Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Melanie Brewer, DNSc, FNP-BC, NEA-BC, FAANP

Second Advisor

Lydia Forsythe, PhD, MA, MSN, RN, CNOR

Abstract

Problem: Colorectal cancer is the second leading cause of cancer death in the United States. Preventive screening for colorectal cancer has been associated with early detection and improved 5-year survival rates. The referral rates for colorectal cancer screening at the practicum site were 17.7%, well below the national benchmarks of 71.8%.

Aim of the Project: The aim of this project was to increase the screening referral rates in adults aged 45 to 75 years by 50% over a ten-week period by implementing an evidence-based toolkit.

Review of the Evidence: Literature review highlighted barriers to colorectal cancer screening, such as knowledge deficits of providers and patients, inconsistent screening practices, and the absence of standardized screening practices.

Project Design: The project framework was provided by the Institute for Healthcare Improvement (IHI) Model for Improvement. Three Plan-Do-Study-Act (PDSA) cycles were used over the course of the project. The OhioHealth Change Management Model supported engagement and adoption of change among the clinic staff.

Intervention: A Quality Improvement Toolkit for Busy Office Practices provided a guideline for selecting evidence-based interventions to address the problem. Interventions included clinic staff education about colorectal cancer screening recommendations, implementation of a patient questionnaire to determine colorectal cancer screening eligibility, and distributing bilingual patient education materials.

Significant Findings/Outcomes: Referral rates for patients 45 to 75 years increased from a baseline of 17.7% to 34.1%, representing a 92.7% improvement. All clinic staff completed the education and demonstrated understanding. Due to the option to opt out and failure to screen repeat patients, a total of 77.9% of patients aged 45 to 75 years were screened for eligibility. Patient education materials were made available in 100% of patient encounters.

Implications for Nursing: This project was aligned with the IHI Triple Aim and the Institute of Medicine (IOM) Six Aims for improvement of healthcare. Compliance with colorectal cancer screening recommendations supports the IHI Triple Aim by improving population health, reducing costs through early detection of treatable conditions, and improving the experience of care by preventing high-acuity procedures associated with advanced disease processes. The IOM Six Aims are addressed by thoroughly screening all patients in the target population for colorectal cancer screening eligibility efficiently and by referring eligible patients to gastrointestinal specialist within a reasonable timeframe. The results of this project demonstrate that advanced nurse-led, quality improvement initiatives can improve preventive health measures in underserved rural settings.

Rights

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