Nurses helping boost access to colorectal cancer screening at Hotel Dieu Hospital

Increasing patient access to colon cancer screening is the driving force behind an innovative project at Hotel Dieu Hospital that taps into specialized nursing skills to tackle the second deadliest form of cancer yet one with a 90 per cent cure rate if detected early.

Hotel Dieu has been selected as a site for the Registered Nurse (RN)-Performed Flexible Sigmoidoscopy (FSIG) Pilot Project, spearheaded by Cancer Care Ontario in partnership with the Ministry of Health and Long-Term Care. The project is evaluating the feasibility of using appropriately-trained RNs to perform FSIG exams, a screening option for individuals at average risk for colorectal cancer. The procedure, conventionally performed by physicians, can detect cancer and pre-cancerous polyps in the lower part of the colon.

“This is very exciting news for our nurses and patients,” says Marg Atkinson, chief of patient care and chief nursing executive at Hotel Dieu. “We have excellent physician trainers and we’re confident we have skilled and motivated RNs from both Hotel Dieu and Kingston General Hospital to participate. It’s another important step towards catching and curing one of the most treatable cancers.”

In an FSIG exam, a thin, flexible tube (sigmoidoscope) is inserted into the rectum. A tiny video camera at the tip of the tube lets the clinician view the inside of the rectum and most of the sigmoid colon—about the last 2 feet of the large intestine. Preparation for FSIG is easy and requires no sedation; patients leave immediately after the procedure. Tissue samples can be taken if polyps requiring biopsy are detected.

RNs participating in the pilot at Hotel Dieu will be required to have approximately three years of experience in endoscopy nursing and will be trained and supervised by gastroenterologists who practice at both Hotel Dieu and KGH.

The FSIG clinic is slated to run a half-day each week, targeting a minimum of six cases per week. Ontario is the first province in Canada to train RNs to perform FSIGs.

In 2005, the Ontario Task Force on Large Bowel Endoscopic Services recommended expanding the delivery of FSIG by appropriately-trained non-physicians. The Task Force determined that trained RNs have the authority to perform FSIG within their scope of practice. In 2006, the first RN-led FSIG clinics were piloted in Ontario. Working with those original sites, Cancer Care Ontario has now established a comprehensive training program in partnership with the Michener Institute for Applied Health Sciences.

“Hotel Dieu already has a very active screening program for patients at high risk for colon cancer,” says Atkinson. “This new project now provides an opportunity to develop a screening service for those at average risk. We’re eager to begin this work with our trained RNs and physicians, and also with local family health care teams who will recruit the most appropriate patients for this innovative service.”