Among the cancer screening tests known to significantly reduce mortality, screening for colorectal cancer (CRC) is utilized least. Rates of CRC screening are lowest among the underserved, those who are non-white or non-English speaking and/or of low socioeconomic status. Late stage diagnosis for CRC is more common among African Americans, Asians, and Hispanics than non-Hispanic whites. More than other cancer screening tests, CRC screening is dependent upon effective communication between provider and patient, an interaction that can be problematic under any circumstance but is further complicated when provider and patient are from different cultures. The proposed research represents the formative phase of an intervention to adapt electronic tailoring to produce guidelines and messages that will aid providers in effective communication across cultures on CRC screening.
Our specific aims are, for African American, Latino and Vietnamese patients, to: 1.) Identify the cultural, social, and psychological factors that influence the effectiveness of provider-patient communication on CRC screening; 2.) Develop and test communication strategies that enable providers to bridge the most important cultural, social and psychological differences for a CRC screening referral; 3.) Develop a research plan for a controlled trial of tailored provider-patient communication across cultures regarding CRC screening. The conceptual framework for the study draws from subjective culture theory, communication theory and behavior science theory. This three-year qualitative study consists of two phases of research. Phase I, Concept Identification, will include 20-40 video-taped observations of actual provider-patient visits in which the physician recommends CRC screening, followed by unstructured interviews with the patients. Phase I also includes 4 provider focus groups; key informant interviews with experts on the three targeted cultures; and 8 patient focus groups, 2 in each of the 3 targeted culture and two with Anglos. Phase II, Refinement and Testing of provider guidelines and messages will include another set of 8 patient focus groups and a round of 10-20 observations to pilot test guidelines and messages. Results will inform an intervention to be tested in a subsequent study.
| Walsh, Judith M E; Karliner, Leah; Burke, Nancy et al. (2010) Physicians' approaches to recommending colorectal cancer screening: a qualitative study. J Cancer Educ 25:385-90 |
| Ge Gao; Burke, Nancy; Somkin, Carol P et al. (2009) Considering culture in physician-- patient communication during colorectal cancer screening. Qual Health Res 19:778-89 |
