer is the second leading cause of mortality in cancer patients, and early intervention is essential for reducing the number of deaths. The risk factors associated with this cancer include inflammatory bowel disease, smoking, obesity, and family history (Gausman et al., 2020).
According to Stoffel and Murphy (2020), the incidence of this disease in the younger population increased almost twice over the last three decades. The PICOT model will be used to explore whether colonoscopy screening every five years in people with a family history of colon cancer predicts better outcomes compared to those without such genetic predisposition.
PICOT for Early Diagnosis of Colon Cancer
Colon cancer screening and early intervention are critical to prevent the disease progression that leads to unfavorable outcomes. Indeed, according to Wolf et al. (2018), detection and surgical resection of precursor lesions reduce mortality from colorectal cancer (CRC). Such screening and diagnostic tools as a fecal occult blood test (FOBT), colonoscopy, flexible sigmoidoscopy, and computed tomography colonography are available (Wolf et al., 2018). The invasiveness and complexity of this test vary; therefore, it is critical to select the proper screening or diagnostic approach for the right population and at an appropriate time. For example, people with a family history of CRC should be recommended to undergo colonoscopy ten years younger than when their relative was diagnosed with colon cancer (Wilkinson et al., 2019).
The population of interest, in this case, are patients whose first-degree relatives had colon cancer. The comparison population is people with no genetic predisposition for CRC development, who are advised to start screening with FOBT at the age of forty-five (Wolf et al., 2018). The outcome of interest will be if colonoscopy screening people with the risk for colon cancer development reduces mortality.
Evidence from Scholarly Resources
Family history is a strong predictor for colon cancer development in healthy individuals. Kastrinos et al. (2020) describe two valuable methods to evaluate familial predisposition: the 3-question CRC assessment tool and the PREMM5 model. The latter is an online tool that allows calculating a patient’s risk for having Lynch syndrome. This autosomal dominant disorder can cause cancers of the colon, endometrium, stomach, ovaries, and other malignancies (Kastrinos et al., 2020). The former is the short questionnaire to identify risks for CRC development based on personal and family history. These two techniques allow determining if a person has specific inheritance patterns that will lead to colon cancer and decide about subsequent screening approaches.
If the abovementioned risk assessment methods showed that a person had a first-degree relative with colon cancer or one of the CRC syndromes, clinicians should recommend colonoscopy at a particular age. Specifically, these people should start to be screened endoscopically at the age of forty every five years (Wilkinson et al., 2019). In some exceptional cases, fecal immunohistochemistry can replace this technique, but the screening interval should be shortened to less than two years (Wilkinson et al., 2019). Overall, individuals with inherited colon cancer predisposition should undergo colonoscopy earlier and more frequently than people with low risk for developing this cancer type.
The current guidelines suggest introducing endoscopic screening in the population with a family history of CRC. According to Bilal et al. (2020), the adenoma detection rate (ADR) during colonoscopy was significantly higher in people who had first-degree relatives with colon cancer. Specifically, in this retrospective cross-sectional study, the ADR of patients with the CRC family history was almost 28%, while the comparison group’s ADR was 20% (Bilal et al., 2020).
Moreover, researchers investigated other risk factors such as BMI, gender, and race. Still, adjusting for confounding variables showed that family history was an independent predictor for CRC development. Thus, this article is relevant to the question posed within the PICOT framework because it explores the benefit of implementing colonoscopy for screening individuals with inherited CRC risks. This paper is credible because it had a large sample size of more than 2000 colon cancer patients and was published in a peer-reviewed journal.
Screening colonoscopy should be conducted in high-risk patients every five years. Indeed, the cohort study by Samadder et al. (2017) demonstrated that regular screening in patients with a family history of CRC had a sustained reduction in the risk of colon cancer development. Furthermore, the authors showed when the follow-up period was longer for these people, the CRC incidence increased, which was not the case for the group without such family history (Samadder et al., 2017). This paper is relevant because it revealed the benefits of regular colonoscopy for individuals with a genetic predisposition for CRC at shorter intervals than for the general population. Since this research was a ten-year large cohort study published in a peer-reviewed journal, it can be considered credible.
Early colorectal cancer detection is the cornerstone of reducing incidence and mortality. People with a family history of this disease are at increased risk of developing it earlier; therefore, they should be screened every five years starting from age forty. The PICOT framework was applied in this paper to demonstrate that introducing colonoscopy for high-risk patients at regular intervals resulted in a drop in CRC incidence. Finally, research showed that doing screening less frequently than recommended in this group of patients results in worse outcomes than in the comparison group.
Bilal, M., Singh, S., Le, T. T., Al-Saadi, Y., & Guturu, P. (2020). Select group of patients might benefit from early colonoscopic screening for colorectal cancer. Surgical Endoscopy, 34(10), 4463–4471. Web.
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.
Gausman, V., Dornblaser, D., Anand, S., Hayes, R. B., O’Connell, K., Du, M., & Liang, P. S. (2020). Risk factors associated with early-onset colorectal cancer. Clinical Gastroenterology and Hepatology, 18(12), 2752–2759. Web.
Kastrinos, F., Samadder, N. J., & Burt, R. W. (2020). Use of family history and genetic testing to determine risk of colorectal cancer. Gastroenterology, 158(2), 389–403. Web.
Samadder, N. J., Pappas, L., Boucherr, K. M., Smith, K. R., Hanson, H., Fraser, A., Wan, Y., Burt, R. W., & Curtin, K. (2017). Long-term colorectal-cancer incidence after negative colonoscopy in the state of Utah: The effect of family history. The American Journal of Gastroenterology, 112(9), 1439–1447. Web.
Stoffel, E. M., & Murphy, C. C. (2020). Epidemiology and mechanisms of the increasing incidence of colon and rectal cancers in young adults. Gastroenterology, 158(2), 341–353. Web.
Wilkinson, A. N., Lieberman, D., Leontiadis, G. I., Tse, F., Barkun, A. N., Abou-Setta, A., Marshall, J. K., Samadder, J., Singh, H., Telford, J. J., Tinmouth, J., & Leddin, D. (2019). Colorectal cancer screening for patients with a family history of colorectal cancer or adenomas. Canadian Family Physician, 65(11), 784–789.
Wolf, A., Fontham, E., Church, T. R., Flowers, C. R., Guerra, C. E., LaMonte, S. J., Etzioni, R., McKenna, M. T., Oeffinger, K. C., Shih, Y. T., Walter, L. C., Andrews, K. S., Brawley, O. W., Brooks, D., Fedewa, S. A., Manassaram-Baptiste, D., Siegel, R. L., Wender, R. C., & Smith, R. A. (2018). Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians, 68(4), 250–281. Web.