1. Baker, Kathy A. PhD, RN, ACNS-BC, FAAN

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This week, I had my third screening colonoscopy within the past 10 years and, as usual, my gastroenterologist "harvested" three small benign polyps. As a gastrointestinal (GI) endoscopy nurse, I am always grateful for both the evidence and technology that allows me to so easily manage my risk for colorectal cancer (CRC). There is a history on both sides of my family of CRC, but for my generation and my parents', the advent of CRC screening has resulted in my family's ability to now have a hand in "beating the odds." Gratefully, over the last 10 years, improvement in bowel preparations as well as sedation has made the experience of colonoscopy a very minor inconvenience for me. I even lost five pounds as an added benefit of the clear liquid diet the day before my procedure (and the purging effect of my bowel preparation)!

Kathy A. Baker, PhD,... - Click to enlarge in new windowKathy A. Baker, PhD, RN, ACNS-BC, FAAN

Colonoscopy is one of several screening techniques that allows us to greatly impact the incidence of CRC. According to the American Cancer Society (ACS) (2014), CRC is the third most commonly diagnosed cancer and the third leading cause of cancer death in all Americans. Despite the advances in screening knowledge and technology for CRC, approximately 1 of 3 Americans who should participate in colorectal screening is not getting tested as recommended (National Colorectal Cancer Roundtable,


As GI nurses, we have a great responsibility to take an active role in promoting CRC screening. Consistent with the goals of the American Cancer Society (ACS) and the Centers for Disease Control and Prevention (CDC), The National Colorectal Cancer Roundtable has set a goal of colorectal screening for 80% of U.S. adults ages 50 years and older by 2018 ( According to the Roundtable, 23 million Americans are not getting tested as recommended with Hispanics, American Indians or Alaska Natives, rural populations, men, individuals ages 50 to 64, and those with lower education and income being the groups less likely to be screened. Gastroenterology nurses should be actively involved in engaging these at-risk groups to participate in CRC screening and educating these groups on the evidence that suggests we can modify known at-risk factors (ACS, 2014). Additionally, ongoing, consistent encouragement is important to assure individuals adhere to the recommended guidelines for repeated screening across their adult life.


The ACS (2014) suggests evidence-based approaches to increase CRC screening including patient-level interventions (i.e., home screening methods, face-to-face discussions, and mailed reminders) and healthcare system-level interventions (i.e., patient navigators, reminder systems for care providers). A recent integrative review by Gimeno Garcia, Alvarez Buylla, Nicolas-Perez, and Quintero (2014) found that educational interventions (one-to-one or group interventions), screening reminders, and reduction of structural barriers (i.e., transportation assistance, fecal occult blood tests (FOBTs) mailed to home, patient navigators) and out-of-pocket costs are the most effective patient-level interventions for increasing CRC screening participation rates. A 2005 report of a CRC education, screening, and treatment program based in Montgomery County, Maryland showed 52% of low income uninsured individuals who registered with the program completed screening within one month, most by colonoscopy. Access to colonoscopy was free and driven by nurse referral and case management or direct physician referral (Sarfaty & Feng, 2005). Baker et al. (2015) found success in their interventional study using a bundled approach of (1) a mailed reminder letter, (2) a free fecal immunochemical test, and (3) a telephone call 3 months past the follow-up due date for individuals requiring a second FOBT screening who had not yet responded. Implementation of the bundled approach resulted in 71.6% of a vulnerable population (90% Latino, 77% uninsured) in Chicago remaining fully up to date on CRC screening during the two-year study period.


Gastrointestinal endoscopy nurses are well aware of the statistics and implications for non-participation in routine CRC screening. Many of you have been actively engaged in community efforts at increasing public health participation in colorectal screening. I would invite you to submit a Letter to the Editor ( describing your outreach efforts and lessons learned. Others of you have had great success with one-to-one efforts with patients, family members, or friends. Share your success stories and recommendations as well.


We need a united effort as gastroenterology nurses to lead the siege on CRC in the United States. Whether as a national organization, local regional group, with unit-based colleagues, or individually, you and I have a responsibility to engage others in CRC prevention. "Eighty Percent by 2018" ( is a worthwhile goal for gastroenterology nurses to embrace. We must take the lead in fighting colorectal cancer.




American Cancer Society (ACS). (2014). Colorectal cancer: Facts & figures 2014-2016. Available online at[Context Link]


Baker D., Brown T., Goldman S., Liss D., Kollar S., Balsley K., Buchanan D. R., (2015). Two-year follow-up of the effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers. Cancer Causes & Control, 26(11), 1685-1690. [Context Link]


Gimeno Garcia A. Z., Alvarez Buylla N. H., Nicolas-Perez D., Quintero E. (2014). Public awareness of colorectal cancer screening: Knowledge, attitudes, and interventions for increasing screening uptake. ISRN Oncology, Article ID 425787,[Context Link]


Sarfaty M., Feng S. (2005). Uptake of colorectal cancer screening in an uninsured population. Preventive Medicine, 41(3/4), 703-706. [Context Link]