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Colorectal Cancer Nursing Proof Reading Services
This assignment is aimed at critically evaluating the research studies on colorectal cancer suggesting certain lifestyle behavior as the risk factor for occurrence of this type of cancer. Various studies and research has been done on this common type of cancer which is also among the top causes of cancer deaths in several countries and is found to be closely related to lifestyle related conditions like obesity, lack of physical activity, smoking, etc. First and foremost, the associated lifestyle behavior would be discussed along with highlighting the factors predicting this behavior. Following this, the research studies depicting the relation between the lifestyle behavior and the colorectal cancer would be summarized and evaluated for their strengths and weakness to support the argument and finally, the assignment would be concluded.
Colorectal cancer (CRC) also called bowel cancer and colon cancer involves cancerous growth in colon or rectum and most of the cases are found to be related to old age and lifestyle factors. Particular diet, smoking, obesity and sedentary lifestyle have been found as major risk factors for CRC and diet especially consumption of red and processed meat increases the chances of occurrence of this cancer. It has been recommended to consume more of fibrous diet, fruits and vegetables and avoiding red and processed meat to prevent this cancer. Further, regular exercise and avoiding long sitting hours have been recommended along with avoiding alcohol and smoking. Although, there are numerous modifiable risk factors that may be acted upon to significantly reduce the number of cases of this cancer still the incidence rate of CRC is high especially in developed countries. This may be due to the low awareness among people about the disease prevention through lifestyle factors. Various studies have revealed that more than 50% people are unaware of association of obesity or consumption of red and processed meat with occurrence of colorectal cancer suggesting immediate requirement of awareness and educational programs (Zhang, et al. 2014).
Factors predicting behavioral outcomes:
It is really not easy to modify people’s lifestyle as their lifestyle behavior is a result of various factors that have direct and indirect effect on their ultimate actions. Changes in particular lifestyle behavior can be made at three different levels viz. individual, interpersonal and community.
Individual factors include the hardships required by an individual in modifying his particular lifestyle behavior. Usually, healthy behaviors are less pleasurable making it hard for people to readily adopt them over unhealthy choices and many a times the unhealthy behavior becomes a habit that becomes even tougher to be altered. It has also been observed that people who are healthy at present are least motivated to adopt healthy preventive behavior and they are required to have cognitive resources like awareness & information about health protective behaviors and have ability to overcome barriers to change their current lifestyle (Chou, et al. 2013).
Along with individual factors, certain social factors also predict behavioral outcomes like family traditions, peer habits, cultural backgrounds, etc. There should be support and encouragement from family and friends for modifying lifestyle and adopting health promoting behaviors. Further, if the whole community is encouraged to adopt healthy lifestyle through government programs or health care organizations, the change can be brought in a much better and easy manner (Neville & Cole, 2013). This is because community exerts a great impact over individual perception and if everybody around a person is adopting preventive behaviors, one gets easily motivated to do the same.
For encouraging people to adopt healthy lifestyle practices of doing regular exercise, avoiding red and processed meat, alcohol, smoking and maintain a healthy weight to prevent and control occurrence of CRC, first it is important to understand the factors predicting people’s lifestyle (Frampton & Houlston, 2016).However, it’s not easy to predict people since lifestyle is affected by multiple factors including genetic, hereditary factors, social, emotional factors, perception & cognition, developmental, socio cultural factors and gender.
Genetic factors are found associated with certain lifestyle behavior like excessive alcohol consumption as many research studies have been conducted that suggests that alcoholism has some hereditary connections. Lifestyle behaviors are also affected by learning and consequences which may be reinforcement, extinction or punishment. People readily adopt certain behavior if the consequences are positive and satisfying. But if the consequences are eliminated, their desire to maintain the behavior weakens over time (Armstrong, 2013). Thus, there should be one or another positive reinforcement to motivate people to adopt health related behavior. There is another consequence, punishment that suggests that a behavior bringing unpleasant consequences is less likely to be adopted. Along with these consequences, people also get influenced to adopt certain behaviors by observing others especially well known reputed community members (Richardson, et al. 2016). For instance, teenagers may be encouraged to remain non smoker by observing their favorite athlete or movie star’s commitment to stay away from smoking.
Another major factor is perception and belief that may be explained through health belief model. As per this model, people are likely to adopt any lifestyle behavior based on their perception of the outcome. They may either be afraid of illness outcomes or analyses the benefits of doing or avoiding any action. As per this theory, there are following three types of situations:
Perceived seriousness of illness: people will adopt preventive behavior for colorectal cancer if they believe that disease is serious and can majorly affect them.
