Abstract B74: Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients
Authors: Wang Judy Huei-yu , Ma Grace X. , Liang Wenchi , Gehan Edmund , Tan Yin , MaKambi Kepher , Wang Yiru , Vernon Sally W. , Tu Shin-Ping , Mandelblatt Jeanne 
Published: October 2015

Asian Americans have much lower colorectal cancer (CRC) screening rates than other ethnic groups, even after controlling for access and language factors. According to a national report, Chinese Americans (the largest Asian subgroup) had the lowest screening rates. Their low screening rates were largely attributed to the lack of physicians' recommendations, in addition to lacking screening knowledge and stressing self-care over medical checkups. Thus, we conducted a cluster randomized controlled trial to examine whether an intervention group of Chinese-speaking primary care physicians would motivate their Chinese-speaking patients to obtain higher rates of CRC screening versus usual care practice (control group). The physician-based intervention was culturally targeted and guided by social cognitive theory. It consisted of two components: a communication guide describing and responding to Chinese patients' screening barriers and two in-office training sessions mimicking real life medical encounters to practice the guide. Twenty-five Chinese primary care physician practices from Washington DC, Philadelphia, and New York City were enrolled and randomized (13 to intervention and 12 to control). Patients aged 50 -75 years, non-adherent to CRC screening guidelines, and were active patients of the 25 physicians were eligible. In total, 371 out of 458 consented patients who completed both of the baseline assessment and 12-month post-baseline follow-up via telephone were included in the outcome analysis. Physicians were blinded about their patients' participation until the follow-up assessment was completed. The end outcome was patients' self-reported receipt of CRC screening. Medical verification of the self-reported screening was conducted among 20% of the screened patients. Validated measures were used to assess physicians' knowledge of screening guidelines, self-efficacy in communication, and outcome expectancies, as well as patients' knowledge, self-care views, and perceived quality communication with physicians about CRC screening. We examined the screening outcome by two-sample t-tests, due to a balanced randomization of physician practices, and ran hierarchical logistic regression models to examine the impact of physician and patient factors in the screening outcome. The weighted (by sample size) CRC screening rates after one year of follow-up were .31 for the intervention group and .23 for the control group. The 8 percentage point difference was not statistically significant (P=.17), even after adjusting for group differences in patient characteristics. Self-reported screening was 100% consistent with medical records among those who were verifiable. Patients who had better knowledge, lower self-care views, and perceived better communication with physicians were more likely to obtain CRC screening after controlling for group assignment and patient demographics. Overall, the physician-based intervention led to a modest increase in Chinese patients' CRC screening rates, although patients in the intervention group had a greater increase in knowledge and perceived quality communication (both p&lt;.01). Many of our physicians reported a time constraint in reading through the communication guide and attending the intervention. This might have limited their capacity to maximize the intervention effects. Educating Chinese patients about CRC screening and how to communicate with physicians may be an efficient alternative to promote their overall screening rates.

Citation Format: Judy Huei-yu Wang, Grace X. Ma, Wenchi Liang, Edmund Gehan, Yin Tan, Kepher MaKambi, Yiru Wang, Sally W. Vernon, Shin-Ping Tu, Jeanne Mandelblatt. Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B74.