Bowelcancer is the second most common cancer killer in the UK. A clinical specialistnurse in bowel care describes how OH can help develop an awareness in theworkplace, By Sue Frost This article describes the background and progress to date of a project topromote healthy bowel awareness in the workplace. The work, funded by ColoplastLtd, is being carried out from the University of Birmingham. Bowel cancer is the second most common cancer killer in the UK, with morethan 35,000 people diagnosed with the disease each year, and 16,000 deaths peryear – which equates to around 43 people dying every day.1 Unfortunately,evidence suggests that many people are not aware of the signs and symptoms ofthe disease.2,3,4 I have spent 17 years helping people diagnosed with bowel cancer, in my roleas a bowel care clinical nurse specialist, and this experience has highlightedthe difficulties and challenges associated with a lack of knowledge of thesigns and symptoms of the disease. It was also clear that embarrassment and denial could lead to a delayeddiagnosis. Many patients had symptoms for several months and some even foryears, but had chosen not to seek help at an early stage, because they wereunaware of a potential problem, because they were too embarrassed to seekadvice, or because they hoped the symptoms would go away. This is unfortunate,as many would have been in a position to be treated and cured during the earlystages, but for a significant number, a cure was not possible by the time theywere diagnosed. In the late 1990s, I felt a more proactive stance was required to influencethe knowledge and attitude of our local community regarding bowel cancer anddisease. So in 1997, along with a colleague, I set up a registered charity (TheHolly Trust) in our local area. It is dedicated to raising local awareness ofthe disease, and funds to help those diagnosed. The charity’s founders includedex-patients and nurses with an interest in the subject. One of the major difficulties the charity encountered was how to get theinformation across to the public in the most effective way. After designing ourown bowel cancer awareness leaflets, we organised many events. One such examplewas to hand out the leaflets at our local shopping centre, but this only seemedto capture the interest of a certain number of people, and in fact, a smallnumber even looked offended when they saw what the leaflets were about. Despite successfully raising funds and promoting bowel cancer issues in thelocal community, there was a need to find a way of getting the informationacross to the public in a more effective manner. In 1997, Lynn Faulds-Wood – former Watchdog presenter, and now aninvestigative reporter on GMTV – co-founded the bowel cancer charity, theCrocus Trust. She then moved on to the charity Beating Bowel Cancer, and nowruns her own charity, Lynn’s Bowel Cancer Campaign. We discussed thepossibility of setting up a project to work with occupational health nurses(OHNs). As a patron of the Association of Occupational Health Nurses (AOHNP),Faulds-Wood knows they are in a unique position to gain access to the generalpublic at work. Having already done some work on this with the Institute ofOccupational Health at the University of Birmingham, Faulds-Wood now felt theproject would benefit from someone running it full-time. We believed this wasan excellent platform to start addressing issues about healthy bowel awarenessand a great opportunity to work with OHNs. It is acknowledged that they havemany priorities in their working day, which includes political processing,policy making, programme development, research, health service provision,counselling and teaching.5 So to include healthy bowel awareness, it had to bepromoted in the most time and cost-effective manner. The workplace, along with schools, hospitals and neighbourhoods, wasidentified as a vehicle for health promotion by the World Health Organisation,offering the ideal setting to support the promotion of health to a large groupof people.6 This is particularly relevant to cancer prevention activities,because the majority, including bowel cancer, are related to lifestyle, and aretherefore potentially preventable.7 Cutler asserts that nurses are ‘keyplayers’ in cancer prevention. 8 A proposal was developed and accepted by the university, and the project,entitled ‘Promoting Healthy Bowel Awareness in the Workplace’, was furtherdeveloped as a higher-degree project. The project The overall aim of the project is to develop and explore the capacity forpromoting healthy bowel awareness within the workplace. The project has fourstages: Stage one: – To nationally assess OHNs’ current knowledge, attitudes and practiceregarding healthy bowel awareness in the workplace. Stage two: – To develop and implement a healthy bowel awareness learning and developmentprogramme with three occupational health departments. Stage three: – To support individual OHNs/departments to develop and implement their ownhealthy bowel awareness intervention, within their own workplace. Using a postal survey, assess workforce knowledge, attitudes and behaviourregarding healthy bowels and bowel cancer for both pre- and post intervention.The pre- and post- intervention survey will also be carried out by an OHdepartment which does not carry out a bowel awareness intervention to enablethe comparison of survey results from intervention and non-interventiondepartments. Stage four: – Interview consenting OHNs to evaluate the development, implementation andimpact of the project. Project progress After gaining ethical approval for the overall project, stage one has nowbeen completed. Stage two is currently in progress – three OH departments havebeen randomly chosen and agreed to participate in the intervention group, andone has been randomly chosen and agreed to participate in the non-interventiongroup. A pilot of the workforce questionnaire is in progress. Preliminary results of stage one are discussed below, and the final resultswill be published at a later date. 9 Stage one – survey of OHNs regarding the practice and perception ofhealthy bowel awareness in the workplace A postal questionnaire, including an invitation letter and participantinformation sheet, was sent to 969 OHNs from three data sources: an OHNdatabase held at the Institute of Occupational Health, University ofBirmingham, a database set up by Faulds-Wood, and a randomly selected group ofOHNs from a generated list of companies in the UK and Ireland. The survey consisted of mainly quantitative