Perceived susceptibility to the health problem: Until and unless, people consider themselves at risk of developing CRC, they would not modify their lifestyle and adopt preventive behaviors.
Perceived benefits vs barriers: people need to believe that adopting these preventive actions can really protect them from CRC and then they would make efforts to overcome the barriers in adoption of health behavior.
Next important factor is developmental in predicting lifestyle behavior. People’s needs and preventive requirement are different at different stages of human development as children are required to develop habit of eating nutritious and balanced diet while teenagers are required to stay away from smoking and alcoholism. Thus, as the needs changes with age and development, so does the health related behavior. Various health related behaviors are also gender related as men smoke and drink alcohol more than women do and men are also little less conscious about their weight and diet than women (Morrison, et al. 2013). In addition to these factors, there are other factors as well like cultural background, social class, etc. Thus, a large number of factors need to be considered while motivating people to modify their behavior for preventing CRC.
Evidences and research studies on colorectal cancer
The connection between this lifestyle behavior of smoking, alcohol, obesity, lack of exercise and consumption of red and processed meat with occurrence of colorectal cancer has been suggested by a number of researches. As per Pasumarthy (2009), obesity is a risk factor for development of colon cancer. In order to assess the strength of relation between obesity and colon cancer, a chart review of 137 patients aged 60 or below having colon cancer was done and their body mass index was reviewed. Data was also collected from CDC website to find the obesity rate of the region (Pasumarthy & Srour, 2009).It was found that 48% of 137 colon cancer patients admitted in the hospital were obese while the obesity rate of the region was 27.8% indicating obesity as a risk factor for CRC. However, on doing chi square analysis of age vs obesity, any significant difference in mean age of colon cancer detection was not found. Thus, although the study strengthen the fact that obesity is closely related to risk of occurrence of colon cancer but was unable to depict that screening obese for colon cancer before 50 could be advantageous. The study was conducted in a hospital of New York, thus, the study results are too local to be generalized. Further, only single factor, obesity was taken into consideration thus can be said that the study has very limited scope.
Zaid, 2016 conducted a study in Malaysia having high incidence and prevalence rate of CRC to understand and identify modifiable risk factors of this cancer that would assist in preventing and controlling the same. Diet and lifestyle have been found closely associated with CRC and can be modified to reduce the chances of occurrence of CRC. The study found an association of obesity, smoking, physical activity, consumption of red & processed meat and fibrous food with colon cancer and has depicted that not only these factors prevent or delay CRC rather they also help in treating and managing disease symptoms and prevent disease recurrence (Zaid, 2016). The study was conducted to find the awareness, knowledge and behavior of people with CRC and people with Intestinal bowel disease (at high risk of developing CRC). It was found that people with CRC had comparatively lower awareness and knowledge about modifiable diet and lifestyle risk factors than people with IBD and the risk factors were much more prevalent in people with CRC. It was also studied whether the difference exist in the prevalence of risk factors in people with different BMI but it was found that very few differences exist in risk factors prevalence in normal weight people, overweight or obese people, but the difference was gender related irrespective of age. Women were found to adopt healthier lifestyle behavior than men. Thus, if better health outcomes are desired, people must be made aware about the preventive modifiable risk factors especially the ones who are at higher risk of getting CRC than others. Moreover, study was done to find the impact of diet and lifestyle intervention on CRC patients on chemotherapy and it was found that the intensive diet and lifestyle counseling improved the health outcomes of these patients by decreasing the prevalence of malnutrition. Thus, by imparting essential knowledge about modifying lifestyle, counseling them and extending required support, health outcomes can really be improved for CRC patients. Although this thesis by Zaid, 2016 has depicted essential information for prevention and control of CRC incidence rate, has used validated assessment tools, has low error and measurement variance but the studies have few limitations as well like the sample size is small and response rate is also small limiting the generalisability of the findings. Further, different tools were utilized in different studies making it difficult to compare findings of these studies. Thus future studies are required with large sample size and using a common analysis tool to generate more useful and reliable data.
