The problem of colon cancer among male Hispanic population in the United States is a major cause of concern. According to Gorin (2014), about 140,000 people are diagnosed with cancer every year in the United States, out of which 50,000 succumb to the disease. Colon cancer was one of the most common types of cancer among men in the 1990s. It affected white, Hispanics, and African Americans in equal measure. However, a report by Sommers and Fannin (2015) shows that the screening initiative that was introduced by the U.S. Department of Health and Human Services (HHS) in the mid-1990s has helped reduced incidences of colon cancer among white and African American men. The initiative meant that the disease could be diagnosed early enough and proper measures taken to address it before it reaches advanced stages. It is worrying that while other races are benefitting from this initiative, incidences and mortality rates among Hispanic men have not changed.
A study by Edelman, Mandle, and Kudzma (2017) shows that one of the main reasons why colon cancer is still a major problem among Hispanics is the lack of screening to help identify the problem at the earliest stage possible. Although these services are affordable and easily accessible throughout the United States, studies show that majority of the Hispanic men rarely go for screening. Most of them ignore the early symptoms of the disease, hoping that it will be resolved by over-the-counter drugs. Some scholars blame this problem on limited awareness among this group, while others believe the problem is caused by the problem of illegal immigration. Irrespective of the real reason behind the limited screening, it is evident that colon cancer is claiming lives of Hispanic men at a higher rate than the country’s average. Measures are needed to ensure that this problem is resolved. In this paper, the researcher seeks to identify factors that increase the incidence of colon cancer among male Hispanic population. Both qualitative and quantitative methods of research will be used to achieve the set objectives.
Significance of the Practice Problem
Managing cancer at advanced stages is a costly and painful undertaking that should be avoided at all cost. Mercola (2017) explains that surgical processes and chemotherapy that one has to go through in the treatment of cancer is painful. Advancements made in this field have introduced new forms of medicine that can help relieve the pain. However, the side-effects of the medication process are still devastating. When one is diagnosed with stage three or four colon cancer, the person will not be able to undertake the normal economic activities. The rigorous process of treatment will force such an individual to avoid work. Some can only be offered palliative care within the few months or years that they can still withstand the growth when doctors determine that the stage of the disease cannot be treated. For those who have a chance to fight the disease, the financial burden is sometimes too great to bear. According to Sommers and Fannin (2015), an eight-week session of chemotherapy can cost an upward of $ 30,000. It may have to be followed by a $ 2,000 a month follow-up radiation therapy for one or two years. It means that one may be forced to spend more than $ 50,000 in a year to deal with this health problem.
Such a financial burden may be too great to bear for many Hispanics in the country, some of which immigrated to the country to take low-paying jobs that American-born citizens are not willing to do. Most of these male Hispanics are breadwinners in their families. When they are bedridden, it means that finding the basics may be a big challenge, let alone paying for the medication. A significant number of those diagnosed with colon cancer at the advanced stage do not overcome the disease. The United States government is also spending millions of dollars fighting colon cancer (Riegelman& Kirkwood, 2015). The money is spent on hiring the medical staff, expanding the healthcare facilities because of the increase in demand, purchasing the medicine and the right equipment, and supporting research. The undesirable socio-economic consequences and the physical pain caused by colon cancer make it necessary to find effective solutions and address it. The advanced technologies in the field of medicine make it easy to deal with the problem if it is diagnosed early enough.
PICOT Question
According to Edelman et al. (2017), cancer is one of the major medical concerns in the United States. Colon cancer Problem (P) is more common among male Hispanics than the rest of the population in the United States partly because of the limited screening. The study seeks to come up with an intervention (I) plan on how this problem can be addressed among the identified population. It will be necessary to conduct comparative (C) studies to find different ways through which the problem can be addressed. The desired outcome (O) of the study will be reduced cases of colon cancer among male Hispanics in the United States and early diagnosis of the disease. The goal should be achieved within the shortest time (T) possible, most preferably within twelve months. It means that the finding of the study is expected to be put to use to transform lives of the targeted population. The following is the primary research question that will be answered in this study:
What are the factors in male Hispanic population that increase the incidence for colon cancer?
