YULE-CAPSTONE 3

Capstone Part 2: Review of Literature

Student’s name: Yulexis Moreda

Instructor: Carmen Lazo

Course: MSN Capstone Project-DBX-DL01

Date: March 31, 2026

Literature Review

The problem of colorectal cancer poses a significant threat to the population since it is a highly common and deadly disease. However, it is preventable if it is detected early and screened. The general screening adherence is still less than the suggested figures, particularly in the underserved populations, which is indicative of the existing gaps in the delivery of preventive health care. There is existing evidence to indicate that interventions that are multicomponent, nurse-based are effective interventions to improve the uptake of screening through education, follow-ups, and patient involvement. This literature review aims to summarize the available primary studies and systematic findings in the interventions aimed at raising the rate of colorectal cancer screening. The review corresponds to the PICOT model, and the emphasis on the evidence-based practice facilitates the effective change in the primary care environment.

Synthesis of Current Evidence

The current evidence shows that interventions led by nurses play a positive role in the screening of colorectal cancer among various groups of people, a factor that underlines their relevance in the prevention and care delivery. Combined interventions, such as multicomponent behavior change education, reminders, and navigation, are more effective than single-component interventions and should be applied to facilitate behavior change initiatives (Rana et al., 2023). Patient navigation and education help to increase screening uptake among underserved groups by overcoming access barriers, literacy, and distrust in systems (Glaser et al., 2024). The screening rate increased to nearly 60 percent with guided interventions that were identified to increase 30 percent of screening rates (Glaser et al., 2024). Electronic messengers and phone calls are considered to be significant screening, compliance, and patient engagement facilitators (Oladunjoye & Valdez, 2025).

Areas of similarity in the studies are that a patient education strategy is a central strategy of the studies and that cost, access, and health literacy are reported to be barriers. In the majority of the interventions, a multidisciplinary or nurse-led model is employed to improve coordination and deliver homogeneous prevention care in a variety of healthcare settings and diverse populations. The effectiveness, however, varies depending on how intense interventions are and the population attributes, with some of the strategies having more effects on the minority groups than the other groups. There are gaps in the evidence of cost-effectiveness and long-term outcomes due to the fact that there is very little literature in which economic analysis or long-term follow-up are conducted to clarify whether interventions are sustainable in the long term (Kava, 2025). Absence of consistency across all healthcare systems and generalizability limits the ability to be broadly implemented, but integrated and culturally sensitive nurse-led practices are the most effective.

Application of Evidence to PICOT Question

The PICOT question will target adults in the age group of 45 to 75 years in the primary care facilities where nurse-led education is being implemented as a form of improving the rates of colorectal cancer screening. Such practice is directly linked to the existing evidence because it has been noted that the uptake rates of colonoscopy and fecal tests among the target populations are increased significantly due to nurse-led education as well (Han et al., 2025). It has been established that multimodal interventions such as education, reminders, and follow-ups can greatly enhance screening compliance in the primary care environment (Oladunjoye & Valdez, 2025). The community-based methods and culturally specific interventions are used to further enhance engagement, particularly among underserved groups of people experiencing access barriers (Rana et al., 2023). Structural problems such as access and coordination can be resolved by means of patient navigation, which directly contributes to the implementation of the provided design of the offered intervention (Glaser et al., 2024). Overall, viability, performance, and measurable results are proven in six months and are supported in the literature.

Evidence Supporting Practice Change

In the prevention of colorectal cancer, nurses play a central role by being the leaders of the educational programs among patients, leading patient care, and creating effective follow-up in the primary care environment (Hashemi et al., 2022). Compliance with the screening recommendations and reduction of the inequalities of the underserved and vulnerable groups also grow with the help of nurse navigators and advanced practice nurses (Loughrey et al., 2026). Signs of good screening outcomes are present, such as an odds ratio of 2.51 of colonoscopy uptake due to interventions by nurses (Han et al., 2025). The other findings show an increase in screening rates by 65.5 percent to 74.3 percent when using organized multimodal interventions, including education and reminders (Oladunjoye & Valdez, 2025). Early screening in the disease process will reduce the treatment cost in the long run and the burden of the disease (Kava, 2025). Prevention measures will also increase the quality of life, reduce hospitalization, and improve the effectiveness of the health care system.

Objectives and Rationale for Practice Change

The primary objectives of the proposed change will involve enhancing the rates of screening of colorectal cancer in adults (45-75 years old) through the application of nurse-led education and engagement methods. The other priorities include improvement of patient knowledge, development of awareness, and taking preventive care practices. Reduction of disparities among the underserved populations is also one of the priority areas in this initiative. The rates of screening are also below the national average, and this fact speaks to the gaps existing in the delivery of preventive services (Glaser et al., 2024). Higher rates in younger demographics of people and systemic obstacles, such as cost, access, and health literacy, also serve to justify the need for systematic evidence-based interventions (Siegel et al., 2023).

