Respond your fellow classmates per the Discussion Rubrics guidelines: Critic you

Respond your fellow classmates per the Discussion Rubrics guidelines:
Critic your fellow classmates in one response supported by a credible reference. Do you agree with their plan? What would you have said or done differently?
Original peer post provided below:
What exactly is a colonoscopy and how is it done?
A Colonoscopy is the gold standard screening tool for colon cancer and typically recommended for adults over the age of 45. A colonoscopy procedure allows the provider to view the inside of the entire large intestine, visualizing the distal rectum up to the cecum with a camera (Fowler, 2020). This is an overall safe procedure that can be done relatively quickly. In most cases, colonoscopies are performed at a hospital under the observation of surgeons and anesthesiologists. A scope will be inserted into the patient’s anus and the provider will visualize and assess for abnormalities throughout the procedure. Pictures will be taken for the provider and the patient to reference, and other procedures may be performed if needed, such as a biopsy. Colonoscopies are better for diagnostic purposes of colorectal cancer than other screening assessments (Fowler, 2020). Most examiners perform the procedure with the patient under conscious sedation, with the possibility of unsedated colonoscopies in rare circumstances (Fowler, 2020).
What is the guideline for average-risk screening for CRC?
Screening is recommended to start at age 45 for all adults at an average risk of colorectal cancer (Doubeni, 2023). Screening is continued throughout the older adult years and halted at age 75. Although recommended through age 75, the provider must consider the patients risk factors for colorectal cancer as well as potential complications of the procedure and ensure that the reason for continued screening is justified (Doubeni, 2023). There are multiple screening tests for colorectal cancer, each with their own recommended screening intervals. The screening tests and frequency recommendations from the USPSTF (2021) are as follows:
“High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year
Stool DNA-FIT every 1 to 3 years
Computed tomography colonography every 5 years
Flexible sigmoidoscopy every 5 years
Flexible sigmoidoscopy every 10 years + annual FIT
Colonoscopy screening every 10 years”
What would you recommend for Tom? Argue in favor of colonoscopy
According to the US Preventive Services Taskforce (USPSTF) (2021), colorectal cancer is the third leading cause of death from cancer for both men and women. Due to this large statistic, I would recommend that Tom undergo this procedure to rule out his risk or diagnosis of colorectal cancer. With Tom’s mother dying of colon cancer, the risk for Tom to get colon cancer is higher. According to Shaukat et al. (2021), it is suggested that Tom has a colonoscopy every 5 years instead of every 10 years, and the recommended age for this procedure is actually 40 years old. The guidelines for frequency are lowered due to the increased risk Tom has for colorectal cancer. Screening between the ages of 50 to 75 years is determined by the USPSTF (2021) to have a substantial net benefit, and those who have never had screenings will be even more likely to benefit from the procedure. Even with his complex health history, he will likely largely benefit from this screening tool. While there are other tools for screening, a colonoscopy has the highest specificity and sensitivity for detecting colorectal cancer and other abnormalities (Fowler, 2020).
After hearing your recommendation & explanation of a colonoscopy, Jack states ” I do not think I want to proceed with the procedure. What else can we do?”
There are other options that are proven to be reliable for screening for colorectal cancer. Five other options include the following:
High-sensitivity gFOBT (HSgFOBT)
This test can be performed at home and is recommended yearly (USPSTF, 2021). This test is not able to detect as many cases of advanced colorectal cancer as some other methods are, such as colonoscopy. Two stool samples are required and adequate adherence to this is important (USPSTF, 2021).
Fecal immunochemical test (FIT)
Evidence shows that screening with this non-invasive test decreases the rate of mortality from colorectal cancers (USPSTF, 2021). This test, much like the HSgFOBT, is also recommended yearly and performed at home.
Stool-DNA FIT (sDNA-FIT)
This test is recommended every 1-3 years and is performed at home. The sDNA-FIT test can be done with one single sample, but it must be the entire bowel movement (USPSTF, 2021). Unfortunately, this test is proven to have a lower sensitivity than the HSgFOBT or FIT tests (USPSTF, 2021).
CT colonography
With this test, there is reliability to screen for colorectal cancer. This test is recommended every 5 years and does require bowel preparation but does not require anesthesia (USPSTF, 2021).
Flexible sigmoidoscopy
This test is an invasive option to screen for colorectal cancer and is proven to lower mortality. Flexible sigmoidoscopy tests are recommended every 5 years and have a lower rate of bowel perforation and bleeding than colonoscopies offer USPSTF, 2021).
Chart your treatment PLAN exactly as it will appear in your documentation.
Plan: Educated Tom and Jack (Tom’s legal guardian) on the benefits and evidence-based recommendations for colorectal cancer screening through use of colonoscopy. Despite recommendations and education, Jack declined the procedure. Alternate screening methods reviewed with Tom and Jack. FIT test ordered and educated Jack on collection of stool sample and importance of adhering to instructions provided. Will review results and assess the need for re-examination or further testing vs referral to GI specialist. Advised Jack and Tom to call the clinic with any further questions on FIT test and let them know we will contact them with results.
Tom lives in a group home with CNA care givers. You need to educate the CNA STAFF on the colon prep.
A thorough bowel prep is important for the best visual ability of the colon during the procedure. This is also important because it can decrease the risks and improve outcomes for the patient undergoing the colonoscopy (Fowler, 2020). Since Tom has a G-tube and is NPO, the bowel prep should be poured down the G-tube.
Half of a 4-L polyethylene-glycol (PEG) solution should be given via GT between 4pm and 6pm the evening before the procedure (Fowler, 2020).
The other half of the PEG solution is to be given approximately 6 hours before the procedure (Fowler, 2020).
After the start of the preparation, Tom should receive only clear fluids up until midnight the day of the procedure, then remain NPO until the time of the colonoscopy (Fowler, 2020)
It is important to maintain adequate hydration for Tom during the bowel prep process, as it will aide in adequate healing and decrease the risk of electrolyte disturbances that can negatively affect him. Make sure you are providing Tom with plenty of clear fluids and fluids with electrolytes to ensure proper hydration status pre-procedurally.
Reference
Doubeni, C. (2023, February). Screening for colorectal cancer: Strategies in patients at average risk. UpToDate. Retrieved March 2, 2023, from https://www.uptodate.com/contents/screening-for-colorectal-cancer-strategies-in-patients-at-average-risk?search=Colonoscopy&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
Fowler, G. C. (2020). Pfenniger & Fowler’s procedures for primary care (4th ed.). Elsevier.
Shaukat, A., Kahi, C. J., Burke, C. A., Rabeneck, L., Sauer, B. G., & Rex, D. K. (2021, March). ACG clinical guidelines: Colorectal cancer screening 2021 : Official Journal of the American College of Gastroenterology: ACG. AJG. Retrieved March 2, 2023, from https://journals.lww.com/ajg/Fulltext/2021/03000/ACG_Clinical_Guidelines__Colorectal_Cancer.14.aspx
US Preventive Services Taskforce (USPSTF). (2021, May 18). Colorectal cancer: Screening. Recommendation: Colorectal Cancer: Screening | United States Preventive Services Taskforce. Retrieved March 2, 2023, from https://uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening#fullrecommendationstart