How Effective Is Tele-Nursing in Overcoming Psychological Barriers to Colonoscopy Screening?

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths worldwide. According to global statistics, over ۱.۹ million new cases of this cancer are diagnosed annually, resulting in approximately ۹۳۵,۰۰۰ deaths(Miller et al., ۲۰۱۹). The rate of colorectal cancer in Iran over the past years has been reported to be ۷ cases per ۱۰۰,۰۰۰ people, making it the fourth most common cancer in Iran(Vakili et al., ۲۰۱۴). Colonoscopy remains the gold standard for CRC screening and diagnosis, capable of reducing mortality rates by ۴۰–۶۰% (Miller et al., ۲۰۱۹). Despite its proven efficacy, acceptance rates for colonoscopy, particularly in developing countries and rural areas, remain suboptimal(Wang et al., ۲۰۱۹). Colonoscopy screening represents a powerful tool in the fight against colorectal cancer, offering both early detection and preventive capabilities. While many high-income countries achieve screening coverage of ۵۰–۸۰%, low- and middle-income countries typically report rates below ۱۰% (Dare et al., ۲۰۲۱, Gravitt et al., ۲۰۲۱, Petersen et al., ۲۰۲۲). This disparity reflects significant structural, financial, cultural, and educational barriers that disproportionately affect vulnerable populations(Petersen et al., ۲۰۲۲). In developed countries, psychological factors such as fear of pain, embarrassment, and anxiety about findings represent primary barriers(Miller et al., ۲۰۱۹, Yue et al., ۲۰۲۵). In developing countries, systemic challenges, including limited healthcare infrastructure, financial constraints, and low awareness, play a more significant role(Wang et al., ۲۰۱۹, Travis et al., ۲۰۲۴, Lim et al., ۲۰۲۱, Paudel et al., ۲۰۲۵). Numerous studies have identified fear and anxiety as major barriers to colonoscopy acceptance (Wang et al., ۲۰۱۹, Travis et al., ۲۰۲۴, Lim et al., ۲۰۲۱, Paudel et al., ۲۰۲۵). Accordingly, patients commonly report concerns about pain during the procedure (۶۸% of cases), anxiety about potential complications such as bleeding or perforation (۵۴%), embarrassment due to the invasive nature of the procedure (۶۲%), and worry about possible findings (۴۵%)(Miller et al., ۲۰۱۹, Yue et al., ۲۰۲۵). These psychological factors, combined with insufficient knowledge about the benefits of early detection and health literacy limitations, lead many individuals to avoid this critical screening method(Miller et al., ۲۰۱۹, Wang et al., ۲۰۱۹). Various educational interventions have been proposed to alleviate patient anxiety. Studies such as Shahrbabaki et al. (۲۰۲۲) have demonstrated that structured education programs can reduce patient anxiety by up to ۳۵% (Shahrbabaki et al., ۲۰۲۲). In addition to requiring physical presence, these interventions are costly and time-consuming. Although digital interventions are available, they usually lack personal interaction and ongoing support(Evans et al., ۲۰۲۵). Tele-nursing—structured telephone counseling and education delivered by trained nurses—offers a promising solution to these challenges. Research indicates that tele-nursing interventions can significantly increase colonoscopy acceptance rates by addressing psychological barriers remotely(De Leo et al., ۲۰۲۲, Hsueh et al., ۲۰۱۶, Tsagkaris et al., ۲۰۲۳). This approach has been shown to reduce patient anxiety by providing personalized education and emotional support(Coughtrey and Pistrang, ۲۰۱۸). The method is particularly valuable in contexts with limited healthcare access, such as rural areas and during public health emergencies(Peng et al., ۲۰۲۴). The effectiveness of tele-nursing can be explained through self-efficacy theory. When patients receive targeted education and emotional support through telehealth platforms, their confidence in managing the procedure increases, thereby enhancing their willingness to undergo colonoscopy(Shahrbabaki et al., ۲۰۲۲). This method effectively addresses health literacy gaps and provides continuous support throughout the screening process(Cevheroğlu and Büyükyılmaz, ۲۰۲۴). Despite promising evidence, challenges remain in implementing tele-nursing. Variations in telehealth infrastructure and digital literacy may affect effectiveness across different populations (Shahrbabaki et al., ۲۰۲۲). Additionally, standardizing educational content and training specialized personnel require more attention(Evans et al., ۲۰۲۵). Future research should focus on developing culturally adapted interventions and measuring long-term outcomes in diverse populations(Chen et al., ۲۰۲۳). The study by Mashhadi et al. showed that face-to-face education and educational videos were able to reduce the anxiety of patients who were candidates for colonoscopy, and also emphasized that the implementation of such interventions should be planned according to the time constraints of medical personnel and the conditions of the patients, including cultural differences; their literacy level should also be taken into account(Mashhadi et al., ۲۰۲۰). This point can indicate the importance of distance education and tele-nursing.