Abstract CT164: A culturally adapted decision support navigation trial to increase colorectal cancer screening among Chinese and Korean American primary care patients
Authors: Lee Sunmin , Ryu Soomin , Kwan Carissa , Myers Ronald E. , Shi Yuxi , Jiang Luohua , Morey Brittany N. 
Published: June 2022

Background: Colorectal cancer (CRC) is the second most common cancer among Asian Americans. However, cancer screening rates among Chinese- and Korean Americans are lower than other racial/ethnic groups in the United States. To address this disparity, we tested the effectiveness of a culturally adapted decision support navigation trial.

Methods: The STOP CRC (Screening TO Prevent CRC) program, a cluster randomized controlled trial, recruited 24 Chinese and Korean primary care physicians (PCP) from Maryland and northern Virginia. Then, 400 Chinese and Korean Americans were recruited through the PCPs’ clinics. Participants randomized to a decision support navigation intervention group (n=200) received an informational booklet, instructions to access colonoscopy screening, and a free fecal immunochemical test (FIT) kit at baseline. A bilingual patient navigator also guided them through an exercise to facilitate screening test choices. Six months after enrollment, participants randomized to the control group (n=200) received the informational booklet, colonoscopy instructions, and a FIT kit. Participants selected a method of CRC screening between the FIT or colonoscopy. Screening (completion of FIT or colonoscopy) was measured at 6 and 12 months after enrollment by medical record review and self-report. Generalized estimating equations (GEE) models with an exchangeable working correlation matrix to account for clustering effects at the PCP level were employed to examine intervention effects on CRC screening outcomes.

Results: Intervention and control participants were comparable on socio-demographic background and access to healthcare at baseline. The mean age of participants was 58 years, and 53% of participants were female. The majority of participants (85%) were married, 34% had less than or equal to high school education, 32% had annual household income less than $40,000, and 21% did not have health insurance. At 6 months, screening adherence in the intervention group was (91%) predominantly greater than in the control group (8%) (Prevalence Ratio: 11.31, 95% confidence interval: 6.95-18.43). At 12 months, although the gap between the two groups was reduced, the screening adherence in the intervention group was (93%) still substantially higher than in the control group (63%) (Prevalence Ratio: 1.51, 95% confidence interval: 1.37-1.66).

Conclusions: The STOP CRC program, a culturally and linguistically adapted decision support navigation intervention, is effective in increasing CRC screening among Chinese and Korean American primary care patients who are not up-to-date with the screening. This program can potentially be adapted and implemented for other Asian Americans who are not up-to-date with the CRC screening in the U.S.

Citation Format: Sunmin Lee, Soomin Ryu, Carissa Kwan, Ronald E. Myers, Yuxi Shi, Luohua Jiang, Brittany N. Morey. A culturally adapted decision support navigation trial to increase colorectal cancer screening among Chinese and Korean American primary care patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT164.