Strategies of Advanced Practice Nurses, Promoting Colorectal Screening

Friday, 17 July 2009: 8:50 AM

Camille P. Wicher, RN, MSN, Esq
Executive Office, Roswell Park Cancer Institute, Buffalo, NY
Suzanne Steffan Dickerson, RN, DNS
School of Nursing, University at Buffalo, State University of New York, Buffalo, NY
Thomas H. Feeley, PhD
School of Nursing, University at Buffalo, Buffalo, NY

Learning Objective 1: describe strategies for and barriers to colorectal cancer screening.

Learning Objective 2: describe one process for promoting compliance with colonoscopy screening


Colon cancer is the third most commonly diagnosed cancer in the United States and United Kingdom and is curable if found early; therefore, it is imperative that Advanced Practice nurses (APN) effectively encourage colorectal screening (CRC) in their patients.  The purpose of this secondary data analysis was to identify strategies and tactics used by ANP’s to facilitate CRC in their patient populations.


4 focus groups totaling 27 ANPs were interviewed about their experiences with patients seen in urban, suburban and rural primary care clinics to understand the influence of health communication practices. Transcripts provided the data for this grounded theory analysis. Using constant comparative techniques, a core category emerged describing the screening strategies: Working in the system to promote health.


The APN’s used tactics and strategies to overcome barriers to convince patients to have CRC screening. The major strategy categories included: Knowing the screening guidelines and assessing patients’ risks; Promoting through education and the use of stories, Scheduling using office practices, Doing appropriate screening tests, and Follow up regarding patient’s compliance. Major barriers included: Access to testing centers, cost, reimbursement, and transportation issues, Lack of Knowledge of actual prep and test practices overcoming patients’ fear, Time needed for prep, test and recovery, consistency and follow up.


The ANPs promoted CRC by the use of personal stories related to the nurse’s own experience or that of a close family member. This was the most effective patient-based strategy to enhance CRC screening.  When APNs “told the story” patients listened, the test was more easily facilitated and the most common barrier - fear of the prep- was alleviated. Given the time and cost constraints of other methods of encouraging compliance, this could be a low cost, effective tool to increase compliance with CRC screening.