YULE CAPSTONE PP

Final Capstone Project

Student name: Yulexis Moreda

Course: MSN Capstone Project-DBX-DL01

Instructor: Carmen Lazo

Institution: Florida National University

Date: April 16, 2026

Improving Colorectal Cancer Screening Rates Through Nurse-Led Education in Primary Care Settings

Colorectal cancer remains a tremendous pandemic among the health of the American population since it is the second-largest cause of cancer-related death, even though it is preventable through early screening. The current rates of screening among the population remain lower than the suggested ones, particularly concerning the underserved and vulnerable populations with a prevention barrier. There is also poor screening, which results in late diagnosis and more mortalities and considerably increased costs of treatment as a result of late infections of the disease. The financial expense is not only immense on the national and local level, but also in the millions of dollars expended annually, and even additional taxation on the local healthcare infrastructure in areas such as Miami-Dade County. The outcome is also worsened by inequality in access to care among minority and low-income groups. This project will involve an appraisal of a nurse-led intervention tool in education that is capable of resolving the problem of improving the levels of colorectal cancer screening among adults in the range of forty-five to seventy-five years.

PICOT Question and Description

The PICOT framework provides a methodological approach that administers the evidence-based clinical research process and develops measurable healthcare interventions within nursing. It allows the workers of a specific health facility to articulate a clinical problem and outline all methods that can be adopted to improve patient outcomes within a given facility. The PICOT question of the project has been framed in the following format: Does a nurse-led intervention in the primary care clinics of Miami-Dade County, for adults aged between forty-five and seventy-five years, enhance screening completion rates? The question introduces the targeted approach to education to traditional care that is not coupled with uninterrupted patient-centered education (Hashemi et al., 2022). This organization will make it possible to retain the proposed intervention in focus, practical, and aligned with the quantifiable healthcare outcomes.

The intended population of this project will include adults aged forty-five to seventy-five years who are under primary care at clinics located in Miami-Dade County, with a majority of them constituting the different underserved groups. The intervention is based on an education program, with a nurse acting as a leader and involving an interaction with patients one-on-one, offering a personalized counseling session, providing information to patients in an easy-to-understand format, and patient follow-up to remind them of screening. The referrals used by general doctors are the reference. It is expected that the desired change will strive to improve the screening rates of the target population with colorectal screening (Han et al., 2025). The time frame for determining the effectiveness of the intervention is six months following the implementation, whereby sufficient time will be left to assess a change in behavior and screening compliance.

Vulnerable Population and Setting

The vulnerable groups in this project will be the adults between forty-five and seventy-five years who receive care services at the primary care clinics in Miami-Dade County. This group includes the uninsured or underinsured patients, the ethnic minorities, Hispanics, and African Americans, as well as the low-income earners. There is also a high number of patients in the population who lack access to regular healthcare services and have poor health literacy, which is likely to lead to avoidance of preventive screening. The language barriers and cultural beliefs also influence attitudes to screening colorectal cancer and reluctance towards screening (Oladunjoye & Valdez, 2025). Another challenge that influences access to timely preventive medical services is the transportation problems and cost issues.

Several risk factors could be attributed to making this population more vulnerable and increasing their risk of developing colorectal cancer, and rendering this process ineffective. Among older adults above the age of forty-five, the age factor happens to be one of the most significant risk factors, and the family history and lifestyle also contribute towards the rise in the occurrence of type 2 diabetes, through poor diets and the absence of physical activities. Late-stage diagnosis as a result of either the avoidance of screenings or delays in high-risk individuals reduces the survival rate and makes the treatment even costlier. This can be solved through screening so as to detect cases early enough and offset the burden of disease in the long run (Kava, 2025). In Miami-Dade County, the primary care clinics represent the most significant access points to this population. However, the number of patients tends to circumvent the use of preventative care and follow-ups.

Evidence-Based Research Support

The current available evidence provided by the latest peer-reviewed literature demonstrates the effectiveness of nurse-led interventions in improving the assessment of enrolled colorectal cancer screening in different groups. It is constantly demonstrated in the literature research that when conducting patient education, the deployment of nursing professionals leads to increased awareness and compliance with the proposed preventive screening protocols (Glaser et al., 2024). Follow-ups, phone calls, and messaging are examples of reminder systems that will enhance additional patient involvement and improve screening rates of colorectal cancer. Culturally specific educational strategies are also applied to language, beliefs, and health literacy barriers and lead to the successful engagement of patients (Hashemi et al., 2022). This evidence adds to the incorporation of a structured nurse-based education program and establishes the role of nurses as the core of preventative health promotion.

Proposed Intervention

The proposed intervention is the adoption of a nurse-based education intervention program on colon-rectal cancer screening that would raise the screening rate in the primary care settings. As compared to the other program, this program has personal in-person education, provision of well-defined and culturally relevant printed materials, and following up with the patient on the phone to remind him or her of the involvement. It will also require qualified nursing staff, educational resources, and institutional resources in the actual clinic room and time to initiate it effectively (Han et al., 2025). The partners of the primary care providers, administrative nurses, and advanced practice nurses include the integration of the program into routine care. It is a practical intervention since it is cost-effective, unlike other interventions that may require a period of two years due to the planning, implementation, and evaluation stages.

Theoretical Framework / Nursing Theory

The Health Belief Model is a strong theoretical model as well, which forms a strong foundation of the project, since it details the impacts that individual conviction has on health-related actions and choices. This model highlights the perceived susceptibility, perceived severity, perceived benefits, and perceived barriers as significant factors that predetermine the readiness to engage in preventive health behavior of a person. This intervention improves patient awareness of the risks of colorectal cancer but overcomes the subconscious fears of the screening procedure because of the implementation of this framework. The approaches to educating or implementing education based on such a model will result in the reduction of perceived barriers and demonstration of the benefits of early detection (Oladunjoye & Valdez, 2025). The solution will help in patient-centered care and also improve the role that nurses can play to bring meaningful change in health behaviors.

