Nurses in Türkiye and Serbia Reveal Gaps in Colorectal Cancer Screening Knowledge

Colorectal cancer remains one of the deadliest and most preventable malignancies worldwide, yet the people who stand on the front line of early detection are often overlooked in discussions of screening policy: nurses. A new comparative qualitative study published in BMC Cancer has now provided a rare, detailed portrait of how primary healthcare nurses in Türkiye and Serbia understand colorectal cancer symptoms, screening pathways, and their own professional roles in catching the disease early. The findings reveal both encouraging common ground and striking national differences that could reshape how these two countries train and deploy their nursing workforces in cancer prevention.

The research, conducted by Esra Özkan of Giresun University in Türkiye and Katarina Vojvodic of the Institute of Public Health of Belgrade in Serbia, employed a phenomenological design, a qualitative approach that seeks to capture lived experience in depth rather than to measure knowledge with checklists. The team carried out semi-structured, in-depth interviews with 26 nurses working in primary healthcare services across the two countries. Participants were recruited through purposive criterion sampling, meaning the researchers deliberately selected nurses whose daily work positioned them to encounter screening questions and patient concerns about colorectal cancer. Interviews continued until data saturation was achieved, the point at which additional conversations stop yielding new themes, and each session was audio-recorded with the participant’s consent, transcribed verbatim, and analyzed using Colaizzi’s seven-step phenomenological method, a rigorous framework that moves from reading raw transcripts to extracting significant statements, formulating meanings, clustering themes, and validating the resulting description against the original data.

Methodological transparency was a priority. The study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research, known as COREQ, a 32-item checklist designed to ensure that qualitative studies disclose enough detail about the research team, the interview process, and the analytic choices for readers to judge their trustworthiness. Ethical approval was granted by the Giresun University Scientific Research and Publication Ethics Committee and by the Ethics Committee of the Institute of Public Health of Belgrade, and informed consent was obtained from every participant before interviews began. The work was supported by a Short-Term Scientific Mission grant through COST Action CA23151, a European networking framework that funds cross-border research collaboration, which is precisely the kind of mechanism that made this two-country comparison possible.

From the transcripts, six major themes emerged: colorectal cancer early symptoms and awareness; nurses’ roles in screening and patient education; education, guidance, and the screening process; risk stratification in colorectal cancer; nurses’ educational experiences, knowledge competence, and development needs; and challenges and limitations in the screening process. The thematic architecture itself tells a story. It moves from what nurses know about the disease, through what they actually do in clinics, to what they feel they lack and what stands in their way. This structure mirrors the journey a patient takes through a screening program, and it suggests that the researchers see nursing knowledge not as an abstract asset but as a functional component of the early-detection pipeline.

The most encouraging finding is the shared foundation. Nurses in both countries demonstrated solid awareness of common colorectal cancer symptoms and clearly recognized that their profession has a legitimate role in patient education, guiding people toward screening, and following up on results. This matters because primary care nurses are frequently the first, and sometimes the only, health professionals a hesitant patient speaks with at length. When a nurse understands that persistent changes in bowel habits, unexplained weight loss, or blood in the stool warrant urgent investigation, that understanding can translate directly into a timely referral. The study suggests that this basic clinical literacy is present in both health systems, providing a platform on which stronger screening programs could be built.

Yet beneath the similarities, the comparative analysis exposed meaningful divergences in how nurses in the two countries conceptualize risk. Turkish nurses more frequently emphasized lifestyle-related risk factors, such as diet and physical activity, and placed greater weight on patient education as their contribution to prevention. Serbian nurses, by contrast, placed greater emphasis on family history and age-based screening, focusing on systematically identifying individuals eligible for screening programs. These are not trivial differences. A nurse who instinctively thinks in terms of lifestyle counseling will approach a patient differently from one who instinctively thinks in terms of pedigree and age thresholds. Effective risk stratification for colorectal cancer requires both perspectives: lifestyle factors modulate baseline risk, while family history and age determine who should be prioritized for colonoscopy or fecal occult blood testing. The study implies that each country’s nurses may be operating with half of the risk-assessment picture more salient than the other half, a finding with direct implications for continuing education curricula.

The barriers the nurses described were equally revealing, and here the two national contexts produced distinct portraits of friction. Nurses in both countries reported a pressing need for continuous education and identified heavy workloads, staffing limitations, time constraints, and difficulties reaching the target population as major obstacles to effective screening work. These are systemic constraints that no amount of individual knowledge can overcome; a nurse who understands screening guidelines perfectly cannot act on that knowledge if the appointment schedule leaves no room for counseling. Serbian nurses additionally emphasized referral delays and particular difficulty reaching working-age populations, people who are employed, mobile, and often absent from routine primary care contact. Turkish nurses, meanwhile, highlighted fear and avoidance among patients, the psychological resistance that keeps people from attending screening even when they are eligible and invited. The contrast is instructive: one system struggles with plumbing, the pipes of referral and outreach, while the other struggles with psychology, the emotional barriers that screening programs must address through communication and trust-building.

The authors argue that strengthening continuous, structured, and practice-based education for nurses is the central lever for improvement. The distinction between continuous and practice-based is important. Periodic lectures that update guidelines may refresh factual knowledge, but they do little to build the conversational skills needed to talk a frightened patient past their avoidance of a colonoscopy, or the organizational instincts needed to flag an eligible individual in a crowded clinic. Practice-based education embeds learning in the actual workflow of primary care, where the real decisions about who gets educated, who gets referred, and who gets followed up are made. Combined with improved organizational support, adequate staffing, and effective referral and follow-up systems, the study’s implications section suggests, this educational investment could enable nurses to participate far more actively in colorectal cancer screening and early detection rather than serving as passive adjuncts to physician-led programs.

The broader significance of the study lies in its comparative design. Most studies of nursing knowledge in cancer screening examine a single country, leaving open the question of whether observed gaps reflect universal features of the profession or local conditions. By running identical methods in parallel in Türkiye and Serbia, Özkan and Vojvodic have shown that the core competencies and the core frustrations of frontline screening nurses travel across borders, while the specific emphases and barriers are shaped by each health system’s structure and culture. For policymakers in both countries, the message is twofold: invest in the shared foundation of symptom awareness and role recognition that already exists, and tailor interventions to the distinct weak points each system exhibits, whether that is referral infrastructure in Serbia or patient fear in Türkiye. For the rest of the world, the study is a reminder that the cheapest, most scalable improvements in cancer early detection may not come from new technology at all, but from better equipping the nurses who already occupy the decisive first conversation with every patient who walks through a clinic door.

Subject of Research: Nurses’ knowledge on early diagnosis and screening of colorectal cancer: a comparative qualitative study of the cases of Türkiye and Serbia

Article Title: Nurses’ knowledge on early diagnosis and screening of colorectal cancer: a comparative qualitative study of the cases of Türkiye and Serbia

Article References: Özkan, E., & Vojvodic, K. (2026). Nurses’ knowledge on early diagnosis and screening of colorectal cancer: a comparative qualitative study of the cases of Türkiye and Serbia. BMC Cancer. https://doi.org/10.1186/s12885-026-16885-4

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16885-4

Keywords: Nurses, knowledge, early, diagnosis, screening, colorectal, cancer, comparative, qualitative, cases, rkiye, Serbia