Colorectal cancer (CRC) is one of the most commonly diagnosed cancers and the third leading cause of cancer death among Chinese Americans, the largest sub-group of Asian American and Pacific Islanders. Older Chinese Americans, who are mostly immigrants, face unique cultural barriers to screening and have among the lowest CRC screening rates in the US. Physician recommendation is the most important determinant of ZRC screening in older Chinese. Unfortunately, Chinese seeking care from Chinese-speaking physicians eceive CRC screening recommendations less often than those seeing English-speaking providers. We have assembled an experienced interdisciplinary, multi-cultural, bilingual team to conduct community primary care-based research guided by the Social Cognitive Theory with Chinese physicians and their Chinese patients in the Washington DC and the Philadelphia areas.
The specific aims are to develop an intervention to mprove Chinese physicians' skills in culturally appropriate communication about CRC through observational earning, and conduct a randomized controlled trial to evaluate the impact of this physician-based intervention on CRC screening rates among their asymptomatic Chinese-American patients ages 50 and older who are non-adherent to screening. There are more than 110 Chinese physicians in our area. We have conducted formative work with 54 Chinese American primary care physicians (PCP's) to understand their barriers to CRC screening. Results from this formative work have been used to inform the intervention. Thirty Chinese PCP's will be randomized to the intervention or the usual care group. Physicians in the intervention group will receive (1) mailed culturally appropriate educational materials on CRC screening and communication skills, tool kits for identifying patient barriers, and examples of tracking systems for screening and (2) two sessions of in-office training with standardized Chinese patients to increase skills and self-efficacy for making screening recommendations. We will also audio-tape a sample of encounters to understand actual communication about CRC screening. Preliminary results from an NCI-funded pilot study awarded since the last submission show that the mailed materials and in-office training are feasible and acceptable to Chinese physicians. The main outcome will be CRC screening rates of 600 non-adherent Chinese American patients aged 50 and older (20 per physician) one year post-intervention. This research is consistent with the NCI's plan to reduce cancer health disparities in minority groups via new intervention research to identify and successfully overcome sociocultural and health system barriers to cancer screening. The proposed research will be the first study to use a culturally appropriate, theoretically-grounded physician intervention to improve CRC screening rates in Chinese Americans. If effective, this intervention will be highly transportable and have broad reach to physician audiences and increase screening in the growing Chinese population. This approach should also be broadly portable to developing culturally appropriate primary care cancer control interventions in other minority groups. ? ? ? ? ?