Theoretical Framework
Leininger’s theory emphasizes the need to promote culturally congruent care in hospitals. The United States is one of the culturally-diverse countries because of the many decades of immigration. Although education and constant interaction at work and places of worship have helped in breaking the cultural barrier, Haber (2013) explains that the society there is still a significant difference in the behavior of people from varying social backgrounds. The American natives have values that they still believe in, which are different from that of the African Americans and whites. Similarly, the minority Muslims have cultural practices that make them different from Christians. When offering care to patients, this theory holds that it is necessary to consider the unique values of patients. Sommers and Fannin (2015) argue that some patients are often very uncomfortable when being physically handled by nurses of the opposite sex because of their religious beliefs. The theory emphasizes on the following factors.
Communication and language
Leininger’s Culture Care Theory holds that one of the barriers that may hinder effective service delivery among nurses is the language barrier. When a patient is not able to communicate effectively about personal needs, it may not be easy to offer quality care to them (Flick, 2015). Nurses are encouraged to find ways of addressing the communication barrier. One way of doing that is to have a team of nurses from diversified nurses.
Gender considerations
Nurses are encouraged to consider the gender of their patients when offering care that require physical contact. Irrespective of one’s religious beliefs, female patients often feel uncomfortable being handled by male nurses. Sometimes a patient may not talk freely about his or her health complications because of the issue (Bleyer, Barr, Ries, Whelan, & Ferrari, 2016). The administrators should ensure that nurses are assigned duties based on these gender considerations.
Sexual orientation
The American society has made significant steps towards embracing different sexual orientation. However, some people still consider the LGBT as people of abnormal sexual orientation. This theory encourages nurses are encouraged to avoid discussions relating to sexual orientation with patients because it may make them uncomfortable. When collecting bio-data from the patient, sexual orientation should not be one of the questions because in most of the cases it is irrelevant to the type of medication needed.
Occupation and socioeconomic status
The occupation of a patient often defines the quality of healthcare services a patient would receive. The rich can afford expensive healthcare services. Such individuals would go for screening regularly just to ensure that life-shortening illnesses are detected early enough. On the other hand, those from financially-challenged families would seek medication only when they feel it is very necessary. Diseases such as cancer are often detected at advanced stage among these patients, making it difficult to offer them any meaningful medication.
Interpersonal relationships
The quality of healthcare services that a patient gets may sometimes be defined by interpersonal relationships. Patients who are able to express their views freely and relate easily with the nurses often get better services than their introverted colleagues (Flick, 2015). They can explain their concerns to nurses in a respectful manner and suggest how their needs can be met.
Appearance
Bryman (2016) explains that it is unfortunate that appearance still define the nature of healthcare services that patients receive in the United States. Racism is still a major problem despite the effort made by the society to fight the vice. Haber (2013) states that many healthcare institutions, both public and private, offer preferential services to whites. African Americans are often subjected to different forms of discrimination when seeking for medical services in the country. It is an issue that will require policy change to ensure that it is eliminated.
Synthesis of the Literature
Objective of the Literature Review
Literature review is an integral part of research that helps in identifying areas of prior scholarship in a given field f study. The primary objective of this review is to investigate what other scholars have found out in this field. As Gorin (2014) observes, medical researchers have conducted extensive studies to understand causes, impact, and ways of managing different types of cancer. Reviewing their findings will help in avoiding repetition of already existing information. It will be possible to understand the existing knowledge gaps that need to be addressed in the study. Literature review will also help in determining the relationship of the findings of different sources. It will be possible to identify any contradicting information and how such issues can be addressed to provide a clear path towards solving the problem. Another important objective of the review is to provide a way forward for further research. The researcher understands that various dynamics in the field of medicine may redefine the nature of the current problem. It is not enough to only rely on the current studies.
Continuous research will be needed to understand these changing trends and the need to redefine appropriate strategies that will improve quality of care. The findings made from this chapter will be critical because it will be compared with the outcome of the primary research. Some of the studies were conducted three or four years ago. Within that period, a lot has changed in the United States healthcare sector (Petzold, 2016). By comparing the findings made from the primary data analysis and information obtained from literature review, it will be possible to determine if meaningful progress is made in this sector. The researcher will be able to determine if the Department of Health and Human Services and individual hospitals within the United States are following the recommendations made by medical researchers. It means that this section of the research plays a critical role in defining the recommendations that will be made in the study.