As these above studies, several studies have established close association between diet and lifestyle behavior with occurrence of CRC but the information and awareness among people is very low. One such study has been conducted by Anderson, et al. 2015 to find the level of awareness about the causes of CRC in people with colorectal adenoma. This involved the NHS Scotland Bowel Screening Program where a 12 month weight loss intervention was provided by a lifestyle counselor to promote people to bring changes in their diet, physical activity and body weight. This 12 month program involved open ended questionnaire to assess the knowledge of lifestyle risk factors of CRC at both time point. At the base line, out of 329 participants, 12% of the participants depicted their no awareness about the risk factors and 11% failed to identify specific diet and physical activity related risk factors. The knowledge and awareness level was very low at the baseline with no difference between the control group and intervention group as they both depicted a mean score of 1.5 from a potential score ranging from minimum 1 to maximum 6. However, after 12 months of follow up, the intervention group was found to have much better knowledge and awareness level about the potential risk factors than the control group and their diet, physical activity and weight loss were also appreciable (Caswell, et al. 2009).The mean score rose from 1.5 to 1.8 and participants became aware that CRC is associated with body weight and red meat. This study, although has selected a group of individual, but has depicted very essential information. Despite of having an established knowledge that nearly 47% of CRC cases can be prevented by healthy lifestyle choices, the issue is that awareness of these factors for prevention is very low in most of the countries. Even people at high risk of cancer are also unaware of these risk factors highlighting the immediate consideration of this major issue (Johnson, et al. 2013).
Bowel health to better health Program was organized in Scotland for people with colonoscopy and had their adenomas removed as a part of Cancer screening program. The program was organized to test the hypothesis that minimal contact lifestyle intervention can promote people to make healthy changes in their diet and activity. The study done by Caswell et al, 2009 involved questionnaire for participants of BHBH program and control groups at both baseline and follow up of three months. The results suggested that at baseline only 6% of BHBH participants were high fiber consumers that rose to 53% at follow up and 53% were low fiber consumers that reduced to 16% at follow up. The increase in high fiber consumers increased in control group as well from 10% at baseline to 20% at follow up but low fiber consumers also increased from 43% to 63% at follow up. Physical activity was increased in both the groups but changes were better in BHBH participants. Further, there was just one participant of control and BHBH that follow the recommended lifestyle at baseline but it increased to 15 in BHBH participant and 4 in control group at follow up (Anderson, et al. 2015).
Thus, following the considerations of all these studies, researches and evidences, it can be said that numerous research studies have been one to find association between occurrence of colorectal cancer and lifestyle behaviors and they have successfully established a close association between lack of physical activity, obesity, consumption of red and processed meat, alcohol and smoking with occurrence of this type of cancer. In fact, it has been found that nearly 50% of cases can be prevented by adopting healthy lifestyle habits and behavior but the issue is that people are very less aware of this correlation (van Rooijen, et al. 2017). General population is aware of association of this lifestyle behavior with heart diseases or metabolic diseases but not with the occurrence of cancer. Thus, it is really important to educate and inform people avoid these modifiable risk factors and their role in prevention of CRC. Although, it is unlikely that imparting information and creating awareness among people would promote them to change their lifestyle behavior and adopt healthy preventive lifestyle, but still these are one of the essential pre requirements towards preventing and controlling CRC cases.
Lifestyle behaviors are affected by a variety of factors as depicted in previous sections and thus, for preventing and controlling the incidence rate of CRC, to prevent the recurrence of colon cancer and to improve health outcomes, people are required to be encouraged to modify their current lifestyle practices and adopt healthier ones. People would need to be supported and encouraged to overcome individual, interpersonal and community barriers that exist in adopting healthy lifestyle behaviors. Community programs need to be organized that not only impart essential information about modifiable risk factors of CRC but also about the negative impact of the disease over body and disease prognosis. When programs are targeted to public at large, efforts are taken to modify a large group of people’s lifestyle behaviors; the results are better as people get encouraged seeing each other. Further, people must be provided with positive reinforcement to adopt preventive behavior and they should be made believe that they would really get benefitted by modifying their behavior. Additionally, their cultural factors must also be considered. Finally the health promotional programs should be targeted, for instance, it has also been found that when these programs are targeted towards high risk group like people with intestinal bowel disease or people with family history of cancer, the results can be more satisfying and CRC incidences can be better prevented (Salazar, 2015).
On critically evaluating the research studies on colorectal cancer, it was found that consumption of red and processed meat, alcohol, lack of physical activity; obesity and smoking are certain lifestyle behaviors that act as risk factor for occurrence of this cancer. Various studies and research has been done on this common type of cancer as it is among the top causes of cancer deaths in several countries and it has been found that by adopting preventive and healthy lifestyle, this cancer can be prevented by 47%. But the awareness about these modifiable risk factors associated with CRC is very low, even in high risk people. Thus, it was required to educate people about these lifestyle behaviors and adopt preventive actions but it is not easy to encourage people to change their lifestyle as it is affected by variety of factors like genetics, hereditary, beliefs, perceptions, gender, development, cultural background and social class and all these need to be considered to modify the same.
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