Problem Description and Proposition for Change

The problem exists within primary care settings where colorectal cancer screening adherence remains suboptimal despite the availability of effective screening methods and established clinical guidelines. Multiple barriers contribute to this issue, including limited patient awareness, cultural misconceptions, and structural challenges related to access and cost (Lee & Holmes, 2023). Inconsistent implementation of evidence-based interventions further perpetuates low screening rates and missed opportunities for early detection. Underserved populations continue to experience disproportionate impacts due to these persistent challenges (Loughrey et al., 2026). Implementing nurse-led education programs, culturally tailored communication, and patient navigation offers a practical, evidence-based approach to meaningful change.

Comprehensive Analysis: Pros vs Cons and Current State

The current situation is described as the low screening rates and the ongoing gap between the rich and the low-income populations, regardless of the established clinical recommendations and preventive measures. The proposed nurse-led intervention has some advantages, including the evidence level, the encouragement of early diagnosis, and the participation of patients in preventive measures (Rana et al., 2023). Cost reduction, due to the reduction of late-stage treatment needs, also forms part of long-term benefits. However, they are limited by additional personnel and training requirements, and the lack of consistency in their application in healthcare facilities (Lee & Holmes, 2023). Despite all the listed challenges, the benefits of using nurse-led solutions are higher than the limitations.

Conclusion of Literature Review

The current evidence is quite supportive in that nurse-led and multicomponent interventions are effective interventions used in improving colorectal cancer screening among a diverse group of people in the primary care setting. The literature has still noted great growth in the screening uptake in the underserved groups that have obstacles to accessing preventive care. In order to achieve a sustainable effect of the enhancement of health outcomes, structural and educational barriers should be addressed. The proposed change in practice implies a practical and evidence-based solution, which does not violate the principles of patient-centered care. Therefore, such an intervention is something that can be adopted to improve the early detection, inequality, and health outcomes of the population.

References

Glaser, K. M., Crabtree-Ide, C. R., McNulty, A. D., Attwood, K. M., Flores, T. F., Krolikowski, A. M., Robillard, K. T., & Reid, M. E. (2024). Improving Guideline-Recommended Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC): Implementing a Patient Navigation and Practice Facilitation Intervention to Promote Health Equity. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health, 21(2), 126–126. https://doi.org/10.3390/ijerph21020126

Han, Y., Han, Y., Huang, W., Liu, Y., Wang, Z., Zhao, W., & Zhang, W. (2025). Effects of nurse-led interventions on enhancing patient-related outcomes in colorectal cancer management throughout the cancer care continuum: A systematic review and meta-analysis. International Journal of Nursing Studies, 105100. https://doi.org/10.1016/j.ijnurstu.2025.105100

Hashemi, N., Bahrami, M., Tabesh, E., & Arbon, P. (2022). Nurse’s Roles in Colorectal Cancer Prevention: A Narrative Review. Journal of Prevention, 43(6). https://doi.org/10.1007/s10935-022-00694-z

Jefford, M., Howell, D., Li, Q., Lisy, K., Maher, J., Alfano, C. M., Rynderman, M., & Emery, J. (2022). Improved models of care for cancer survivors. The Lancet, 399(10334), 1551–1560. https://doi.org/10.1016/s0140-6736(22)00306-3

Kava, C. M. (2025). Interventions to Increase Colorectal Cancer Screening Uptake in Rural Settings: A Scoping Review. Preventing Chronic Disease, 22. https://doi.org/10.5888/pcd22.250025

Lee, R., & Holmes, D. (2023). Barriers and recommendations for colorectal cancer screening in Africa. Global Health Action, 16(1). https://doi.org/10.1080/16549716.2023.2181920

Loughrey, M., Forry, M., Horgan, R., & Hegarty, A. (2026). An Exploration of Nursing Roles in Hereditary Colorectal Cancer- A Narrative Literature Review. Seminars in Oncology Nursing, 152120. https://doi.org/10.1016/j.soncn.2025.152120

Oladunjoye, O., & Valdez, I. (2025). Improving Colorectal Screening Compliance Through Targeted Quality Improvement Interventions in Primary Care. Cureus. https://doi.org/10.7759/cureus.96031

Rana, T., Dorothy, N., Choi, & Winnie. (2023). Effectiveness of Community Health Worker-Led Interventions in Enhancing Colorectal Cancer Screening Uptake in Racial and Ethnic Minority Populations. Cancer Nursing, Publish Ahead of Print. https://doi.org/10.1097/ncc.0000000000001222

Siegel, R. L., Wagle, N. S., Cercek, A., Smith, R. A., & Jemal, A. (2023). Colorectal cancer statistics, 2023. CA: A Cancer Journal for Clinicians, 73(3), 233–254. https://doi.org/10.3322/caac.21772