Overview of the Subject under Consideration
Colon cancer is one of the major medical concerns in the United States today. It does not discriminate against gender or race, as Mercola (2017) observes, but some behavioral patterns and lifestyle may make it worse within a group of people. Recent studies show that the problem is worse among the male Hispanics. It is the second-most common cause of cancer death among the Hispanics (Riegelman& Kirkwood, 2015). Significant portions of the Hispanics who are diagnosed with cancer do not survive. It is a worrying trend because emerging technologies have made it easy to manage this health problem. Colonoscopy screening makes it easy to detect polyps at a very early stage before it can advance into cancer (Flick, 2015). This simple and less expensive method of screening makes it easy to manage the disease before it can turn into a serious medical problem. The government of the United States has made major investment in the healthcare sector. Most of the local hospitals across the country offer colonoscopy screening at affordable cost.
The initiative is part of the larger plan by the government to fight the growing problem of cancer. Evidence-based researches have confirmed that the best way of fighting any form of cancer is to ensure that it is detected at the earliest stage possible. The colonoscopy screening is available in both public and private institutions in the country, but statistics show that less than 48% of the Hispanics often go for the screening. The cancer awareness campaigns which are often sponsored by the U.S. Department of Health and Human Services, Center for Disease Control and Prevention (CDC), and many other private institutions have helped in increasing the overall number of those who go for cancer screening. The average population of American males seeking for regular colonoscopy screening is almost 70%, but that of the male Hispanics has never reached 50% (Bryman, 2016).
According to Sommers and Fannin (2015), various reasons may be attributed to the low rates at which Hispanics seek for medical check-ups until it is too late. Majority of the Hispanics in the United States are Mexicans and Central Americans who have been immigrating into the country over the years. Some of them moved to the United States through legal means and others were born in this country. However, a large portion of these Hispanics are in the country illegally. They are under constant fear of being arrested and deported back to their home country by the United States Immigration and Customs Enforcement (ICE) (Mercola, 2017). They often try to lead a quiet life that would avoid betraying their presence in the country. It means that they try to avoid seeking for services that may force them to reveal their identity. Some avoid public institutions for fear of being arrested. As such, screening is often one of the last things on their mind. As long as they are feeling strong enough to go to work, they rarely consider going for medical check-ups. Gorin (2014) explains that this may be the leading reason why colonoscopy screening among Hispanic males is lower than any other race in the United States.
The socio-economic status of the population is another issue that may be hindering early screening of cancer. Unlike immigrants from Africa and Asia who are often academically-empowered, many of the illegal immigrants from Mexico and other Central American countries are semi-illiterate. Some of them cannot even communicate effectively in English (Flick, 2015). They come to the country hoping to get manual jobs in large companies such as loaders, cleaners, cook, or gardeners. Many employers with the knowledge that these people are desperate and can accept low-paying jobs often offer them wages below the acceptable minimum. The illegal nature of their existence means that they cannot join labor unions in the country. In fact, their existence in the country is not known by the government. The little money they get from these manual jobs is barely enough to meet their basic needs in the country. According to Bryman (2016), patients who have medical insurance can have the services done at no cost in most of the public hospitals. However, those without the insurance cover may pay from $ 2,100 to $ 3,800 depending on the hospital that is visited. The illegal immigrants do not have insurance cover because they are undocumented. These peasants cannot afford such an amount of money for regular screening. They believe in seeking for medical attention only when they feel overwhelmed by a given disease.
Limited cancer awareness is another issue that is making the problem worse among the Hispanic males. Many people still have a misconception towards cancer. They view it as a death sentence. In fact, Haber (2013) notes that a section of the American society still consider this disease a curse. Just like it was the case with HIV/AIDS, people fear being diagnosed with any form of cancer. Most of the promotional campaigns often explain how early intervention can help one to get proper treatment. However, that has done little to convince some of these people to go for screening. The problem is more prevalent among those with limited education. The fear that they have towards cancer is based on misconceptions fuelled by cultural beliefs and misunderstanding of the disease.
