Sandra Stone, nurse follow-up coordinator with the Newfoundland and Labrador Colon Cancer Screening Program.

I’ve thoroughly enjoyed nursing throughout my 30 plus year career.  As we all know, there are any different types of nurses – some of us work in emergency, some with public health, others with obstetrics and so on.  Most of my career has been spent providing hands on nursing in the areas of surgery and gastroenterology (focus on digestive system).

That was until March 2011, when my career took a meaningful turn.

I applied for the position of follow-up nurse coordinator with the new Newfoundland and Labrador Colon Cancer Screening Program. This position was very different from the hands on nursing career to which I had been accustomed and thoroughly enjoyed.  After being offered the position and consulting with family and trusted colleagues, I accepted the job and embarked on a new style of nursing.

Colon cancer is the second most commonly diagnosed cancer among men and women in Newfoundland and Labrador.  But for me, there’s a personal connection. Colon cancer screening is near and dear to my heart as I lost my father and other family members to this disease.

I viewed this new position as nurse coordinator as an opportunity for me to try to help, in some small way, to reduce the incidence of the disease in our province.

My new responsibilities included:

• Informing colon cancer screening participants that their colon cancer screening test was positive and sharing test results with them;
• Completing the detailed health assessments needed to network with regional health authorities across the province to navigate patients through to follow-up colonoscopies;
• Monitoring the results of colonoscopies and ensuring appropriate follow-up for patients.

I also work closely with the manager of the Newfoundland and Labrador Colon Cancer Screening Program and the program’s Medical Director to provide education sessions on colon cancer screening for health care employees and the general public.

Even though I no longer have that “in person” interaction with colon cancer screening program patients, the bond I develop with my patients is so important to me throughout the entire process.

Fecal Immunochemical Test (FIT) home kit.

My initial contact with patients is to inform them that they have a positive result to the Fecal Immunochemical Test (FIT) they completed. The FIT test involves providing two stool samples for analysis. The test has no dietary or medication restrictions and is completed in the privacy of one’s home and mailed backed to the lab at no cost to the client.  Test results are sent to the client and their family doctors. Those with a negative test result are automatically re-screened in two years while those with a positive result are contacted by the screening program and navigated through to colonoscopy.

The immediate reaction I hear from most patients to a positive test is fear that they have bowel cancer which, in the vast majority of the cases, is not the case. It is important that I explain the test result in a caring and compassionate manner to alleviate their fears and concerns.

Reasons for a positive FIT result may vary from something harmless such as hemorrhoids or something more concerning as polyps. If polyps are detect during the colonoscopy, the endoscopists will remove them during the procedure and send them for analysis. Polyps start out as small harmless growth on the inner wall of the colon which can bleed into the colon. Not all polyps are precancerous; however some types of polyps, if not removed, may develop into cancer. Research has found that when colon polyps and cancer are found and treated early, there is a 90 per cent cure rate.

The way I see it – early detection and treatment is at the heart of the Newfoundland and Labrador Colon Cancer Screening Program.

During my initial discussion with the patient, I schedule an appointment to conduct a health assessment and consult with the program’s Medical Director on any areas of concern.  The health assessment provides a detailed review of the participant’s past and present medical history. I provide patients with an explanation of the colonoscopy procedure including possible risks, outcomes and potential follow-up care required, as well as all the necessary information required to ensure a thorough examination.

Following the assessment, I send a referral to one of the screening program’s enrolled endoscopists who will review the assessment and schedule a colonoscopy. Participants are mailed a complete information package reviewing all the information that was given during the telephone assessment. My contact information is also provided and participants are encouraged to call me at any time.

It is through conversations such as these that I develop close relationships with my patients. I have frequent contact with these participants and am privileged to become the person they rely on to address concerns, and answer their questions. After the colonoscopy is completed, many of these patients call to inform me of their colonoscopy experience and to thank me for my guidance and support.

This new style of nursing is rewarding in so many ways.  My level of job satisfaction continues to grow knowing that I have supported our patients people through a sometimes frightening experience. It is also very satisfying knowing that I have contributed towards organizational efforts to decrease bowel cancer among people all over our province.

The Newfoundland and Labrador Colon Cancer Screening Program was launched in July of 2012.  This screening program is currently available to residents of Western and Central Newfoundland who are between the ages of 50-74 and at normal risk for colorectal cancer.  For more information on the screening program or to participate, residents can call the program toll-free at 1-855-614-0144, or email nlccsp@easternhealth.ca. ■

This story was written by Sandra Stone, nurse follow-up coordinator with the Newfoundland and Labrador Colon Cancer Screening Program.