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.

Description of the Practice Change and Setting

The change suggested in this project is the incorporation of a systematic nurse-directed colorectal cancer screening education agenda in the regular care of two Federally Qualified Health Centers (FQHCs) in Miami-Dade, Florida. This change on the organizational level is implemented in a clinic environment and is aimed at freeing adults within the age range of 45-75 years of age who belong to undervalued population segments such as Hispanic, African American, and low-income patients. The rationale behind this change is that screening in these clinics has remained low, below national averages, and has led to late-stage cancer diagnosis of colorectal cancer, increased mortality, and increased healthcare expenditure (Glaser et al., 2024). Disparities in preventive care are worsened by barriers, including low health literacy, misconceptions about cultures and beliefs, language barriers, transport barriers, and a lack of patient engagement (Oladunjoye & Valdez, 2025; Lee & Holmes, 2023).

Implementation Plan and Timeline

It will be implemented within six months in a diffuse story. During the second and first month, the registered nurses and advanced practice nurses will undergo specific training regarding the Health Belief Model, motivational interviewing, and a culturally specific approach to education (Baskar et al., 2024). Individual personalized teaching on the topic will occur in those primary care visits, not before the third month, and after that, all qualified patients will receive this education. These sessions will cover risk discussion, benefits of early detection, and simplification of materials, in English and Spanish. Two to four weeks later, an automated telephone or text prescription of the demonstration will occur, and patient navigation to schedule the test is provided (Shaukat et al., 2025; Han et al., 2025). The program will be incorporated into the current workflows via the e-health record flags, up-to-date examination rooms, and bilingual employees. The internal success factors include administrative commitment and nurse leadership, whereas external factors include the health department in the area partnering to provide resources. The potential obstacles, such as the nurse workload and patient access, will be addressed by staggered schedules and regular team huddles (Rana et al., 2023).

Evaluation of the Change Process

The pre-post quasi-experimental design will be used to evaluate the impact of the change. The baseline rates of colorectal cancer screening completion rates (fecal immunochemical test, colonoscopy, or other modalities recommended by the guidelines) will be obtained through the electronic health records 6 months before implementation. The same metrics will be compared at the sixth month of intervention, and they will be targeted to improve by 20-30 % according to the evidence-based benchmarks (Kava, 2025; Glaser et al., 2024). The validated brief Colorectal Cancer Screening Survey will include items that will measure patient knowledge, perceived barriers, and satisfaction at the end of the education. Process indicators will monitor education delivery rates, reminder success, and completion of referrals. Variations will be analyzed with descriptive statistics and chi-square tests, which will guarantee quantifiable results (Oladunjoye & Valdez, 2025).

Literature Support for Change and Implementation

This multicomponent approach, led by nurses, has strong support in the literature. The systematic reviews and trials have shown that nurse-led education, reminders, and navigation are effective in improving screening uptake in the primary care and FQHC setting, specifically with minority and underserved populations (Han et al., 2025; Shaukat et al., 2025; Baskar et al., 2024). The interventions are efficient in reaching the barriers and facilitating the behavior change (Hashemi et al., 2022).

Transformational leadership will also motivate the project's success by providing visionary plans, effective communication, teamwork, and flexibility. To guide the implementation of the change and track fidelity to the implementation, the project lead (advanced practice nurse) will lead by example, encourage their dedication to the team, and apply change management expertise in dealing with resistance (Loughrey et al., 2026; Jefford et al., 2022).

Stakeholder Engagement and Presentation

The stakeholders who are invited to the proposal include clinic administrators to distribute resources and support policy efforts, primary care physicians to support referrals, frontline nursing staff to implement directly, patient representatives of underserved communities to provide cultural input, and local health department liaisons to sustain. This group has been selected based on its overall power, clinical acumen, trust, and operational leverage within the community. The proposal will be discussed in a PowerPoint session at the stakeholder meeting, including a summary of the PICOT question, literature evidence, time, outcomes, and budget. Its approximate budget would be $8,500, comprising the cost of printed and translated materials $3,000, training $2,500, improvement of the reminder system $2,000, and the data tool $1,000. It will be funded using internal quality improvement funds and small grants, which would be highly cost-effective in terms of long-term savings due to early detection (Siegel et al., 2023; Kava, 2025).

This implementation plan gives a viable, evidence-based intervention that follows parts I and II to enhance colorectal cancer screening rates and lower health disparities in Miami-Dade County primary care contexts.

Conclusions

Colorectal cancer screening is among the most pressing health issues, which needs attention of the general population due to its high morbidity, mortality, and health care spending in the United States. Despite the presence of the preventative measures, the proportion of individuals who continue to experience barriers to the timely screening and early diagnosis is very high. Nurse-led interventions offer viable and practical solutions that would promote the level of awareness, involvement, and screening rates among patients in the primary care units. The inequity can be minimized through social determinants of health by means of specific education to guarantee the equitable provision of preventive health care. Therefore, this capstone project will show how an evidence-based nursing practice is important in addressing issues in population health.

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.

This capstone paper and synthesis of the identification of low colorectal cancer screening rates and related health disparities in Part I, the strong evidence of nurse-led interventions in Part II, and the step-by-step six-month implementation, evaluation, leadership, and stakeholder engagement plan in Part III. This initiative will result in significant positive change as it will lead to a statistically significant higher level of screening completion, decrease the disparities in underserved communities, and achieve sustainable preventive health results by means of a nurse-led education program using culturally oriented educational material and patient navigation in Miami-Dade County primary care clinics.

References

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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

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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

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