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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 1, Pages 13-18
http://dx.doi.org/10.1155/2014/561749
Commentary

Registered Nurse-Performed Flexible Sigmoidoscopy in Ontario: Development and Implementation of the Curriculum and Program

Mary Anne Cooper,1,2,3 Jill Margaret Tinmouth,2,3,4 and Linda Rabeneck3,5

1RNFS Program, Cancer Care Ontario, Canada
2Department of Gastroenterology, Sunnybrook Health Sciences Centre, Canada
3Department of Medicine, University of Toronto, Canada
4ColonCancerCheck Program, Cancer Care Ontario, Canada
5Cancer Care Ontario and the University of Toronto, Toronto, Ontario, Canada

Received 16 August 2013; Accepted 16 September 2013

Copyright © 2014 Canadian Association of Gastroenterology. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution, and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.

Abstract

Although colorectal cancer is a leading cause of death in Canada, it is curable if detected in the early stages. Flexible sigmoidoscopy has been shown to reduce the incidence and mortality of colorectal cancer in patients who are at average risk for this disease and, therefore, is an appropriate screening intervention. Moreover, it may be performed by nonphysicians. A program to enable registered nurses to perform flexible sigmoidoscopy to increase colorectal cancer screening capacity in Ontario was developed. This program incorporated practical elements learned from other jurisdictions as well as specific regional considerations to fit within the health care system of Ontario. The nurses received structured didactic and simulation training before performing sigmoidoscopies on patients under physician supervision. After training, nurses were evaluated by two assessors for their ability to perform complete sigmoidoscopies safely and independently. To date, 17 nurses have achieved independence in performing flexible sigmoidoscopy at 14 sites. In total, nurses have screened >7000 Ontarians, with a cancer detection rate of 5.1 per 1000 screened, which is comparable with rates in other jurisdictions and with sigmoidoscopy performed by gastroenterologists, surgeons and other trained nonphysicians. We have shown, therefore, that with proper training and program structure, registered nurses are able to perform flexible sigmoidoscopy in a safe and thorough manner resulting in a significant increase in access to colorectal cancer screening.