Research Methods and Critical Appraisal

This assignment focuses on the colorectal cancer screening in detecting and treating colon cancer among women aged 55 to 65 years old. It includes the use of PICO framework to study the given topic.

Research Methods and Critical
Appraisal

Table of Contents
Introduction......................................................................................................................................1
Background......................................................................................................................................1
Methodology....................................................................................................................................3
Critical appraisal..............................................................................................................................4
Discussion and recommendations....................................................................................................6
Conclusion.......................................................................................................................................7
References........................................................................................................................................9
Appendix........................................................................................................................................10

Introduction
Colon cancer refers to a type of cancer that started from large intestine which is known as final
part of digestive tract. It includes the situation when a malignant tumour arising from inner wall
of the large intestine (colon). Meanwhile, it consist the weakness or fatigue, unexplained weight
loss, rectal bleeding etc. In context of this project, it is based on the health problem of colorectal
cancer which can be consider as third largest cause of cancer on both men and women (Aran and
et. al., 2016). It is known as severe health problem which is difficult to be treated by efforts of
care practitioners. People are required to improve their lifestyle and include balanced diet and
regular exercise to remain disease free. This assignment will focus on the colorectal cancer
screening in detecting and treating colon cancer among women having age between 55 to 65
years old. It will also include the use of PICO framework to study the about given topic.
Background
In context of this project, it is based on the topic of colon cancer between women having age of
55 to 65 years. It includes the fact that there are various kinds of people who were suffering from
the problem of colon cancer. However, it has been analysed that it is important to carry out more
effective as well as efficient study on this health problem in order to evaluate its rate of
increasing among women. It is necessary to study about different types of causes and symptoms
which can be initially observed to take immediate treatment in order to avoid severe condition of
the same. Meanwhile, this investigation has an important in respect of evaluating about
appropriate practices which are helpful to avoid occurrence of the problem of colon cancer. It
involves the criterion of analysing that the colon cancer condition and cause of its occurrence
among older age of women. It is necessary to study about these aspects so that clinical practices
can be improved in terms of delivering better quality of care facilities for wellbeing of them
(Das, Kalita and Pal, 2017). This study plays an important role to reduce the cases of colon
cancer among old age females in order to make their lives comfortable and disease free. This
assignment will focus on PICO framework by considering its elements that are mentioned here.
Population: Women aged 55 to 65 years
Intervention: Colorectal cancer screening in preventing and treating colorectal cancer
Comparator: Participants were 280 women who were part of a larger study (total = 435) 7
assessing attitudes and adherence to multiple cancer screenings
1

Outcome: Detecting and treating colon cancer
The colon cancer is condition of occurring cancer in large intestine and takes severe form which
is critical for patient as well as care professionals to deal with it. It has been analysed that any
type of cancer can be treated at its initial stages in order to make an individual disease free
whereas doctor can only put possible efforts for wellness of patient but they are not sure to save
the person. Meanwhile, the colon cancer condition is responsible for developing number of
symptoms such as fatigue, weakness, shortness of breath, change in bowel habits, narrow stools,
weight loss, abdominal pain, cramps or bloating (Favoriti and et. al., 2016). When the colon
cancer acquire severe form then it will show several other problems including irritable bowel
syndrome (spastic colon), ulcerative colitis, Crohn’s disease, diverticulosis and peptic ulcer
problem that can have signs of mimic bowel syndrome. However, it has been analysed that colon
cancer can be considered as a severe health problem which requires years to develop but its
potential symptoms are mostly observed in severe condition. It is necessary for people to
improve their lifestyle by avoiding fast food, alcohol, smoking etc. whereas they should adopt
using regular exercise, yoga, meditation, balanced diet, intake fruits to remain healthy.
On the other hand, this assignment will focus on detection and treatment of colon cancer among
women having age between 55 to 65 years of age. It is well known that this health problem is
accountable to develop in several years then it is necessary to identify the relevant cause to avoid
the same for remaining disease free. Basically, the colon cancer can be considered as critical
health issues which is required to be investigated that helps physicians to examine its actual
causes in respect of establishing appropriate precautions for the same. It is helpful for medical
practitioners to establish set of more effective as well as efficient precautions to convey them for
welfare of common people (Ambalam and et. al., 2016). However, it will facilitate to reduce
colon cancer rate among men and women both which enhance the health condition of entire
population. This project is mainly focus on appropriate detection of cause and symptoms related
to colon cancer according to which accurate care plan can be prepared to make patient healthy. It
includes evaluating the effective diagnosing procedure which is suitable establishes accurate
treatment plan to deliver desired care facilities. It is very important to make detection of disease
accurate which facilitates to deliver better quality of clinical services for wellbeing of particular
patient.
2