The impact of lack of early screening of colon cancer among the male Hispanics is devastating. When colon cancer is detected at stage 1 or early stage 2, it is easy to manage it. The process of treatment is often simple, less painful, and less financially demanding. However, when it is detected at advanced stages, it may not be possible to treat it. The problem with cancer, as Gorin (2014) observes, is that it has limited symptoms at the early stages. It is easy for one to ignore the problem at its earliest stage. Some of the symptoms are easily ignored because they are not accompanied with significant amount of pain or discomfort. The only way of detecting the problem at its earliest stages is to be disciplined enough to go for regular screening. When that fails to happen, the disease will advance to stages where it is very costly to manage.
Mercola (2017) notes that many private and public hospitals are currently keen on determining the ability of a person to pay for specialized treatment before offering the same. An illegal immigrant with no documentations and with limited financial capacity will rarely get the needed help. For most of them, being diagnosed with cancer is the ultimate death sentence. For many, that is always the case because of the difficulty in treating stage 4 colon cancer. It is important to reiterate that the prevalence of colon cancer among the male Hispanics has nothing to do with their race. This form of cancer affects Americans of all races depending on one’s lifestyle and hereditary factors. However, it is worse among this particular group because of the lack of screening that would help in the early detection.
Different Position
The fact that male Hispanics are at a greater risk colon cancer than any other race in the United States is undisputed. Statistics are clear that they are the worse affected group by this public health problem (Riegelman& Kirkwood, 2015). However, people have given different arguments about real reasons why this problem is prevalent among male Hispanics. While many studies have suggested that illegal immigration status of some of the Mexicans and Central Americans and limited financial capacity are some of the reasons, there is a section of scholars opposed to this argument. According to Flick (2015), the main reason why fighting of colon cancer among male Hispanics is still a problem is the prevalence of racism in the country.
The United States has one of the highest levels of literacy in the world. The society has had a unique opportunity to mingle with people from diverse background. These are factors that should have made it easy for Americans to embrace cultural diversity. The learned community would be expected to understand that diversity gives strength to the society. However, that is not the case. White supremacy is still cherished even by those who do not support such groups directly. Haber (2013) explains that racism is common in many public institutions, including hospitals. While the procedure required of a white American to access services such as colonoscopy screening is simple, the same is not the case when handling Hispanics.
There is a misconception in the country that Hispanics are Mexican or Central American illegal immigrants. Many hospitals are often more demanding when handling these patients. They not only ask for proof of citizenship or legality of residency but also the capacity to pay. Bryman (2016) argues that most of these hospitals feel that Hispanics may be illegal immigrants with fake documentation. As such, they fear offering them services because the insurance may fail to pay. The preferential treatment offered to the whites disfavors the Hispanic. While American white male will only need to present the relevant documents to have access to colonoscopy screening, a male Hispanic will be required to confirm their ability to pay. The situation is worse in private hospitals. These institutions demand for upfront payment before they can offer the services. They reject insurance payment when handling people they believe are in the country illegally.
Mercola (2017) notes that it is unfortunate that many studies blame low-levels of literacy and ignorance among Hispanics as the main reason why the problem of colon cancer is prevalent among them while the real reason is that the system is designed in a way that does not favor them. It may be true that majority of the illegal immigrants in the United States are from Mexico and other regional countries. However, that does not validate the level of discrimination that is common in the country. When a person realizes that some public institutions treat him or her as a second-class citizen, the anger and fear will discourage such a person from revisiting the institutions. Edelman et al. (2017) observe that no one wants to be constantly reminded that he or she is a lesser being compared with others. It means that if the systems can be changed, the current problem can be resolved.
Distinctiveness of the Source and the Similarities
The varying views of different sources about the problem facing male Hispanics in the United States may be caused by different beliefs and experiences. While one section blames the systems and structures in the United States which make it difficult for the male Hispanics to access regular colonoscopy screening, the other section blames it on the limited level of awareness about colon cancer among the affected group and illegal nature of their existence in the country. However, it is important to note that their arguments have significant similarities worth noting. It is clear that both sources are in agreement that colon cancer is more prevalent among male Hispanics than any other race in the country (Riegelman& Kirkwood, 2015). Statistics have confirmed that the number of Hispanics, who die of the disease, proportionate to their population in the country, has been the highest over the last two decades. The two sources are also in agreement that the primary reason why the problem is common among the Hispanics is because of limited screening. The focus group rarely goes for screening until such a time that they feel they have a medical problem.