and some quantitative questionsregarding knowledge and attitude concerning bowel cancer and participation,attitude and experience regarding health promotion. Of the 244 responses returned, 38 could not be included, predominantlybecause the nurse no longer worked in the department. The remaining 206 wereanalysed. The findings are outlined below. Findings Just over three-quarters of the respondents worked full-time. Respondentswere providing a service, in total, for more than a million of the UK’s workingpopulation. It was clear that the knowledge regarding bowel cancer signs and symptomswas fairly high. Just over half the respondents correctly ranked bowel canceras the second biggest cancer killer in the UK. Nearly all the respondents couldname a way that could reduce the chances of getting bowel cancer, and name atleast one symptom of the disease. In contrast, when asked about predisposingfactors associated with bowel cancer, a quarter could not name any factor atall. There seemed to be some confusion over what to do when a client shows symptomsthat may indicate bowel cancer. The majority opted to advise the client to seetheir GP immediately or at the earliest convenient stage. In fact, theDepartment of Health referral guidelines for colorectal cancer advise it issafe to watch symptoms for up to six weeks before seeing a doctor.10 Information leaflets regarding bowel cancer are available from many sources,including the national bowel cancer charities, but only a third of therespondents had accessed these. Embarrassment is the biggest barrier to people contacting OHNs withbowel-related problems. Healthy bowel awareness activities had been undertakenby just over a quarter of the respondents. Of those that had not taken part in an activity, time constraints and otheractivities taking priority were given as the major reason. More than half the respondents said they had taken part in another cancerhealth promotion activity, with lung, testicular, prostate, skin, and cervicalcancer being stated the most frequently. Many respondents said they felt bowel cancer was important, but did not havethe time to promote it. Some said funding was also an issue, and a minority didnot feel it was a priority at all. Discussion The survey indicates that the OHNs who responded to the survey have a fairlyhigh knowledge of the disease and its signs and symptoms. There also seems tobe a genuine interest in the subject, and its importance is acknowledged. The major barrier in the promotion of healthy bowel awareness appears to betime constraints, and the fact that other activities take priority. Somedepartments have taken part in healthy bowel awareness promotion, but almostthree-quarters have not had the time or funding. Information leaflets areavailable, but not all departments have them. It is not appropriate to make recommendations for practice at stage one ofthe study, as work is still in progress. However, the work raises thisquestion: how can the OHN incorporate healthy bowel awareness into currentpractice, with minimal time and financial implications? Many nurses say theyincorporate questions about bowel function in their routine employee screening.This would seem to be an ideal opportunity to discuss the preventativemeasures, and signs and symptoms, maybe using a leaflet from one of thecharities. Leaflets in the department may be useful, as these can be accessedwithout necessarily speaking with someone face-to-face. Preventative measures do require behavioural change, and to support andencourage this, some nurses had collaborated with other areas, such as theworkforce canteen, who were able to offer a more healthy diet choice. Such collaborations are a positive step to both reinforcing and creatingsustainable changes of the health of a workforce. Conclusion Bowel cancer is a disease with high incidence and high mortality rates. OHNsare in a unique position to be able to disseminate knowledge and encourage andsupport behaviour change where appropriate. The aim of the project discussed inthis article is to deliver a model for the design and implementation of anintervention to facilitate this. It is clear that time constraints are a majorfactor in the lack of healthy bowel awareness in many occupational healthdepartments, and although they recognise it is a priority, mandatoryrequirements have to take precedence. The progress of the project will be reported in the future, so that otherOHNs can utilise the results in their own workplace in the most time and costeffective manner. Sue Frost RGN, postgraduate student, School of Health Sciences, Universityof Birmingham Acknowledgements My supervisors, Dr Sandy Herron-Marx, Professor Collette Clifford, and DrBarbara Mullan; Lynn Faulds-Wood; the OH nurses who responded to the survey instage one, and to those who were randomly selected and agreed to take part inthe next stages of the project; Coloplast Limited; Sarah Wheeler, Bowel careCNS; Good Hope Hospital NHS Trust, Sutton Coldfield; and The Holly Trust. References 1. CancerStats Large bowel – UK (2003) Cancer Research UK 2. Pullyblank, AM, Cawthorn, SJ and Dixon, AR (2002), Knowledge of cancersymptoms among patients attending one-stop breast and rectal bleeding clinics.European Journal of Surgical Oncology, 28 (5), 511-515 3. Yardley, C, Glover, C and Allen-Mersh, T G (2000) Demographic factorsassociated with knowledge of colorectal cancer symptoms in a UKpopulation-based survey. Ann R Coll Surg Engl, 82 205-209 4. Camilleri-Brennan, J and Steele, RJC (1999) A comparative study ofknowledge and aware-ness of colorectal and breast cancer. European Journal ofSurgical Oncology, 25 580-583 5. Parker-Conrad, JE (2002) A century of practice: Occupational HealthNursing. AAOHN Journal, 50 (12), 357-541 6. World Health Organisation (1997) The Jakarta declaration on Healthpromotion into the 21st century. WHO publications 7. Doll, R and Peto, R.(1981) The causes of cancer: quantitative estimatesof avoidable risks of cancer in the United States today. J Natl Cancer Inst.,66 1191-1308 8. Cutler, L (1999) The contribution of nursing to cancer prevention.Journal of Advanced Nursing, 29 (1), 169-177 9. Frost, SE, Herron-Marx, S, Clifford, CM, Mullan, B, (2004) The promotionof healthy bowel awareness in the workplace: a survey of Occupational health nurses(in progress) 10. Executive, N. (2000) Referral Guidelines for Colorectal cancer.Department of Health, London www.bowelcancer.tv Comments are closed. 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