Methodology
Literature review can be described as a survey of number of scholarly sources which are helpful
in providing relevant information about selected topic. It includes analysing the views and
opinions of different authors who have already carried out research on similar topic. However, it
consist the criterion of conducting a type of review of specific research article (Moreno and et.
al., 2016). In context of this investigation, the PICO framework is used with the help of
considering its components which is based on specific PICO question.
Research question or PICO question: How effective is colorectal cancer screening in detecting
and treating colon cancer on women aged between 55 and 65 years old?
Population Women aged 55 to 65 years
Intervention Colorectal cancer screening in preventing and treating colorectal cancer
Comparator Participants were 280 women who were part of a larger study (total = 435) 7
assessing attitudes and adherence to multiple cancer screenings
Outcome Detecting and treating colon cancer
Search keywords used in terms of studying about prevention and detection of colon cancer to
reduce the relevant deaths are mentioned here. It includes several key words such as
colonography; computed tomography; X-ray computed tomography; spiral computed
tomography; radiography; colonoscopy; colon diseases; colon neoplasms. However, it also
consist Cancer prevention and screening, Colorectal cancer, Community health, State and
community programs, Uninsured Underinsured and Women’s health.
The search strategy involves different type’s key words and terms which are required to be
studied in order to analyse the effective detection methods of colon cancer. It is very important to
detect accurate causes and symptoms which are suitable to make appropriate decision making
related to treatment methods for wellbeing of people. In context of this investigation, the
scholarly search article were used which are much effective as well as efficient in terms of
gaining accurate findings (Vermeer and et. al., 2017). It will provide support to address the
selected research question in respect of gaining accurate findings respectively. Basically, it is
necessary for government bodies to make sure about availability of free screening services
among people so that they can detect their problem earlier and gain desired treatment to save
their lives. Moreover, it has been analysed that colon cancer is observed mostly among women
3

of age 55 to 65 years of age then it is required for government provide free screening as well as
treatment services for making their lives disease free.
Critical appraisal
Article 1: Computed Tomography Colonography: The Future of Colon Cancer Screening
Considering the selected research article, it has been analysed that colorectal cancer can be
considered as common cause of cancer among Canadian non-smokers. It includes the fact that
around 21500 citizens of the country were diagnosed with colorectal cancer (CRC) every year.
Basically, it is observed that 90 % of cases related to CRC were diagnosed among people aged
50 years or older (Fraser-Hill and et. al., 2008). It includes an estimated figure that 4800 male
and 4100 female citizens of the nation leads to death every year form the given health problem
accordingly. Meanwhile, it has been evaluated that around 70 % of new cases of colon cancer
were founded among those people who does not have any kind of known risk factor. In addition
to this, it is necessary to carried out diagnosis of colorectal cancer in more effective as well as
efficient manner which helps o deliver better care services for wellbeing of an individual. It
involves the utilisation of computed tomography colonography (CTC) that is knonw as effective
method in which a cross sectional imaging examination of colon has been carried out. It is
helpful in order to permit complete structural examination of the colon that is accountable to
indicate promise as a toll for CRC screening.
On the other hand, it has been founded that the computed tomography colonography (CTC) is
considered as an effective method in order to diagnose the actual problem colon cancer. It will
provide support to provide suitable treatment for making patient disease free. Meanwhile, it is
observed that CTC cannot replace process of OC that consist gold standard complete structural
colonic examination, permitting direct inspection of the colonic mucosa, diagnostic biopsy, and
therapeutic polypectomy. It has been analysed that, it has a limitation of not defining about
specific guidelines of screening which should be followed by professionals at the time of
detecting the colon cancer condition in proper manner (Fitzpatrick-Lewis and et. al., 2016). This
research is reliable much as it has proper explanation about effectiveness of diagnosing method
of CTC in order to detect colorectal cancer that helps to deliver appropriate treatment for saving
lives of people. It is valid investigation in terms of using CTC diagnosing method for accurate
detection of colon cancer problem. The article has generalizability regarding findings because
4

