A Pilot Physician-Based Trial to Increase Colorectal Cancer Screening in Chinese
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 CRC screening in older Chinese, Unfortunately, Chinese seeking care from Chinese-speaking physicians receive CRC screening recommendations less often than those seeing English-speaking providers. The overall goal of this research is to increase CRC screening intentions in Chinese Americans. To accomplish this goal, we have assembled an experienced interdisciplinary, multi-cultural, bilingual team to conduct community primary care-based research guided by Social Cognitive Theory with Chinese physicians and their Chinese patients in the Washington DC and the Philadelphia areas. The objectives are to develop an intervention to improve Chinese physicians skills in culturally appropriate communication about CRC through observational learning, and conduct a pilot trial to evaluate the feasibility and usefulness of this physician-based intervention, and examine the impact of this intervention on CRC screening intentions among asymptomatic Chinese-American patients ages 50 and older who are non-adherent to screening. Four Chinese primary care physicians will be assigned to the intervention or the usual care control group. Physicians in the intervention group will receive (1) 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 on communication with standardized Chinese patients. The main outcome will be CRC screening intentions of 100 non-adherent Chinese American patients aged 50 and older (25 patients per physician) who visit the participating physicians within four months post-intervention. Process evaluation of the feasibility of the intervention and usefulness of the educational materials and in- office training will be conducted with participating physicians. 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 study will be the first study to pilot test a culturally appropriate, theoretically-grounded physician intervention to influence Chinese American primary care physicians' recommendation about CRC screening and their patients' intentions for and use of CRC screening. If feasible and acceptable, we will extend the intervention to a large-scale multiple-site randomized trial (R01) to examine the effectiveness of this culturally appropriate physician-based intervention in improving CRC screening rates in Chinese Americans. If proven effective, this intervention will be highly transportable to reach a large physician audience and impact screening rates in the Chinese population.