Practice Recommendations
The review of literature strongly suggests that incidences of colon cancer are more common among male Hispanics than any other race in the country. One of the reasons cited in the review is the limited knowledge among the target population. The researcher strongly recommends the need to promote awareness about colon cancer among the target population. If male Hispanics are empowered, they will understand the need to go for regular screening. The problem can be managed effectively if it is detected in its early stages of development.
Project Description
Research Design
When planning to conduct research, Ioannidis, Fanelli, Dunne, and Goodman (2014) advise that one of the most important steps that should be followed is the definition of the method that will be used to collect and analyze data. It helps in understanding the focus of the study and the sources of data. The appropriate design that will be used in this research is mixed (both qualitative and quantitative) research method. The focus of the study is to investigate the problem of cancer prevalence among male Hispanics in the United States. Statistics already show that this is the worst affected group. However, scholars are not in agreement about the main reason that makes the problem more common among these people. As explained in the literature review, medical studies conducted so far indicate that colon cancer does not discriminate along the racial line. It affects whites, African Americans, Hispanics, and Native Americans. It means that the problem that faces male Hispanics is more of a social issue than racial. Qualitative research will make it possible to investigate the problem based on experiences of the affected groups and medical practitioners in the United States, and propose appropriate solutions based on the findings made. Quantitative research will make it possible to present statistics in relation to the problem under investigation.
Research Variables
It is important to identify the variables that will define the focus of the study. They will be broadly classified as dependent and independent variables. The study will be investigating the relationship between groups of variables. The review of literature has pointed out that the main cause of the high prevalence of colon cancer among male Hispanics is the lack of screening. These people, unlike the rest of the population, often fail to go for regular testing. Having identified lack of screening as the main source of problem, it will be considered the independent variables. Factors that limit the ability of male Hispanics to go for regular screening will be the independent variables. They will include limited awareness among Hispanics about colon cancer, limited education among the interest group, financial challenges, and the fear of arrest because of the illegal status in the country (this issue affects only a fraction of the Hispanics). Other factors will be an American social system that still tolerates racism and strict policies that many healthcare institutions have when they feel that they are handling an illegal immigrant.
The Reliability and Validity of the Instrument
It will be necessary to ensure that reliable data that can be validated is collected from the respondents. As such, the researcher has developed a questionnaire that will be used to facilitate the process of primary data collection. The instrument has three sections. The first section focuses on the background and demographic information of the participants. It will be necessary to understand the background of the respondents to make it easy to identify any possible bias in the response. The second section focused on academic qualification. It will be important to determine if the academic qualifications of the respondents influences their views towards the issue of interest. The last section focuses on specific issues relating to male Hispanic population and colon cancer.
Reliability and validity of the instrument
To enhance reliability of the data, the researcher will be keen on sampling individuals in the affected group and experts in this specific field. Triangulation will help in ensuring that information in this report is based on data from different sources. The use of both qualitative and quantitative methods will also provide a comprehensive understanding of the issue. The instrument of data collection is attached at the appendix of this document.
The Population and the Sample
Sampling will be necessary to have a manageable number of respondents in this study. It will be necessary to collect data from two groups to have a fair understanding of the problem. The first group will be composed of medical practitioners who have been handling these patients. They will explain why they feel male Hispanics rarely go for colonoscopy screening in time. The second group will be composed of the male Hispanic (the affected group). They will explain why some of them fail to go for early screening. As such, stratified sampling will be used. A sample of 50 respondents will be identified.
Steps To Protect the Rights of Human According to IRB Criteria
The IRB criteria expect researchers to protect the rights of participants in a given study. The researcher will seek permission from institutions targeted for the study before collecting data from participants. The respondents will receive full briefing about the relevance of the study and their role in it. The researcher will address questions and concerns that these respondents may have. To ensure that the rights of the respondents are protected, participation in this study will be voluntary. Only those willing to be part of the study will be involved. The identity of the respondents will also be protected to avoid cases where they are victimized because of their views that may contradict that of the majority (Ioannidis et al., 2014).