the method of CTC is much effective to conduct proper examination of the condition to deliver
desired care services respectively.
Article 2: USE OF COLONOSCOPY TO SCREEN ASYMPTOMATIC ADULTS FOR
COLORECTAL CANCER
As mentioned in given article, it has been studied that colonoscopy method of screening has its
role on diagnosis which is uncertain. It includes the utilisation of around 13 Veterans Affairs
medical centres in order to carry out colonoscopy which helps to identify the location and
prevalence of advanced colonic neoplasms. It is favourable to evaluate the risk of advanced
proximal neoplasia in context of asymptomatic sick individuals with or without distal neoplasia
(Lieberman and et. al., 2000). Meanwhile, it has been examined that an advanced colonic
neoplasia is known as an adenoma having a diameter of 10 mm or more than that, a villous
adenoma and an adenoma with high grade dys-plasia or invasive cancer. It is observed that the
classification was most advanced lesion based among ill people having more than one neoplastic
lesion respectively. Basically, it includes the consideration of around 17732 patients screened for
enrolment in which 3196 were enrolled whereas 3121 of enrolled patients underwent complete
examination of the colon. However, it has been founded that the process of colonoscopic
screening is much effective in respect of detecting an advanced colonic neoplasms in
asymptomatic adults. It includes the fact that many of these neoplasms were not able to detect
with the help of carrying out signoidoscopy.
In addition to this, this research article has a limitation that it does not have detailed explanation
of sigmoidoscopy method regarding its ineffectiveness to diagnose colon cancer condition in
accurate manner. Basically, it has another limitation that statistical analysis used in this study is
very limited which is required to be in little bit detailed form by more statistics with its
theoretical description. It includes the reliability of the selected investigation due to having
effective use and benefits of method of diagnosis that is colonosvopy in order to detect actual
condition of colon cancer of an individual (Li and et. al., 2017). It is much effective as well as
efficient method to accurately detect the specific health issues which facilitate to provide
potential treatment for wellness of patient. This study is valid so that practitioners can use
colonoscopy to detect the relevant diseases among people to deliver proper care facilities.
Moreover, the generalizability is that the findings are applicable in detection of colorectal cancer
by avoiding sigmoidoscopy to gain accurate results.
5

Article 3: Colorectal Cancer Screening Pilot Program for Underserved Women in
Cumberland County, Maine
The selected article has been studied that around 800 Maine residents may be diagnosed with the
severe disease of colorectal cancer (CRC) in which approximately 300 may die from the health
problem. It includes the utilisation of CRC screening that is favourable in terms of reducing these
rates among the population. Basically, it can be considered that it is only insured among
populations which has screening rates exceed around 50 % (Miesfeldt and et. al., 2010). In
context of this project, it will focus on addressing the aim of decreasing barriers to as well as
enhanced rates of CRC screening between uninsured and underinsured women having age 50
years and above than that living in Cumberland County in Maine. It involves the utilisation of
Current network related to Maine Breast and Cervical Health Program (MBCHP) that is required
to be considered for reaching the target population. Meanwhile, it has main focus on use more
screening technique in order to reduce the burden of CRC among population ion Maine. It has
been founded that it is necessary to make sure about availability of prevention as well as
screening facilities in every geographical area in order to decrease the burden of CRC in Maine.
In addition to this, it is necessary for people to have prevention precautions information and
screening of colon cancer which is favourable to reduce the death rate in relation to colon cancer.
It has been evaluated that colon cancer can be considered as a potential threat which has
efficiency to increase death rate. However, this research article has a limitation that it has
information about several diagnosing methods in order to detect CRC to deliver appropriate
treatment for better health of infected person but it will not study about most appropriate method
of detection. It has reliability due to its findings that given method related to detection of colon
cancer area applicable in different cases of CRC (Lima and et. al., 2016). Meanwhile, the
findings of this investigation are much valid because prevention and screening services should be
available to reduce the burden of death rate occurs due to colorectal cancer.
Discussion and recommendations
Theme 1: Computed Tomography Colonography: The Future of Colon Cancer Screening
The method of computed tomography is known to be more effective in order to detect the
problem of colorectal cancer which helps physicians to provide appropriate medical services for
welfare of patient. It includes the accurate screening of colon cancer which helps doctor to
evaluate actual cause according to which they can warn people to avoid harmful habits to avoid
6

