Comparison of Flexible Sigmoidoscopy Screening in Average Risk Patients Performed by Nurses Versus...

Area of Science:

• Gastroenterology
• Oncology
• Healthcare Management

Background:

• Colorectal cancer (CRC) screening sigmoidoscopy effectively reduces mortality.
• A nurse-performed flexible sigmoidoscopy program was established in Ontario in 2009.
• This program followed a pilot screening initiative by gastroenterologists.

Purpose of the Study:

• To compare neoplasia detection rates between nurse- and physician-performed screening sigmoidoscopies.
• To evaluate the associated costs of these two screening approaches.

Main Methods:

• Retrospective chart review of flexible sigmoidoscopies from two average-risk screening programs.
• Categorization of detected polyps (hyperplastic, low-risk adenoma, high-risk adenoma).
• Estimation of average procedure costs, including personnel, pathology, and administrative expenses.

Main Results:

• Nurses performed 538 procedures; physicians performed 174.
• Adenoma detection rate was 18% for nurses vs. 9% for physicians (p=0.003), primarily in low-risk adenomas.
• Average cost per case was higher for nurses ($387.54) than physicians ($309.37).

Conclusions:

• Well-trained nurse-endoscopists can effectively perform CRC screening.
• The current structure in Ontario results in higher costs for nurse-performed procedures.
• Further analysis is needed to optimize cost-effectiveness of nurse-led screening programs.