Communication with doctors is essential for cancer survivors to manage treatment-related side effects and promote their functioning. However, Chinese immigrant cancer survivors consistently report poorer communication with doctors than non-Hispanic White (NHW) survivors. This is likely related to the Chinese cultural value of complying with authorities to maintain social harmony which goes against the American cultural value of patient autonomy; thus, Chinese are less likely to express their concerns and needs to doctors, increasing challenges in treating their cancer-related symptoms. Our data showed that Chinese immigrant breast cancer survivors (BCS) had more physical problems and poorer physical functioning than NHW BCS. Chinese Americans' breast cancer incidence rates are steadily increasing and over 90% of breast cancer patients survive over 5 years. Yet, there are no interventions designed to improve Chinese immigrant survivors' follow-up care communication with doctors about symptom management. About 76% of Chinese Americans are foreign-born, the fastest growing immigrant group in the US. We propose a two-phase research study to develop and evaluate a culturally appropriate, web-based intervention program called E-Talkcare to enhance Chinese immigrant BCS' communication competence and functional status. Guided by communication and social cognitive theories, we will use community-based participatory research principles to develop E-Talkcare to educate Chinese immigrant BCS on how to seek, provide, and verify information with doctors and provide a platform for them to build English-Chinese symptom reports and question prompt lists (QPL)for medical visits. For phase I, we will convene a community advisory board and run two focus groups with at least 16 Chinese immigrant BCS, and individual interviews with 5-7 Chinese BCS to test the usability of E-Talkcare. In phase II, we will conduct a randomized controlled trial to pilot test the efficacy of E-Talkcare in enhancing Chinese BCS' communication, perceived control, and self-efficacy (intermediate outcomes), as well as symptom distress, adherence to breast cancer survivorship care guidelines, and quality of life (distal outcomes) by using the Chinese patient-reported outcomes measurement information system (PROMIS) short forms. Using Los Angeles (LA) cancer registry cases, we will enroll 118 Chinese immigrant BCS with stage 0-III breast cancer, aged 18 or older, and within 1-3 years post-diagnosis. They will be randomized to either the E-Talkcare intervention or usual care control arms. The full intervention can be completed in ~30 minutes. Participants will be telephone interviewed at baseline, and 3-months and 6-months post-randomization. E-talkcare is the first culturally relevant e-communication program for Chinese BCS. The use of bilingual PROMIS symptom reports and QPL is a novel approach for the target group. This study is prospective in identifying culturally efficacious tools to assist clinical practice to reach and care for this underserved but growing immigrant population.
This study will conduct 1) formative work to develop a culturally appropriate web-based patient communication program, and 2) a pilot randomized trial to examine its efficacy in improving communication skills, perceived control, self-efficacy, symptom distress, and functioning of Chinese immigrant breast cancer survivors.