this severe disease. It has been recommended that government should put efforts to make policy
of social mediums to promote healthy living for reducing cases of colorectal cancer. It is
suggested that care professionals and government are required to perform collaboratively to
make availability of free screening facilities for welfare of citizens.
Theme 2: Use of colonoscopy to screen asymptomatic adults for colorectal cancer
The colonoscopy refers a method of carrying out examination which is utilised to detect changes
or abnormalities in large intestine. It is used to detect the problem of colorectal cancer condition
among patients so that desired medications and treatment can be provided for their wellness.
However, it has been recommended that sigmoidoscopy is required to be avoided because it is
potential method to given accurate detection information about infected people (Weng and et. al.,
2017). Moreover, it is suggested to utilise the effective method of colonscopy in order to
improve effectiveness of treatment method as well as increase patient outcomes respectively.
Theme 3: Colorectal Cancer Screening Pilot Program for Underserved Women in
Cumberland County, Maine
It has been analysed that the extra burden of colon cancer and its relevant death rate is required
to be reduced by putting effective efforts in Maine. It includes the utilisation of screening
methods and technique to diagnose the problem of colon cancer in order to save people.
However, the burden of death rate related to colon cancer can be considered as a sever threat in
develop of given geographical area. Moreover, it has been recommended that government is
required to focus on making availability of free screening to diagnose the problem of colon
cancer among people so that they can get treatment at correct time to become disease free. It is
suggested to government for promoting information about preventive measure with the
cooperation of healthcare professionals to reduce the burden of increased death rate at a place.
Conclusion
From the above assignment, it has been analysed that colorectal cancer can be described as a
medical situation when a malignant tumour arising from inner wall of the large intestine. It
includes the severe condition while showing relevant symptoms as this condition takes number
of years in order to develop condition of colon cancer. Meanwhile, it involves the utilisation of
different research article by considering their specific aims to address them about detection as
well as treatment for wellbeing of people. It is observed that availability of screening services
and information of preventive measure is must in order to reduce the death rate among
7

population suffering from colon cancer. However, it involves more effective method CTC in
terms of evaluating the actual symptoms as well as cause which provide support to establish
more effective as well as efficient plan of action for making an individual healthy.
8

References
Books and journals
Aran, V. and et. al., 2016. Colorectal cancer: epidemiology, disease mechanisms and
interventions to reduce onset and mortality. Clinical colorectal cancer, 15(3), pp.195-203.
Das, V., Kalita, J. and Pal, M., 2017. Predictive and prognostic biomarkers in colorectal cancer:
A systematic review of recent advances and challenges. Biomedicine & Pharmacotherapy, 87,
pp.8-19.
Favoriti, P. and et. al., 2016. Worldwide burden of colorectal cancer: a review. Updates in
surgery, 68(1), pp.7-11.
Ambalam, P. and et. al., 2016. Probiotics, prebiotics and colorectal cancer prevention. Best
practice & research Clinical gastroenterology, 30(1), pp.119-131.
Moreno, C.C. and et. al., 2016. Colorectal cancer initial diagnosis: screening colonoscopy,
diagnostic colonoscopy, or emergent surgery, and tumor stage and size at initial
presentation. Clinical colorectal cancer, 15(1), pp.67-73.
Vermeer, N.C.A. and et. al., 2017. Colorectal cancer screening: systematic review of screen-
related morbidity and mortality. Cancer treatment reviews, 54, pp.87-98.
Fitzpatrick-Lewis, D. and et. al., 2016. Screening for colorectal cancer: a systematic review and
meta-analysis. Clinical colorectal cancer, 15(4), pp.298-313.
Li, S. and et. al., 2017. Bacterial biofilms in colorectal cancer initiation and progression. Trends
in molecular medicine, 23(1), pp.18-30.
Lima, A.I.G. and et. al., 2016. Legume seeds and colorectal cancer revisited: Protease inhibitors
reduce MMP-9 activity and colon cancer cell migration. Food chemistry, 197, pp.30-38.
Weng, M. and et. al., 2017. Noncoding RNAs in the development, diagnosis, and prognosis of
colorectal cancer. Translational Research, 181, pp.108-120.
Online
Fraser-Hill, M. and et. al., 2008. Computed tomography colonography: the future of colon cancer
screening. [Online]. Available
through<https://search.proquest.com/openview/282650329a2862de0f3f4a1477cdd0bb/1?pq-
origsite=gscholar&cbl=34862>
Lieberman, D.A. and et. al., 2000. Use of colonoscopy to screen asymptomatic adults for
colorectal cancer. [Online]. Available
through<https://www.nejm.org/doi/full/10.1056/NEJM200007203430301>
Miesfeldt, S. and et. al., 2010. Colorectal cancer screening pilot program for underserved women
in Cumberland County, Maine. [Online]. Available
through<https://link.springer.com/article/10.1007/s10900-009-9204-2>
9