The Procedure to Complete the Study
The first stage of the study (developing a research proposal) has been completed. A questionnaire that will be used has also been developed. The second step will be to conduct a further review of literature to understand what other scholars have found out. The researcher will then focus on collection of primary data from the respondents. The collected data will then be analyzed both qualitatively and quantitatively, as explained in the section below. The last stage will be to compile a final report. Before delivering the report, the researcher will proofread the document to eliminate any typos as expected in a standard academic document.
Project Evaluation Results
Primary data collected from the sampled respondents will have to be analyzed to understand the issue under investigation in its current form. As explained above, the researcher will used mixed method to analyze the response obtained from the participants. Quantitative data analysis will help in determining the current statistical figure about this problem and the magnitude of different causes. Using structured questions, the researcher will code the data into SPSS (Statistical Package for Social Scientists) software or excel spreadsheet. The information will be coded appropriately and output produced based on each question. To make it easy to understand the statistical findings, the output will be presented in the form of graphs. Qualitative analysis will also be critical in answering the research question. The researcher will allow respondents to explain specific issues relating to the research questions. Some of the respondents will be asked to explain their experiences when handling male Hispanic patients (respondents from medical institutions) or when seeking for medical services (male Hispanics) in the country. Their explanation will be crucial in validating the statistical outcome of data analysis.
Discussion and Implications for Nursing and Healthcare
It is clear from the project evaluation result that Hispanic males are more susceptible to colon cancer than any other population group in the United States. Limited education and language barrier were determined to be some of the factors that make it difficult to fight this disease among the target group (Mercola, 2017). Internal validity of the study was enhanced by ensuring that data was collected from various sources. The main limitation faced was the short time within which the study had to be completed. The researcher was keen to avoid personal bias that would pose a threat to the internal validity during evaluation. The outcome of the study will have a positive implication on nursing practice and healthcare. It will offer a guideline on how to address the problem.
Plans for Dissemination
It will be necessary to find ways of disseminating the knowledge to the target group. One of the strategies that will be used is through the use of posters. The researcher will create posters that will help create awareness about colon cancer among male Hispanics. It will also be necessary to reach out to the nurses and advise them on how to handle such patients. As such, it will be necessary to publish the findings in the local nursing and medical journals.
Summary and Conclusion
This study should find ways of addressing the problem of high incidences of colon cancer among male Hispanic population in the United States. The government has been spending a lot of money to ensure that colon cancer is diagnosed at the earliest stage possible to reduce its management cost. However, while the rest of the population is recording impressive improvement, there is no significant change among the male Hispanics.
References
Bleyer, A., Barr, R., Ries, L., Whelan, J., & Ferrari, A. (Eds.). (2017). Cancer in adolescents and young adults (2nd ed.). Cham, Switzerland: Springer International.
Bryman, A. (2016). Social research methods (5th ed.). Oxford, England: Oxford University Press.
Edelman, C.L., Mandle, C.L., &Kudzma, E.C. (2017).Health promotion throughout the life span (9th ed.). Maryland Heights, MO: Mosby.
Flick, U. (2015).Introducing research methodology (2nd ed.). Washington, DC: SAGE Publication.
Gorin, S.S. (2014). Prevention practice in primary care. Oxford, England: Oxford University Press.
Haber, D. (2013). Health promotion and aging: Practical applications for health professionals (6th ed.). New York, NY: Springer Publishing Company.
Ioannidis, J.P., Fanelli, D., Dunne, D.B., & Goodman, S.N. (2014). Meta-research: Evaluation and improvement of research methods and practices.PLOS Biology, 13(10), 1-17.
Mercola, J. (2017). Fat for fuel: A revolutionary diet to combat cancer, boost brain power, and increase your energy. Carlsbad, CA: Hay House
Petzold, P. (2016). No regrets: Love, laughter and life with colon cancer. New York, NY: Pretty Printing.
Riegelman, R.K., & Kirkwood, B. (2015).Public health 101: Healthy people healthy populations (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Sommers, M S., &Fannin, E.F. (2015).Diseases and disorders: A nursing therapeutics manual (5th ed.). Philadelphia, PA: F.A. Davis Company