Appendix
Articl
e
details
Aim Study
design
Details
of
particip
ants
Details of
interventi
on
Key
findings
Limitations Recommendatio
ns
Fraser-
Hill,
M. and
et. al.,
2008.
Comp
uted
tomogr
aphy
colono
graphy
: the
future
of
colon
cancer
screeni
ng. [O
nline].
Availa
ble
throug
h<http
s://sear
ch.pro
quest.c
om/op
enview
/28265
0329a
2862d
e0f3f4
a1477c
dd0bb/
1?pq-
origsit
e=gsch
olar&c
To
analyse
the
effective
ness of
Compute
d
Tomogra
phy
Colonogr
aphy as
the
Future of
Colon
Cancer
Screenin
g.
A cross
section
al study
design
The
participa
nts
includes
the age
group of
50 years
and
above
who
were
participat
ed to
study
about
respectiv
e topic.
CRC
screening,
currently
recommen
ded
Canadian
and
American
screening
guidelines
and
screening
tools, and
current
evidence
supporting
CTC
It has been
founded
that CTC
is effective
detection
method of
CRC
problem to
provide
accurate
treatment
to patients.
It has
limitation
that specific
guidelines
of carrying
diagnosis
are not
explained.
It has been
recommended
that care
professionals
should utilise
CTC method to
diagnose CRC
and deliver
appropriate care
for wellbeing of
sick individuals.
10

bl=348
62>
Lieber
man,
D.A.
and et.
al.,
2000.
Use of
colono
scopy
to
screen
asympt
omatic
adults
for
colore
ctal
cancer.
[Onlin
e].
Availa
ble
throug
h<http
s://ww
w.nej
m.org/
doi/ful
l/10.10
56/NE
JM200
00720
34303
01>
To study
the use of
colonosc
opy in
order to
screen
asympto
matic
adults for
colorectal
cancer
effectivel
y.
A
descript
ive
researc
h
design
It
includes
the
17732
patients
were
participat
ed in
study in
which
age
range is
between
50 to 75
years
The
interventio
n is use of
colonosco
py in order
to screen
colorectal
cancer.
It has been
founded
that
colonosco
py is
beneficial
to detect
the
problem of
colon
cancer
rather than
sigmoidos
copy.
It has
limitation
that the
detailed
information
about
sigmoidosc
opy is not
explained
about its
ineffectiven
ess for
diagnosing
colon
cancer
among
people.
It has been
recommend that
care professionals
should use
colonoscopy to
gain accurate
knowledge about
problem and
deliver better care
services for
wellness of an
indvidual
Miesfe
ldt, S.
and et.
al.,
2010.
Colore
ctal
project
aimed to
reduce
barriers
to, and
increase
rates of
A cross
section
al study
design
The
participa
nts
involve
300
individua
ls for
The
interventio
n is to
make
availabilit
y of
detection
It has been
founded
that
increased
detection
methods
and
It has a
limitation
that other
detection
methods
were not
explained in
It has been
recommended
that government
is required to put
efforts for making
proper availability
of detection
11

cancer
screeni
ng
pilot
progra
m for
unders
erved
wome
n in
Cumbe
rland
Count
y,
Maine.
[Onlin
e].
Availa
ble
throug
h<http
s://link
.spring
er.com
/article
/10.10
07/s10
900-
009-
9204-
2>
CRC
screening
among
underinsu
red and
uninsured
women,
ages 50
years and
over,
residing
in
Cumberla
nd
County,
Maine.
participat
ing in
respectiv
e process
of
investiga
tion.
services to
reduce
burden of
colon
cancer
among
population
.
diagnosing
centres are
required to
extra
burden of
colon
cancer
patients.
detail to
understand
their
effectivenes
s and to
decide the
best
diagnosing
method of
CRC.
services for
reducing burden
of CRC.
12

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